Oregon
Oregon’s Dying With Dignity Act allows for
medical practitioners to prescribe drugs for self-administration by a person to
allow the person to end his or her life.
Oregon publishes
annual reports on the operation of the Dying
With Dignity Act. The latest annual report for 2015 was published recently.
A careful analysis
of this data reveals significant issues with the practice of physician assisted
suicide in Oregon and should sound a warning to other jurisdictions considering legalising assisted suicide.
1 Physical
suffering is not a major issue but “being a burden” is
The Oregon annual
reports indicate that physical suffering is not a major issue for those
requesting physician assisted suicide.
Of the 991 people
who had died from ingesting a lethal dose of medication as of 27 January
2016 only 25.2% mentioned “inadequate pain control or concern about it”
as a consideration.[1]
Earlier annual
reports noted that “Patients discussing
concern about inadequate pain control with their physicians were not
necessarily experiencing pain.”[2]
However, in 2015 nearly one out of two (48.1%) people
who died after taking prescribed lethal medication cited concerns about being a
“Burden on family, friends/caregivers”
as a reason for the request.[3]
Physician assisted
suicide has more to do with relieving other people of a “burden” than relieving unbearable, unrelievable pain.
To facilitate and
fund euthanasia and assisted suicide of persons simply because feel they are a
burden on family, friends or caregivers sends a cruel message to the disabled
or chronically ill who may need the care and support of others in order to
function in daily life. It implies that only the strong and fully independent
have the right to live.
2 Mental health:
No adequate screening
Research by Linda
Ganzini has established that one in six people who died under Oregon’s law had
clinical depression.[4]
Depression is
supposed to be screened for under the Act.
However, in 2015 less
than one in twenty five (3.8%) who died under the Oregon law were referred by
the prescribing doctor for a psychiatric evaluation before writing a script for
a lethal substance.[5]
In 2011 Dr. Charles
J. Bentz of the Division of General Medicine and Geriatrics at Oregon Health
& Sciences University explained that Oregon's physician-assisted suicide
law is not working well. He cited the
example of a 76-year-old patient he referred to a cancer specialist for
evaluation and therapy. The patient was
a keen hiker and as he underwent therapy, he became depressed partly because he
was less able to engage in hiking. He expressed a wish
for assisted suicide to the cancer specialist, who rather than making any
effort to deal with the patient’s depression, proceeded to act on this request
by asking Dr Bentz to be the second concurring physician to the patient’s
request.When Dr Bentz declined
and proposed that instead the patient’s depression should be addressed the
cancer specialist simply found a more compliant doctor for a second opinion.
Two weeks later the
patient was dead from a lethal overdose prescribed under the Act.
Dr Bentz concludes “In most jurisdictions, suicidal ideation is
interpreted as a cry for help. In
Oregon, the only help my patient got was a lethal prescription intended to kill
him.”
3 Financial
considerations
Of the 991 people
who had died from ingesting a lethal dose of medication as of 27 January
2016 some 3.1% mentioned the “financial implications of treatment” as
a consideration.[7]
It is
appalling that 30 Oregonians have died from a lethal prescription after
expressing concerns about the financial implications of treatment.
In two notorious
cases, those of Barbara Wagner and Randy Stroup, the Oregon Health Plan
informed a patient by letter that the particular cancer treatment recommended
by their physicians was not covered by the Plan but that the cost of a lethal
prescription to end their life would be covered.[8]
4 The
misleading notion of a peaceful death
Euthanasia and
assisted suicide proponents hold out the promise of a peaceful death by
fast acting lethal substances. The
lethal drugs most likely to be preferred by medical practitioners are
secobarbital and pentobarbital. As of 27
January 2016 secobarbital had been used in 58.5% of cases and pentobarbital in
39% of cases in Oregon.[9]
These drugs do not always result in a swift and peaceful
death.
In 2015 nearly one in thirteen (7.4%) of those for whom information
about the circumstances of their deaths is available regurgitated the lethal
dose.[10]
The interval from ingestion of lethal drugs to
unconsciousness has been as much as 38 minutes while the interval from
ingestion to death has ranged from 1 minute to as long as 104 hours (4 days and
8 hours).
In 2005, one patient regained consciousness 65 hours after ingesting
the medications, subsequently dying from their illness 14 days after awakening.[11]
Lumberjack David
Prueitt who, after ingesting the prescribed barbiturates spent three days in a
deep coma, then suddenly woke up, asking his wife “Honey, what the hell happened? Why am I not dead?’
Since 2005 five
other people have regained consciousness after ingesting the lethal medication,
one of them some 88 hours (nearly 4 days) after taking it.[13]
In 2012 “one patient ingested the medication but
regained consciousness before dying of underlying illness and is therefore not
counted as a DWDA death. The patient
regained consciousness two days following ingestion, but remained minimally
responsive and died six days following ingestion”.[14]
5 Cruel and
unusual punishment
Since 2011 sodium pentobarbital has been used by several
States in the United States in the execution of prisoners.
David Waisel, MD, an anaesthesiologist, has testified about
the use of this drug in executions.
… as the lethal injection commenced Mr. Blankenship jerked his head
toward his left arm and made a startled face while blinking rapidly. He had a
“tight” grimacing expression on his face and leaned backward.
Shortly thereafter, Mr. Blankenship grimaced, gasped and lurched twice
toward his right arm.
During the next minute, Mr. Blankenship lifted his head, shuddered and
mouthed words.
Three (3) minutes after the injection, Mr. Blankenship had his eyes
open and made swallowing motions.
Four (4) minutes after injection, Mr. Blankenship became motionless.
About thirteen (13) minutes after the injection, Mr. Blankenship was
declared dead. Again, his eyes were open throughout.
Based on his lurching toward his arms and the lifting of his head and
the mouthing of words, I can say with certainty that Mr. Blankenship was
inadequately anesthetized and was conscious for approximately the first three
minutes of the execution and that he suffered greatly. Mr. Blankenship should
not have been conscious or exhibiting these movements, nor should his eyes have
been open, after the injection of pentobarbital.
Given prior executions of Brandon Rhode and Emanuel Hammond in September
2010 and January 2011, respectively, during which these inmates reportedly
exhibited similar movements and opened their eyes (Rhode’s eyes were open
throughout the execution process), Mr. Blankenship’s execution further
evidences that during judicial lethal injections in Georgia there is a
substantial risk of serious harm such that condemned inmates are significantly
likely to face extreme, torturous and needless pain and suffering.[15]
6 Increase
in number of deaths
The number of deaths from ingesting lethal substances
prescribed under Oregon’s Death With
Dignity Act reached 132 in 2014, up 25.7% from 2014, continuing a steady
rise since 1998, the first year of the Act’s operation when 16 people died
under its provisions.[16]
7 Faulty
prognosis
The Death With Dignity Act provides that
before prescribing a lethal substance a doctor must first determine whether a
person has a “terminal disease”. This is
defined by section 127.800 (12) of the Oregon Revised Statute to mean “an
incurable and irreversible disease that has been medically confirmed and will,
within reasonable medical judgment, produce death within six months”.
In 2015 one person
ingested lethal medication 517 days after the initial request for the lethal
prescription was made. The longest
duration between initial request and ingestion recorded is 1009 days (that is 2
years and 9 months).[17]
Evidently
in these cases the prognosis was
wildly inaccurate.
Dr Kenneth Stevens has written about his experience of how
the prognosis of six months to live works in practice under Oregon’s law:
Oregon’s assisted-suicide law
applies to patients predicted to have less than six months to live. In 2000, I had a cancer patient named
Jeanette Hall. Another doctor had given
her a terminal diagnosis of six months to a year to live. This was based on her not being treated for
cancer.
At our first meeting, Jeanette
told me that she did not want to be treated, and that she wanted to opt for
what our law allowed – to kill herself with a lethal dose of barbiturates.
I did not and do not believe in
assisted suicide. I informed her that
her cancer was treatable and that her prospects were good. But she wanted “the pills.” She had made up
her mind, but she continued to see me.
On the third or fourth visit, I
asked her about her family and learned that she had a son. I asked her how he would feel if she went
through with her plan. Shortly after
that, she agreed to be treated, and her cancer was cured.
Five years later she saw me in
a restaurant and said, “Dr. Stevens, you saved my life!”
8 Short relationship with attending physicians
The Oregon statute specifies that lethal prescriptions only
be written by a person’s “attending
physician” who is defined as “the
physician who has primary responsibility for the care of the patient and
treatment of the patient's terminal disease.”[19]
The data indicates that in some cases doctors have had a
relationship with the patient of less than one week’s duration and that
in 2015, in half the cases the doctor-patient relationship was of 9 weeks duration
or less.[20]
A total of 106 physicians wrote 218 prescriptions during
2015 (1‐27 prescriptions per physician).[21]
Taken together this data suggests that there are some doctors
in Oregon very willing to write prescriptions for lethal substances for
patients they barely know.
9 Who administers the lethal medication?
In 2015 either the prescribing physician (11.36%) or another
provider (9.84%) was known to be present at the time the lethal medication was ingested.
For the remaining 78.8% of people there was no physician or other health
provider known to be present at the time of ingestion.[22]
In other words for nearly four out of
five cases there is no independent evidence that the person took the lethal
medication voluntarily. It may well have been administered to them by a
family member or other person under duress, surreptitiously or violently. We
can never know.
10 Increase
in suicide rate
Proponents have claimed that legalising physician assisted
suicide would actually prevent, or at least delay, suicides by giving those
faced with a terminal illness an assurance that the means for obtaining peaceful death was legally available.
However, a study of comparative rates of suicide in US states found that for
the states, like Oregon and Washington, which had legalised physician assisted
suicide there is an increase in the overall suicide rate of 6.3% compared to
all other states and of the sucide rate of those aged 65 and over of 14.5%.
There is no reduction in either the rate of non-assisted suicides or in the
mean age of suicide.[23]
[1] Oregon Public Health Division, Oregon’s Death With Dignity Act:
2015 Data Summary, Table 1. Characteristics and end‐of‐life care of
991 DWDA patients who have died from ingesting DWDA medications, by year,
Oregon, 1998‐2015, p.6, https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year18.pdf
[2] Oregon Health Authority, Sixth Annual report on Oregon’s Death With Dignity Act, 2004, p. 24 http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year6.pdf
[3]Oregon Public Health
Division, Oregon’s Death With
Dignity Act -2013 Table 1, Characteristics and end-of-lif Oregon Public Health Division, Oregon’s Death With Dignity Act
-2014, Table 1, Characteristics and end-of -life care of 857 DWDA
patients who died after ingesting a lethal dose of medication as of February 2,
2015, Oregon, 1998-2014, p. 5, http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year17.pdf
[4] Linda Ganzini et al., “Prevalence of
depression and anxiety in patients requesting physicians’ aid in dying: cross
sectional survey”, BMJ 2008;337:a1682, http://www.bmj.com/content/bmj/337/bmj.a1682.full.pdf
[5] Oregon Public Health Division, Oregon’s Death With Dignity Act:
2015 Data Summary, Table 1. Characteristics and end‐of‐life care of
991 DWDA patients who have died from ingesting DWDA medications, by year,
Oregon, 1998‐2015, p.6, https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year18.pdf
[6] Charles Bentz, “Oregon’s assisted suicide law
isn’t working”, The
Province, December 5 2011, http://blogs.theprovince.com/2011/12/05/province-letters-icbc-egypt-assisted-suicide-oregon-christmas-pre-marital-sex/
[7] Oregon Public Health Division, Oregon’s Death With Dignity Act:
2015 Data Summary, Table 1. Characteristics and end‐of‐life care of
991 DWDA patients who have died from ingesting DWDA medications, by year,
Oregon, 1998‐2015, p.6, https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year18.pdf
[8] Susan Donaldson James, “Death drugs cause
uproar in Oregon:, ABC News, August 6, 2008, http://abcnews.go.com/Health/story?id=5517492#.Ty9-VsXy8sI
; Dan Springer, “Oregon Offers Terminal Patients
Doctor-Assisted Suicide Instead of Medical Care”, July 28, 2008, http://www.foxnews.com/story/0,2933,392962,00.html
[9] Oregon Public Health Division, Oregon’s Death With Dignity Act:
2015 Data Summary, Table 1. Characteristics and end‐of‐life care of
991 DWDA patients who have died from ingesting DWDA medications, by year,
Oregon, 1998‐2015, p.6, https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year18.pdf
[10] Oregon Public Health Division, Oregon’s Death With Dignity Act:
2015 Data Summary, Table 1. Characteristics and end‐of‐life care of
991 DWDA patients who have died from ingesting DWDA medications, by year,
Oregon, 1998‐2015, p.6, https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year18.pdf
Note that from 2010 reports of complications
were only recorded if a physician was present at the time of administration so
percentages for complications artificially decline as complications are listed
as “unknown” for the majority of cases in which no physician was present.
[11]Oregon
Health Authority, Death With
Dignity Act, Year 14 - Table 1, Characteristics and end‐of‐life care of 596 DWDA
patients who died after ingesting a lethal dose of medication as of February
29, 2012, by year, Oregon, 1998‐2011, p.3
[12] “Oregon man wakes up after assisted-suicide attempt”, Seattle
Times, 4 March 2005, http://www.seattletimes.com/nation-world/oregon-man-woke-up-after-assisted-suicide-attempt/
[13] Oregon Health Authority, Death With Dignity Act, Year 14 -
Table 1, Characteristics and end‐of‐life care of 596 DWDA patients who died after
ingesting a lethal dose of medication as of February 29, 2012, by year, Oregon,
1998‐2011, p. 3,
[14] Oregon’s Death With Dignity Act -2012 Table
1, Characteristics and end‐of‐life care of 673 DWDA patients who died after
ingesting a lethal dose of medication as of January 14, 2013, by year, Oregon,
1998‐2012, p. 2,
[15] State of Massachussetts, County of
Suffolk., Affidavit of David
B. Waisel, MD, p. 2-3,
[16] Oregon Public Health Division, Oregon’s Death With Dignity Act:
2015 Data Summary, Figure 1, Oregon DWDA Prescription Recipients and
Deaths by Year, 1998-2015, p. 1,
[17] Oregon Public Health Division, Oregon’s Death With Dignity Act:
2015 Data Summary, Table 1. Characteristics and end‐of‐life care of
991 DWDA patients who have died from ingesting DWDA medications, by year,
Oregon, 1998‐2015, p.7,
[18] Kenneth Stevens “Doctor helped patient
with cancer choose life over assisted suicide”, Missoulian, 27 November 2012,
[19] Oregon Revised Statute, Section
127.800 (2)
[20] Oregon Public Health Division, Oregon’s Death With Dignity Act:
2015 Data Summary, Table 1. Characteristics and end‐of‐life care of
991 DWDA patients who have died from ingesting DWDA medications, by year,
Oregon, 1998‐2015, p.7, https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year18.pdf
[21] Oregon Public Health Division, Oregon’s Death With Dignity Act:
2015 Data Summary, Table 1. Characteristics and end‐of‐life care of
991 DWDA patients who have died from ingesting DWDA medications, by year,
Oregon, 1998‐2015, p.4, https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/year18.pdf
[22] Oregon Public Health Division, Oregon’s Death With Dignity Act
-2014, Table 1, Characteristics and end-of -life care of 857 DWDA
patients who died after ingesting a lethal dose of medication as of February 2,
2015, Oregon, 1998-2014, p. 5,
