Six Years of Assisted Suicide in Oregon

Under Oregon’s law permitting physician-assisted suicide, the Oregon Health Division (OHD) – now called the Oregon Department of Human Services (DHS) – is required to collect information, review a sample of cases and publish a yearly statistical report. [ORS 127.865 §3.11] Since the law, called the "Death with Dignity Act" went into effect in 1997, six official reports* have been published. However, due to major flaws in the law and the state's reporting system, there is no way to know for sure how many or under what circumstances patients have died from physician-assisted suicide.

OFFICIAL REPORTS DO NOT TELL THE WHOLE STORY

The only physicians interviewed for the official reports are those who prescribed lethal drug doses for patients. [OHD 2^nd Year Report, p.7, DHS Report, 3/10/04, p.9]

According to OHD official Dr. Katrina Hedberg, the division has to rely on the word of doctors who prescribed the drugs. [Oregonian, 2/24/00]

Referring to physicians' reports, the OHD admitted: "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]

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

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

ASSISTED SUICIDE DEATHS REPORTED DURING 1^ST SIX YEARS

Official Reports: 171
Actual number: Unknown

The latest annual report indicates that reported assisted-suicide deaths have increase by more than 250% since the first year of legal assisted suicide in Oregon. [American Medical News, 4/5/04] The number of deaths could be far higher.

COMPLICATIONS OCCURRING DURING ASSISTED SUICIDE

Official Reports: 7 (instances of "regurgitation")
Actual Number: Unknown

Prescribing doctors don’t need to be present when patients take the lethal medication. [DHS Report, 3/6/03, p. 9] Since physicians who prescribe the lethal drugs for assisted suicide are present at fewer than 30% of reported deaths, they may not know about complications that took place. [DHS Report, 3/10/04, p. 9]

Complications found in news reports were not included in official reports:

Patrick Matheny received his lethal prescription from Oregon Health Sciences University via Federal Express. He had 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, pro-assisted suicide attorney Cynthia Barrett described a botched assisted suicide. "The man was at home. There was no doctor there," she said. "After he took it [the lethal dose], 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 1999 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 declined to provide the lethal prescription. 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

The percentage of patients who were referred for counseling before receiving prescriptions for assisted suicide declined to only 5% during the sixth year. [American Medical News, 4/5/04] 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 Dr. Peter Goodwin, medical director of the assisted-suicide group Compassion in Dying (CID), determined that she was an "appropriate candidate" for death and referred her to a doctor who provided the lethal prescription. In an audiotape, 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: 2 or 4***
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. [ORS 127.800 §12; 127.815 §a] However, in the first two years of the law's implementation, at least one lethal dose was prescribed more than 8 months before the patient took it. [NEJM, 2/24/00, p. 599]

The sixth annual report noted that 2 patients who received prescriptions in 2002 and another who received the prescription in 2001 died from the lethal drugs in 2003. [DHS Report, 3/10/04, p. 11]

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

FIRST PHYSICIAN ASKED AGREED TO WRITE PRESCRIPTION

Official Reports: 27 (41%) in first three years****
Actual number: Unknown

"Many patients who sought assistance with suicide had to ask more than one physician for a prescription for lethal medication." [NEJM, 2/24/00, p. 603] Patients and their families can "doctor shop" until a willing physician is found. There is no way to know, however, why the previous physicians refused to lethally prescribe (i.e. the patient was not terminally ill, not competent, etc.), since non-prescribin physicians are not interviewed for the official state reports.

If a physician opposes assisted suicide or believes the patient does not qualify under the law, Compassion in Dying (CID) may arrange the death. According to Dr. Peter Goodwin, CID's medical director, about 75% of those who die using Oregon's assisted suicide law do so with CID's assistance. [Goodwin speech audiotape, Hemlock Society Conference, 1/11/03]

SHORTEST LENGTH OF RELATIONSHIP BETWEEN PATIENTS & PRESCRIBING PHYSICIANS

Official Reports: Less than 1 week
Actual length: Unknown

Although at least 2 weeks must elapse between the first and last requests for the lethal dose, [ORS 127.840 §3.08] the physician who prescribes the drugs for assisted suicide need not be the same physician to whom the first request was made.

For the 3rd through the 6th years, the doctor-patient relationship in some assisted suicide cases was under one week. [DHS Report, 3/10/04, p. 11] Thus, either some physicians are not complying with the 2 week requirement or they stepped in to write an assisted-suicide prescription after other physician(s) refused.

ASSISTED SUICIDE REQUESTS BASED ON FINANCIAL CONCERNS

Official Reports: 4 (2 %)
Actual number: Unknown

Over the 6 years of assisted suicide, 38% of patients whose deaths were reported were on Medicare or Medicaid. [DHS Report, 3/10/04, Table 4] The report does not differentiate between Medicare (for senior citizens) and Medicaid (for the poor).

Oregon's Medicaid program pays for assisted suicide but does not pay for many other medical interventions that patients need and want. [Oregonian, 4/26/99]

ASSISTED SUICIDE REQUESTS BASED ON FEAR OF BEING A BURDEN

Official Reports: 60 (35 %)
Actual number: Unknown

ASSISTED SUICIDE REQUESTS BASED ON INADEQUATE PAIN CONTROL

Official Reports: 37 (22 %)
Actual number: Unknown

The sixth official report notes that patients who who expressed concerns about pain control were not necessarily experiencing pain. [DHS Report, 3/10/04, Table 4]

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* Links to official Oregon reports and extensive documentation of information in this fact sheet.

** Official reports do not contain this category.

*** After the 2nd year, official reports stopped including this category.

**** After the 3rd year, official reports stopped including this category.