International Task Force
on Euthanasia and Assisted Suicide
Update
Year 2008, Volume 22, Number 2
| 10 years under Oregon’s assisted-suicide law It’s been a frustrating ten years for anyone who really wants to know the facts regarding assisted-suicide practice in Oregon. Why? Because, since the Oregon Death with Dignity Act (O-DWDA) took effect in October 1997, imposed secrecy regarding individual deaths has left the public—and independent researchers—without the data needed to accurately assess the law and its implementation. But that is precisely what the authors of the assisted-suicide law wanted. Soon after the O-DWDA originally passed in November 1994, co-author Barbara Coombs Lee, a former HMO executive and now president of the assisted-suicide advocacy group Compassion & Choices (C&C), told a newspaper interviewer, "[T]he people of Oregon do not deserve to know the details of the individual fatal diseases and deaths." [Oregonian, 11/27/94] To ensure that the shroud of secrecy would prevail even within the ranks of the state agency charged with monitoring assisted-suicide practice, the O-DWDA authors included provisions (1) authorizing the Oregon Department of Human Services’ Public Health Division (OPHD) to review a "sample" of assisted-suicide records and (2) insuring that case data "shall not be a public record and may not be made available for inspection by the public." [O-DWDA, ORS 127.865 s.3.11, 1994] After the O-DWDA passed, Coombs Lee and other proponents argued that state officials should not even be allowed to look at assisted-suicide patients’ medical records since that would be a breach of doctor/patient confidentiality. Furthermore, since death certificates are a matter of public record, doctors should lie on those documents by indicating the cause of death as the patient’s underlying illness, not the lethal drugs the patient ingested in accordance with the assisted-suicide law. Doctors lie on death certificates all the time, proponents argued, and to do otherwise would be another breach of confidentiality. [Statesman Journal, 12/2/94] The law’s authors knew, however, that the illusion of adequate state oversight was important in order to get voters to approve the O-DWDA. Consequently, they included a provision mandating that the OPHD "generate and make available to the public an annual statistical report of information collected." [ORS 127.865 s.3.11(3)] [See chart of statistics But in the ten annual reports released thus far, the statistics and analyses the OPHD chose to include were incomplete and skewed. Report researchers claimed that the state agency collected information on all patients who received a prescription for lethal medication, but they omitted from the reports any data on prescription recipients who chose not take the lethal drugs. The data used was almost exclusively from doctors who reported that they had written fatal drug prescriptions. In some cases, however, patients or their families had "doctor shopped" until they found one willing to prescribe the drug overdose. The physicians who had seen these patients previously and determined that the patients were not qualified for physician-assisted suicide (PAS) under the law—as well as psychiatrists and psychologists who came to the same conclusion—were never interviewed. Neither were the PAS patients, themselves, prior to their deaths. In the very first annual report—the version published in the New England Journal of Medicine—the OPHD acknowledged that, since the law contains no penalties for doctors who do not report their involvement in PAS deaths, it is "difficult, if not impossible, to detect accurately and comment on underreporting." "We cannot determine whether physician-assisted suicide is being practiced outside the framework of the Death with Dignity Act." Yet, despite the likelihood that there were unreported PAS deaths to which the OPHD admitted having no knowledge, the state researchers concluded, "Many people feared that if physician-assisted suicide was legalized, it would be disproportionately chosen by or forced on terminally ill patients who were poor, uneducated, uninsured, or fearful of the financial consequences of their illness. In our study of physician-assisted suicides in Oregon in 1998, we found no evidence to support these fears." ["Legalized Physician-Assisted suicide in Oregon: The First Year’s Experience," NEJM, 2/18/99, pp. 582-583] This unfounded and biased conclusion—perpetuated by OPHD
researchers in all subsequent annual reports and by PAS advocates spinning
the law to targeted audiences—continues to be the mantra used in all the
recent campaigns to spread Oregon-style PAS to other states and countries. Oregon PAS from a medical perspective In a new article published in a special issue of the Michigan Law Review on the Oregon PAS law, Dr. Herbert Hendin, CEO and medical director for Suicide Prevention International and a psychiatry professor at New York Medical College, and Dr. Kathleen Foley, neurologist and palliative care specialist at New York’s Memorial Sloan-Kettering Cancer Center and a professor at Cornell University’s Weill Medical College, examine Oregon’s ten-year PAS experience from a medical perspective. (See Editor’s Note on page 4.) "The OPHD annual reports are marked by overreaching in the conclusions they draw from the limited information they have," Hendin and Foley wrote. "Limiting the information collected to one physician when other physicians who saw the patient in connection with an end-of-life decision might have information that would be contradictory runs counter to the basic expectations of research design and undermines the validity of the results." [Hendin & Foley, "Physician-Assisted Suicide in Oregon: A Medical Perspective," Michigan Law Review, June 2008, pp. 1641-1642. Hereafter cited as MLR.] Citing actual PAS cases as well as information obtained from physicians, family members, and caregivers, Hendin and Foley found that the "implementation of the [PAS] law has had unintended, harmful consequences for patients." [MLR, p. 1614] "A concern with physician protection, rather than patient protection, pervades the Oregon experience," they explained. "The statute’s liability shield [for doctors], its incomplete reporting system, and the excessive secrecy with which the law is implemented protect doctors who assist patients with suicide but leave patients vulnerable." [MLR, p. 1629] Furthermore, the "OPHD does not collect the information it would need to effectively monitor the law," and "acts as the defender of the law rather than as the protector of the welfare of terminally ill patients." [MLR, p. 1613] Oregon doctors, they conclude, are given "great power" under the PAS law "without being in a position to exercise it responsibly": They are expected to inform patients that alternatives [to PAS] are possible without being required to be knowledgeable about such alternatives or to consult with someone who is. They are expected to evaluate patient decision-making capacity and judgment without a requirement for psychiatric expertise or consultation. They are expected to make decisions about voluntariness without having to see those close to the patient who may exert a variety of pressure, from subtle to coercive. They are expected to do all of this without necessarily knowing the patient for more than fifteen days. Since physicians cannot be held responsible for wrongful deaths if they acted in good faith, substandard medical practice is permitted, physicians are protected from the consequences, and patients are left unprotected while believing they have acquired a new right. [MLR, pp. 1644-1645] The latest annual report on PAS patients who died in 2007
was released on March 18, 2008. It revealed that 2007 set record highs for
the number of PAS deaths (49), the number of lethal prescriptions written
(85), and the number of doctors who wrote those prescriptions (45).
Comparing the first two categories to the figures for 1998 (the first year
under the PAS law), this amounts to a 306% increase in the number of PAS
deaths and a 354% increase in the number of prescriptions written. As of
December 31, 2007, the total number of reported PAS deaths since the
law took effect is 341. [ODHS, "Tenth Annual Report on Oregon’s Death with
Dignity Act," 3/18/08. Hereafter cited as Tenth Report.] According to Compassion & Choices, the advocacy group that facilitates the vast majority of Oregon’s PAS deaths, only 25 doctors either prescribed drug overdoses or acted as a consulting physician in 1998. Now that figure is about 750. The number of pharmacies willing to fill PAS prescriptions has also increased dramatically, from five in 1998 to more than 85 in 2007. [Oregonian, 3/18/08] The figures contained in the 2007 report indicate that Oregon doctors are becoming accustomed to suicide facilitation and unduly confident in their ability to assess the mental health of PAS-requesting patients. In fact, in 2007, not one lethally-prescribing doctor referred a PAS patient to a psychiatrist or psychologist for an evaluation as to whether the patient was competent to make an informed decision, whether the patient was under even subtle pressure to request PAS, or whether the patient was suffering from a depressive disorder. [Tenth Report, Table 1] According to Dr. Nicholas Gideonse—an assistant professor of family medicine at Oregon Health & Science University (OHSU) who has written a number of lethal prescriptions—physicians have become comfortable with their ability to judge a patient’s mental state. But Dr. Linda Ganzini, an OHSU professor of psychiatry and medicine, questions doctors’ abilities to psychologically evaluate patients. "I think it’s risky how low the rate of mental health evaluation is," she said, "because people with depressive disorders are more likely to be able to get a (lethal) prescription if you’re not being very careful." Patients who want to end their lives often suffer from a treatable depression, she added, "and a trial of depression treatment should be the first approach, not a lethal prescription." [Register-Guard, 3/19/08] PAS requests: No symptoms needed Ganzini, along with two researchers from the Department of Veterans Affairs, published a revealing study in 2007 based on family members’ views on why their relative requested PAS. The study found that those who actually took the lethal drugs and died "feared future declines in quality of life more" than those who opted not to take the drugs. Researchers concluded, Concerns about what may be experienced in the future, including physical symptoms, were substantially more powerful reasons than what they experienced at the time of the request….[W]hile assessment of physical discomfort at the time of the request is an important component of palliative care, the clinician should not be surprised at the relative absence of physical symptoms. Offering information as to how pain and discomfort will be managed as the disease progresses with a focus on maintaining the function and cognition may help assuage fears and ensure a dignified death. [Ganzini et al., "Why Oregon Patients Request Assisted Death: Family Members’ Views," Journal of General Internal Medicine, 12/15/07. Emphasis added.] Editor’s Note: Read the complete Michigan Law Review article by Drs. Hendin and Foley. More information on Oregon’s assisted-suicide law and it’s implementation.
PAS initiative campaign launched in Washington The 2008 initiative battle over whether physician-assisted suicide (PAS) should be legalized in Washington State may well rival the current U.S. presidential battle both in intensity and importance. PAS advocates have pledged to throw everything they have into getting the Washington Death with Dignity Act (I-1000) on the ballot in November. After years of defeated attempts to spread legalized PAS to other states besides Oregon, advocates decided to concentrate most of their time and money on getting just one more state in their "win" column. This strategy, dubbed "Oregon plus One," is based on the premise that winning over one additional state would act as a catalyst for future victories in many others. In a collaborative effort, two national PAS groups—the Death with Dignity National Center (DWDNC) and Compassion & Choices (C&C)—are spearheading the "Oregon plus One" strategy in Washington. In the latest DWDNC annual report, board president Steve Telfer and executive director Peg Sandeen explained: We have spent the last year actively researching and collecting data to determine the state which is most likely to adopt a Death with Dignity law. Through these efforts, we have identified Washington as the state most likely to move forward in offering its terminally ill citizens expanded options at the end of life.… Campaigns, such as the one in Washington, take a great deal of time, effort, and money. In 2006-2007, we invested each of these resources in planning for a 2008 ballot initiative. We raised nearly $250,000 to provide seed money to the campaign, and we participated in extensive early research efforts. [DWDNC, "2007 Annual Report," p.3] The DWDNC intends to increase its substantial financial support during 2008. "[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 in Washington." [DWDNC, "2007 Annual Report," p. 5] As of April 30, 2008, individual pro-assisted suicide groups and those affiliated with the DWDNC, C&C, and Final Exit Network have donated $443,730 to the Washington "Yes on I-1000" campaign. In addition, the initiative’s sponsor and chief spokesman, former Washington governor Booth Gardner (heir to the Weyerhauser fortune), has contributed $120,000. The grand total of all individual and organizational donations made to the "Yes" campaign as of April 30 is $1,076,233.86. [Yes on I 1000, Public Disclosure Commission Statement, 5/7/08] Over the same time period, however, the opposition campaign, mounted by the broad-based Coalition Against Assisted Suicide, has reported only $60,225.61 in total campaign contributions. [Coalition Against Assisted Suicide, Public Disclosure Commission Statement, 5/12/08] I-1000 proponents are currently gathering as many voter signatures as they can to qualify the measure for the November ballot. They need 224,880 valid signatures by July 3. According to one newspaper account, they had garnered 120,000 signatures as of May 9. [The Herald (Everett), 5/9/08] Reportedly, one signature gathering company ran an ad on Craigslist.com in March seeking people for the assisted-suicide effort. It read: "Signature Gatherers Needed Immediately. Great $$$!" [Seattle Post-Intelligencer, 3/30/08]
Legislators attempt to camouflage assisted-suicide intent of new bill (California AB 2747) After unsuccessful attempts to pass physician-assisted suicide (PAS) bills in California in 2005, 2006, and 2007, Democratic Assemblymembers Patty Berg and Lloyd Levine—with considerable help from the assisted-suicide advocacy group Compassion & Choices (C&C)—have opted to try a less obvious strategy to advance their cause. They claim their new bill, AB 2747 ("The Right to Know End-of-Life Options Act"), is not about assisted suicide at all. Rather it’s a "hospice" bill insuring the right of terminally-ill patients to receive information about their end-of-life options. But AB 2747 isn’t really about giving patients new rights to information. Its purpose is to erode resistance to future attempts to legalize assisted suicide in California. (A similar bill failed to advance this year in Vermont, another state where repeated attempts to pass more transparent PAS bills have been defeated.) AB 2747 is clearly an attempt by the authors and C&C to establish the "voluntary stopping of eating and drinking" (VSED) as a medical option. In fact, the bill lists it among bona fide treatment protocols—for pain control, nausea, shortness of breath, fatigue, palliative chemotherapy, and palliative sedation—as part of "comprehensive pain and symptom management at the end of life." [AB 2747, § 442.5(a)(5)] But, VSED is not a recognized medical treatment. Its purpose is to directly cause death, usually within two or three weeks. Medically speaking, it would be highly inappropriate for health care providers to suggest VSED to terminally-ill patients, especially since AB 2747 defines such patients as having up to one year to live. [§442.5] Establishing VSED as a medical option, however, would allow assisted-suicide advocates to argue later that a prescription for lethal drugs—like those written under Oregon’s assisted-suicide law—would be far more humane than letting patients suffer for weeks while they starve and dehydrate to death. The intention to use AB 2747 as a "Trojan Horse" for assisted suicide is made even clearer by the authors’ inclusion of the following provisions in the bill:
Editor’s Note: On May 28, 2008, AB 2747 passed in the California Assembly by a vote of 42-34. Next stop: the Senate.
Assisted Suicide & the Corruption of Palliative Care For the past two decades, euthanasia/assisted-suicide ideologues have worked overtime to conflate palliative care—the medical alleviation of pain and other distressing symptoms of serious illness—with intentionally ending the life of the patient. The movement’s first target was the hospice, a specialized form of care for the dying created forty years ago in the United Kingdom by the late, great medical humanitarian Dame Cicely Saunders. Determined to treat what she called the "total pain" of dying patients, Saunders’ great innovation was to bring a multidisciplinary team to the task of ensuring that their physical pain, existential suffering, spiritual needs, and mental health are all properly attended. Saunders believed that suicide prevention, when needed, is an essential part of the package, crucial to fulfilling a hospice’s call to value the lives and intrinsic dignity of each patient until the moment of natural death. Indeed, when I was trained as a hospice volunteer, my instructor pounded into my head the importance of reporting to the hospice team any suicide threats or yearnings my patient might express so they could initiate proper intervention. As a consequence of this philosophy, many patients who might have killed themselves were later very glad still to be alive to get the most of the time they had remaining. But assisted-suicide advocates wish to transform hospice into "hemlock" (as one advocate once put it), a facilitator of suicide rather than a preventer. They believe that access to lethal prescriptions should be considered merely another menu item available for dying patients (and ultimately others) "to control the timing and manner of their deaths." Toward this end, advocates often point to a statistic involving assisted-suicide deaths in Oregon. According to the state, approximately 86 percent of people who died by swallowing poisonous overdoses under the Oregon law were receiving hospice care at the time they committed assisted suicide. Promoters of such "aid in dying" claim that this proves dying patients need the additional choice of a lethal prescription to ensure a "good death" if hospice care does not suffice. But there is another way to look at it. What advocates don’t mention—and this is an issue about which the state bureaucrats seem utterly indifferent—is that most of Oregon’s assisted suicides were facilitated in some way by people affiliated with the assisted-suicide advocacy group Compassion and Choices (formerly the Hemlock Society), either as end-of-life "counselors" or as prescribing doctors after the patient’s own physician refused to write a lethal prescription. This means that the patients in the hospice who committed assisted suicide under Oregon’s law most likely did not receive suicide prevention—either because the hospice team was not alerted to their patient’s suicidal desire or perhaps the Oregon law has effectively short-circuited the prevention response by hospice professionals. In other words, rather than showing the need to expand hospice "services," Oregon demonstrates how assisted suicide actually interferes with the proper delivery of hospice services—at least as the hospice was envisioned by Saunders. If undercutting proper hospice medical practice were not bad enough, now assisted-suicide advocates have launched an effort to Shanghai an important but rarely needed method of end-of-life pain and symptom control known as "palliative sedation" into the assisted-suicide cause. Palliative sedation offers relief for the very few cases in which either agonizing pain or other symptoms such as severe agitation cannot be alleviated through more conventional medical methods at the very end of life. In such cases, the patient is placed into a drug-induced coma until death comes from the underlying disease. But assisted-suicide advocates want to give patients a right to demand palliative sedation whether they actually need it or not. In California, for example, Assembly members Patti Berg (D–Mill Valley) and Lloyd Levine (D–Van Nuys)—who have tried for years without success to pass an Oregon-style assisted-suicide law through the California legislature and are soon be term-limited out of office—have sponsored AB 2747, a bill to establish the legal right of dying patients to demand palliative sedation and then refuse medically supplied sustenance so they dehydrate to death. The effect of the bill would be insidious. If AB 2747 becomes law, doctors would be required to facilitate death by dehydration on demand for terminally ill patients—and this "treatment" would not be reserved only for those at the very end of life, since the bill defines terminal illness as having one year or less to live. Moreover, if the doctor believes that palliative sedation is medically unnecessary and/or believes it to be ethically wrong under the circumstances, he or she would still be legally required to be complicit in the patient’s dehydration death under the requirement that refusing doctors refer a requesting patient to another doctor willing to go along. Anyone who cares about the proper practice of medicine should be up in arms about the assisted-suicide movement’s attempt to make hospice and palliative sedation stalking horses for backdoor assisted suicide. Not only do such schemes subvert medicine by transforming legitimate medical interventions into life-terminating protocols, but proposals such as AB 2747 effectively deprofessionalize medical practice by reducing physicians to mere order-takers. Alas, this is par for the course for a movement obsessed with transforming killing into a legitimate answer to the problems of human suffering. Wesley J. Smith is an attorney for the International Task Force on Euthanasia and Assisted Suicide. His article, which originally appeared in First Things, 5/15/08, is reprinted here with the author’s permission. … According to an article Ronson wrote as a preview to his revealing documentary "Reverend Death" (aired May 19 on U.K. Channel 4), he was originally pro-assisted suicide, that is until he realized that most of Exoo’s clients "were not terminally ill, just depressed and in need of psychiatric help." But the article and documentary also suggest that Exoo, himself, is in need of a psychiatric work up. During a conference of international right-to-die experts meeting to discuss various death-producing methods, Dr. Pieter Admiraal, a pioneer of euthanasia practice in the Netherlands, told Ronson of his concerns regarding Exoo. "I’ve been observing him for a long time," Admiraal said, "and I’ve asked our psychiatrists to observe him…." "He is, in my opinion, enjoying the death of another person. And that’s dangerous," Admiraal explained. "I have the strong impression that he wants to be there and see something dying." Exoo, however, sees himself as "a midwife to the
dying," the reason for which he was "placed on this planet." "I’ve
never done anything as important as this in my ministry," he told
Ronson. But as Ronson observed Exoo interacting with clients, he
noticed that the minister became impatient if those about to commit
suicide hesitated at all. In one case Ronson cited, Exoo became
irritated with a woman who had chronic fatigue syndrome, telling her
that he wasn’t going to leave until he had "‘finished’ guiding her
through her suicide." One of the most alarming facts revealed by Ronson deals with a North Carolina woman who Exoo trained to be his assistant. The woman, referred to as Susan, told Ronson that Exoo didn’t know it, but she had set up her own assisted-suicide business and would help anyone to die as long as the price was right—about $7,000. "For me," she said, "it’s no cash, no help." Ronson said that Susan had even flown to New Zealand "to help a depressed, non-terminally ill woman she had met on the internet commit suicide." [Ronson, "I make it look like they died in their sleep," The Guardian (London), 5/12/08] As a result of this revelation, Auckland
authorities are investigating the death of Audrey Wallace,
whom they’ve identified as the woman Susan Wilson (aka
Cassandra Mae) helped to die. Wallace had reportedly withdrawn
$12,000 from her bank account just prior to her August 2007 death.
The money remains unaccounted for. [stuff.co.nz, 5/18/08 & 5/25/08] Following the Netherland’s lead, some members of
Belgium’s coalition government are calling for the euthanasia law to
be expanded to include children and elderly dementia patients who
are not competent to choose death for themselves. Currently,
euthanasia is allowed for infants. Of all the babies who die before
their first birthday, half have been euthanized. In 16% of those
cases, parental consent was deemed unnecessary. [Telegraph
(London), 3/26/08] Expanding the boundaries of induced-death practices seems to be an ongoing task in the Netherlands. In March, a poll conducted by the Dutch research bureau Intomart GfK found that 63% of those survey favored euthanasia for the elderly even if they are healthy. Another 74% supported making "suicide pills" available to those who considered their lives done. [Reuters, 5/6/08] After she sustained brain damage, Lauren, who was pregnant at the time, was kept on a ventilator and feeding tube until her baby was born in February 2007. But Lauren has improved over time and no longer needs a ventilator to maintain her breathing or any other life-support other than food and fluids. Her mother says Lauren would not want to live in her present condition, a claim her father says is absolutely false. "I am willing to do anything possible to avoid death being imposed on my daughter, mediate, whatever it is," her father said. "My feeling, my concern is my daughter be given the chance to live." [Delaware Online, 2/3/08] For more information on this case, see: Life for Lauren.
Back | Home | Contact | Search | Site Map International Task Force on Euthanasia and
Assisted Suicide Copyright © 1996 - 2008, International Task Force. All Rights Reserved. |