Marlowe's Shade

Friday, May 13, 2005

Why Assisted Suicide Laws Lead to Involuntary Euthanasia: Part 2

In Part 1 of this post yesterday, I pointed out how guidelines failed in the Dutch physician-assisted suicide laws, and inevitably a slippery slope toward involuntary euthanasia resulted. This post will concern itself with Oregon Death with Dignity and similar laws that were based on the Dutch experiment.

Previous to the passage of this Law in 1997, New York Gov. Mario Cuomo set up a task force to study this issue and recommend policy for his state. There findings are unambiguous:

In this report, we unanimously recommend that New York laws prohibiting assisted suicide and euthanasia should not be changed. In essence, we propose a clear line for public policies and medical practice between forgoing medical interventions and assistance to commit suicide or euthanasia. Decisions to forgo treatment are an integral part of medical practice; the use of many treatments would be inconceivable without the ability to withhold or to stop the treatments in appropriate cases. We have identified the wishes and interests of patients as the primary guideposts for those decisions.

Assisted suicide and euthanasia would carry us into new terrain American society has never sanctioned assisted suicide or mercy killing. We believe that the practices would be profoundly dangerous for large segments of the population, especially in light of the widespread failure of American medicine to treat pain adequately or to diagnose and treat depression in many cases. The risks would extend to all individuals who are ill. They would be most severe for those whose autonomy and well-being are already compromised by poverty, lack of access to good medical care, or membership in a stigmatized social group. The risks of legalizing assisted suicide and euthanasia for these individuals, in a health care system and society that cannot effectively protect against the impact of inadequate resources and ingrained social disadvantage, are likely to be extraordinary.

The report often references the Netherlands experiment, and had taken the lessons of how the program has obliterated its own guidelines to heart. This report is a good example of how due diligence in this debate will clearly reveal the best course for avoiding abuses

Oregon took the opposite course and based its law on the Dutch experiment despite the New York task force decision and even became an embarassment to right-to-die proponent Daniel Callahan of the Hastings Center.

The bioethicist Daniel Callahan and attorney-ethicist Margot White reviewed bills introduced in 12 states (U.S.A.) that would permit assisted suicide; in 6 states the bills were modeled after the Oregon law. They found that with regards to safeguards concerning informed consent, mental competence, voluntariness, and restriction of eligibility to the terminally ill, all 12 bills had the same failings as the Oregon law (or were even worse). Callahan and White concluded that the bills appeared to be primarily written for the protection of doctors not patients.(Callahan and White 'the legalization of physician assisted suicide: creating a regulatory potemkin village' University of Richmond law review, 1996,30:1-83

The problems were the same as those which plagued the PAS/euthanasia program in Holland:

The provisions of the Oregon suicide law enacted in an Autumn 1997 voter referendum (rejecting efforts to undo a previous statute) make it an inviting target for anyone concerned with protecting human life. For example, the Oregon law authorizes doctors to assist a patient with suicide if the patient is expected to die in six months (Or. Rev. Stat. 127.800, 127.805) and is not suffering from ``a psychiatric or psychological disorder, or depression causing impaired judgment.'' (Or. Rev. Stat. 127.825) Yet clinical experience and medical literature all point to the general unreliability of such judgments. And does impaired judgment mean the inability to remember the name of a casual acquaintance you met a year ago?

Moreover, the chief author of the Oregon "Death with Dignity" law has stated that "depression in itself does not rule out the physician's assistance'' under the Act. (Cheryl K. Smith, "Safeguards for Physician_assisted Suicide: The Oregon Death with Dignity Act,'' in S. McLean (ed.), Death, Dying and the Law (Dartmouth Publishing 1996), 69_93 at 75.)

Even these loose legal guidelines are covered by a generous "good faith" standard which protects doctors from civil, professional and criminal liability so long as they believe "in good faith" that they have complied with the guidelines. (Or. Rev. Stat. 127.885) And the law's confidentiality provisions (Or. Rev. Stat. 127.865) and the section barring notification of family members without a suicide patient's express consent (who is presumed to be incompetent anyway) would insure that no oversight of "abuses" would occur. (Or. Rev. Stat. 127.835) Assassins must envy the protections given doctors who are called to assist an Oregon suicide.

It is already obvious that "abuses" have crept into the Oregon scheme of self-deliverance, which have produced inaction by state officials toward those who perpetrating the abuses, and hostility toward those disclosing them.

For example, Oregon Governor John Kitzhaber told a Congressional Committee that as far as he knows there are no penalties for violating the State assisted suicide guidelines. (Lethal Drug Abuse Prevention Act: Hearing on H.R. 4006 Before the Subcommittee on the Constitution of the House Committee on the Judiciary , 105th Cong. July 14, 1998) Further publicity attending the involuntary active euthanasia of an Oregon patient in violation of Oregon’s homicide law found officials declaring the doctor "unprosecutable" because of the climate created by Oregon’s assisted suicide law. (See "Doctor Won't Be Prosecuted," The Bulletin, Bend, Oregon, Dec. 11, 1997)

Then when Oregon public health workers released a report concerning assisted suicide, the Oregon Health Division issued a memo to state employees stating that state employees who reveal that a physician_assisted death has occurred in his or her county "will immediately be terminated." (Death with Dignity Memorandum from Sharon Rice, Manager Registration Unit, Center for Health Statistics of the Oregon Health Division, to County Vital Records Registrars and Deputies, Dec. 12, 1997, reprinted in Confidentiality of Death Certificates, 14 Issues in Law & Med. 333, 334 - 1998)

The lack of accountability and enforcement of guidelines was reminiscent of the Dutch model. And there was the same misdirection and secrecy in the state's reporting when the inevitable abuses came to light:

Champions of Oregon's Death With Dignity Act point out that the state's recent report on physician-assisted suicide (PAS) reported that "only" fifteen people took advantage of the new law the first year it was in effect. However, critics say the report raises more questions than it answers.


Robert DuPriest, the regional director of Physicians for Compassionate Care (PCC) in Eugene, Oregon, notes that Oregon's suicide rate is already 42% higher than the nation's, with people over 75 being 63% more likely to commit suicide than people of the same age in other states. In this light, "adding 15 more cases by physician-assisted suicide is a tragedy for Oregon, not a 'great value.' "

Dr. Bill Toffler, an Oregon physician and member of (PCC), is troubled by the report. "We have no idea how many people actually committed suicide," he says, because there is no punishment specified for doctors who fail to report an assisted suicide. "We know that 59% of the doctors in the Netherlands never report the times when they help their patients to end their lives. It's very specious to suppose that legalizing assisted suicide will 'get it out in the open.'"

Even the report itself admitted that, "A 1995 anonymous survey of Oregon physicians found that 7% of surveyed physicians had provided prescriptions for lethal medications to patients prior to legalization. We do not know if covert physician-assisted suicide continued to be practiced in Oregon in 1998."

The reports that doctors are asked to file only ask for basic information such as the patient's name, age, diagnosis, and prognosis, and no specific details of the case are required. Doctors were free to anonymously give the Oregon Health Association only those details which they wanted to report, which opens a wide door to abuses.

Dr. Toffler points out that the Oregon Medical Association actively opposed the Death with Dignity Act before it passed, calling it "seriously flawed," partly because of this lack of accountability.

The report states that four of the fifteen patients had been given psychiatric evaluations by their physicians and all 15 were deemed mentally competent to decide to end their lives. "Not all Oregon physicians were willing to participate in physician-assisted suicide in 1998. Six patients who chose assisted suicide had requested lethal medications from one or more providers before finding a physician who would begin the prescription process." In more than a few cases, the patients' long-term physicians refused to assist in the suicides. According to the report, the physicians who gave the lethal prescriptions knew their patients for an average of 69 days.

Dr. DuPriest notes that "nothing useful" was said about the mental health of any of the 15 people who committed suicide. Since many of the victims had to change doctors to get a prescription, "the report doesn't reveal the opinion of the patients long-term physician, or that of the second or third physician. Nor does it address why these physicians chose not to give lethal drugs. Only the doctor who participated in the suicide filled out the questionnaire. Thus the Health Divisions report, and the actual implementation of the law, ignores the opinions of certain treating Oregon physicians."

Despite serious concerns being raised from both sides of the right-to-die debates, similar laws such as AB 654 in California are being introduced. For all and any of the reasons cited above, these should be vigorously opposed. And if the testimony of this survivor of an attempted physician-assisted suicide in Oregon is to be believed, these laws have an evem more powerful Opponent:

Oregon's first-in-the-nation assisted suicide law is coming under fire after a cancer patient woke up following his taking the lethal dose of drugs necessary to end his life.

In late January, lung cancer patient David Prueitt took a fatal dose of drugs, prescribed by a doctor under the assisted suicide law, to take his own life. Three days later he woke up and wondered why he wasn't dead.


Prueitt received a doctor's prescription for 100 capsules of the barbiturate Seconal. On January 30, he swallowed the drug overdose, which was mixed with applesauce and water.

Two days after Prueitt woke up, he told his wife he had been in the presence of God. He said God had rejected his death by suicide and sent him back to die naturally.

Prueitt died of natural causes two weeks later.
papijoe 7:16 AM