Fear of "Burden" Major Reason for Oregon Assisted Suicides

By Jenny Nolan, Legislative Assistant, NRLC Department of Medical Ethics

Sixty-three percent of the 27 people whose suicides were legally assisted under Oregon law in 2000 said they did so because they feared being a burden to family, friends, and other caregivers, according to the official annual report by the Oregon Health Division (OHD). The report, which is the third since Oregon began the practice of legal assisted suicide in 1998, was compiled from health records and telephone interviews with the doctors who participated in legal suicides and was published February 23.

The 63% figure is a big leap from 1999, when only 26% spoke of worries about being a burden as motivating a desire to commit suicide. In a story that appeared in the Oregonian noting the surge in those seeking suicide to avoid burdening others, Dr. Katrina Hedberg, who wrote the OHD report, said that it was "an issue for doctors to address with patients and families." Yet the same report implies the doctor-patient relationship is withering.

The length of time that the doctors and patients had known each other before the physician assisted the patient's suicide reached its all-time low last year. The median length was eight weeks, down from 22 weeks in 1999.

In spite of rising patient concerns over being burdensome and the increasingly brief duration of their relationships with treating physicians, in 2000 only 19% were referred for psychiatric evaluation as compared to 37% the year before, a drop of almost exactly half.

The OHD figures also reveal that patients moved through the process from initial request for suicide until the actual death much faster in 2000. In 1999 the median length of time between a patient's first request for a lethal prescription and the patient's death was 83 days. In 2000 the span fell to 30 days.

OHD noted one remarkable exception - - a patient who obtained a lethal prescription in 1999 and, happily, was still alive at the close of 2000. The assisted suicide law is supposed to be limited to those who will die within six months, but many question medicine's ability to accurately predict death that far in advance.

Particularly disturbing is that almost a third of the 27 patients who were assisted to die last year were also motivated by inadequate pain management. The figure has steadily risen over all three years, while advances in modern medicine have made it possible for virtually all pain to be controlled.

Dr. Gregory Hamilton, senior scholar of Physicians for Compassionate Care in Portland, Oregon, said in a press release criticizing the assisted suicide law, "We can treat depression, pain, and fear in the seriously ill."

Developments in pain management and in diagnosing clinical depression in the elderly and the seriously ill have proliferated in the last 10 years. The problem, however, is that much of the information has not made its way from the leading-edge medical centers into the everyday practice of medicine throughout the country.

There are efforts in Congress to close the gap. A bill introduced last year, the "Pain Relief Promotion Act," would have clarified that federally controlled substances can be used to treat pain, even when there is a risk of death, without fear of Drug Enforcement Administration penalties.

The bill would also have reversed a controversial ruling by former Attorney General Janet Reno authorizing federally controlled drugs to be used in Oregon's assisted suicides. Barbiturates are the most commonly prescribed drugs for assisted suicide there, though their use is supposed to be restricted by a 1970 federal law to "legitimate medical purposes."

The House of Representatives passed the Pain Relief Promotion Act in 1999 and sent the measure along to the Senate. The Senate Judiciary Committee approved the bill in April 2000, but the measure failed to make it to the Senate floor for a final vote.

Senator Ron Wyden (D) of Oregon vigorously opposed the bill, but Senator Gordon Smith (R), also of Oregon, publicly supported it. During his campaign, now-president George W. Bush voiced support for reversing Reno's interpretation of "legitimate medical purposes," and for prohibiting the use of federally regulated drugs in assisted suicides.

While Derek Humphry, president of the pro-death Euthanasia Research and Guidance Organization, did not comment specifically on Oregon's latest statistics, the rise in deaths due to anxiety about burdening others correlates with his ideals as a proponent of euthanasia.

In a 1998 book, Humphry posed the question: "Is there in fact, a duty to die - - a responsibility within the family unit - - that should remain voluntary but expected nevertheless?" Declaring that "the elderly consume a disproportionate amount of health care resources," he continued, "Physician-assisted suicide is an idea whose time has come....[T]he right-to-die movement is gaining momentum in response to...the emotional, physical, and economic toll of the dying experience...on families...."

In small numbers, this idea has begun to take hold in Oregon.

National Right to Life expressed deep concern about the Oregon report. "The assumption that those who need our care most are the least deserving of it is unjust and tragic," said David O'Steen, NRLC executive director. "The latest statistics from Oregon should double our concern that the vulnerable are being pressed into assisted suicide."