OREGON TAKES A CLOSER LOOK AT ASSISTED SUICIDE
Oregonians are reconsidering a law, narrowly passed in 1994, which makes it legal for doctors to intentionally prescribe lethal medication in order to end certain patients’ lives. The law, referred to as Measure 16 or the Oregon Death with Dignity Act, has yet to go into effect, having been held up in the courts due to a constitutional challenge. Concerned that the new law would be enacted once the court challenge ended, the Oregon legislature voted earlier this year to refer the measure back to the voters in November. Lawmakers pointed to new information which came to light after the measure passed in 1994 — information clearly indicating that the law is dangerously flawed. (See Update, 6-7/97:6 & 3-5/97:1.)
Flaws exposed by right-to-diers
Contrary to what they are now claiming, euthanasia advocates themselves provided the proof that Measure 16 meant trouble for Oregon. Just weeks after the law passed in 1994, Derek Humphry, author of the how-to suicide manual Final Exit and a Measure 16 supporter and fundraiser during the campaign, wrote a letter to the NY Times saying that Oregon’s new assisted-suicide law “could be disastrous.” Referring to the fact that the law allows only assisted suicide (lethal drug prescription taken by the patient), not active euthanasia (doctor administered lethal injection), Humphry wrote:
“Evidence I have accumulated shows that about 25 percent of assisted suicides fail, which casts doubts on the effectiveness of the new Oregon law, although it remains a significant demonstration of public opinion. The new Oregon way to die will only work if in every instance a doctor is standing by to administer the coup de grâce [lethal injection] if necessary.”
According to Humphry, Dutch doctors often end up giving lethal injections “because the oral drugs were causing protracted suffering to the patient, the family, and [the doctor].” [Letters, NY Times, 12/3/94]
Humphry, perhaps overly confident after Oregon voters approved the assisted-suicide measure, was laying the groundwork for the next step in the right-to-die strategic agenda — active euthanasia. He told a Canadian reporter, “This law doesn’t help the people who need it most — the people who cannot keep drugs down, because of their terrible diseases, or cannot put hand to mouth.” “In a few years,” he added, “the law is going to have to be adapted to allow for lethal injection.” [T. Appleby, “Suicide law falls short, activist says,” Globe & Mail, 12/7/94:A10]
But Humphry wasn’t the only right-to-die guru to describe Measure 16 as a flawed first step toward active euthanasia. A month after the measure passed, Dr. Pieter Admiraal, often referred to as the father of Dutch euthanasia, told an Oregonian reporter that the state was “in trouble.” “You have accepted phase one (voter approval). Now phase two is coming,” he said. Admiraal, who has personally participated in over 100 euthanasia deaths, also warned that one out of four patients who try to end their lives under Measure 16 would likely have lingering deaths, lasting hours or even days. These kinds of deaths are very upsetting to witness, he said, because patients have difficulty breathing, and family and friends are often faced with the agonizing prospect of suffocating their loved one with a plastic bag. “Is that acceptable in a civilized world? In my opinion, no,” Admiraal said. [M. O’Keefe, “Dutch researcher warns of lingering deaths,” The Sunday Oregonian, 12/4/94:A1]
Admiraal’s comments were based on a study he co-authored for the Royal Dutch Society for the Advancement of Pharmacology. According to Admiraal, 25% of the patients using oral medications took more than three hours to die, some even up to two days or more. The study found that even when 9 grams of a barbiturate (3 times the lethal dose) are taken orally, “this may not always result in rapid death.” The physician “must be willing, if necessary, to inject a muscle relaxant, when death does not materialize for a long time (e.g., longer than 5 hours).” [P. Admiraal et al., “The Administration of and Preparation for Euthanasia,” Royal Dutch Society for the Advancement of Pharmacology, 1995 (translated from Dutch)]
This finding was corroborated by another Dutch physician and euthanasia advocate, Dr. Gerrit K. Kimsma, in a paper entitled “Euthanasia and Euthanizing Drugs in The Netherlands.” Kimsma noted, “Experience has taught us that there are many cases of assisted suicide in which the suicide fails. Physicians need to be aware of the necessity to intervene before patients awaken.” He cited a 1994 Dutch report, entitled Application and Preparation of Euthanasia, and the following empirical finding: “[I]n 20% of the patients who received a barbiturate [orally], a muscular relaxant [paralyzing injection] was needed to end life after the 5 hour time period.”
Kimsma went on to assess measures (like Oregon’s Measure 16) which allow lethal drug prescriptions but prohibit lethal injections:
“Many, though not all, attempts to legalize physician-assisted suicide, both in America and Australia, are limited to just physician-assisted suicide and do not allow euthanasia. From the above facts, it should be abundantly clear that this limitation is headed for disaster if physicians are forbidden by law to end life actively in cases of failure of the chosen route for assistance.” [Kimsma, “Euthanasia and Euthanizing Drugs in The Netherlands,” in Battin and Lipman, eds., Drug Use in Assisted Suicide and Euthanasia, Pharmaceutical Products Press (1996), pp. 200 & 207]
Assisted-suicide advocates try to deny Dutch findings
Measure 16 supporters, not happy over the fact that the flawed assisted-suicide law was back on the ballot for a revote, mounted a campaign to discredit the assisted-suicide “failure” argument. In August 1997, a group called Physicians for Death with Dignity, supported by the Oregon Death with Dignity Legal Defense and Education Center, sent a letter to Oregon doctors calling the argument “a false one.” “There is no study, there is no research that documents a 25% failure rate or prolonged, painful deaths after oral medication,” the letter read.
Then during a debate sponsored by the Oregon Health Forum in September, Barbara Coombs Lee, chief petitioner for Measure 16 in 1994 and currently the executive director of the Seattle-based Compassion in Dying as well as spokesperson for Oregon Right to Die, accused Measure 16 opponents of creating a “well-orchestrated conspiracy of lies.” “Our opponents and members of the Legislature have embarked on a campaign of disinformation and outright lies,” she said. [The Oregonian, 9/5/97; Statesman-Journal, 9/5/97]
To support that contention, Coombs Lee distributed individual letters from Drs. Admiraal and Kimsma intended to show that their research had been distorted by those opposed to assisted suicide. In his letter addressed “To the People of Oregon,” Kimsma wrote:
“…This claim [by Measure 16 opponents] entails that in cases of physician assisted suicide in the Netherlands the established failure rate would be 25%. This is implied to mean that in 25% of the cases where physicians would assist in death through orally applied means the effect would not be death…. This claim has no foundation whatsoever, is misleading and completely wrong. There are no scientific data nor hearsay to support it. On the contrary. In the impressive research data of Van Der Wal and Van Der Maas (1996) the time between applying farmaceutical [sic] substances and death was for 85% of the patients less than one hour and for an additional 11% between one hour and a day, being a total of 96% of the patients. The advised procedure, in cases of prolonged suffering where death does not occur after ingesting these substances, is to end life by intravenous injection of effective means after more than six hours.” [Garrit K. Kimsma, M.D., Letter to the People of Oregon, 7/3/97; emphasis added]
In addition to admitting that there are cases of “prolonged suffering where death does not occur” and that Dutch medical “procedure” in those cases is to actively “end life” by lethal “intravenous injection,” Kimsma also cited the wrong research data to support his argument. He pointed to the “impressive research of Van Der Wal and Van Der Maas (1996),” but erroneously cited the statistics for euthanasia deaths, not assisted-suicide fatalities. [Wal G. van der, Maas P. van der, Euthanasia en andere medische beslissingen rond het levenseinde (Euthanasia and other medical decisions at the end of life), ‘s-Granvenhage, Sdu, 1996:58-59]
Dutch expert criticizes Measure 16
- Dr. Admiraal’s letter was no help to the right-to-diers either. First off, Admiraal stated that The Sunday Oregonian article from 1994 correctly quoted him as saying that one in four patients (25%) will die after a period longer than 3 hours, a finding, Admiraal wrote, which can be found in the Royal Dutch Society for the Advancement of Pharmacology study. He then went on to strongly criticize Measure 16 for not requiring that doctors be present when their patients take the deadly prescriptions. Admiraal wrote, “Doctors should, in our opinion, deliver the drugs personally to prevent misuse, to wittness [sic] that the whole dose has been taken and to give proper information to the family. [P. Admiraal, M.D., Ph.D., Letter to Mr. Duncan, 7/25/97]In the letter, Admiraal’s assertion that the doctor should be present for the patient’s death was similar in wording to a 1995 article he wrote for a Dutch medical journal — with one important omission. In the 1995 article, Admiraal went on to state:
- Karen Shoffstall, 34; from Long Beach, NY; died 8/13/97; had early stage multiple sclerosis.
- Janet Good, 73; from Farmington Hills, MI; died 8/26/97; had only microscopic residual traces pancreatic cancer.
- Thomas E. Summerlee, 55; from Colorado Springs, CO; died 8/29/97; had multiple sclerosis.
- Carol Fox, 54; from Telford, PA; died 9/3/97; had ovarian cancer.
- Deborah Sickels, 43; from Arlington, TX; died 9/6/97; had multiple sclerosis.
- Natverlal Thakore, 78, from Burnaby, B.C. (Canada); died 9/20/97; had Parkinson’s disease.
- Kari Miller, 54; from Englewood, CO; died 9/29/97; had multiple sclerosis.
- John D. Zdanowiez, 50; from Berwyn, IL; died 10/3/97; had ALS (Lou Gehrig’s disease).
- Lois Carol Hawkins Caswell, 65; from Lexington, KY; died 10/8/97; had chronic pain syndrome.
- Annette Blackman, 34; from Presque Isle, MI; died 10/13/97; had multiple sclerosis.
“In spite of these measures every doctor who decides to assist in suicide must be aware that something can go wrong with the result being a failure of the suicide. For this reason one should always be prepared to proceed to active euthanasia, in other words the doctor should always have at hand thiopental and muscle relaxant.” [Admiraal, P.V, “Toepassing van euthanatica,” Ned Tijdschr Geneeskd, vol. 139, no. 6 (February 11, 1995), p. 267, col. 1, paragraph 6 (translated from Dutch); emphasis added]
In September 1997, Admiraal told an American Medical News reporter that one of the reasons why doctors should witness “the event” is to stop any misuse of the deadly medication. There was a case, he said, where a Dutch doctor wrote a lethal drug prescription for a patient, who, in turn, gave it to a neighbor. When the neighbor committed suicide, the doctor was blamed. According to Admiraal, the physician “is not a grocery store where you can order death.” [D. Gianelli, “Dutch euthanasia expert critical of Oregon approach,” American Medical News, 9/15/97:13]
Questionable “study” cited Yet, in spite of all the Dutch data and personal experiences, Coombs Lee still maintains that “oral medications are 100 percent effective.” To substantiate that claim, she cited a 1996 “study” (really an article) entitled, “Observations Concerning Terminally Ill Patients Who Choose Suicide.” The “observations” were reported by co-authors Thomas Preston, M.D., and Rev. Ralph Mero, both longtime assisted-suicide advocates associated with the suicide facilitation group Compassion in Dying (CID) — hardly objective “observers,” let alone researchers. Their uncontrolled study group consisted of merely 24 people; only nine of which were observed first-hand by a CID volunteer at the time of death.
Information regarding the deaths of the remaining 15 subjects was strictly second-hand, hearsay provided by family and/or friends. All 24 patients reportedly took anti-nausea medication, three beta-blockers, followed by “60 to 90 capsules” of a barbiturate, mixed with applesauce and three packets of an artificial sweetener, topped off with two ounces of liquor. According to the authors, “No suicide attempt was unsuccessful,” and all the patients “peacefully died within 25 minutes to 10 hours.” [T. Preston and R. Mero, “Observations Concerning Terminally Ill Patients Who Choose Suicide,” in Battin and Lipman, eds., Drug Use in Assisted Suicide and Euthanasia, Pharmaceutical Products Press (1996), pp. 187-188]
IAETF Executive Director Rita Marker questions the veracity of Preston and Mero’s findings. Both authors have been intimately involved in CID suicide activities in Washington State where assisted suicide is a crime. “To admit that a lethal injection or a plastic bag was used to bring about death,” Marker said, “would implicate them not only in assisted suicide, but in murder.” [R. Marker, “What Now? The Assisted Suicide Debate after the U.S. Supreme Court Decision,” address given at Seattle Pacific University, Discovery Institute Conference, 7/12/97]
Truth or editorial error? The controversy over assisted-suicide failures took a new turn after the Oregon State Bar published its 1997 edition of the Oregon Health Law Manual. Chapter 8 of the manual — co-authored by Barbara Coombs Lee, Oregon Right to Die attorney Eli D. Stutsman, and attorney Kelly T. Hagan — analyzes Measure 16 and its future implementation. The authors provide numerous helpful “Practice Tips” throughout the chapter, mostly dealing with physician behavior in compliance with the provisions in Measure 16. One such “Practice Tip” reads:
“The physician should counsel the patient that although most deaths occur within three hours, death may take longer in the patient’s case and may not occur at all with oral medications.” [B. Coombs Lee et al., “Physician Assisted Suicide,” Oregon Health Law Manual, vol. 2, Life and Death Decisions, Oregon State Bar (1997), p. 8-12; emphasis added]
It would seem that Coombs Lee and the other authors were admitting that deaths may be lingering and that “oral medications” may not do the job at all. Given her public accusations — that those opposed to Measure 16 were lying regarding drug failures — this “Practice Tip” certainly did not help Coombs Lee’s credibility nor that of the pro-Measure 16 camp.
In what appears to be a damage-control move, Coombs Lee and Eli Stutsman obtained a letter from the Oregon State Bar apologizing for giving readers “the mistaken impression that you believed physicians should counsel patients in the way indicated in the ‘Practice Tip’ and also for any embarrassment this error has caused you.” The letter, dated 9/18/97 and sent to everyone who purchased the manual, claimed that the authors did not write that “Practice Tip,” but that it “was inserted editorially in a late redraft of the chapter just prior to going to press.” [K. Garst, Letter to B. Coombs Lee and E. Stutsman, 9/18/97]
But, when the IAETF contacted the Oregon State Bar regarding the letter, director Mary Oberst said that the “Practice Tip” in question had been sent to the authors for review prior to publication. She said that they had the opportunity to see it and that they had not objected to the statement at that time. When asked if there were any other sections of that chapter which were problematic, Oberst replied that there is “only one ‘Practice Tip’ that the authors don’t want to have their name ascribed to.” [Telephone interview with M. Oberst, Oregon State Bar, 9/29/97]
Yes on Measure 51 means repeal of Measure 16 With mail-in ballots being sent out in mid-October for the November 4th special election, Oregon voters are having to sift through all the campaign rhetoric and claims and decide whether Measure 16 should be repealed or allowed to become law. But, this time around, voting either way may be confusing. A NO vote on Measure 16 means a YES vote on Measure 51, the repeal measure placed on the ballot earlier this year by the Legislature.
But what should not be confusing is that Measure 16 is a badly written law which truly is fatally flawed. In addition to the fact that assisted suicides fail, 50% of Oregon doctors polled were not confident they could accurately predict if a patient had less than 6 months to live (a requirement under Measure 16). Only 6% of Oregon psychiatrists said they would be very confident assessing in a single evaluation whether a Measure 16 patient had a psychiatric disorder which impaired his or her judgement. What is also frightening is Measure 16’s lack of protection against for-profit HMOs or managed care programs using the law as a way to cut costs and bolster profits by offering patients the inexpensive “medical treatment” of assisted suicide rather than more expensive treatment options. (See “More about the flaws in Measure 16 for the documentation on these and other Measure 16 flaws.)
Oregon’s largest daily newspaper, The Oregonian, recently ran a 5-part editorial series passionately calling for the repeal of Measure 16 by voting yes on Measure 51. Here are some excerpts from part one of the series, entitled “The vote of our lives”:
“The current law’s pill-only regime will bring sometimes lingering and gruesome deaths, since the pills don’t always work as advertised. Beyond that, many terminally ill patients will march to doctor-assisted deaths, because they’re abandoned, pressured, depressed or fearful. Why? Because the law’s cruelly flimsy safeguards will not guard them in their real time of need.”
“Electorates, it seems to us, should not wipe away the accumulated medical and ethical wisdom of 2,500 years without allowing for some second thoughts. Besides, Oregonians know much more about Measure 16’s defects than we did three years ago, thanks to the admissions of assisted-suicide advocates themselves. And what we’ve come to know should worry even the keenest assisted-suicide backer.”
“If ‘a conspiracy of lies’ is afoot in Oregon, the supporters of Measure 51 aren’t any part of it. The medical truth is enough to compel Oregonians to vote yes on Measure 51 and repeal Measure 16.” [“The vote of our lives,” The Oregonian, 10/8/97]
MORE ABOUT THE FLAWS IN MEASURE 16
ASSISTED SUICIDES FAIL
· When asked about complications related to Measure 16, Dr. Peter Rasmussen, an oncologist and supporter of Measure 16, responded: “They could be many. I don’t have any personal experience, but in reading literature from the Netherlands, I would predict many complications. Approximately 30 percent of their attempts fail, particularly when the mode of administering the drug is by mouth. Nausea and vomiting of the drugs can substantially reduce their effect and delay the death of the patient.” [Peter Rasmussen, M.D., Testimony before the Oregon House Committee on Judiciary, Subcommittee on Family Law, 3/11/97.] · When asked if a doctor would know what prescription and dosage to give a patient to “ensure a successful death,” Rasmussen said: “I doubt anyone could say what dose would be successful. In the Netherlands, they initiate the suicide with drugs by mouth, but they have the option of moving to intravenous drugs. I don’t think we would have that option, under Measure 16.”
[Peter Rasmussen, M.D., Testimony before the Oregon House Committee on Judiciary, Subcommittee on Family Law, 3/11/97.] · “Data from the Netherlands reveal that in 20% of self-deliverances involving lethal dosages of medications, individuals do not die quickly but linger in a coma for up to four days! This is why how-to guides such as ‘Final Exit’ and ‘Departing Drugs’ also recommend the use of plastic bags for self-deliverance.” [“Timelines” (The Hemlock Society USA newsletter), Spring 1997, paid advertisement for customized ” EXIT” plastic bags.] · “Pharmacists say it takes 50 or more barbiturates to bring about death, and it sometimes is accompanied by vomiting and convulsions. ‘It’s absolutely true and something I didn’t realize in 1994,’ [Dr. Peter] Goodwin said of the complication rate. ‘As with any medical procedure, there are risks under Measure 16.'” (Goodwin is a member of Physicians for Death with Dignity.) [Mark O’Keefe, “Doctors debate assisted suicide,” The Sunday Oregonian, 4/27/97, p. D1.]
DOCTORS MAKE MISTAKES · “A total of 1375 [Oregon] physicians (50 percent) were not confident that they could predict that a patient had less than six months to live. Moreover, 761 (28 percent) indicated that they were not confident they could recognize depression in a patient who requested a prescription for a lethal dose of medication.” [Melinda A. Lee, M.D., et al., “Legalizing Assisted Suicide — Views of Physicians in Oregon,” New England Journal of Medicine, 2/1/96, pp. 310-315.] · “Only 6% of [Oregon] psychiatrists were very confident that in a single evaluation they could adequately assess whether a psychiatric disorder was impairing the judgment of a patient requesting assisted suicide.” [Linda Ganzini, M.D., et al., “Attitudes of Oregon Psychiatrists Toward Physician-Assisted Suicide,” American Journal of Psychiatry, Nov. 1996, pp, 1469-1475.] · “The fact that deaths were not nearly as predictable as most would think should radically change our comfortable assumptions that we know who is terminally ill, and that we could provide different care, and advise them with high confidence.” [Joanne Lynn, M.D. (referring to a study on the accuracy of doctors’ prognoses), “Doctors Poor at Predicting Time to Death,” Reuter, 3/18/97.] · “Using statistical estimates of prognosis to designate a category of ‘terminally ill’ patients for public policy purposes [like assisted suicide] is unavoidably arbitrary, will often be contested, and will have differential effects upon those dying with differing diseases.” [Joanne Lynn, M.D., et al., ‘Prognoses of Seriously Ill Hospitalized Patients on the Days before Death: Implications for Patient Care and Public Policy,” New Horizons, 2/97, pp. 56-61.] · “In a review of 1000 autopsies performed between 1983 and 1988, Sarode et al. found ‘major discrepancies’ between the autopsy findings and the clinical diagnosis in 317 (32%) of the 1000 autopsies.” [James E. Dalen, M.D., MPH, Editorial: “The Moribund Autopsy,” Archives of Internal Medicine, Aug. 11/29, 1997, p. 1633.]
DEPRESSION: NOT DETECTED, SERIOUSLY UNDERTREATED · “Most Americans suffering from depression go undiagnosed and untreated, and a Government-backed panel of experts is urging doctors to be more aggressive in attacking the problem. The 12-member panel… said only one-third of patients who visit a primary care doctor with symptoms of depressive disorders are appropriately diagnosed and treated.” [Warren E. Leary, “Doctors Are Urged to Look for Signs of Depression,” New York Times, 4/12/93, p. B8.] · “There is overwhelming evidence that individuals with depression are being seriously undertreated.” [Robert Hirschfeld et al., “The National Depressive and Manic-Depressive Association Consensus Statement on the Undertreatment of Depression,” Abstract, JAMA, 1/ 22-29/97.] · “Psychiatrists’ confidence in their ability to determine whether a psy- chiatric disorder such as depression was impairing the judgment of a patient requesting assisted suicide was low.” [Linda Ganzini, M.D., et al., “Attitudes of Oregon Psychiatrists Toward Physician-Assisted Suicide,” American Journal of Psychiatry, Nov. 1996, pp. 1469-1475.] · “More than 60 percent of patients with advanced cancer have psychiatric problems, with adjustment disorders, depression, anxiety, and delirium reported most frequently.” “The diagnosis of depression is difficult to make in medically ill patients.” [Kathleen M. Foley, M.D., “Competent Care for the Dying Instead of Physician-Assisted Suicide,” New England Journal of Medicine 336:55-58, 1997.] · “There is some concern that with legislation of euthanasia or physician-assisted suicide non-psychiatric physicians, who generally have a poor ability to detect and treat depression may allow life-ending interventions when treatment of depression may be more appropriate.” [Ezekiel J. Emanuel, M.D., et al., “Euthanasia and physician-assisted suicide: attitudes and experiences of oncology patients, oncologists, and the public,” The Lancet 347:1805-1810, 1996.]
SUICIDE NOT NECESSARY · “Patients who request euthanasia are usually asking in the strongest way they know for mental and physical relief from suffering…. Advances in our knowledge of palliative care in the past twenty years make clear that humane care for the terminally ill does not require us to legalize assisted suicide and euthanasia.” [Herbert Hendin, M.D., Testimony before U.S. House of Representatives, Subcommittee on the Constitution, “Suicide, Assisted Suicide and Euthanasia: Lessons from the Dutch Experience,” 4/29/96.] · “When people sit back and say this [assisted suicide] should be legalized, what they’re imagining is a patient in unremitting pain. But in fact, when people get to that point, that’s not what they’re interested in. What they want is pain relief. They don’t want to die.” [Ezekiel J. Emanuel, M.D., (referring to his 1996 Lancet study) quoted in: Don Colburn, “Survey Reveals Differences on Doctor-Assisted Suicide,” Washington Post, 7/21/96, p. Z8.]
MEASURE 16: ULTIMATE COST CONTAINMENT · “Any cost-conscious managed health care plan faces a potential conflict of interest when it comes to hastening the death of patients who require expensive treatment to stay alive.” [Tom Bates and Dee Lane, “Oregon faces experiments as nation’s suicide lab,” The Oregonian, 11/27/94, p. A1.] · “Physician-assisted suicide is far less expensive than palliative and supportive care at the end of life. As medical care shifts to a system of capitation, financial incentives to limit treatment may influence the way that the option of physician-assisted suicide is presented to patients, as well as the range of alternatives patients are able to obtain.” [N.Y. State Task Force on Life and the Law, Supplement to When Death Is Sought — Assisted Suicide and Euthanasia in the Medical Context, April 1997, p. 5.] · “Jan Van Dyke, manager of corporate communications with Blue Cross and Blue Shield of Oregon, said assisted suicide ‘…would be no different than any other covered prescription.’ Blue Cross and Blue Shield covers more than a million people in Oregon and southwest Washington, including participants in HMO Oregon plans.” [Dan Postrel, “State Could Cover Assisted Suicide,” Statesman Journal, 12/6/94, p. 1A.]
DUTY TO DIE AND VULNERABLE PATIENTS · “The legalization of assisted suicide would itself send a message that suicide is a socially acceptable response to terminal or incurable disease. Some patients are likely to feel pressured to take this option, particularly those who feel obligated to relieve their loved ones of the burden of care. Those patients who do not want to commit suicide may feel obligated to justify their decision to continue living.” [N.Y. State Task Force on Life and the Law, Supplement to When Death Is Sought — Assisted Suicide and Euthanasia in the Medical Context, April 1997, p. 5.] · “The State’s interest here goes beyond protecting the vulnerable from coercion; it extends to protecting disabled and terminally ill people from prejudice, negative and inaccurate stereotypes, and ‘societal indifference.’ The State’s assisted suicide BAN reflects and reinforces its policy that the lives of terminally ill, disabled, and elderly people must be no less valued than the lives of the young and healthy, and that a seriously disabled person’s suicidal impulses should be interpreted and treated the same way as anyone else’s.” (Emphasis added.) [U.S. Supreme Court in Washington v. Glucksberg, No. 96-110, 1997 WL 34094 (U.S. June 26, 1997).] · “Predicting the outcome of social legislation with certainty may not be possible. It may be that the safeguards in the Act [Measure 16] do not exclude the possibility that a request for aid in dying could result from pressure on the patient from venal or cruel relatives. Nor can misdeeds by unethical physicians be excluded with certainty.” [Peter Goodwin, M.D. (chairman of Oregon Right to Die during the 1994 Measure 16 campaign), “Oregon’s Physician-Assisted Suicide Law: An Alternative Positive Viewpoint,” Archives of Internal Medicine, August 11/29, 1997, pp. 1642-1644.]
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MICHIGAN CREATES ITS VERY OWN NIGHTMARE
Jack Kevorkian and his co-conspirator lawyer are virtually untouchable these days in Michigan. Since the last Update, there have been ten more known Kevorkian-assisted deaths — yet authorities continue their hands-off stance, sending the message that any further prosecution of Michigan’s most infamous purveyor of death is unlikely.
The ten new victims are:
(See below for more information on Kevorkian’s victims)
Janet Good: A Kevorkian statistic
All but one of the latest victims were abandoned in motel rooms with notes saying to call Kevorkian attorney Geoffrey Fieger for details. The one exception was Janet Good, founder of the Michigan chapter of the Hemlock Society and Kevorkian’s long-time associate who counseled prospective “clients” and actively participated in a number of Kevorkian-induced deaths. At her funeral, Fieger told those gathered, “She was as close as any woman has ever been to Dr. Kevorkian. She was his right hand, his left hand and his conscience.” Good died in her home in the presence of two of her adult children, her husband, and Kevorkian. It was not the first time that her home had been the site of a Kevorkian-assisted death. [Detroit Free Press, 8/27/97]
Good and her daughter, Marjorie Good-Helming, had planned her death over a year ago. She choose 8/26/97 to die because it was Women’s Equality Day; Good had been very active in the women’s rights movement. Good-Helming told reporters, “I hated to see her suffer.” According to her daughter, Good “was on dope from morning to night. She could make it from the bedroom to the couch. But hospice had said she had two days to two weeks left. It was getting to the point where she was going to have to depend on someone to take her to the bathroom. She had always said that that would be a real loss of dignity. She said she would never allow that.” [Detroit Free Press, 8/28/97]
But Good-Helming’s description of her mother’s condition was not totally in line with autopsy findings. According to Oakland County Deputy Medical Examiner Kanu Virani, M.D., who performed the autopsy against the family’s wishes, Good’s cancer was not detectable with the naked eye. “Sometimes you can see cancer obviously, and sometimes not,” he said. “This time I cannot see, so I want to look at samples under a microscope.” Virani’s subsequent findings were later confirmed by Chief Medical Examiner L.J. Dragovic, M.D., who told reporters that the autopsy found only “some evidence of microscopic residual cancer” and that Good was not battling terminal cancer at the time of her death. “There was no cancer buildup in organs,” he explained, “that would have compromised vital function.” Dragovic added that the surgery which Good had a couple of years ago for pancreatic cancer had been “a major success.” [AP, 8/28/97; Detroit Free Press, 9/5/97; Detroit News, 9/6/97]
Prosecutor considers pact with Kevorkian
For a time, Macomb County Prosecutor Carl Marlinga thought it feasible to make a pact with Kevorkian and his lawyers. In fact, he even met with the death doctor and lawyer Michael Schwartz for 45 minutes on 10/6/94 to start work on an agreement that would permit Kevorkian and/or family and friends to leave off future dead bodies at funeral homes or at the local medical examiner’s office without any threat of prosecution. After the meeting, Marlinga told reporters that he was optimistic that an arrangement could be worked out within two-weeks time. “I don’t think anyone will criticize me for lessening the impact on the families,” Marlinga explained. “Family members just lost a loved one. You can argue all day and all night if they should have lost someone, but the fact is there is a death.” Schwartz told the press that Kevorkian may be meeting with elected officials in other counties as well. “He [Kevorkian] wants to reach out to public officials to get input and their views, and to have a dialogue with them,” Schwartz said. [Detroit News, 10/7/97].
It took a few days, but Marlinga ended up reassessing the pending pact. In a letter he wrote to Kevorkian, Marlinga explained that he could not offer immunity in advance to anyone planning an assisted suicide, a common law felony in Michigan. “I am sure you can appreciate the very real possibility that somewhere, sometime in the future, a person is going to commit a homicide and attempt to disguise it as a suicide” Marlinga wrote. “It is possible that a friend or relative accompanying the body may have had motive to persuade a weakened person to accept the option of suicide for (their) own illegal purposes.” [Detroit News, 10/10/97]
Just four days after Marlinga wrote the letter to Kevorkian, the body of 34-year-old Annette Blackman was found abandoned in a motel room in Marlinga’s jurisdiction. The strange thing about Blackman’s death was that she was a Michigan resident. In recent years, Kevorkian has made a habit of quietly offing state residents usually in their homes — no dumping bodies, no media coverage, no notes saying to call Fieger. According to a recent announcement by Fieger, there have been so many secret killings of Michigan residents that Kevorkian’s actual body count was “nearly 100.” [AP, 9/3/97]
Even Marlinga was surprised by the Blackman death, the second in Macomb County in three weeks. “He [Kevorkian] told me there would be no more assisted suicides in Macomb County,” Marlinga said. “I question why he would make that representation and not follow through. I hate to think he would perform an assisted suicide in retaliation for a legal opinion.” [Detroit News, 10/14/97]
Kevorkian’s own prosecution-free killing zone
As things stand now, Kevorkian and, to some degree, lawyer Geoffrey Fieger are above the law. According to Larry Dubin, law professor at the Univ. of Detroit Mercy, “It does appear as if Jack Kevorkian has been granted the implicit authority to be able to assist in suicides in southeastern Michigan under the state of the law.” But Fieger sums up the situation more succinctly: “They’re afraid. They’re never going to prosecute.” [AP, 10/17/97]
Confident that he and his client are above the assisted suicide law, Fieger has been openly hinting at his complicity with Kevorkian-induced deaths. For example, the note left with Carol Fox’s body communicated more than the usual “Call Geoffrey Fieger.” This note said, “To Gestapo Headquarters, Bloomfield Township: Tell Fatso Armstrong to call Geoffrey Fieger.” (The note was referring to Detective Randy Armstrong, who raided a motel room and confiscated evidence over a year ago that was used to charge Kevorkian in Ionia County.) Shortly after Fox’s body was found, Fieger told the media, “Tell Fatso Randy to keep his religious fanatic nose out of other people’s business.” “If they don’t like us using the Quality Inn, they should let Jack open up a clinic,” he added. [Oakland Press, 9/10/97:A4]
Commentary: Twisted values of assisted suicide
by Wesley Smith
Some ironies in life are so bizarre and tragic that they almost defy credulity. Such is the sad case of Janet Good, the acolyte of Jack Kevorkian, who spent the last few years of her life helping Kevorkian decide which disabled, depressed and/or terminally ill persons he should help take out of this life.
Good was a true believer of the assisted suicide cause. In 1989, she founded the Michigan Chapter of the Hemlock Society. In 1990, she supported Kevorkian when he broke onto the national stage by assisting the suicide of Janet Adkins, who had been diagnosed with early Alzheimer’s disease. In 1994, she became Kevorkian’s personal assistant in deciding which persons to help kill. On August 26 this year, she became a Kevorkian statistic.
Good believed that assisted suicide promotes individual empowerment. But through the manner and circumstances of her death, she demonstrated that it is really the ultimate victimization.
Good was supposed to be at death’s door from pancreatic cancer. But an initial autopsy finding showed Good’s cancer wasn’t even in the terminal stage. The coroner declared while there was evidence of microscopic signs of residual cancer, there was “no cancer buildup in organs that would have compromised vital functions.” In other words, Good may have had years to live. Yet, thanks to Kevorkian and her own zeal she is gone before her time.
Under Kevorkian, such tragedies abound. Take the death of Karen Shoffstall, 34, who had multiple sclerosis and died with “Kevorkian in attendance” on August 13. Like most of his victims, Shoffstall wasn’t terminally ill. She was moderately disabled, but that wasn’t what caused her suicidal despair. Rather, she was terrified about future debilitation. Never mind that the disease is unpredictable, that spontaneous remissions can happen, or that once people who are disabled later in life get through the difficult adjustment period, they frequently go on to lead full lives. In Kevorkian, she found someone willing to reinforce her worst fears.
Then there’s the September 6 death of Deborah Sickels, 43, who Kevorkian’s lawyer says was a Kevorkian-assisted suicide because she had MS. But her brother, Robert Allen, claims she was not mentally competent and was deeply emotionally disturbed by family problems. He said correctly that Kevorkian should have referred Sickels to a psychiatrist rather than help kill her.
Not long ago, Kevorkian’s participation in these deaths would have
been perceived rightly as a pernicious abandonment of three despairing women. It would have brought demands that the perpetrator be brought to justice.
No more. That these deaths have barely raised the public’s collective eyebrow illustrates how deeply our values are being eroded by assisted suicide advocacy. Many no longer believe in aggressive suicide prevention when the despairing person is seriously ill or disabled. Rather, many of us assume that we too would not want to live in such circumstances. The Good, Shoffstall and Sickels tragedies are the result.
A recent story illustrates how bizarre all of this is becoming. Charles Woodworth, 54, allegedly became so enraged by his dog’s disobedience that he shot and wounded the animal. After looking into the case, Oakland County, Michigan, Prosecutor David Gorcyca decided not to indict. That caused such a howl that Gorcyca reversed himself and will prosecute the shooting as a felony. Woodworth now faces two years in jail. This is the same place where Kevorkian lives and is so popular that Gorcyca won office by vowing not to enforce Michigan’s law banning assisted suicide.
That the people of Oakland County and its prosecutor appear to care more about the attempted killing of a dog than they do about the actual assisted killing of over 50 people by Kevorkian, should tell us all we need to know about the twisted thinking inherent in the assisted-suicide movement.
Wesley J. Smith is an attorney for the IAETF and the author of Forced Exit — The Slippery Slope from Assisted Suicide to Legalized Murder, published by Times Books/Random House (1997). His commentary originally appeared in USA Today, 9/15/97, and is reprinted here with the author’s permission.
HMOs MAY BE SKIMPING ON STROKE TREATMENT
According to a study published in the Journal of the American Medical Association (JAMA), stroke patients in Medicare health maintenance organizations (HMOs) are “more likely to be discharged to nursing homes and less likely to go to rehabilitation facilities following the acute event.” The study included 19 HMOs from 12 states, with the fee-for-service (FFS) sample coming from the same geographical areas. The study sample was composed of 402 HMO patients from 71 hospitals and 408 FFS patients from 60 hospitals. [Retchin et al., “Outcomes of Stroke Patients in Medicare Fee for Service and Managed Care,” Abstract, JAMA, 7/9/97]
Researchers found that 42% of HMO stroke patients went to nursing homes after hospital discharge, compared with 28% of the FFS stroke patients. Only 16% of the HMO patients were released to rehabilitation facilities or units, compared with 23% of FFS patients. According to lead researcher, Dr. Shelding M. Retchin, “It is not known… whether the higher use of nursing homes and the lower rate of rehabilitation facility use among HMO stroke patients in this study represent a judicious use of expensive resources or a withholding of necessary care.”
But in an accompanying editorial, Drs. James Webster and Joseph Feinglass of Northwestern University wrote that the study’s findings are “disturbing.” “[They] imply that some HMO patients may be denied optimal care as a result of their payer status.” Given the fact that rehabilitation after a stroke can provide long-term benefits for patients, allowing some to possibly live on their own again, Drs. Webster and Feinglass explained that this study’s results are “even more worrisome.” [Reuter Medical News, 7/9/97; AP, 7/8/97]
THE ULTIMATE SPIN ON MANAGED CARE
A recent study published in JAMA found that, while critically-ill Medicare patients enrolled in HMOs were more likely to die within 100 days of discharge, they were less likely to receive aggressive, prolonged, or costly care than those with traditional Medicare coverage. According to the study abstract, “The worst outcome of critical care may not be death itself, rather, the worst may be an extended death process in which a patient’s and his or her family’s suffering has been prolonged by services that are ultimately impotent.” The researchers concluded, “Patients who experience PIC [potentially ineffective care] outcomes are not uncommon…and…consume a disproportionate amount of medical resources. This suggests that HMO practices may be better at limiting or avoiding injudicious use of critical care near the end of life.” [D.J. Cher, M.D., and L.A. Lenert, M.D., “Method of Medicare Reimbursement and the Rate of Potentially Ineffective Care of Critically Ill Patients,” Abstract, JAMA, 9/24/97]
“If you don’t want to die with a lot of tubes in you, then HMO care may be the place to be,” said researcher Dr. L. Lenert. That positive spin – glossing over the fact there were more deaths in the HMO group — was quickly adopted by the media. One Associated Press article began by stating, “HMOs may be making death more merciful for elderly patients, researchers say.” Another one stated that elderly patients in HMOs “are less likely to suffer a drawn-out, painful death.” [AP, 9/24/97, 9/25/97]
But not every one put a rosy spin on the study. Jamie Court, director of Consumers for Quality Care, said that HMO incentives are grossly skewed in support of withholding care. “HMOs are wonderful for people who want to embrace euthanasia,” Court explained. “For those who want the option of whether or not to receive costly, life-prolonging care, HMOs are not the place to go. The real issue is whether elderly patients will have the choice,” he said. [San Francisco Chronicle, 9/24/97]