Assisted Suicide in Oregon: The First Two Years

Oregon's "Death with Dignity Act," permitting physician-assisted suicide, went into effect in 1997. Under the law, the Oregon Health Division (OHD) is required to collect information and publish a yearly statistical report. [ORS 127.865 §3.11] Two official reports have now been published, but there is no way to know how many or under what circumstances patients have died from physician-assisted suicide in Oregon.

• The law contains no penalties for doctors who do not report prescribing lethal doses for the purpose of suicide.

• The Oregon Health Division has no regulatory authority or resources to ensure compliance with reporting requirements. [American Medical News, 9/7/98]

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DEATHS DURING 1ST TWO YEARS FROM PHYSICIAN-ASSISTED SUICIDE:

Official Reports:         43
Actual Number:       Unknown

16 reported deaths occurred in 1998. 27 reported deaths took place in 1999. [NEJM 2/24/00, p. 601]

COMPLICATIONS OCCURRING DURING ASSISTED SUICIDE

Official Reports:        0
Actual Number:      Unknown

According to OHD official Dr. Katrina Hedberg, the division has to rely on the word of doctors who prescribed the drugs. But those doctors don't need to be present when patients take the lethal medication. So they may not even know if complications take place. [Oregonian, 2/24/00]

Peter Rasmussen, an Oregon physician who has prescribed lethal drugs for assisted suicides, claims that Oregon’s process is "predictably comfortable, painless." [USA Today, 11/21/99] But news accounts telling a different story have surfaced:

• Patrick Matheny received his lethal prescription from Oregon Health Sciences University via Federal Express. He experienced difficulty when he tried to take the drugs four months later. His brother-in-law, Joe Hayes, said he had to "help" Matheny die. According to Hayes, "It doesn’t go smoothly for everyone. For Pat it was a huge problem. It would have not worked without help." [Oregonian, 1/17/99 and 3/11/99]

• Speaking to a small group at Portland Community College in December, pro-assisted suicide attorney Cynthia Barrett let the first information slip out about a botched assisted suicide. "The man was at home. There was no doctor there," she said. "After he took it, he began to have some physical symptoms. The symptoms were hard for his wife to handle. Well, she called 911. The guy ended up being taken by 911 to a local Portland hospital. Revived. In the middle of it. And taken to a local nursing facility. I don’t know if he went back home. He died shortly – some….period of time after that…"

Overdoses of barbiturates are known to cause vomiting as a person begins to lose consciousness. The patient then inhales the vomit. In other cases, panic, feelings of terror and assaultive behavior can occur from the drug-induced confusion. But Barrett wouldn’t say exactly which symptoms had taken place in this instance. She has refused to discuss the case since her December revelation. [Oregonian, 3/23/00 and 3/26/00]

ASSISTED SUICIDE DEATHS OF PATIENTS WITH DEMENTIA

Official Reports:     0
Actual Number:   Unknown

Kate Cheney, 85, died of assisted suicide under Oregon’s "Death with Dignity Act" even though she reportedly was suffering from early dementia. Her own physician had declined to provide a lethal prescription for her.

When counseling to determine her capacity was sought, a psychiatrist determined that she was not eligible for assisted suicide since she was not explicitly pushing for it and her daughter seemed to be coaching her to do so. She was then taken to a psychologist who determined that she was competent but possibly under the influence of her daughter who was "somewhat coercive."

Finally, the managed care ethicist, who was overseeing her case, determined that she was qualified for assisted suicide, and the lethal dose was prescribed. [Oregonian, 10/17/99]

ASSISTED SUICIDE DEATHS OF DEPRESSED PATIENTS

Official Reports:       0
Actual Number:     Unknown

Under the Oregon law, depressed patients can receive assisted suicide if they do not have "impaired judgment." [ORS 127.825 §3.03]

The first known legal assisted suicide was that of a woman in her mid-80s who had been battling breast cancer for twenty-two years. Two doctors, including her own physician who believed that her request was due to depression, refused to prescribe the lethal drugs.

But Peter Goodwin, medical director of the assisted suicide group Compassion in Dying, determined that she was an "appropriate candidate" for death and referred her to a doctor who provided the lethal prescription. In an audio-tape, made two days before her death and played at a press conference, the woman said, "I will be relieved of all the stress I have." [Oregonian, 3/26/98 and Los Angeles Times, 3/26/98]

PATIENTS WHO RECEIVED LETHAL DOSE MORE THAN 6 MONTHS BEFORE DEATH

Official Reports:       1 (247 days)
Actual Number:     Unknown

Lethal prescriptions under the "Death with Dignity Act" are supposed to be limited to patients who have a life expectancy of six months or less. However, at least one lethal dose was prescribed more than 8 months before the patient took it. [NEJM, p. 599]

The Oregon Health Division is not authorized to investigate how physicians determine their patients’ diagnoses or life expectancies. [Hastings Center Report, Jan.-Feb., 2000, p. 4.]

FIRST PHYSICIAN THAT PATIENT APPROACHED AGREED TO WRITE PRESCRIPTION

Official Reports:      16 (39%)
Actual number:     Unknown

"Many patients who sought assistance with suicide had to ask more than one physician for a prescription for lethal medication." [NEJM, p. 603] There is no way to know why 61% of physicians refused to lethally prescribe (because the patient was not terminally ill, not competent, etc.) since they were not interviewed for the official reports. The only physicians interviewed were prescribing physicians. [OHD 2^nd Year Report, p. 7]

SHORTEST LENGTH OF RELATIONSHIP BETWEEN PATIENT & PRESCRIBING PHYSICIAN

Official Reports:     2 weeks
Actual length:      Unknown

The official report indicates that some patients knew their doctors for only two weeks before the lethal dose was prescribed. [OHD 2^nd Year Report, Table 2 and NEJM, Table 1]

Since at least 2 weeks must elapse between the first and last requests for the lethal dose, this indicates that the physician-patient relationship was established for the specific purpose of obtaining the drugs for assisted suicide.

REQUESTS FOR ASSISTED SUICIDE BASED ON FINANCIAL CONCERNS

Official Reports:     0
Actual number:    Unknown

Six (14.3%) of the patients whose deaths were reported were on Medicaid. [NEJM, p. 600] Their doctors did not report that they had any financial concerns. However those who qualify for Medicaid are among the poorest Oregonians for whom financial difficulties are a fact of life. The report noted that one family member said a patient (who had private medical insurance) expressed concern about financial matters, but the patient "was concerned about all issues except physical suffering." [NEJM, p. 601]

THE OFFICIAL REPORTS DO NOT TELL THE WHOLE STORY OF PHYSICIAN-ASSISTED SUICIDE IN OREGON

• A limitation of the report includes the fact that "the possibility of physician bias must be considered." [OHD 1^st Year Report , p. 9]

• "[W]e cannot detect or collect data on issues of noncompliance with any accuracy" [OHD 1^st Year Report , p. 9]

• "We do not know if covert physician-assisted suicide continued to be practiced in Oregon in 1998." [OHD 1^st Year Report 1, p. 9]

• "Underreporting cannot be assessed, and noncompliance is difficult to assess because of the possible repercussions for noncompliant physicians reporting data to the division." [NEJM 2/24/00, p. 603 and OHD 2^nd Year Report, p. 12]
  

• "For that matter, the entire account could have been a cock-and-bull story. We assume, however, that physicians were their usual careful and accurate selves." [OHD, CD Summary 3/16/99, p. 2]

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OHD Sources:

Oregon's Death with Dignity Act: The First Year Experience
Official report on the first year of Oregon's assisted suicide law.

OHD CD Summary, 3/16/99