Members of a British House of Lords Committee traveled to Oregon seeking information regarding Oregon’s assisted-suicide law for use in their deliberations about a similar proposal currently under consideration in Parliament.
After hearing witnesses claim that there have been no complications associated with more than 200 assisted-suicide deaths, committee member Lord McColl of Dulwich, a surgeon, said, “If any surgeon or physician had told me that he did 200 procedures without any complications I knew that he possibly needed counseling and had no insight. We come here and I am told there are no complications. There is something strange going on.” (1)
Although the experience with assisted suicide in Oregon is generally portrayed as a complication-free practice with careful safeguards, operating under strict scrutiny, the reality is different. None of the individuals quoted below are opponents of Oregon’s law.
“Safeguards” are disregarded and no one has been disciplined
- Referring to assisted suicide cases that were in violation of the law – where only one of the required two witnesses signed the request or where doctors prescribed the lethal drugs without waiting for 15 days as the law requires – Dr. Katrina Hedberg who has been the lead author of Oregon’s official reports said, “[T]here have been a number over the years.” (2)
- Kathleen Haley, Executive Director of the Oregon Board of Medical Examiners, said four such cases, one involving multiple patients, (3) were reported to the Board of Medical Examiners. This resulted in issuance of two “letters of concern” that are considered “letters of advice.” She explained that the letters “are not public and they are not official disciplinary actions.” (4)
Complications are not investigated or reported
- “[W]e are not given the resources to investigate,” Hedberg said. “[N]ot only do we not have the resources to do it, but we do not have any legal authority to insert ourselves.” (5)
- David Hopkins, Data Analyst for Oregon’s Center for Health Statistics, said, “We do not report to the Board of Medical Examiners if complications occur; no, it is not required by the law and it is not part of our duty.” (6)
- Jim Kronenberg, the Oregon Medical Associations’ (OMA) Chief Operating Officer, explained that “the way the law is set up there is really no way to determine that [complications occurred] unless there is some kind of disaster.” “[P]ersonally I have never had a report where there was a true disaster,” he said. “Certainly that does not mean that you should infer there has not been, I just do not know.” (7)
Patient’s judgment may be impaired at the time the lethal drugs are taken
- Hedberg acknowledged that there is no assessment of patients after the prescription is written. “Our job is to make sure that all the steps happened up to the point the prescription was written,” she said.(8) “In fact, after they write the prescription the physician may not keep track of that patient….[T]he law itself only provides for writing the prescription, not what happens afterwards.” (9)
No way to track the drugs once they are received
- “[W]e do not have a way to track if there was a big bottle [of lethal drugs] sitting in somebody’s medicine cabinet and they died whether or not somebody else chose to use it,” explained Hedberg. (10)
Self-administration is very broadly interpreted
- Dr. Peter Rasmussen who has been involved in Oregon assisted-suicide deaths numbering into double digits explained that, in one case, he opened 90 capsules – a lethal dose – of barbiturates and poured the white powder into a bowl of chocolate pudding. He gave the mixture to the woman’s son who spooned the mixture into his mother’s mouth. Another son gave her sips of water to wash the solution down. The woman died twelve hours later.(11)
- According to Sue Davidson of the Oregon Nurses Association (ONA), a 2002 survey found that nurses were very actively involved in the process and that “some indicated that they had assisted [patients] in the taking of it [the lethal dose].”(12)
Lethal drugs do not need to be taken orally
- Barbara Glidewell who educates Oregon Health & Science University (OHSU) patients and their families about “the need for a dying plan and to rehearse the plan”(13) said that patients who cannot swallow would “need to have an NG tube or G tube placement.”(14) Then, they could “express the medication through a large bore syringe that would go into their G tube.”(15)
- Oregon’s 2005 Guidebook for Health Care Professionals states, “It remains unclear whether the Oregon Death with Dignity Act allows an attending physician to prescribe an injectable drug for the patient to self-administer for the purpose of ending life.” (16)
- Discussing a case in which a man said he helped his brother-in-law take the drugs, Hedberg said that “we do not know exactly how he helped this person swallow, whether it was putting a feed tube down or whatever, but he was not prosecuted….” (17)
Required six months prognosis is considered unrealistic or unimportant
- Kronenberg of the OMA said most physicians have told him that trying to predict that a patient has less than six months to live “is a stretch.” “Two hours, a day, yes, but six months is difficult to do,” he explained.” (18)
- Rasmussen said life expectancy predictions for a person entering the final phase of life are inaccurate. He dismissed this, saying, “Admittedly, we are inaccurate in prognosticating the time of death under those circumstances, we can easily be 100 percent off, but I do not think that is a problem. If we say a patient has six months to live and we are off by 100 percent and it is really three months or even 12 months, I do not think the patient is harmed in any way….” (19)
Pain control has become increasingly inadequate
- As of 2004, nurses reported that the inadequacy of meeting patients’ pain needs had increased “up to 50 percent even though the emphasis on pain management has remained the same or is slightly more vigorous…Most of the small hospitals in the state do not have pain consultation teams at all,” Davidson of the ONA said. (20)
Data for reports is based on self-reporting by doctors who prescribe lethal drugs
- Asked if there is any systematic way of finding out and recording complications, Hedberg replied, “Not other than asking physicians.” (21)
- Dr. Melvin Kohn, Oregon State Epidemiologist and Administrator of the department that oversees the annual reports about Oregon’s law, explained that, in every case that they hear about, “it is the self-report, if you will, of the physician involved.” (22)
Records used in annual reports are destroyed
- Hedberg said, “After we issue the annual report, we destroy the records.” (23)
Doctors decide what “residency” means
- Under Oregon’s law, a patient must be a resident of Oregon. Residency can be demonstrated by means that include [but are not limited to] a driver’s license or a voter registration but, according to Hedberg, “It is up to the doctor to decide” whether the person is a resident. There is no time element during which one must have lived in Oregon. “If somebody really wanted to participate, they could move from their home state,” she said. “I do not think it happens very much….”(24)
Assisted-suicide advocacy group facilitates most of Oregon’s assisted suicides
- According to Dr. Elizabeth Goy of OHSU, Compassion in Dying (now called Compassion and Choices (25)) sees “almost 90 percent of requesting Oregonians….” (26)
- Barbara Farmer of the Visiting Nurses Association said, if a person’s own doctor doesn’t want to participate, “we have advised them to work with Compassion in Dying….” (27)
The state pays for assisted-suicide drugs for the poor
- Ann Jackson, Executive Director and primary spokesperson of the Oregon Hospice Association, explained, “The State of Oregon, under the Oregon Health Plan, will buy the medications….The drugs are very inexpensive.” (28)
(1) Witnesses’ testimony was published in: House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill, “Assisted Dying for the Terminally Ill Bill [HL]“ Volume II: Evidence. Apr. 4, 2005. (Hereafter referred to as HL)
Remarks by Lord McColl of Dulwich, HL, p. 334, Q.956 (Emphasis added.)
(2) Hedberg, HL, p. 257, Q. 555.
(3) Haley, HL, p. 323, Q. 889.
(4) Haley, HL, p. 323, Q. 892.
(5) Hedberg, HL, p. 266, Q. 615.
(6) Hopkins, HL, p. 259-260, Q. 568.
(7) Kronenberg, HL, p. 347, Q. 1035.
(8) Hedberg, HL, p. 259, Q. 566. (Emphasis added.)
(9) Hedberg, HL, p. 259, Q. 567.(Emphasis added.)
(10) Hedberg, HL, p. 262, Q. 591.
(11) Jennifer Page, “A Death in Oregon: One Doctor’s Story,” Washington Post, Nov. 3, 1999.
(12) Davidson, HL, p. 352-353, Q. 1058.
(13) Glidewell, HL, p. 268, No .3.
(14) Glidewell, HL, p. 270, Q. 623.
(15) Glidewell, HL, p. 275, Q. 653.
(16) “The Oregon Death with Dignity Act: A Guidebook for Health Care Professionals,” (2005), developed by The Task Force to Improve the Care of Terminally-Ill Oregonians, convened by The Center for Ethics in Health Care, Oregon Health & Science University; Chapter 10, Pharmacists and Pharmacy-Related Issues, p. 4.
The guidebook notes, “The Act specifically states: ‘Nothing in ORS 127.800 to 127.897 shall be construed to authorize a physician or any other person to end a patient’s life by lethal injection….’” [Chapter 10, p. 4. (Emphasis added.)]
It does not specifically state that a patient cannot end his or her own life by lethal injection.
(17) Hedberg, HL, p. 267, Q. 621.
(18) Kronenberg, HL, p. 351, Q. 1054.
(19) Rasmussen, HL, p. 312, Q. 842. (Emphasis added.)
(20) Davidson, HL, p.357-358, Q. 1098.
(21) Hedberg, HL, p. 263, Q. 597.
(22) Kohn, HL, p. 263, Q. 598.
(23) Hedberg, HL, p. 262, Q. 592.
(24) Hedberg, HL, p. 267, Q. 620. (Emphasis added.)
(25) The co-director of Compassion and Choices was the chief petitioner for the Oregon law. Currently Compassion and Choices is spearheading a California legislative measure – the “Compassionate Choices Act” – modeled on Oregon’s law.
(26) Goy, HL, p. 291, Q. 768. (Goy is an assistant professor in the Dept. of Psychiatry, School of Medicine, OHSU and has worked with Dr. Linda Ganzini in surveys dealing with Oregon’s law.)
(27) Farmer, HL, p. 302, Q. 795. (Farmer is Director, Home Care and Manager for Legacy VNA Hospice, part of the Visiting Nurse Association and the Legacy Health System.)
(28) Jackson, HL, p. 307, Q. 819. (Jackson is Executive Director and Chief Executive, Oregon Hospice Association. She is also the primary spokesperson for OHA and Oregon hospices about the Oregon law.)