Mystery in the Northwest

Recent state reports on the practice of assisted suicide in Washington and Oregon still leave unanswered questions.

OLYMPIA, Wash. — The annual assisted suicide reports for Washington and Oregon show that the numbers of those dying continue to rise, while the information gathered by officials seems increasingly deficient.

In Washington, Donn Moyer, communications director for the State Department of Health, reported that “87 prescriptions were written by 68 different physicians and dispensed by 40 different pharmacists.” The report covers the 2010 calendar year, including data received up to Feb. 9 this year.

Of the 87 people requesting prescriptions, 72 are “known to have died, [with 51 of the 72 dying] after ingesting the medication,” he said. Those who died were “between the ages of 52 and 99,” with 90% of the deceased having lived in western Washington, according to Moyer. (Western Washington is the more densely populated part of the state with the most liberal-leaning voting record.)

He added that most had terminal cancer when they died, with about 10% having neuro-degenerative diseases like amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease), and another 12% having heart problems and other diseases. 

According to prescribing physicians, 90% of those who died by lethal dosage of barbiturates “expressed concern about loss of autonomy as a reason for requesting a prescription.” Other reasons given were “loss of dignity and losing the ability to participate in activities that made life enjoyable,” according to the official DOH report.

Only three of the 87 patients were referred for formal psychiatric or psychological evaluation.

In a March 10 press release concerning the annual report, Compassion & Choices of Washington stated that the report figures showed that “a significant number of patients who received medication died without taking it, showing the benefit of comfort and control the law provides.”

Dr. Tom Preston, one of Compassion & Choices’ medical directors, stated: “The law is working exactly as voters intended.” The physician went on to say that legalized assisted suicide “is having a significant, positive impact on Washingtonians’ end-of-life experiences.” He remarked, “The medical community is integrating aid in dying into the standard of end-of-life medical care.”

The Oregon Public Health Division reported its statistics from assisted suicide in 2010 in January. The data released showed that 96 prescriptions for lethal medications had been written, with 59 patients having died from ingesting the medications. “In addition, six patients with prescriptions written during previous years ingested the medications and died during 2010 for a total of 65 known [assisted suicide] deaths at the time of this report.”

Most of those who died from lethal overdose were over 65 years of age, with a median age of 72 years. Cancer was the main underlying illness reported.

End-of-life concerns mentioned were “loss of autonomy, decreasing ability to participate in activities that made life enjoyable, and loss of dignity,” the Oregon report stated. 

Only one of the 65 patients was referred for formal psychiatric or psychological evaluation.

In a press release, Compassion & Choices of Oregon called the stability in the number of Oregonians dying from legalized assisted suicide the result of suicide being “a normal part of end-of-life care options.”

“People who honestly confront their imminent death, wherever they are, should be able to ask their doctors for an escape from intolerable suffering,” said Barbara Coombs Lee, president of Compassion & Choices.

As Compassion & Choices plays down the numbers of deaths in these annual reports, the suicide rate in Oregon, excluding deaths from assisted suicide, is 35% higher than the national average, according to a Sept. 10 report from the Oregon Health Authority. Among young Oregonians, aged 10 to 24, suicide is now the second-leading cause of death.

In a Dec. 29, 2010, Associated Press article, the rate of suicides in just one county in Washington, King County, “represented the highest rate in nine years of suicide, at 253 deaths.”

Margaret Dore, an elder law and appellate attorney practicing in Washington state, recently surmised that this might be caused by a kind of “suicide contagion.” 

“With the normalization of suicide under the Oregon and Washington acts, other suicides became normalized as well,” she suggested.

Missing Data a Great Concern

Those advocating for elderly, terminally ill and handicapped people in both states find nothing reassuring about the continued death toll from assisted suicide. They are critical both of what the reports say — and what they don’t say.

Eileen Geller, a nurse and president of True Compassion Advocates, points to problems “with the accuracy of the reporting and the timeliness of required documentation.”

The report states that 87 people received lethal doses of medications, with 72 individuals actually dying. Fifty-one people reportedly died after ingesting the lethal dose, and 15 died from other causes.

“The Department of Health does not know if the remaining six people died of assisted suicide or not. It has no idea about the status of the 15 remaining people who requested lethal drugs, whether they are alive or dead, and whether they died from natural causes or from assisted suicide,” she noted.

“The published data … is so limited and unreliable that even those agreeing with the policy have qualms regarding the health department’s inability to determine whether the law operates with the full safety and voluntariness its proponents were promised,” Geller emphasized.

Attorney Dore agrees that the resulting legislation “has significant gaps so that such control is not assured.”

A person’s heir, who benefits financially from the death, may assist in signing up the patient for a lethal dose. There is no requirement to have other witnesses present for that death.

Without disinterested witnesses, “an opportunity is created for someone else to administer the lethal dose to the person without his or her consent. Even if the person struggled, who would know?” Dore asked.

“The Washington report provides no information as to whether the people who died consented when the lethal dose was administered,” she added.

Although the Department of Health requires the prescribing physician to fill out the “After Death Reporting Form,” checking appropriate boxes from a list of seven choices, Dore says that the prescribing physician is rarely present at the death.

This makes it necessary “for the physician to rely on information provided by other persons, or possibly even making it up,” she suggested. “The information provided is [therefore] hearsay.”

Geller notes that “Washington’s 2010 report focuses on the ‘ingestion’ of the lethal dose, but this ingesting does not require a patient’s consent, competency or even awareness.”

“Assisted suicide in Washington is neither safe nor voluntary for those who feel coerced, can’t afford proper health care or are victims of unreported elder abuse,” she concluded.

Information Released Too Soon?

Similar criticism has been made of Oregon’s annual report by Physicians for Compassionate Care Educational Foundation, which noted that the state was releasing the 2010 information two months earlier than past reports, meaning statistics would be incomplete. Statistics would not yet be available about the 15 patients for whom prescriptions were written in 2010, as well as others who died that year.

The physicians’ organization also reported that two individuals did not die from the lethal drug prescription, but regained consciousness and died later from their underlying illnesses. 

“These are not easy drugs to take, being very bitter and foul-tasting,” the physicians’ group explained. Both patients had suffered attacks of vomiting following ingestion of the drug overdose, but neither apparently requested to retake it. Possibly “the experience [was] less pleasant than the promoters led them to believe,” the organization suggested.

“There continues to be no protection for depressed patients in Oregon,” with only one patient referred for psychiatric evaluation in 2010, according to Physicians for Compassionate Care. The organization quoted a 2008 study by researchers at Oregon Health Sciences University which found “that 25% of patients requesting assisted suicide were considered to be depressed.”

Even the Oregon Public Health Division expressed concern in 2009 about the decline in psychiatric evaluations, raising concerns that “depression remains undiagnosed in some patients who receive a prescription under the Death With Dignity Act,” according to Oregon physician Dr. Kenneth Stevens Jr.

Agreeing with those in Washington, the Physicians for Compassionate Care Educational Foundation expressed concern about missing information in the returned forms completed by prescribing physicians, whether health-care providers were present for their patient’s death, if emergency medical services were called following ingestion of the drugs, and the time it took between taking the drugs and unconsciousness and then death.

“When such a substantial proportion of important information is unknown,” the foundation asked, “how are Oregonians to know what is really happening with assisted suicides in the state?”

Elenor K. Schoen writes from Shoreline, Washington.