Update 046: Volume 22, Number 4 (2008)

Washington State: Seduced by Oregon’s big lie

On November 4, 2008, Washington State voters passed Initiative 1000 (the Washington Death with Dignity Act) legalizing Oregon-style physician-assisted suicide by a margin of 58 to 42 percent. It took over ten years — after right-to-die proponents failed to get 90 assisted-suicide bills passed in 23 states and were defeated in costly initiative drives in Maine and Michigan — for another state to embrace assisted suicide after Oregon enacted its Death with Dignity Act in 1997.

Whether or not they realize it, Washington voters have opted to place their state squarely on the crest of an extremely slippery, ice-covered slope. But, they won’t be seeing any noticeable plunges down that slope in the near future — that is if the assisted-suicide advocacy group Compassion & Choices (C&C) has its way. As the facilitator of the majority of assisted-suicide deaths in Oregon and as the group controlling what information, if any, is made available to the public, C&C’s plan is to get as many states as possible to approve assisted-suicide for only terminally-ill adults before there are any overt moves to expand the practice to the chronically-ill, the mentally-ill, those with a diminished quality of life, and those simply tired of living. Widening the categories of patients eligible for an induced death would make it very difficult for C&C and other groups to sell assisted suicide in states targeted for their “win” column.

But shortly after Washington’s I-1000 passed, another national assisted-suicide organization, Final Exit Network (a C&C splinter group), jumped on the bandwagon and issued a press release calling for the right-to-die movement’s real goal: death on demand for all, terminally ill or not. According to the group’s president, Ted Goodwin,

Final Exit Network and its members supported passage of this landmark [Washington] initiative by donating to the advocacy effort…. However, the job is not finished….

Unfortunately, many patients do not meet I-1000’s strict criteria. Individuals with neurological illnesses such as Parkinson’s disease, Multiple Sclerosis, Muscular Dystrophy, Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease) and Alzheimer’s disease often lose the reason and will to live long before their disease qualifies as “terminal.” For these individuals, neither I-1000 nor the Oregon law go far enough. That is why Final Exit Network pledges, until laws protect the right of every adult to a peaceful, dignified death, Final Exit Network will be there to support those who need relief from their suffering today! [Final Exit Network Press Release, 11/5/08. Emphasis added.]

The big lie

One might ask, if Final Exit Network (FEN) had released its death-on-demand comments before the Washington election, would it have changed the outcome of the I-1000 vote? Probably not, because C&C and the Death with Dignity National Center, the two groups which orchestrated the “Yes on I-1000” campaign, carefully honed their strategy and talking points to undermine, among other things, any attempt to get voters to see the reality of legalized assisted suicide. There was a reason that these two groups chose Washington as the state most likely to pass an assisted-suicide law. Voters there were seen as easy marks since they closely mirrored Oregon voters in being independent minded, valuing total control, and being largely un-churched.

The majority of voters bought the “Yes” campaign’s mantra that 10 years of legalized assisted suicide in Oregon proves that the practice is transparent, safe, abuse free, and even beneficial to overall health care — despite proof to the contrary.

They ignored Oregon’s largest newspaper, the Oregonian, when its editorial board exhorted Washington voters to reject I-1000 because, “Oregon’s physician-assisted suicide program has not been sufficiently transparent.” “Essentially,” the board wrote, “a coterie of insiders run the program, with a handful of doctors and others deciding what the public may know.” [Oregonian, 9/20/08]

They ignored a recent Oregon Health & Science University study that found that one in four Oregonians who request assisted suicide may, in fact, be clinically depressed. The authors of the study, published in the British Medical Journal, concluded, “[T]he current practice of the Death with Dignity Act may fail to protect some patients whose choices are influenced by depression from receiving a prescription for a lethal drug.” [Ganzini et al., “Prevalence of depression and anxiety in patients requesting physicians’ aid in dying: cross sectional survey,” British Medical Journal, 10/8/08]

When the Washington media reported on the study, the “Yes on I-1000” camp immediately spun the findings to their advantage:

The report proves that most patients who request death with dignity are not depressed, and the safeguards work so that those who are must be referred for counseling. Every single one of the many safeguards in the Death with Dignity Act is working. [Yes on I-1000 Report, 10/7/08. Emphasis added.]

Apparently, voters believed that spin job even though most of it was untrue. Neither the Oregon law nor Washington’s I-1000 requires that depressed patients be referred for counseling. In fact, of the 49 assisted-suicide patients who died in Oregon last year, NOT ONE was referred for a psychological evaluation or counseling.

Given the study’s finding that one in four assisted-suicide patients is likely to be clinically depressed, not having even one out of 49 such patients with symptoms of depression is highly questionable. According to psychiatrist Linda Ganzini, lead author of the study, “What it means is that primary care physicians probably need to use more rigorous or well-validated instruments rather than just their gut impression about whether the patient is depressed.” [Oregon Public Radio, 10/7/08]

The campaigns

As previously reported in the Update, assisted-suicide advocacy groups Compassion & Choices and the Death with Dignity National Center spent most of last year preparing for the I-1000 campaign. They raised almost $250,000 as seed money in anticipation of launching their initiative in January 2008; they conducted extensive research, testing the best arguments to use to convince Washingtonians that they needed to legalize assisted suicide; and they did all this before the ink was dry on the final version of the initiative.

The opposition, on the other hand, was slow off the mark, perhaps because they hoped that the initiative wouldn’t get the needed signatures to qualify it for the November ballot. When it did qualify in July, the “No on I-1000” group had to ramp up its efforts quickly.

But the “No” campaign couldn’t compete with the large sums of money that initiative proponents were able to generate from assisted-suicide advocates and groups across the U.S. as well as from Australia and Britain. As of November 1, the “Yes on I-1000” committee reported receipts in the amount of $4,856,732. Over the same period, the “No on I-1000” committee received only $1,510,442. (For more on campaign contributions, see: funding)

Despite the lack of funds, the “No” campaign was able to produce two very effective TV ads. The first one featured actor Martin Sheen warning voters about the dangers legalized assisted suicide poses for poor and vulnerable patients. The second ad featured Barbara Wagner, an Oregon cancer patient whose health insurer, the Oregon Health Plan, had denied her payment for a cancer treatment drug prescribed by her doctor, but offered instead to pay for her assisted suicide. Unfortunately, the ads were aired during the latter part of the campaign and, in some cases, after many voters had mailed in their ballots.

Implementing a bad law

Washington’s new assisted-suicide law is scheduled to take effect on March 4, 2009. “We’re going to be gathering information over the next few weeks and expect to start the rulemaking process by the end of the month [November],” explained a spokesperson from the Washington Department of Health, the agency charged with compiling annual statistical reports on assisted-suicide deaths. [The Olympian, 11/7/08] Compassion & Choices of Washington plans to take an aggressive, combative role in that “rulemaking” process. According to the group’s web site,

Now the next battle begins. As the established leaders in end-of-life care in Washington State, Compassion & Choices of Washington (C&C) will be the protector and guardian of Initiative 1000. Our opponents will spare no expense in attacking I-1000, just as they did in Oregon. We need to prepare for a long and potentially costly fight to ensure that the law implemented is the same law that voters endorsed on November 4…. [C & C web site]

Indeed, there may be battles on the horizon. Even the Tacoma News Tribune, one of the many Washington papers that endorsed I-1000, is calling for changes in the new law:

The News Tribune editorial board endorsed I-1000, but we believe it needs stronger public disclosure and mental evaluation requirements. The Legislature should closely monitor implementation of I-1000 and make any needed changes. [News Tribune, 11/7/08]

The “No on I-1000” camp is also considering “every option on the table,” including a legal challenge. [AP, 11/7/08]

Oregon’s suicidal approach to health care

Rita L. Marker

Oregon seems to have found a surefire way to lower health care costs: Tell the patient you’ll pay for drugs that will end her life, but not those that would extend her life. Here’s how it works:

In May 2008, 64-year-old retired school bus driver Barbara Wagner received bad news from her doctor. She found out that her cancer, which had been in remission for two years, had returned. Then, she got some good news. Her doctor gave her a prescription that would likely slow the cancer’s growth and extend her life. She was relieved by the news and also by the fact that she had health care coverage through the Oregon Health Plan.

It didn’t take long for her hopes to be dashed.

Barbara Wagner was notified by letter that the Oregon Health Plan wouldn’t cover her prescription. But the letter didn’t leave it at that. It also notified her that, although it wouldn’t cover her prescription, it would cover her assisted suicide.

After Wagner’s story appeared in the Eugene Register-Guard, the Oregon Health Plan acknowledged that it routinely sends similar letters to patients who have little chance of surviving more than five years, informing them that the health plan will pay for assisted suicide (euphemistically categorized as “comfort care”), but not for treatment that could help them live for months or years.

Certainly, spending $100 for deadly drugs is cost effective because patients die sooner, avoiding any costly care. And, ever since the Oregon Death with Dignity Act transformed the crime of assisted suicide into a “medical treatment” more than ten years ago, it has been perfectly legal. So Oregon doctors prescribe the lethal drug overdoses and pharmacists dispense them, sometimes with instructions to “take all of this with a light snack and alcohol to cause death.”

The road to Seattle

Now, an Oregon-style, assisted-suicide law has passed in Washington State. After engineering passage of Oregon’s Death with Dignity Act, assisted-suicide advocacy groups thought other states would rapidly adopt similar laws. But they were wrong. Because their attempts to pass Oregon-style laws in more than twenty states failed, the Portland-based Death with Dignity National Center (DDNC), along with Compassion & Choices (the former Hemlock Society), devised a plan in 2005 called “Oregon plus One” to break the logjam. It was based on the premise that, if just one more state followed Oregon’s lead, then other states would fall in line.

The plan was put into effect in early 2006. In its 2007 annual report, the DDNC noted that it had spent a year “researching and collecting data to determine that state which is most likely to adopt a Death with Dignity law…Through these efforts we have identified Washington as the state.” (Note that the assisted-suicide group chose Washington. Washingtonians were not in on the selection.

After choosing Washington as the target state, the DDNC reported, “[W]e have never had such great odds of success as we have in Washington in 2008. That is why we will be directing $1.5 million over the next year and a half to the efforts….Our organization is providing leadership, political strategy, and financial resources to this monumental effort.”

The political campaign was formally announced in late 2007 and, in mid-July 2008, Initiative 1000 (called the “Washington Death with Dignity Act,” a measure virtually identical to Oregon’s law) qualified for the 2008 general election ballot. Its advocates contended that Oregon’s ten-year experience demonstrates that a Death with Dignity law not only works well, but is actually a benefit to patients. As proof they point to Oregon’s annual official reports, to the law’s “safeguards,” and to studies in professional journals.

However, their claims were at best misleading. For example, under Oregon’s law doctors participating in assisted suicide must file reports with the state. So the only physicians providing data for official annual reports are those who actually prescribe lethal drugs for patients. First, they help the person commit suicide and, afterwards, they report whether their actions complied with the law. Then, that information is used to formulate the state’s official annual reports. However, according to American Medical News, Oregon officials in charge of issuing the reports have conceded that “there’s no way to know if additional deaths went unreported.” (The official number of reported assisted-suicide deaths in Oregon is 341.)

Indeed, the official summary accompanying one annual report noted that there is no way to know if information provided by the physicians is accurate or complete. But, it stated, “[W]e, however, assume that doctors were being their usual careful and accurate selves.” The reporting agency also acknowledged that it has no authority or funding to investigate the accuracy of those self-reports.

It would be nifty if the Internal Revenue Service allowed such unverified and unverifiable self-reporting.

The Oregon law’s safeguards are equally problematic. They contain enough loopholes to drive a hearse through them. The safeguards certainly do have the appearance of being protective. They deal with requests for assisted suicide, family notification, and counseling or psychological evaluation. However, those safeguards are about as protective as the emperor’s new clothes:

• The oral requests, which must be separated by fifteen days, do not need to be witnessed. In fact, they don’t even have to be made in person. They could be made by phone – even left on the physician’s answering device. The written request must be witnessed, but it could be mailed or faxed to the doctor.

• The law states that the physician is to “recommend that the patient notify next of kin,” but family notification is not required. It is entirely possible that the first time family members find out that a loved one was contemplating suicide could be after the death has occurred.

• Doctors can facilitate the suicides of mentally-ill or depressed patients without any prior counseling being provided. A psychiatric evaluation is required only if the physician believes that the mental illness or depression is causing impaired judgment. According to Oregon’s latest official report, not one patient who died after taking the lethal drugs was referred for counseling prior to being given the prescription.

Additionally troubling are omissions in both the Oregon and Washington laws. For instance, doctor shopping is not prohibited. If one physician refuses to prescribe assisted suicide because, for example, the patient is not competent to make an informed death request, that patient or a family member can go from doctor to doctor until finding one who will write the prescription.

Moreover, neither law has any type of protection for the patient once the prescription is written. While the requests for assisted suicide are to be made knowingly and voluntarily, there is no provision that the patient must knowingly and voluntarily take the lethal drugs. Dr. Katrina Hedberg, the lead author of most of Oregon’s official reports, acknowledged that there is no assessment of patients after the prescribing is completed. She said that the “law itself only provides for writing the prescription, not what happens afterwards.”

Forcing physicians to lie

The new Washington law, in a major departure from Oregon’s law, adds a layer of unprecedented deception by forcing doctors to lie about the cause of death. It requires that, when a patient dies after taking the prescription for assisted suicide, the physician “shall list the underlying terminal disease as the cause of death.” Washington State Medical Association president, Brian Wicks, M.D., described the requirement in a WSMA press release opposing the initiative:

[I]f a physician prescribes a lethal overdose, when that physician completes the death certificate, he or she is required — actually required — to list the underlying disease (say lung cancer) as the cause of death, even when the doctor knows full well that the patient died due to the suicidal overdose he or she prescribed. To my knowledge there’s no other situation in medicine in which the death certificate is deliberately falsified — and in which this falsification is mandated by law.

Questionable data

Concerns about assisted suicide often are thrust aside by citing studies to bolster the benign nature of legalized assisted suicide. Such studies are often far from un-biased as indicated by one that was released in late 2007, just as the Washington campaign formally got underway. Published in the Journal of Medical Ethics, and widely reported in news articles across the country, it concluded that assisted suicide in Oregon is abuse free, even for vulnerable people. (The basis for that conclusion was an examination of Oregon’s official annual reports.) Its principle author was Margaret Pabst Battin. Battin, a University of Utah philosophy professor, is a longtime supporter of assisted suicide and a member of DDNC’s advisory board — information not disclosed in either the journal article or the initial flurry of national media coverage.

Thus, the “proof” for the benign nature of legal assisted suicide — found in official annual reports, safeguards and studies — is preposterous. Assisted-suicide advocates take great umbrage when this is pointed out, as they do at any suggestion of assisted suicide being used for cost containment. Do assisted-suicide advocates intend this as a cost-containment measure? Does it matter? Did their intentions mean anything to Barbara Wagner? Or does it really come down to recognizing that, even if its advocates don’t intend to follow such a path, the force of economic gravity inevitably leads in this direction?

When all is said and done, it is not the intent of assisted-suicide supporters that matters. Instead, it is the law’s deadly content and the inevitable price that we will all pay for health care cost containment — Oregon style.


Rita L. Marker is an attorney and the executive director of The International Task Force on Euthanasia and Assisted Suicide. An earlier version of her article appeared in the September 14, 2008, on-line edition of American Thinker.

Assisted suicide: The wind in their sails

Wesley J. Smith

Between November 1994 and November 2008, the assisted-suicide movement in this country was moribund. After Oregon passed Measure 16 (the Death with Dignity Act) in 1994 and saw it go into effect in 1997-despite widespread expectations, myriad state legislative efforts, and two voter referenda (Michigan and Maine) — no other state swallowed the hemlock.

Frustrated advocates adopted an “Oregon-plus-one” strategy, believing that if only a second state legalized assisted suicide, it would put the winds back into their sails. That theory is about to be tested. Boosted by a multi-million dollar campaign budget that swamped the opposition — most coming from out of state, some even from out of the country — fronted by a popular former governor who also poured hundreds of thousands of dollars of his own money into the cause, and cheered on by a media all but unanimously in favor of “death with dignity,” Washington State became the “plus one” on November 4, 2008 when Initiative 1000 cruised to a 58-42 percent victory.

And with that success, the sails of the ghost ship Euthanasia rippled with the briskly rising breeze, and once again began to plow through the waves toward other shores, far and near. Soon, legislation will be introduced to legalize assisted suicide in states throughout the country — California, Vermont, Arizona, Wisconsin, Hawaii, perhaps Ohio, and others — to make it Oregon-plus-two, -three, -four, and -five.

The victory will also be used to further the euthanasia cause internationally. Every time a legal sovereignty says yes to mercy killing, it grants permission for others to do the same. Thus, expect I-1000’s passage to boost the cause in countries such as Australia, France, the United Kingdom, and New Zealand — to name just a few — all of which have been edging ever closer in recent years to joining the Netherlands and Belgium in permitting euthanasia, and Switzerland, which allows assisted suicide by lay facilitators.

Beyond the politics of the thing, the passage of I-1000 begs a far more fundamental question: Why now, when for the first time in human history the pain and discomforting symptoms of serious illness can be substantially alleviated, do so many find mercy killing and suicide so appealing? Think of it as a symptom rather than a cause. The euthanasia movement reflects a profound nihilism that has been spreading like a cancer throughout the West for the past hundred years.

The extent of our societal illness was described succinctly several years ago by the Canadian journalist Andrew Coyne. Writing in the wake of widespread public support for Robert Latimer, a Saskatchewan farmer who murdered his twelve-year-old daughter Tracy because she was disabled by cerebral palsy, Coyne wrote: “A society that believes in nothing can offer no argument even against death. A culture that has lost its faith in life cannot comprehend why it should be endured.”

Ponder three recent stories out of the United Kingdom, which seem to validate Coyne’s premise. The first story involved a mentally ill woman named Kerrie Wooltorton, who had repeatedly attempted to kill herself by swallowing antifreeze. On her last attempt, she called an ambulance — but when she was wheeled in to the ER, Wooltorton was clutching a “living will” in which she declined to be saved. That note morally paralyzed the medical team. Queries were made, consultations held — and the decision made to let her die. The physician who could have saved her life later told an inquest: “It’s a horrible thing to have to do but I felt I had no alternative but to go with her wishes.”

Then, there is “suicide tourism” — think Jack Kevorkian on the international stage — in which hundreds of people have flown from their own countries to Switzerland for assisted suicides at the hands of a death facilitating organization. One of the most recent cases involves a young man named Daniel James who was taken to Switzerland by his parents for an assisted suicide after the young man was paralyzed in a rugby accident and became despondently suicidal. The grieving parents are unapologetic and the case has become a cause célèbre for legalizing assisted suicide in the UK. After all, why should such things have to be done overseas? The idea of suicide prevention seems not to come up much in the discussion.

Meanwhile, the agenda is also being furthered by a woman named Debbie Purdy. Purdy has progressive multiple sclerosis and wants her husband to be able to take her to Switzerland for assisted suicide so that she can choose to die without legal consequence. Boosted by the James case, Purdy has garnered much media support.

Thus, the Times of London columnist Libby Purves wrote:

Debbie Purdy has an incurable degenerative disease and all she wants is permission to shorten the last painful months. Knowing there is an escape route might be so comforting that you never use it. Many terminally ill people willingly live each day, particularly if they get palliative care and comfort from the hospice movement rather than suffering in a stressed, overlit general hospital. But the law on Swiss-bound helpers must be clarified. Dignitas [a Swiss assisted-suicide organization] will not be un-invented.

Of course, James wasn’t, and Purdy isn’t, terminally ill. So we see the slippery slope slip-sliding away even within Purves’ own column.

Doctors’ letting Wooltorton die, James’ parents taking him to Switzerland to die, Purdy’s lawsuit agreed upon by her husband, and suicide-supportive columns like Purves’ are unquestionably intended to be kind; but they are not. With such deaths emotively and sympathetically reported in the media, and with every lawsuit that chinks away at the laws intended to protect people with serious difficulties from suicide, mercy killing becomes more easily envisioned, more comfortably embraced.

By passing I-1000, Washington voters added dry kindling to this smoldering fire. If more of us don’t man the hoses soon, we risk being consumed by the flames.


Wesley J. Smith is an attorney for the International Task Force on Euthanasia and Assisted Suicide, a Senior Fellow in Human Rights and Bioethics at the Discovery Institute, and a special consultant to the Center for Bioethics and Culture. His article originally appeared in the November 10, 2008 edition of First Things and is reprinted here (with minor changes) with the author’s permission.