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diggSuicide lessons from Oregon
After ten years and 300 deaths, what is there to learn from America's assisted suicide frontier?
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.
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.
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.
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.
Dana, I have experienced all of the things you have experienced, and then some: a father who had Alzheimer’s his last 6 years, also totally incontinent both bowel and bladder, the death of many friends and family by cancer, my own 92 year old mother a three time cancer survivor who also now has dementia, myself a two-time survivor who is her sole caregiver.
Our family sees suffering through the eyes of God and our caring for those who are nearing death as a service to Him.
It is a precious privilege and an honor to take care of a person who is suffering and aging into eternity. May we all be so lucky to be able to care for a beloved family member who becomes more and more dependent upon us in their last days.
Death isn’t dignified, never has been, never will be even if you knock granny off with pills or injections. That death is not dignified is one of the lessons we are supposed to learn here. But faithfully caring for those who suffer and not complaining about how it affects us as the caregiver IS dignified.
For those against the legalization of physician assisted suicide and voluntary euthanasia, just let me say this: five years before i was born, my grandma developed early stages of Alzheimer’s disease. By the age of seven the only images i saw of her were my mother and aunts changing her diapers and feeding her in bed. How anyone can rectify that is a dignified way to leave this earth is beyond me. I know Alzheimers patients are not beneficiaries of the current physician-assisted suicide laws, but I support them regardless.
PAS and Euthanasia are matters of autonomy and should be made legal. I understand the hardships doctors face when patients request to die, that it undermines their actions as life protectors. However after also seeing my aunt and two friends die from cancer all before the age of 17, I believe there should be alternatives to aggressive end-of-life care. Prolonging a painful situation does not help anyone, it’s simply putting off what could be done in a precise and dignified manner.
“Proponents of the initiative never thought there’d be a rush to die. The opponents-the Catholic Church and others-said, ‘Oregon’s going to become a killing state; people are going to be dying like crazy in Oregon with this thing.’ Well, that did not happen.
“In the first place, most people cling to life. The natural thing is to cling to life. Usually people do that no matter how much they’re suffering. But if that is so, one might ask, then why bother? If this is going to benefit so few people, and so few people take advantage of the law, then why are we struggling to get this going in other states? Which we certainly are.
Dr. jack Kevorkian argues as many people do that it is ethical , who are we to take away liberty to play the role of a judge or to say that some is not a good judge of them self!
Is it ethical to let some one suffer through pain! While some is dying and we say they have to live the full term of there illness because we say it is unethical!
Of recent poles taken 55% agree that its ethical, 39% say its not ethical, government wont allow it afraid of it being abused! Who should we let take these positions?
it should only be legalized and used only under extensive evaluation!
and there is a religious key factor being played in theses decisions, the roman Catholic doctors or not for this nor the Baptist!
but those who watch there family member, friend or significant other suffer would know about not being selfish those who say they would not let there loved ones do this are truly thinking of them self’s there afraid to let go or don’t believe this is right but yet it is ethical to pull the plug while some is in a vegetated state or coma! They are in competent unable to decide and we make the decision weather or not they are suffering and the are no longer going to have a life of choice but we still pull the plug. Why should a person be forced to die of natural death and suffer in stead of PAS!
Great blog I hope we can work to build a better health care system as we are in a major crisis and health insurance is a major aspect to many.
“But I like the way you presented your opinions overall^^ I hope to see you around here more often.”
-> I didn’t think I would get a reply let alone a compliment so thanks ^_^
“God does not exist, but compassion and reason do.”
-> Reason I can understand, but why compassion? (why not just say ‘emotion’)
“It would appear your balance leans more towards bare logic than mine does;”
-> Eh I’m actually in between because, in whatever state of mind we may be in, it is an emotion (which is always). I just present myself--as so it seems--more logical because, well, logic is...logic. There’s no way to bend it, not even with emotion.
“because I’m admittedly a bit of a hopeless romantic”
-> ditto :P
Cogitative^^
You’re opinions are a bit different from mine, but I’m impressed with the way you presented them. You seem to break a mental barrier that many posters get stuck at. Well done^^
But on to defending my own position; I, too, am an opinionated person^^
“To include ‘feelings’ or ‘moralities’ is too humane.”
This sort of ideology always interests me; if I might quote Glen from a few posts back, “God does not exist, but compassion and reason do. Use those as guiding principles rather than the word of some imaginary being.”
That’s sort of the way I feel about things; I believe that emotion and logic are both awfully important, and that a (not necessarily equal) balance should be struck between them. It would appear your balance leans more towards bare logic than mine does; I think humaneness is a very desirable trait, albeit one that -has- been tampered with by generations of mankind.
But earlier in your post, you discuss selfishness. I suppose that scenario does contain selfishness on both sides, although, if I were the friend of one who contemplated committing suicide, I would not want to keep them alive out of a selfish desire for them to ease my own pain; I would want to keep them alive out of a compassionate desire to ease -theirs- in a non-lethal way.
In this way, I believe sometimes situations can work themselves out where nobody is selfish, and both parties benefit^^ These are the situations I like best, because I’m admittedly a bit of a hopeless romantic.
But I like the way you presented your opinions overall^^ I hope to see you around here more often.
Until then, adieu.
“It just seems selfish to not think of pain caused to other people.” If you’re giving up your happiness--in this case it is your death--for the happiness of someone else, who then is selfish: the person wanting to die while not caring about someone else’s feelings, or the person not wanting that person to die, so that they can be happy themselves? Either way you look at it, every decision we make deals with the concept of being ‘selfish’.
In my opinion, we are entitled to do as we please; we are all nothing but a species and if we deem ourselves appropriate to death, then let it be so. To include ‘feelings’ or ‘moralities’ is too humane. But because we have been exposed to living as humans for who knows how long, we have this perspective in which we base our opinions as how you are doing in saying that the pain caused to another is proclaiming yourself as selfish and such.
Sorry if my opinions are a bit dogmatic; even though I don’t see it as dogmatism, but more as a...strong opinionated person ^_^
Glen says “doctors helping people to kill themselves” is a smear on euthanasia. Could he explain further? It reads like a neutral description to me (NPOV, as Wikipedia says). It’s certainly not inaccurate. Perhaps it’s an over-simplification - or perhaps it’s just a simplification.
Also, Glen, a word of advice: don’t attack people’s motives. Attack their arguments. You may or may not be right about the motives, but these are second-order. You won’t make converts among those you’re attacking ("I see now that I didn’t believe what I said, I was only saying it to look good” is not too likely a scenario) and it puts off any neutrals, who are probably more interested in the arguments than speculation about the motives of the people advancing them.
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.
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.
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.
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.
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^-^
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.
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.
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