Oregon Suicide Cloaked in Secrecy
PORTLAND, Ore. — After drinking half of a fatal dose of pentobarbital, a vile-tasting intravenous tranquilizer commonly used to euthanize animals, the patient vomited. Before he could drink the rest of the poison, he lapsed into a coma. He died two days later.
The patient's final cause of death was either brain damage caused by drug-induced oxygen starvation, pneumonia caused by aspirating his own vomit or suffocation at the hands of a family member or friend.
The only thing certain is that the patient didn't die from the lethal prescription provided to him by a physician under Oregon's Death With Dignity Act. Yet this is how his demise is recorded in the sixth annual report on the act, published March 10 by Oregon's Department of Human Services.
This is why Dr. Kenneth Stevens, director of Physicians for Compassionate Care, warns there is a “wall of secrecy around assisted suicide.” Stevens said the sixth-annual report, like the previous five, is incomplete and misleading.
“Under the guise of confidentiality, assisted suicide is practiced covertly in Oregon,” he said.
He said the number of doctors prescribing more than one lethal dosage is unknown, as is much about their cause of death. That, Stevens said, is highlighted by this death.
“Those are fast-acting barbiturates that last only about six hours,” he said. “If the patient died after 48 hours, what was the actual cause of death?”
Even the choice of pentobarbital as the preferred prescription for physician-assisted suicide deserves more attention and analysis, he said.
“They say it is being used orally, but how are we to know?” he asked.
Noting that some patients died within five minutes, Stevens said this indicates the possibility they were injected.
“Oral barbiturate medication needs time to be absorbed and enter into the tissues of the brain, and it seems that five minutes is too soon for that to occur,” he said.
“The state has no control and has not been asking the right questions,” he contended. “As a result, this is in the hands of doctors and patients [who are not held accountable].”
It has been a decade since Oregon's voters approved the nation's only assisted-suicide law. Oregon's Death With Dignity Act, approved by referendum in 1994 and again in 1997, has been used to provide 265 lethal prescriptions, which have resulted in 171 deaths, according to the state report.
Again last year, the number of people seeking to end their lives under the act increased. A total of 42 physicians wrote 67 prescriptions, nine more than 2002 and 23 more than the 44 prescriptions written in 2001. Deaths also continue to increase, with 42 people taking their own life last year, four more than 2002 and twice as many as the 21 people who died from lethal prescriptions in 2001, according to the Department of Human Services.
Darcy Niemeyer, director of the agency's Office of Disease Prevention and Epidemiology, doesn't disagree with Stevens' criticism but says there is little her office can do.
“At the time this was assigned to us, [Department of Human Services] was given very limited oversight and no budget,” she said.
Drawing on the recommendations of the bipartisan Task Force to Improve Care for Terminally-Ill Oregonians, the agency developed its criteria for what data it should and shouldn't collect.
However, the agency still has only one full-time employee collecting and analyzing data for the report, Niemeyer said, “and there still is no budget. His time and other resources come out of other budgets. This restricts how proactive we can be in gathering data.”
“Over the years, we have modified the report,” she said, adding “loss of dignity” to the list of reasons cited by those seeking lethal prescriptions in 2003. “Next year, we'll begin reporting the number of prescriptions written by each physician.”
“We have also noted trends, including the decline in the number of patients referred for psychological evaluation [from 31% in 1998 to 5% in 2003], but we can't make evaluations,” Niemeyer said. “We have to keep in mind our role, the limitations on it and on our resources.”
Meanwhile, Compassion in Dying of Oregon's executive director, George Eighmey, points to the last six years with pride, saying they prove fears about physician-assisted suicide are misplaced.
His organization is so happy it's published a book on it. Compassion in Dying: Stories of Dignity and Choice is a compilation of accounts by friends and family of those who ingested lethal prescriptions under Oregon's Death With Dignity Act, which was sponsored and promoted by the group, originally called the Hemlock Society.
Eighmey said these accounts demonstrate that other states should follow Oregon's lead and permit doctors to give terminal patients the choice of hastening their own deaths.
“All of the fears expressed by opponents of the law haven't come true,” he said. “There's no evidence of coercion, of little old ladies or the vulnerable being forced to kill themselves.”
He points to the report's conclusion that assisted suicide remains an extremely rare choice, accounting for only 14 out of every 10,000 deaths during the year in the state, and one most likely to be made by urban, college-educated, divorced or never-married people.
As with previous years, suffering was rarely cited as a cause. Instead, loss of autonomy and the ability to engage in enjoyable activities accounted for 93% of those who sought to end their lives. Eighty-two percent saw “loss of dignity” as unendurable.
“We're seeing younger, well-educated people saying, ‘When I get to that line where life is no longer worth living, I feel it is my right not to cross it.’ In the last month, I've had a Catholic, an Adventist and an atheist give me that same response,” Eighmey said.
Compassion in Dying, which popularized the use of living wills, advance medical directives and medical care based on quality-of-life considerations by patients, their families and doctors, continues to be the leading supporter of the act in the state's battle with Attorney General John Ashcroft, who is attempting to prohibit doctors from prescribing controlled substances for use in physician-assisted suicide.
In his 1995 encyclical Gospel of Life, Pope John Paul II warned that “moved by an understandable even if misplaced compassion,” family members may consent to loved ones' deaths. “All this is aggravated by a cultural climate which fails to perceive any meaning or value in suffering, but rather considers suffering the epitome of evil, to be eliminated at all costs. This is especially the case in the absence of a religious outlook.”
Philip S. Moore writes from Vail, Arizona.
- May 2-8, 2004