How to Die in Oregon (2011)

The film opens with an Oregon man swallowing a lethal dose under the state's Death with Dignity Act, surrounded by his family, footage almost never shown on screen. From there Peter Richardson follows several threads across roughly a year. The central one is Cody Curtis, a 54-year-old Oregon Health and Science University faculty member with liver cancer whose earlier surgery bought her time that is now running out. She obtains a prescription, keeps it in the house, and repeatedly does not take it. Her deteriorating body and her family's ambivalence carry the film. Around her are people navigating the law's practical barriers, a widow campaigning to pass a similar act in Washington State, and volunteers who sit with those who choose it. The film also shows a patient whose insurer declines to fund chemotherapy while noting that assisted death is covered, a sequence that provoked considerable argument. Richardson does not editorialise. Curtis eventually takes the medication at home, and the camera stays.

Spoilers throughout. Discussing the cancer storyline means discussing how this ends.

About as accurate as film gets on the end of life, because it is documentary rather than reconstruction. It shows what advanced abdominal cancer actually does: fluid swelling the abdomen, jaundice, weight loss, unrelenting fatigue, and the shrinking of a person's world down to a few rooms. It is accurate about the Oregon law's mechanics, including repeated requests, waiting periods, and the requirement that the person swallow the medication themselves, and about the fact that many people obtain a prescription and never use it. It is clear that hospice and palliative care run alongside this, not instead of it. It also captures something rarely filmed: that dying is mostly logistics, family negotiation and boredom, punctuated by fear.

The main distortion is selection. These are articulate, insured, largely white Oregonians with supportive families and access to a system that works for them, and the film barely represents people without that, which critics argue makes the law look more benign than the wider evidence supports. Editing compresses months of decline into a handful of sequences, so deterioration reads faster and cleaner than it was. Opposing arguments appear but are given comparatively little room. And the film says almost nothing about the disease itself: how it was found, or whether anything could have found it sooner.

On liver cancer, the National Cancer Institute is explicit that there is no standard or routine screening test, and none is recommended for average-risk adults. Ultrasound and the alpha-fetoprotein blood test are used as surveillance in people at high risk, chiefly those with cirrhosis or chronic hepatitis B, and that is a decision made with a specialist rather than a public programme. For bile duct cancer (cholangiocarcinoma), the NCI states there are no routine screening tests before signs and symptoms appear. Symptoms of both arrive late and look unremarkable: jaundice, dark urine, pale or clay-coloured stools, itchy skin, pain in the upper abdomen, fever, nausea and vomiting, and unexplained weight loss. Because the liver has no pain nerves in its substance and keeps working while substantially diseased, tumours are often sizeable before anything is felt, which is a large part of why these cancers are so often found advanced. The practical message here is not "get screened", because for most people there is nothing to get. It is that persistent jaundice, itching, upper abdominal pain or unexplained weight loss should be investigated quickly rather than monitored at home.

A film is not a diagnosis, and a dramatised illness is not a guide to your own. What a story like this is genuinely good for is lowering the barrier to a conversation you might otherwise put off.

If something in your body has changed and stayed changed for a few weeks, that is worth raising with a doctor — not because it is likely to be cancer, but because most of the time it will not be, and finding that out is the point. Where screening exists for a cancer, it is the one thing you can do before anything is wrong at all. See screening and possible warning signs.

Cancer Explained is free and ad-free. Nothing is sold on this page and no sponsor sits behind it.

If this helped you understand something, or moved you to ask a question you had been avoiding, you can help keep clear cancer information free for whoever needs it next. Support our work.

How to Die in Oregon is worth watching as a film. It is not a guide to the disease it portrays. The gap between the two is what this page is for — and the thing worth carrying away is that a change which persists is worth a conversation, whatever a story led you to expect.

This page describes a work of film or television for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email [email protected].