Assisted Suicide in Oregon: Deaths More Widespread

By Brian Johnston

Oregon's 2002 official report on assisted suicide within the state found that 38 people died by doctor's prescription, up from 21 officially reported for 2001. This represents a 57% increase over 2001 and almost two and half times the number of assisted suicides that occurred in 1998, the first year the "Death with Dignity Act" was in place.

Despite claims by euthanasia proponents that assisted suicide would be used only in dire circumstances, as a "last resort," 84% of those who killed themselves with lethal drugs were motivated by fear of "losing autonomy," according to the official report. Over a third (37%) feared being a burden on family, friends, or caregivers.

Under provisions of the act, state health officials are required to issue the reports, based on death certificates, interviews, and reports filed by doctors and pharmacies. They have compiled an annual report for five years.

Who committed assisted suicide in Oregon?

The official report for 2002 found that 38 of the 39 victims were white; seven in ten were men; the average age was 69; and the three most commonly cited motives were loss of autonomy (84%), a decreasing ability to enjoy activities (84%), and loss of control of body functions (47%). In addition, 26% feared inadequate pain control.

"Tragically," said Burke J. Balch, J.D., director of the National Right to Life Committee's Department of Medical ethics, "the report just released fulfills the fears of euthanasia opponents that once assisted suicide is accepted for 'hard cases' it will spread to more and more circumstances until it is justified as just another 'choice,' an exercise of 'autonomy.'"

Balch also noted that over a quarter feared inadequate pain control. "In modern medicine, there is no need for anyone to suffer uncontrolled pain," he said. "We should be working to improve access to existing means of pain relief, not killing those in pain. It is also troubling that over a third feared being a 'burden' on family, friends, or caregivers."

This shows, Balch said, "That the so-called 'right to die' is becoming a perceived 'duty to die.'"

Both the accuracy and nature of the report were hotly debated. Dr. Kenneth Stevens, a Portland, Oregon, cancer specialist and president of Physicians for Compassionate Care, observed, "There is no outside, independent monitoring. I worry that there may be things happening that are not reported." Indeed, while reporting such cases is ostensibly required, there is no penalty for failure to report.

Moreover, as Diane Coleman, president of Not Dead Yet, a disability rights advocacy organization, pointed out, the most recent reports clearly contain the caveat that they "do not include patients and physicians who may act outside the law." Echoing Dr. Stevens' sentiments, Coleman said, "There is no mechanism to assess or address physician non-reporting or non-compliance."

Thirty-four patients used the prescription drug phenobarbital, two used secobarbital, and two used Tuinal. In previous years the drug of choice had exclusively been secobarbital, which Eli Lilly stopped producing in May 2001. Each of these drugs is a federally controlled substance. Federal laws and regulations restrict their use to "legitimate medical purposes," which the Clinton Administration interpreted to include the killing of patients when authorized by state law.

In November 2001, Bush Administration Attorney General John Ashcroft reversed that ruling, prohibiting federally controlled substances from being used to assist in suicides. However, the state of Oregon challenged his order in court, U.S. District Court Judge Robert Jones blocked the Ashcroft ruling from taking effect, and the practice was allowed to continue.

Attorney General Ashcroft has appealed the Jones decision to the 9th U.S. Circuit Court of Appeals, and oral argument is set for May 7 with a ruling expected in late summer. That court's decision, when issued, will likely be appealed to the U.S. Supreme Court.

Economic factors

Assisted suicide in Oregon is particularly troubling in as much as the state is the only one that openly rations medical treatment for those poor people eligible for Medicaid. Under the Oregon rationing program, while certain pain-relief and life-sustaining treatments are not covered, the state fully covers suicide prescriptions.

At least one Oregon HMO is attempting to recruit willing physicians. On August 6, 2002, Kaiser Permanente's Northwest regional ethics service sent out an e-mail to 740 physicians asking doctors who "were willing to act as attending physicians if a person requests assisted suicide to notify Kaiser Administrator Robert Richardson, M.D.," according to American Medical News.

Richardson is controversial for his alleged role in the 1999 case of an elderly patient, Kate Cheney. An October 17, 1999, story in the Portland paper The Oregonian told Cheney's story.

The 85-year-old woman was declared ineligible for assisted suicide by a psychiatrist who diagnosed her as cognitively impaired. (He noted that she could not remember recent events and people, including the names of her hospice nurses or her new doctor.) The psychiatrist noted that her family appeared to be pressuring her, according to The Oregonian.

A second consultation was ordered, this time with a clinical psychologist rather than an M.D. psychiatrist, according to anti-euthanasia activist Wesley Smith. Writing for National Review online, Smith observed,

"Like the first report, the psychologist found that Cheney had significant memory problems. For example, she could not recall when she had been diagnosed with terminal cancer. The psychologist also worried that Cheney's decision to die 'may be influenced by her family's wishes.' Still, despite these reservations, the psychologist determined that Cheney was competent to commit suicide.

"The final decision to approve the assisted suicide was made by Richardson. Despite two mental-health professionals' significant concerns about Cheney's mental state and the potential that familial pressure was involved in her decision, after he interviewed Cheney, Richardson approved the writing of a lethal prescription," wrote Smith.

Unreported deaths cast ominous shadow

In addition to the officially reported increases in sanctioned suicide, The Oregonian has reported on a concomitant increase of suicides that have swept through the state in the last 3-1/2 years.

In a front-page story of December 29, 2002, entitled, Did They Have to Die, The Sunday Oregonian found that 94 depressed and suicidal individuals who had been referred to the Oregon mental health system took their own lives, "under troubling circumstances such as delayed treatment, neglect, abandonment and other lapses in case management." While the article did not tie the suicides to the Death With Dignity Act, it did note that many of the suicides were not reported as suicides, and seriously questioned the Oregon Health System's efforts to protect the emotionally vulnerable.

"Official reports" in Netherlands also called into question

The Netherlands has also legalized euthanasia, ostensibly in a controlled environment, with physician oversight. Official records for the year 2002 found an 8% drop in the number of intentional deaths. But another government report, the Remmelink Report, has found that one in four Dutch euthanasia deaths are not voluntary and that 60 percent of physicians do not report cases in which they commit euthanasia, as required.

Sources outside the anti-euthanasia movement have documented these practices. On February 27, 2003, the Dutch television program Reporter aired an expose of this practice of "shortening lives" in the Netherlands.

The program found that many thousands of cases of euthanasia were going unreported. According to the 355 lung specialists surveyed by the program, the official figures offered by the Dutch government are not to be trusted. Many doctors said they didn't report acts of euthanasia because they resent the "intrusion" of the euthanasia protocols and the duty to report. It is worth noting that in Oregon there is no penalty for non-reporting.

"Now, more than ever, it's up to doctors to stand up and say: 'We will never abandon a patient,'" Smith told American Medical News. He added that he would like Oregon physicians to put up plaques in their offices that read: "This is a euthanasia-free zone."