PORTLAND, Ore.—In 1997 Oregonians voted to allow physicians to prescribe a lethal dosage of drugs for mentally sound patients who wish to commit suicide.

In 1999 the debate over the issue continues.

Euthanasia advocates contend that nothing has changed in Oregon, except that people are free to commit suicide with the help of their doctors. Not everyone agrees.

Dr. Bill Toffler, a physician from Portland, said that he has seen a definite climate change in health-care practices since the measure became law. “Many people no longer have the level of trust they once did in the doctor-patient relationship,” he told the Register.

A report released earlier this year by the Oregon Health Association revealed that 15 people had taken advantage of the new measure.

Robert DuPriest, regional director of Physicians for Compassionate Care, in Eugene, noted that the state's suicide rate is already 42% higher than the nation's — 63% higher for people over age 75.

In this light, “adding 15 more cases by physician-assisted suicide is a tragedy for Oregon, not a great value,” DuPriest said.

Toffler also pointed out that there is no way of knowing how many people actually committed suicide. Doctors who assist with suicides are asked, but not required, to file reports which list only basic information, such as the patient's name, age, diagnosis and prognosis. Further details are not necessary.

‘People need empathy and support from their physicians, not a lethal prescription.’

He said that the Oregon Medical Association actively opposed the Death with Dignity Act before it was passed, calling it “seriously flawed,” partly because of this lack of accountability.

Toffler added that 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,” he asserted. “It's very specious to suppose that legalizing assisted suicide will ‘get it out in the open.’”

Even the health association report issued earlier this year admitted, “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.”

Many doctors are also worried that lonely and unconnected patients are at risk because of this law. According to the report, 13 of the 15 victims who ended their lives were divorced, single or never married. These people, Toffler contended, most likely “turned to suicide in isolation and desperation.”

Dr. Gregory Hamilton, a psychiatrist from Portland, said his fear was that identification and treatment of depression in dying patients could be overlooked in these and other cases. “People need empathy and support from their physicians, not a lethal prescription,” he added.

However, Hannah Davidson, director of Oregon Death With Dignity, said she thought it unlikely that a depressed person would be allowed to commit suicide.

“Doctors are aware of any question of depression and are very cautious,” she said. “I've never heard of a person being allowed to commit suicide who was depressed. These people are going to die. So there's undoubtedly sadness. But it's not depression in the way we think of it. This is really the end of their life.”

Yet, Hamilton cited the first case of legal assisted suicide in Oregon, which was reported in several medical journals, including the American Medical News and The American Journal of Psychiatry.

The longtime physician of an 80-year-old woman refused to write her a lethal prescription, and referred her to another doctor who would be more open to the procedure. The doctor examined her and diagnosed her as depressed. He said she was not eligible for assisted suicide and prescribed anti-depressants.

The woman's husband then contacted the euthanasia activist organization Compassion in Dying. A doctor who was working there diagnosed the woman over the phone as mentally competent and referred her to other doctors, one of whom wrote her the prescription. Three weeks later she was dead. “No one challenged this,” Toffler said.

Asked about this case, Davidson, of Oregon Death With Dignity, pointed out, “Four out of five doctors who spoke with her said she was not clinically depressed. One of them did a psychiatric evaluation. There was only one physician who thought she might be depressed.”

‘Handled Very Poorly’

Hamilton, however, saw the facts much differently.

“You have at least four psychiatrists saying in print in reputable journals that this case was handled very poorly,” he said. “At the very least, ask why the three other pro-suicide doctors did not check with the second doctor, who was also pro-suicide, to see why he found grounds for depression.”

Depression may not even be the lone criterion being used to justify suicide nowadays, Toffler warned.

In a recent suicide case, Patrick Matheny, a Coos Bay resident who suffered from amyotrophic lateral sclerosis (Lou Gehrig's disease) received a lethal prescription but kept putting off taking it.

In the end, he couldn't swallow the pills. His brother-in-law told the Oregonian newspaper that “he had to help him to end his life,” but he didn't say how.

“No one bothered to find out,” Toffler said. “All the district attorney asked was, if the victim asked to be killed. No one asked why the brother in law helped to kill him.”

Despite this recent case, Toffler is optimistic. “I think it's possible to re-educate the public on this issue, and I think other states will be more wary of the risks involved in legalizing this practice.”

He hoped that the measure had a chance of being repealed. “We've actually been quite successful in airing the flaws in the law. We'll continue to be vigilant and eventually the truth will set us free.”

Regina Doman is based in Front Royal, Virginia.

Physicians for Compassionate Care can be reached at P.O. Box 6042, Portland, Ore. 97228, (503) 533-8154.