PAS advocates have claimed that the report proves that the DWDA is working well and without abuses. But a closer look at the report reveals flawed findings about a fundamentally flawed law.
NO PENALTIES FOR NON-COMPLIANCE:
The OHD has no enforcement authority over doctors who do not report assisted deaths. This means that there are no penalties for doctors who do not report prescribing lethal drugs for suicide.
Even if just one doctor in the state did not report a PAS death, OHD's subsequent statistical report would be incomplete and suspect.
OHD researchers, themselves, acknowledged this problem in their first report, saying that it is "difficult, if not impossible, to detect accurately and comment on underreporting." "We cannot determine," they explained, "whether physician-assisted suicide is being practiced outside the framework of the Death with Dignity Act." [Report, p. 583]
STUDY DATA ONE-SIDED:
The data for this report was obtained exclusively from the doctors who prescribed the lethal drugs for the patients, with no corroboration from other sources. The OHD, citing privacy concerns, never even interviewed the patients' families, friends, or other caregivers about the circumstances or pressures surrounding the deaths.
Nor did the OHD contact the patients' other physicians who, for some reason, refused to write the deadly prescription. Yet, based on this one-sided information from the death-prescribing doctors, OHD researchers concluded that there was "no evidence to support" the fears that vulnerable patients would be unduly pressured by financial and other concerns to opt for assisted suicide. [Report, p. 582]
But, as Dr. Herbert Hendin, head of the American Foundation for Suicide Prevention, has pointed out, just because a patient chose not to tell the doctor about his or her financial problems or other pressures, doesn't mean those problems didn't exist.
The report's lead author, Dr. Arthur Chin, has acknowledged that there were better sources than the death-prescribing doctor for some of the data, but said that the researchers were restricted by the need to insure the privacy of the patients and the doctors. Chin also stated that the OHD's only aim was to comply with the DWDA and issue an annual statistical report - not a comprehensive study on physician-assisted suicide. [Associated Press, 2/26/99]
OHD ASSUMED DOCTORS' GOOD WILL AND HONESTY:
According to another OHD publication (CD Summary, published by OHD's Center for Disease Prevention and Epidemiology), there are serious limitations to the report's findings. One such limitation is possible "recall bias" on the part of death-prescribing doctors when they report their accounts of PAS deaths to the state.
"For that matter," the summary reads, "the entire account could have been a cock and bull story. We assume, however, that physicians were their usual careful and accurate selves." [OHD, "A Year of Dignified Death," CD Summary, vol. 48, no. 6, 3/16/99; emphasis added]
In other words, the state is just assuming that doctors who are engaged in ending patients' lives are well intentioned, have been totally compliant with the provisions of the DWDA, and completely truthful and forthright in their reports to the state. That explains why OHD's researchers concluded, "All the reports submitted by the physicians who prescribed lethal medications were in full compliance with the law." [Report, p. 578]
Realistically, why would a doctor even bother to report a less-than-perfect death, one that might cause legal and professional problems for that doctor with the OHD, the state medical licensing board, or even the police?
A similar situation exists in the Netherlands, where doctor-induced deaths are technically illegal but not prosecuted as long as physicians comply with established legal guidelines. Recent studies clearly indicate that the majority of Dutch doctors (59%) do not report PAS or euthanasia deaths to authorities. [van der Wal et al., "Evaluation of the Notification Procedure for Physician-Assisted Death in the Netherlands," NEJM, 11/28/96.]
While failure to report is a clear violation of the legal guidelines, Dutch doctors are rarely, if ever, penalized for noncompliance. In fact, the authors of one study concluded, "Dutch claims of effective [euthanasia] regulation ring hollow." [Keown & Jochemsen, "Voluntary Euthanasia under Control? Further Empirical Evidence from the Netherlands," Journal of Medical Ethics, February 1999]
DWDA DISCRIMINATES AGAINST THE DISABLED:
According to Oregon Deputy Attorney General David Schuman, the DWDA violates both the Oregon State Constitution and the federal Americans with Disabilities Act by discriminating against patients who are too disabled to swallow or self-administer the prescribed lethal drugs.
The DWDA refers to the lethal drugs being ingested by the patient. It is presumed that the patient would have the ability to self-administer and swallow the drugs. Schuman's analysis was requested by State Senator Neil Bryant after the 3/10/99 PAS death of Patrick Matheny, a man disabled by ALS (Lou Gehrig's disease).
A newspaper account of the death revealed that Matheny's brother-in-law had to "help" him die. The brother-in-law, who never revealed exactly how he helped Matheny die, told the Oregonian, "It [PAS] doesn't go smoothly for everyone. For Pat it was a huge problem. It would have not worked without help." [Oregonian, 3/11/99]
According to Schuman's analysis, "The Death with Dignity Act does not, on its face and in so many words, discriminate against persons who are unable to self-administer medication. Nonetheless, it would have that effect." "It therefore seems logical" he added, "to conclude that persons who are unable to self-medicate will be denied access to a 'death with dignity' in disproportionate numbers." [D. Schuman, Letter to Senator Neil Bryant, 3/15/99]
Once killing becomes accepted public policy for one group (those able to self-administer), it isn't long before that policy is amended to accommodate more and more groups. Essentially, that has already happened in Oregon. When the Coos County district attorney ordered an investigation into Matheny's death and the "help" he received, the case was quickly dropped because, according to authorities, the "purpose of the law was served." [Oregonian, 3/17/99]
If the Matheny case is any indication, Oregon patients, who are too disabled to kill themselves, can now be killed by someone else - a situation which PAS advocates promised voters would never happen if the DWDA became law. So, the allegedly strict PAS safeguards and regulations aren't so strict after all. In fact, instead of being protections, they have become obstacles to be circumvented.
