Assisted Suicide in Oregon: Lessons Learned and Unanswered Questions

Bioethics   |   Steven Ertelt   |   Jan 1, 2009   |   12:00AM   |   WASHINGTON, DC

Assisted Suicide in Oregon: Lessons Learned and Unanswered Questions

By Alex Schadenberg Note: Alex Schadenberg is the executive director of the Euthanasia Prevention Coalition.

On April 17, 2004 Dr. Kenneth Stevens, the President of Physicians for Compassionate Care and a cancer specialist spoke to the provincial pro-life conference in Hamilton. Physicians for
Compassionate Care is an organization which was founded in 1995 in response to the legalization of assisted suicide in the State of Oregon.

Dr. Kenneth Stevens understands the issue of physician-assisted suicide both personally and professionally. In 1982 his terminally ill wife was told by her doctor that "Nothing more can be done." The doctor then said: "I can write an "extra-large" prescription." Dr. Stevens wife told him that: "he wants me to kill myself." His wife was devastated that her trusted physician, would subtly suggest that her life was no longer of any value. She died a comfortable death a few weeks later, but the message was clear. The simple suggestion of assisted suicide was powerful enough to give the impression that her life was not worth living.

Physicians for Compassionate Care was organized to promote the:
*Physicians role as healers,
* to alleviate suffering and
* provide comfort for the sick and the dying.

They also work to ensure appropriate care for patients, and to uphold the time-honored values of the Hippocratic oath.

In 1994 a plebiscite was held in Oregon on the question of assisted suicide. The plebiscite passed with a margin of 51% in favor of assisted suicide 49% opposed. This was a significant loss knowing that plebiscites to legalize assisted suicide failed in the state of Washington in 1991 and California 1992 (46% in favor in both states).

The questions Canadians need to analyze are:

. Why did the plebiscite in Oregon pass

. What has been the experience with legalized assisted suicide in

In 1994 the Oregon Medical Association decided to take a neutral position regarding the plebiscite. The press recognized this as a change in their previous position and interpreted it to mean that the Oregon Medical Association favored assisted suicide.

Derek Humphrey, founder of the Hemlock Society wrote in his book "Lawful Exit" that: "the difference between winning and losing was the failure to convince the medical profession." He said that to pass assisted suicide into law requires a supporting public and a supporting medical profession. (Pg. 25)

The first lesson for Canada is that we cannot let the Canadian Medical Association take a neutral position on assisted suicide. Neutrality is interpreted to mean that medical professionals are not opposed to assisted suicide.

Between 1994 – 97 there were legal challenges to the Oregon law. A plebiscite to repeal the assisted suicide law was organized and failed with 60% supporting Assisted Suicide. Assisted Suicide became legal in 1998.

The arguments in favor of assisted suicide were: Autonomy and Choice, Anti-religious, and the state governor favored assisted suicide. Legalizing assisted suicide did not give any new rights to patients. It’s purpose was to legally protect doctors who write prescriptions for lethal drugs.

Since legalizing assisted suicide new euphemism’s have developed. Physician-assisted suicide is being called: "Hastening death," "Death with Dignity," "Comfort Death," "Aid in Dying," "Acts of Self-Determination," and one physician in Oregon actually calls it healing. The assisted suicide movement have developed euphemisms in order to distort the truth about assisted suicide and cloud the issues.

The assisted suicide movement fosters fear of dying, of suffering in pain and being held hostage by medical technology. They exploit the concepts of self-determination and limitless autonomy and they claim that assisted suicide is for the public good.

Physician-assisted suicide is: A doctor writing a prescription for lethal drugs. A prescription is a written order to the person. Assisted suicide is really a doctor-ordered, doctor-prescribed, doctor-directed suicide.

Physicians for Compassionate Care believe that the focus should be on killing the pain and not the patient. The fear of pain is only a factor in the minority of assisted suicide cases and
uncontrolled pain only happens in rare circumstances. Studies show that the general public supports assisted suicide to a greater degree than patients with terminal cancer.

The assisted suicide movement acknowledge that physical pain and suffering are not the main argument for assisted suicide. The main arguments are autonomy and self-determination.

Physicians for Compassionate Care believe that attitudes toward assisted suicide change when people know the facts. People need to know that:
* they have the right to consent or refuse medical treatment,
* stopping life-support is very different than assisted suicide,
* Life-support has nothing to do with assisted suicide.

People with disabilities fear assisted suicide and are generally appalled by the negative message portrayed by the advocates of assisted suicide. Assisted suicide advocates de-value people with disabilities by playing on the horror of dependency. Disability activists rightfully fear that they are the next target of the assisted suicide movement.

Depression is the leading cause of suicide. There is a direct relationship between depression and requesting assisted suicide. Depression should be diagnosed and properly treated with
counseling and appropriate medications. Depression is not a contra-indication to assisted suicide in Oregon, a person requesting it just has to "be capable."

Physicians for Compassionate Care are concerned that assisted suicide is being promoted because of money, resources and burden. Assisted suicide is cheaper than providing good care for people who are dying, chronically ill or have disabilities. People who have limited resources feel pressured to "choose" assisted suicide.

In 2003, an individual with an 11 year history with chronic pain inquired about assisted suicide due to his frustration with recent cutbacks in healthcare.

The state of Oregon has cut off many drug benefits due to "financial crisis." This has led some people to ask for assisted suicide and others to commit suicide. Due to cuts in drug
benefits many people feel pressured to "choose" assisted suicide. This fulfills the prediction by Derek Humphrey, who wrote in 1998 that Physician-assisted suicide can help solve the problem of rising health care costs.

Since depression is the most common condition leading to suicide therefore patients with depression deserve mental health care, not assisted suicide. In 1998 in Oregon 31% of the patients who died by assisted suicide were sent for a psychologic evaluation in 1999; 37% in 1999. In 2003 only 5% were sent for a psychologic evaluation.

There has been a significant increase in both the number of prescriptions written for assisted suicide and the number of deaths. In 1998 there were 24 prescriptions written resulting in
16 deaths from assisted suicide, while in 2003 there were 67 prescriptions written resulting in 42 deaths by assisted suicide in Oregon.

The criteria for assisted suicide in Oregon are a person must:
* be terminally ill with less than 6 months to live,
* be at least 18 years old,
* live in Oregon,
* be competent to medical decisions,
* be able to take the lethal medication by mouth on their own.

The Oregon rules don’t safeguards vulnerable persons but are boundaries that limit access to assisted suicide.

Since euthanasia and assisted suicide are presented as the ultimate expression of personal autonomy, therefore we must recognize that boundaries and personal autonomy are not a good mix.

Barbara Coombs Lee, the author of the assisted suicide law, wrote in her book: that she was advocating for a man named Jake who was seeking assisted suicide. Since Jake was dying so quickly she became concerned that he would not be able to determine the time
of his death. Coombs Lee visited the doctor and requested that Jake receive a prescription for assisted suicide. When the doctor said that Jake did not qualify for assisted suicide because he was incompetent to make decisions Coombs Lee pressured the doctor
until he finally agreed. Coombs Lee wrote that the doctor filled the prescription with tears in his eyes.

On March 11, 1999; Patrick Matheny died of assisted suicide. The newspaper article indicated that due to his condition (ALS) that his brother needed to assisted him. The article never indicated what kind of assistance.

Kate Cheney died of assisted suicide on August 29, 1999. Her first psychiatric evaluation concluded that Kate had dementia and therefore didn’t qualify for assisted suicide. Kate’s daughter brought her for a second psychiatric evaluation, to a psychiatrist referred by an assisted suicide group. The second evaluation concluded that she was capable of making the decision. Did Kate Cheney’s assisted suicide take place due to the pressure of her daughter?

On November 3, 1999 Dr. Rasmussen assisted in the assisted suicide death of a woman whereby he emptied 90 capsules into chocolate pudding. The patients son then fed the pudding to her and helped her drink water. All she did was swallow. Was this self-determination?

David Schuman, the deputy Oregon state attorney general stated that the Oregon physician-assisted suicide law may discriminate against those who are paralyzed or on life support and they can’t swallow. He further stated that Euthanasia would eliminate this discrimination.

37 of 42 deaths in 2003 were from pentobarbital which is only available as an injectable liquid. "Pentobarbital sodium injection" is the official name of the drug. Once this injectable
liquid is in the hands of the doctor or others, there is no way to prevent it from being injected into the patient. Since pentobarbital is an injectable liquid, therefore legalizing physician-assisted suicide has led to euthanasia in Oregon.

A wall of secrecy surrounds physician-assisted suicide in Oregon. Information is self-reported to the state by prescribing doctors. In only 29% of the cases, the doctor was present at the death. Information from the reports are from (second hand) conversations
with those who were present at the death.

The reported time from ingestion to death for all assisted suicides range from 5 minutes to 48 hours. The only way that the person could have died in 5 minutes would be through an injection (euthanasia).

Physicians for Compassionate Care oppose assisted suicide because:
* it is against medical ethics to give a deadly drug,
* it is dangerous to give the power to kill to medical professionals,
* there are financial incentives involved in assisted suicide,
* it destroys the trust relationship between the patient and medical professional,
* it devalues the inherent dignity of human life, and
* it desensitizes society toward suicide.

When a doctor writes a prescription for assisted suicide, they are really stating: "I think your life is not worth living, "I think you are better off dead, "I don’t value you or your life," "I want you dead," "I order you to die," "I direct you to die."

For more information about Physicians for Compassionate Care –

For more information about the Euthanasia Prevention Coalition send to: Box 25033 London ON N6C 6A8, or call toll free: 1-877-439-3348