A Dose of Sober Realism in Oregon

By Burke Balch, J.D.
Director of NRLC's Robert Powell Center for Medical Ethics

Editor's note. The following takes on additional urgency in light of the decision by an appeals court panel that U.S. Attorney General cannot sanction or hold Oregon doctors criminally liable for prescribing lethal dosages of drugs, under Oregon's "Death with Dignity" Act. (See story, page 6.)

For years, there have been warnings that legalizing assisting suicide risks denying suicidal individuals who are psychologically ill the treatment they need. Advocates of legalized assisting suicide have retorted that "safeguards," such as those found in Oregon's 1994 "Death with Dignity" law, will screen out suicide attempts that are based on psychological imbalance as distinct from those involving so-called "rational suicide."

Now, a paper delivered by Oregon psychiatrist Dr. N. Gregory Hamilton at the May 6, 2004, meeting of the American Psychiatric Association alleges that an Oregon man with lung cancer was given a lethal prescription even though he had a history of psychological problems, including depression, alcoholism, and previous suicide attempts that long antedated his cancer diagnosis. Delivered at a symposium on ethics and end-of-life care, Hamilton's paper was based on medical records and interviews with the patient.

BACKGROUND

Michael Freeland was haunted by thoughts of suicide since his early 20s when his mother shot herself. Shortly after his mother's suicide, Freeland attempted suicide himself.

In March 2000, his doctor diagnosed him, at age 62, with lung cancer. According to the New York Times, "Dr. Hamilton said Mr. Freeland came into contact with the couple [Dr. Hamilton and his wife] because he mistakenly dialed their organization in 2000 after receiving his diagnosis of terminal cancer, thinking that he could get information about ending his life. Instead, Dr. Hamilton said, the three began a two-year relationship in which the Hamiltons helped Mr. Freeland receive treatment for depression and other medical problems."

In early 2001, however, a lethal prescription was prescribed for Mr. Freeland, although he was not actually "terminally ill" and did not die for another year and a half. Dr. Hamilton reported in his paper that Mr. Freeland was subsequently admitted to a hospital psychiatric ward for evaluation for "possible suicidal or homicidal ideation." He was diagnosed with depression and probable intermittent delirium, as well as an adjustment disorder. A social worker home visit found his house uninhabitable because of its state of disorder, rodent feces, fireplace ashes protruding two feet into the living room, and lack of food and heat - - and found 32 firearms with thousands of ammunition rounds.

Although the patient was eventually discharged from the psychiatric ward, a Multnomah County judge found him incompetent to make medical decisions, and the guns and ammunition were removed from his home, Dr. Hamilton explained. Despite all this, the lethal prescription was not removed, and indeed a new certification that he had less than six months to live was written to make the lethal prescription legal.

Oregon law requires a certification that death is expected within six months in order for assisting suicide to be legal. In this case, the patient ultimately died from natural causes almost two years after the original six-month certification. In fact, while it was predicted that the patient would be further incapacitated in a "matter of weeks," no attendant care was arranged for. It was concluded that, because the patient had "life-ending medication," to provide for additional care might be "a moot point."

"This case makes it abundantly clear that doctor-assisted suicide is incompatible with the physician's role as healer," Dr. Hamilton told the Times.

Just how far proponents are willing to go became clear in that same May 7 Times article. The physician who provided the suicide drugs to Mr. Freeland was not available for comment. His partner, Dr. Eugene Uphoff, who said he did not know the specifics of the Freeland case, "did argue, however, that the interpretation of the Oregon law by its opponents is overly narrow and that depression should not make it impossible to receive a doctor's assistance in ending one's life," according to the Times.

"'Even if they do have a depression, that would not preclude them from receiving drugs to help them end their life,' so long as it can be determined 'that it is not the depression that makes them want to kill themselves,' Dr. Uphoff said."

In fact, experts like Drs. Harvey Chochinov and Leonard Schwartz, professors of psychiatry at the University of Manitoba, insist that clinical depression often affects the "will to live." They note, "Patients who are treated for their depression often recover .... the renewed ability to find meaning in life...."

Psychiatrist Dr. Joseph Richman, former president of the American Association of Suicidologists, emphasizes that "effective psychotherapeutic treatment is possible with the terminally ill, and only irrational prejudices prevent the greater resort to such measures."

The alleged circumstances of this case starkly challenge the claim that Oregon's much-touted "safeguards" in fact work to protect the psychologically ill.