Suicide lessons from OregonAfter ten years and 300 deaths, what is there to learn from America's assisted suicide frontier?
Next month marks the tenth anniversary of the state's physician-assisted suicide (PAS) law. Although Oregon's Death with Dignity Act was initially approved by state voters in 1994, legal proceedings kept it from becoming operational until November 1997. The first recorded legal assisted suicide deaths began at the start of 1998. According to the Oregon Department of Human Services, which monitors the Act, in the nine years from 1998 through 2006 there were 292 such deaths. Information regarding the 2007 calendar year will be released in March 2008.
In the first four years (1998 to 2001) there were 91 deaths or about 23 a year. In the last five years (2002 to 2006) there were 201 deaths or about 40 a year. In 2006 there were 46 deaths; there were 65 prescriptions for lethal doses of secobarbital or pentobarbital written by 40 doctors. Currently about one in 700 deaths in Oregon is from assisted suicide. Why have these Oregonians chosen to end their lives? Although the sponsors of the PAS law claimed that uncontrolled physical pain was the primary reason for legalizing assisted suicide, we have since learned that pain is not the main reason that some Oregonians have chosen it. The assisted suicide movement itself has acknowledged that physical pain is not the main reason for ending life. Oregon assisted suicide patients have been described by their doctors as being fiercely independent and controlling people. They fear dependency. Control and choice are the key words now used in the promotion of assisted suicide. Less incentive to care The arrival of "death with dignity" in Oregon has not created a health paradise. The national organization, Last Acts, issued a "report card" in November 2002 to states regarding their end-of-life care. Oregon was given a D grade for hospice care and an E grade for palliative care programs. There are concerns regarding pain management in Oregon. After four years of assisted suicide, an Oregon medical university study reported that there were almost twice as many dying patients in moderate or severe pain or distress as there had been prior to the law change. Once a patient has the means to take his or her life, there is less incentive to care for the patient's symptoms and needs. A detailed report in the American Journal of Psychiatry in 2005 told of a depressed lung cancer patient in Oregon who had been committed to a mental hospital unit. During planning for his discharge, a palliative care consultant wrote that he probably needed attendant care at home, but providing for that additional care might be a "moot point" because he already had "life-ending medication" at home. His assisted suicide doctor did nothing for his pain and palliative care needs, but did offer to sit with him while he took the overdose. This seriously physically and mentally ill patient received poor medical advice and care because he had been prescribed lethal drugs. An excuse for rationing care Legitimising suicide for some can create danger for others. At a time of rising health costs administrators may build assisted suicide into their calculations.For instance, Oregon Medicaid covers the cost of assisted suicide, but not the cost of curative or local medical treatment for patients with cancer who have a less than a five per cent chance of living five years, even when that treatment can prolong valuable life. In 2003 Medicaid stopped paying for medicines for 10,000 poor Oregonians; this included patients with AIDS, those needing bone marrow transplants, people who are mentally ill and those with seizure disorders. In 2004 and the first half of 2005, an additional 75,000 Oregonians were cut from the health plan to keep the state budget balanced. Even if an Oregon patient has Medicare or Medicaid coverage, there is limited access to health care. Sixty per cent of Oregon physicians limit or do not see Medicaid patients, and 40 per cent do not see Medicare patients. Seventeen per cent of Oregonians are without health insurance, and the share of Oregonians without health insurance has grown faster than in any other state over the past four years. Abuse of the lawThe so-called “safeguards” in Oregon’s law are meant to limit access. It is to be expected, however, that when controlling-type people -- as PAS patients in Oregon allegedly are -- come up against the requirements of the law, something has to give, and so the boundaries around assisted suicide in Oregon have stretched. Some of the legal requirements are: being an Oregon resident, being mentally capable, being diagnosed with a terminal illness that will lead to death within six months, and self-administering the prescribed medication. Predictably, there are reported instances of these rules not being followed. In any case, there is no protection for the depressed or mentally ill: in recent years, only five per cent of those dying from assisted suicide had a mental health consultation. In 2006, only two of the 46 patients dying from assisted suicide were referred for psychiatric evaluation, yet depression is the most common cause of suicidal thoughts. There are published reports about a patient diagnosed by a psychiatrist as having dementia, who still received a prescription for lethal drugs. The drug is supposed to be self-administered and ingested, and yet we have media reports of cases where that has not occurred because the patient was not capable of doing it. Other reports concern two patients whose lethal medication entered the body via a feeding tube, one of them a PEG tube (feeding straight into the stomach) placed for the sole purpose of taking the lethal medication. Terminally ill people are reportedly moving to Oregon from other states because of Oregon’s assisted suicide law. Many doctors are writing prescriptions for lethal drugs to patients for whom they have not previously cared and some appear to be making it their specialty. Dr Peter Rasmussen reported that 75 per cent of the patients who come to him regarding assisted suicide are people he has never seen before. In the past four years, one doctor each year has written between six and eight prescriptions. One thing Oregon’s PAS law has not done: it has not reduced other suicides. Between 1999 and 2002 the state had a rate of suicide (not counting deaths from assisted suicide) among those 65 years of age and older that was sixth highest in the nation and one and a half times the national average. At the same time there is no real monitoring of Oregon's assisted suicides. In the last three years the prescribing doctor was present at the time the patient took the lethal dose of sleeping drugs in only 29 of the 121 deaths. Knowledge of complications for the other 92 patients is obtained second- or third-hand. Following David Prueitt's failed assisted suicide attempt in January 2005, the state Department of Human Services (DHS) publicly stated that they had "not authority to investigate individual Death with Dignity cases -- the law neither requires or authorizes investigations from DHS." An isolated anomaly - for now With majorities voting twice -- in 1994 and 1997 -- in favor of legalization, it is unlikely that Oregon will repudiate assisted suicide in the near future. However, the north-west state has failed to be the predicted harbinger of assisted suicide spreading to other states. In keeping with its geographic fringe location, Oregon represents a solitary anomaly in legalizing assisted suicide. Voter referendums and legislative bills similar to Oregon’s assisted suicide law have failed in Alaska, Arizona, California, Hawaii, Maine, Michigan, Washington and Wisconsin. The failure of assisted suicide extended across the Atlantic where an Oregon-type assisted suicide bill was rejected in the British House of Lords in 2006. In early October 2007 the Washington State Medical Association rejected a proposal to be neutral in this area and strengthened its policy of opposition to PAS. Why have PAS bills failed in other states? Because of the concern of a broad coalition of health care professionals, hospice workers, disability rights advocates, minority groups, pro-life advocates, and various moral and ethical leaders who have vigorously opposed the legalization of assisted suicides in these political jurisdictions. They are concerned about the impossibility of containing assisted suicide once it starts; about the financial inequalities in society and about fair access to medical care by the disadvantaged. Above all, they worry that the so-called “safeguards” of Oregon’s assisted suicide law are being disregarded.
Kenneth R. Stevens Jr, MD, is Vice-President of the Physicians for Compassionate Care Education Foundation. The foundation promotes compassionate care for severely-ill patients without sanctioning or assisting their suicide. Members affirm that all human life is inherently valuable and that the physician’s roles are to heal illness, alleviate suffering, and provide comfort for the sick and dying. |
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Oregon during fall rivals states more famous for the beauty of their dying foliage, according to the north-west state's official website. That claim may be contentious, but in one thing Oregon is definitely unique in the American landscape: it has a law that allows doctors to help people kill themselves.
Comments (23)
That Lesbian Down The Street said...You make it sound like these Oregonians are the only people to do such things^^;; Oregon is just the only state where it’s -legal-.
But that aside… I’m a very opinionated person, as anyone who I’ve had a conversation with can attest to.
But… I don’t really have an opinion of this. It might be because I don’t think of it a lot, or it might be because it doesn’t seem much my business.
If a person wants to end their own life, I guess it’s their human right to do so… but I do think that this desire to end one’s own life should be balanced, by the person in question, against the pain one would cause to friends and family. It just seems selfish to not think of pain caused to other people.
But, going back to personal rights, it seems like it’s -their right- to decide if they want to cause pain to their friends and relatives, and end their own.
I guess the principal of suicide doesn’t bother me so much as the psychological consequences to those left behind. After all, a person’s problems (and virtues, too, I might add) end when they’re dead. (Unless you believe in heaven; I don’t, so I can’t offer an opinion there.)
Well, in all, the passing of this law seems like people making decisions. Good or bad is a matter of personal taste, and I haven’t come to a personal opinion at this point in time.
(...I may have just taken up a lot of space for nothing, then^^;;)
Have a nice day, regardless^^;;
-- | Saturday, 27 October 2007 at 8:38 am
The Old Bloke Up The Road said...The very thought of assisted suicide seems horribly repugnant. What`s the world coming to?
I am so glad that I can look back with pride on my Nana`s death. I was just a young bloke when she died, after she struggled for five years with a terminal illness. She fought the pain, defied the odds and was an inspiration to us all. Her illness brought her back in contact with her Catholic faith (which made her much at peace). It was moving to see my Pop, an atheist, lovingly assist Nana with her prayers and devotions, when she was too weak to perform them without help. Her illness gave him something more to live for. Nana`s pain was shared by all of us and gave both friends and family a strong sense of dignity. Good on you Nana, for living your life to the very end. Many years later, you remain an inspiration to us all.
-- | Saturday, 27 October 2007 at 3:43 pm
a concerned Canadian said...I have great concern that we too in Canada may follow in Oregon’s footsteps. There is a bill “in the works” for its potential acceptance.
I am a Registered Nurse and am a pro life advocate. Funny enough, you would think all people dedicated to their medical professions would be. There has been a terrible shift from promoting life to promoting every one’s right to do as they please.
Society today has developed an aversion and fear of suffering. We constantly ask “why me?” and “what have I done to deserve this?” The reality is that suffering is a part of this world, and we need to learn not so much to completely alleviate it and relieve ourselves from it, but to find a way to use it for our own good & the good of others. When we suffer we are united to Jesus in a unique way, and can offer up our suffering for our families and their salvation, and ask our Lord to use it for good.
Those who think that the good shouldn’t suffer are forgetting our Lord on Calvary. He alone should not have suffered, and yet he chose to for us. There could not have been salvation without it.
The physicians who seem to be making PAS their specialty need to look at themselves and deterine what they are afraid of. It seems they might be projecting their fear of suffering on their patients. Perhaps they should be looking at truly trying to help their patients to embrace life as it comes instead of taking the easy way out.
Canada | Sunday, 28 October 2007 at 7:13 pm
stephanie b said...I am currently studying nursing in Mexico City. I just started my studies, but there is something I have learned, which is that as professional, we nurses and doctors, should be looking for the betterment of the person, helping the patients overcome whatever difficulties they might be going through, and assisting them in any of their physical or moral needs. We are not there to give them a note that allows them to kill themselves, on the contrary, we are doing this to help them prevent death, or in other cases to face death as someone who realizes that they didn’t “purchase” life in a store, and so, they don’t have the right to take it away either. Not themselves, nor the doctors (or nurses)
Mexico | Monday, 29 October 2007 at 3:52 am
Duty said...Dear Down:
“I’m a very opinionated person, as anyone who I’ve had a conversation with can attest to.”
I will agree with you there, and plead guilty too. This is a good place to star a discussion.
“But… I don’t really have an opinion of this. It might be because I don’t think of it a lot, or it might be because it doesn’t seem much my business.”
Now we can disagree. It is your business! This is a question of Natural law, which applies to all people, and you are subject to that law.
“If a person wants to end their own life, I guess it’s their human right to do so”
Not at all! You have a right to LIFE, not death. Death would be the absence of that right.
“I do think that this desire to end one’s own life should be balanced, by the person in question, against the pain one would cause to friends and family. It just seems selfish to not think of pain caused to other people.”
A good point! Now, add to it the pain that they will bring upon themselves buy breaking the Natural law, and you have an even stronger argument.
“But, going back to personal rights, it seems like it’s -their right- to decide if they want to cause pain to their friends and relatives, and end their own.”
‘Seems’? By this you mean an opinion not a legal or official position. They have no RIGHT TO DECIDE. Obviously they can make a decision to die, but the act of making a decision is quite different than having the right to make a decision. I can beat my neighbour over the head, but that does not give me the RIGHT to hit him or her over the head.
Part II will follow
Canada | Monday, 29 October 2007 at 4:50 am
Duty said...Dear Down (Part II)
“I guess the principal of suicide doesn’t bother me so much as the psychological consequences to those left behind. After all, a person’s problems (and virtues, too, I might add) end when they’re dead. (Unless you believe in heaven; I don’t, so I can’t offer an opinion there.)”
You should form an opinion on this. Certainly before you get older, and those around you start thinking that you are no longer contributing to society, but rather are a drain on their resources. They might form an opinion for you.
“Well, in all, the passing of this law seems like people making decisions. Good or bad is a matter of personal taste”
We can agree, at least that they can make bad decisions.
Your opinion of this law may shared by many. However, the Kingdom of Heaven is not a democracy and a majority opinion carries no weight in the real Supreme Court!
“I may have just taken up a lot of space for nothing, then”
Here is where I disagree with you the most. Your valuable contribution to this discussion reflects what you truly believe. They help us to use our God given gifts of logic and reason in order to form an opinion based on truth. Thank you for your thoughts!
-- | Monday, 29 October 2007 at 4:52 am
LIZ said...Voluntary Euthanasia is suicide. Involuntary euthanasia of the handicapped is murder. What more is there to say?
Nicaragua | Wednesday, 31 October 2007 at 7:46 am
Christopher Canaris said...Any “right” carries with it a corresponding “duty.” A major concern for me as a psychiatrist and a physician is that as “right to die” may create a “duty to kill.” “Reproductive health” is a case in point. Here, physicians, nurses, and pharmacists who feel unable to accommodate therapeutic abortions often encounter considerable hostility to their conscientious objections from employers, colleagues, politicians, and society.
Moreover, even in the field of “passive” euthanasia (eg, non-provision of futile treatment), a perception that someone will shortly die “anyway” may lead to a substantial decline in overall quality of care. Palliative care as a speciality does redress some of these problems. However, in the climate of increasing economic rationalism and managed care, active euthanasia may well become the more attractive option for the health economists who increasingly govern medical decisions.
Australia | Thursday, 1 November 2007 at 11:58 am
Malcolm Lyons said...An individual’s most fundamental right is the right to life, to live. We now have Exemption rights such as Abortion, experimentation with human embryos and euthanasia which allow citizens in some states to circumvent an individual’s fundamental right with or without the victims permission. These exemption rights have never been, and could never be, fundamental in nature.
Australia | Thursday, 1 November 2007 at 8:29 pm
Kelly said...Even if you think people should have the right to make their own decision on this very touchy subject, I think this article proves that legalized assisted suicide should never, ever be allowed in any state or country. The results of such legalization has been played out in Oregon and several European countries:
1. Even if suicide is illegal, it cannot be stopped. If someone really wants to take their own life, they are going to do it. It’s easy and there are often people willing to help.
2. Getting the government involved and making it a legal and funded “medical” option does not grant a right to dying people. The net effect is that it takes rights away from people. As this article shows, the poor, the disabled and the mentally ill are denied the full opportunity make free choices because others no longer see the value in caring for them, since death is a cheaper and easier option.
In the end this new right, makes people less free.
United States | Saturday, 3 November 2007 at 2:56 am
That Lesbian Down The Street said...Dear Duty^^
(sorry it took me so long^^;;)
First, I have to say… As I read your post, I had no idea you were talking about me until I read my entire post within yours, just because… I’ve never been called “Down” in my history of posting. Did you do it just to be original, or for some other reason? Regardless, I got a kick out of it^^
Now for actual debate.
I thought your take on ‘rights’ was interesting^^ I think I define ‘rights’ differently than you do. To me, a right is anything a person is capable of doing; so, while you may not have a -legal- right to “beat [your] neighbor over the head”, you do have the ‘natural’ right to do so. You have the natural right to anything you can do, actually. Civil Law is just a restraint on natural rights for the protection of those living within government, which is a good idea, I think.
And this part, too: “Now, add to it the pain that they will bring upon themselves buy breaking the Natural law”.
We’re… talking about suicide here. They won’t have -any- pain for breaking the ‘natural law’ or whatever. Unless you believe in heaven, but I don’t, so I’m under the impression that a person’s ability to experience anything ends when their life does.
And in closing, this bit:
“However, the Kingdom of Heaven is not a democracy and a majority opinion carries no weight in the real Supreme Court!”
I won’t get mad at you, because a lot of people make this mistake with me^^;; It’s impossible to convince me of anything by using faith (Christian, Muslim, Hindu, or otherwise.)
I’m an agnostic, so I’m not one to think there -is- a kingdom of heaven. So that comment was just kind of… there, on the end, to show me that you’re a Christian. That’s about how much influence it had on me.
But I’m thankful you took time from your busy day to pick apart my argument^^ Thank you for caring, and telling me my comments were worth something.
Have a nice day, all^-^
-- | Saturday, 3 November 2007 at 11:03 pm
marycontrary said...Just wait until assisted suicide happens in the apartment right next door to you. This happened to one of my best friends a little over a year ago. The manager of their apartment complex told the residents the date 15 days hence when one of the dwellers in the senior and disabled housing apartments would be doing this. My friend lived right next door, saw the doctor and the assistant drive up, saw the body wheeled out in a body bag, had terrible nightmares for days afterwards.
United States | Sunday, 4 November 2007 at 2:13 pm
Glen said...Hi there,
I understand many of the concerns raised here about euthanasia.
Most of the arguments rotate around a potential ‘slippery slope’ with the administration of euthanasia, rather than with the concept of euthanasia itself.
To deny the ideal of euthanasia (the paradigm case) is inhumane, and I question the real motives of those doing so.
The day that medical providers begin frorcing euthanasia upon people to ‘cut costs’ would be a terrible day. However, I do seriously doubt that this is often the case, especially since the numbers of people being euthanized are extremely small.
I believe that euthanasia is a compassionate thing, should not be smeared by phrases like “doctors helping people kill themselves”, and will aleviate a great deal of suffering - provided it is monitored accordingly and is provided only when palliative care fails.
The nagging thought that I am left with is that arguments against euthanasia are not being advanced because of a genuine concern for potential ‘euthanites’, but more because it stands as contradictory to what the Bible says. The day that people base their opinions solely on what is consistent with Biblical teachings, rather than with what is genuinely compassionate, is probably just as dangerous and shameful as the day euthanasia is used to ‘cut costs’.
Remember, God does not exist, but compassion and reason do. Use those as guiding principles rather than the word of some imaginary being.
New Zealand | Wednesday, 7 November 2007 at 11:35 am
John said...I would argue with the notion that denying the ideal of euthanasia is inhumane. When laws are passed legalizing euthanasia, a society is saying that helping a person to end their life may be better than helping them with their suffering. Where would one draw the line objectively? It is not reasonable.
All people suffer to some extent and wish to be happy. I would suggest that true compassion lies in helping people reduce their experience of suffering or to be happy in spite of it. Are we saying that death is really a better answer? It certainly doesn’t help one to be happier.
I think what may be missing is an understanding of the true value of a life and the value of enduring hardship, including physical pain. Those who endure suffering provide an example for those around them, especially when it is done for a greater good. How may heroes took the easy way out? The quick fix is not always the best answer.
United States | Monday, 12 November 2007 at 5:32 am
Bruce said...Down,
You are right in assuming your post has no value. In fact none of your arguments that I have read bare any value. They are poorly written and completely subjective. Your utilitarian outlook is inconsistent in that you give personal feelings and societal feelings imbalanced weighting. Who is to say an individual’s desire to die should trump another’s desire for that individual to live? Who is to say your opinion about God and Heaven should trump my own?
All that said, you do not have a real argument concerning this article so I will not waist as much time as Duty refuting it.
-- | Friday, 16 November 2007 at 8:57 am
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