Oregon State Assisted Suicide Reports Substantiate Critics’ Concerns

One of the most frequently repeated claims by proponents of assisted suicide laws is that there is “no evidence or data” to support any claim that these laws are subject to abuse, and that there has not been “a single documented case of abuse or misuse” in the 18 reported years. These claims are demonstrably false.

Regarding documented cases, please refer to a compilation of individual cases and source materials pulled together by the Disability Rights Education and Defense Fund entitled Oregon and Washington State Abuses and Complications. For an in-depth analysis of several cases by Dr. Herbert Hendin and Dr. Kathleen Foley, please read Physician-Assisted Suicide in Oregon: A Medical Perspective.

The focus of the discussion below is the Oregon Health Division data. These reports are based on forms filed with the state by the physicians who prescribe lethal doses and the pharmacies that dispense the drugs. As the early state reports admitted:

“As best we could determine, all participating physicians complied with the provisions of the Act. . . . Under reporting and noncompliance is thus difficult to assess because of possible repercussions for noncompliant physicians reporting to the division.”

Further emphasizing the serious limits on state oversight under the assisted suicide law, Oregon authorities also issued a release in 2005 clarifying that they have No authority to investigate Death with Dignity case.

Nevertheless, contrary to popular belief and despite these extreme limitations, the Oregon state reports substantiate some of the problems and concerns raised by opponents of assisted suicide bills.

Non-Terminal Disabled Individuals Are Receiving Lethal Prescription In Oregon

The Oregon Health Division assisted suicide reports show that non-terminal people receive lethal prescriptions every year.

The prescribing physicians’ reports to the state include the time between the request for assisted suicide and death for each person. However, the online state reports do not reveal how many people outlived the 180-day prediction. Instead, the reports give that year’s median and range of the number of days between the request for a lethal prescription and death. This is on page 7 of the 2015 annual report. In 2015, at least one person lived 517 days; across all years, the longest reported duration between the request for assisted suicide and death was 1009 days. In every year except the first year, the reported upper range is significantly longer than 180 days.

The definition of “terminal” in the statute only requires that the doctor predict that the person will die within six months. There is no requirement that the doctor consider the likely impact of medical treatment in terms of survival, since people have the right to refuse treatment. Unfortunately, while terminal predictions of some conditions, such as some cancers, are fairly well established, this is far less true six months out, as the bill provides, rather than one or two months before death, and is even less true for other diseases. Add the fact that many conditions will or may become terminal if certain medications or routine treatments are discontinued – e.g. insulin, blood thinners, pacemaker, CPAP – and “terminal” becomes a very murky concept.

The state report’s footnote about “other” conditions found eligible for assisted suicide has grown over the years, to include:

“. . . benign and uncertain neoplasms, other respiratory diseases, diseases of the nervous system (including multiple sclerosis, Parkinson’s disease and Huntington’s disease), musculoskeletal and connective tissue diseases, cerebrovascular disease, other vascular diseases, diabetes mellitus, gastrointestinal diseases, and liver disease.”

Overall in 2015, 7%, or 68 individuals, had conditions classified as “other”. In addition, it should be noted that the attending physician who determines terminal status and prescribes lethal drugs is not required to be an expert in the disease condition involved, nor is there any information about physician specialties in the state reports.

The Only Certifiers of Non-Coercion And Capability Need Not Know the Person

Four people are required to certify that the person is not being coerced to sign the assisted suicide request form, and appears capable: the prescribing doctor, second-opinion doctor, and two witnesses.

In most cases, the prescribing doctor is a doctor referred by assisted suicide proponent organizations. (See, M. Golden, Why Assisted Suicide Must Not Be Legalized, section on “Doctor Shopping” and related citations). The Oregon state reports say that the median duration of the physician patient relationship is 12 weeks. Thus, lack of coercion is not usually determined by a physician with a longstanding relationship with the patient. This is significant in light of well-documented elder abuse-identification and reporting problems among professionals in a society where an estimated one in ten elders is abused, mostly by family and caregivers. (Lachs, et al., New England Journal of Medicine, Elder Abuse.)

The witnesses on the request form need not know the person either. One of them may be an heir (which would not be acceptable for witnessing a property will), but neither of them need actually know the person (the form says that if the person is not known to the witness, then the witness can confirm identity by checking the person’s ID).

So neither doctors nor witnesses need know the person well enough to certify that they are not being coerced.

No Evidence of Consent or Self-Administration At Time of Death

In about half the reported cases, the Oregon Health Division reports also state that no health care provider was present at the time of ingestion of the lethal drugs or at the time of death. Footnote six clarifies:

“A procedure revision was made mid‐year in 2010 to standardize reporting on the follow‐up questionnaire.  The new procedure accepts information about time of death and circumstances surrounding death only when the physician or another health care provider is present at the time of death.  This resulted in a larger number of unknowns beginning in 2010.”

While the only specific example mentioned is the “time of death,” other “circumstances surrounding death” include whether the lethal dose was self-administered and consensual at the time of death. Therefore, although “self administration” is touted as one of the key “safeguards”, in about half the cases, there is no evidence of consent or self-administration at the time of ingestion of the lethal drugs. If the drugs were, in some cases, administered by others without consent, no one would know. The request form constitutes a virtual blanket of legal immunity covering all participants in the process.

Pain Is Not the Issue, Unaddressed Disability Concerns Are

The top five reasons doctors give for their patients’ assisted suicide requests are not pain or fear of future pain, but psychological issues that are all-too-familiar to the disability community: “loss of autonomy” (92%), “less able to engage in activities” (90%), “loss of dignity” (79%), “losing control of bodily functions” (48%), and “burden on others” (41%).

These reasons for requesting assisted suicide pertain to disability and indicate that over 90% of the reported individuals, possibly as many as 100%, are disabled.

Three of these reasons (loss of autonomy, loss of dignity, feelings of being a burden) could be addressed by consumer-directed in-home long-term care services, but no disclosures about or provision of such services is required. Some of the reported reasons are clearly psycho-social and could be addressed by disability-competent professional and peer counselors, but this is not required either. Moreover, only 5.3% of patients who request assisted suicide were referred for a psychiatric or psychological evaluation, despite studies showing the prevalence of depression in such patients.

Basically, the law operates as though the reasons don’t matter, and nothing need be done to address them.

Conclusion

The Oregon assisted suicide data demonstrates that people who were not actually terminal received lethal prescriptions in all 18 reported years except the first, and that there is little or no substantive protection against coercion and abuse. Moreover, reasons for requesting assisted suicide that sound like a “cry for help” with disability-related concerns are apparently ignored. Thus, the data substantiates problems with the implementation of assisted suicide laws and validates the concern that the risks of mistake, coercion and abuse are too great. Well-informed legislators on both sides of the aisle should vote against assisted suicide bills.

6 thoughts on “Oregon State Assisted Suicide Reports Substantiate Critics’ Concerns

  1. Diane Coleman tells hard truths that are backed with facts about the danger to the disabled, the elderly, the poor and the mentally ill under the PAS laws governing medical care/health insurance and the constitutional right to live or die in the for-profit health care scenario of the trillion dollar Medical Industrial Complex of the United States.

    The dangers of PAS laws under state laws that appear to be compassionate to the public are hidden from the view of the masses who aren’t informed by the Press and Media that if they become disabled, elderly, poor, or mentally ill, their lives may be declared “not worth living” by special interests, including their own families and state Medicare and Medicaid, and the private health insurance giants who earn billions in profits from selling public and private health insurance in the USA.

    The hurry-up-and- die -to- save- money culture is growing in the USA and the victory of the ADA for the disabled is being undermined as the elderly, disabled, poor, mentally ill are increasingly being sacrificed to the scenario of hastened death or shortened life to save treatment costs. This becomes possible and legal with PAS laws and unilateral DNRs, and/ or refusal of curative treatments and, instead, referrals to Hospice under the “quiet” unilateral and undemoctatic change to managed care and managed death from fee-for-service Medicare/Medicaid implemented by Obama care, The Affordable Care Act.

    The democrats give and the democrats taketh away. Would the disabled community and the elderly be better off voting for a Republican platform that purports to respect the dignity and the value and the sanctity of human life as protected by the ADA — and the right to decide to live or to die of the elderly, the disabled, the mentally ill, and the poor?

    1. The situation is complicated. Right now, the majority of the GOP – especially the powerful Tea Party Caucus – would like to see health care handed over entirely to the “free market” and health care available but limited to what one can pay for (or the insurance they can afford). There’s a body count attached to those types of policies as well.

      1. I agree! It is complicated! But, will the democrats continue to fight for a single payer system? As the “Advantage” Insurers take over more of the Medicare market, will they influence Medicare to provide even less because, of course, under Medicare Law right now, the Advantage Insurers are required to provide as much under their Advantage policies as is provided under original Medicare.

        Unfortunately, it’s always about the money and profits and both political parties don’t have the will to serve the people and risk the loss of the financial support of the wealthy big insurance companies who influence the Medicare/Medicaid laws in their own interests, of course.

  2. I know people with chronic illnesses and disabilities who are literally suicidal right now BECAUSE we have the GOP in 3 branches and SCOBA, and the ACA, Medicare, Disability and even Social Security are on the chopping block. We have lupus, schizophrenia and bipolar, and stand to lose access to medication. Having gone psychotic and suicidal without meds before, I would rather take my life on my own terms than be thrown into the street or an institution because of the cuts the GOP wants to make. ProLife my ass; they don’t care about those already born! There are fates worse than death. Some of us don’t want to spend the rest of our lives in terror of locked up just because lawmakers refuse to let our nation join the rest of the civilized world and provide health care to all.

    1. Hi Celeste – Yes, I think we are all very concerned, as you are. Not Dead Yet is on the Steering Committee of the National Disability Leadership Alliance (www.disabilityleadeship.org), and all of us will be advocating to preserve the hard won gains we have made in the last two decades. You may be interested in participating in one or more of the groups involved, which are listed here: http://www.disabilityleadership.org/about/. We’ll need all the help from advocates that we can engage. – Diane Coleman

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