A lethal dosage was authorized by a managed care executive for an elderly cancer patient whose daughter was aggressively pushing for her death, despite the findings of a consulting psychiatrist that the woman's memory loss meant she lacked the mental "capacity to weigh options about assisted suicide" and that she did "not seem to be explicitly pushing for this," according to an Oregon newspaper report.

On October 17, a story in the Portland paper The Oregonian told the tale of Kate Cheney, an 85-year-old woman with growing dementia. The psychiatrist who declared her ineligible for assisted suicide diagnosed her as cognitively impaired, noting 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.

When Oregon legalized physician-assisted suicide by referendum in 1994, its proponents touted what they called its safeguards. If there was doubt about a person's competence, they emphasized, the law required the individual to be referred for a psychiatric evaluation.

But the "safeguard" of the opinion evaluating Cheney was apparently disregarded. Another opinion was sought, this time from a psychologist who wrote that the patient could not remember when she was diagnosed with terminal cancer, although it had only been a few months ago. The psychologist also wrote that the patient's "choices may be influenced by her family's wishes and her dau-ghter, Erika, may be somewhat coercive," according to the Oregonian. Nevertheless, this psychologist said she was competent. Presented with this opinion, the managed care company executive authorized giving Kate Cheney lethal pills, she took them, and she died.

"Doctor-shopping" is apparently a common practice to evade the " safeguards" that the law's proponents said would avert legal resort to suicide by the mentally ill. At least five of the fifteen deaths in the first year of the law's operation were of people who had first been turned down by at least one doctor, according to official reports.

Indeed, the woman whose March 1998 death was the very first publicly reported under the Oregon law was turned down by her own physician, as well as a second physician who concluded that she was de-pressed and that her depression was affecting her desire to end her life. Instead of being treated for the depression, however, she was put in touch with the medical director of the pro-euthanasia organization Compassion in Dying, Dr. Peter Goodwin.

Goodwin later told the American Medical News that the woman was able to look after her own house, was able to walk up and down stairs, and was not in great pain. However, she had had breast cancer for 22 years, could no longer garden, and for two weeks had been unable to do aerobic water exercises, so Goodwin believed "the quality of her life was just disappearing" and referred her to another doctor who prescribed the lethal drugs she used to kill herself.

In the words of Wesley Smith, commenting on the Cheney death in the November 8 Weekly Standard, "Once the legal view of killing is shifted from automatically bad to possibly good, it becomes virtually impossible to restrict physician-assisted suicide to the very narrow range of patients for whom proponents claim it is reserved. The 'protective guidelines' allegedly designed to guard the lives of vulnerable people soon become scorned as obstacles to be circumvented. And so, eligibility for physician assisted suicide steadily expands to permit the killing of increasing categories of ill and disabled patients. Thus, an act that is supposed to be 'rare' is likely to become more common. And what was seen as a last resort, something that might be considered if palliative treatment failed, becomes an alternative to treatment."