Serious Limitations In Reporting System Mean Abuses Could Not Be Detected

Oregon's First Year of Government-Approved Assisted Suicide

The Oregon Health Division's first annual report on legally sanctioned physician-assisted suicide reveals no violations of the state's guidelines - - but also demonstrates why the reporting system cannot be expected to find such violations. Unless otherwise noted, quotes are from Chin, Hedberg, Higginson, and Fleming, "Legalized Physician-Assisted Suicide in Oregon - - The First Year's Experience," 340 New England Journal of Medicine 577-583 (Feb. 18, 1999).

Why the Report Could Not Detect Abuses:

· All reporting was by suicide assisters themselves, and the Health Division had no way to verify their claims. "We did not interview the patients, their families, or other physicians who provided care at the end of life" (p. 578).

· The Health Division is "obligated by law to report any cases of noncompliance with the law to the Oregon Board of Medical Examiners," and notified physicians of this fact. Thus physicians had every incentive to falsify reports, making it "difficult, if not impossible, to detect accurately and comment on underreporting" (p. 583).

· Physicians also had the option of simply not reporting a case if it involved the violation of a guideline. "We cannot determine whether physician-assisted suicide is being practiced outside the framework of the Death with Dignity Act" (p. 583). Governor John Kitzhaber testified to Congress's House Judiciary Committee last year that the state has established no penalty for assisting suicides outside the state guidelines.

· All other possible sources of public information were suppressed. The Health Division declared that any employee who reported a real cause of death to the public, or even admitted that an assisted death had ever taken place in his or her county, "will immediately be terminated" (OHD memorandum reprinted in Issues in Law & Medicine, winter 1998, p. 334).

What the Report Found:

· The most common factor leading to assisted suicide was not unrelieved pain or even seriousness of illness, but concern about "loss of autonomy" or "loss of control of bodily functions." Many of these patients "had been decisive and independent throughout their lives" (p. 582), and could not cope with being weak or dependent. Only 4 of the 15 received any psychological assessment (p. 579).

· The most decisive social factor: never having married, a factor 24 times more likely among these patients than a control group (p. 580). Loners with no family support system are choosing assisted suicide.

· Regarding the time it took for lethal drugs to cause death: "Although the majority of patients died within 1 hour, four patients died more than 3 hours after taking the prescribed medications, and one died 11.5 hours afterward" (p. 582). All used federally controlled substances, generally barbiturates.

· In 40% of cases (6 out of 15), patients were turned down by one or more physicians before finding one who would write a lethal prescription (p. 582). (In the first reported case, two physicians had refused, and one had made an initial diagnosis of clinical depression, before the patient was referred to a willing physician by a pro-suicide group - - see March 1998 Life at Risk.) Assisted suicide patients, on the average, had known their physician about one-tenth as long as control patients (69 days vs. 720 days) (p. 581). At a February 25 briefing for congressional staff in Washington, D.C., Dr. Katrina Hedberg of the Oregon Health Division conceded that suicide advocacy groups had counseled patients or otherwise played a role in "10 or 11" of the 15 cases.

Editor's note. Reprinted with permission from Life at Risk, Vol. 9, No. 2, February/March 1999. NCCB Secretariat for Pro-Life Activities.