Prescription Death - Suicide as a Medical Treatment

by Rita Marker - December 18, 2007

Reprinted with permission.

Imagine that you are standing in line at the supermarket pharmacy. As you wait to pick up your prescription, you overhear the pharmacist explaining to the person ahead of you. "To induce death, mix all of this into a sweet beverage and drink it very quickly."

Unimaginable? Unfortunately, no – that type of prescription is currently permitted in Oregon.

In 1994, Oregon passed an assisted-suicide law, transforming the crime of assisted suicide into a "medical treatment." Since then, proposals patterned on Oregon's law have been introduced in 22 states – in many of those, multiple times – but not one has passed. Now, with a planned 2008 ballot initiative in Washington State, assisted-suicide activists hope to break the logjam.

Spearheaded by the euphemistically named Compassion & Choices (formerly known as the Hemlock Society), steps are being taken to achieve a win in Washington and propel that victory into states across the country.

To achieve their goal, they've taken a number of steps. Recognizing that all social engineering is preceded by verbal engineering, they've sanitized the language. The "s-word" is out. No longer do proponents refer to "physician-assisted suicide." Now it's called "physician-assisted death," "aid-in-dying," or "death with dignity." They've formed a political action committee called It's My Decision. They've started raising funds for the anticipated multi-million dollar campaign, and they've selected a primary spokesperson.

For a number of reasons, former two-term governor Booth Gardner was tapped to be the public face of the campaign. Although he has been out of office for over a decade, he remains exceptionally popular in the state. Gardner has pledged significant funding for it (he is heir to the vast Weyerhauser fortune). On top of that, he has Parkinson's Disease, adding the "Michael J. Fox effect," which could make opposition to his plea for the assisted-suicide law appear mean-spirited.

Assisted-suicide advocates plan to lull the public into accepting their proposal by claiming that it will give terminally ill adults the right to request "medication to end suffering" in accord with strict safeguards. They further claim that the practice will require careful reporting to add transparency and prevent abuse.

Oregon will be the centerpiece of the campaign.

Assisted-suicide activists use questionable studies about Oregon's law to bolster their claims that assisted suicide has been "working well in Oregon."

For example, a recent study by University of Utah philosophy professor Margaret Pabst Battin purported to prove that Oregon's law does not have a disproportionate impact on vulnerable people. The study, published in the Journal of Medical Ethics, received widespread attention in the media. However, Battin is a longstanding assisted-suicide activist who, as early as 1981, called on suicide prevention programs to adopt a more "humane" approach by cooperating with suicide advocacy groups. Currently she serves on the advisory board of the Death with Dignity National Center, an Oregon-based group that helps coordinate support for legalizing assisted suicide in other states. (That information was conveniently omitted from any identifying information in the Journal.)

In addition, assisted-suicide advocates claim that official reports on Oregon's law demonstrate that it has been free of problems. However, that claim cannot be verified. Consider the following:

All information in official reports is provided by those who carry out assisted suicide.

Under Oregon's law, doctors participating in assisted suicide must file reports with the state. The doctor first helps the person commit suicide and, afterwards, reports that his or her actions complied with the law. That information is then used to formulate the state's annual reports. But according to American Medical News, Oregon officials in charge of issuing the reports have conceded that "there's no way to know if additional deaths went unreported."

Several years ago, members of a British House of Lords committee traveled to Oregon seeking information regarding its law for use in their deliberations about a similar proposal that was under consideration in Parliament. They held closed-door hearings where authors of Oregon's official reports and physicians who carry out assisted suicide were surprisingly candid – perhaps because they assumed that their testimony, buried in Parliament's transcript of the hearings, would go unnoticed.

Melvin Kohn, a lead author of several official reports, said that information received from doctors "is a self-report, if you will, of the physician involved." Furthermore, there are no penalties for non-reporting.

Complications or other problems associated with assisted suicide are almost impossible to determine.

When Katrina Hedberg M.D., who also has headed up the formulation of official reports, was asked by the British Committee if there is a systematic way of finding out and recording complications, she said, "Not other than asking physicians." Yet even if they were inclined to report complications, physicians may not be aware of them, since "afterthey write the prescription, the physician may not keep track of the patient."

According to the last official report, physicians who prescribed the drugs for assisted suicide were present at only 21.5 percent of reported deaths. Therefore, any information they provide might come from secondhand accounts or be based on guesswork.

The state does not have any authority to verify whether reports made by assisted-suicide providers are accurate or complete. It also does not have the authority or the funding to track complications or abuse.

Dr. Hedberg told the British Committee, "Not only do we not have the resources to do it, but we do not have any legal authority to insert ourselves."

Records used in annual reports are destroyed.

According to Dr. Hedberg, "After we issue the annual report, we destroy the records." Therefore, there is no way to reexamine information if questions or concerns about an assisted-suicide death arise later.

Assisted-suicide advocates also claim that Oregon's law has safeguards to protect patients, but in destroying patient records, they've contradicted their own claims.

The waiting period between requests for assisted suicide and provision of the lethal prescription is based on political strategy, not patient protection.

Oregon's law requires a 15-day waiting period between the first request and the provision of drugs for suicide. Kathryn Tucker, legal counsel of Compassion & Choices, addressing a conference soon after Oregon's law went into effect, admitted that the waiting period was included to assure passage of the law. Referring to the waiting period, she explained that after failing in several states their strategy evolved:

In my view, the Oregon measure, in some sense, became overly restrictive. It has a fifteen-day waiting period. And my own view of the federal constitutional claim is that a fifteen-day waiting period would be struck down immediately as unduly burdensome. As we've seen in the reproductive rights context, you can't have a waiting period of that kind of duration. But in the legislative forum, to pass, you need to have measures that convince people that it's suitably protective so you see a fifteen day waiting period.

The required life expectancy of six months or less is both disingenuous and disregarded.

Oregon's law requires that patients be diagnosed with a life expectancy of six months or less before they are eligible for assisted suicide. However, a physician who has been involved in Oregon assisted-suicide deaths numbering in double digits said that such life expectancy predictions are inaccurate. Dr. Peter Rasmussen, an advisory board member for Compassion & Choices of Oregon, dismissed the need for an accurate prognosis of life expectancy. He told the British Committee:

Admittedly, we are inaccurate in prognosticating the time of death under those circumstances. We can easily be 100 percent off, but I do not think that is a problem. If we say a patient has six months to live and we are off by 100 percent and it is really three months or even twelve months, I do not think the patient is harmed in any way…

A doctor can help a mentally ill or depressed patient commit suicide.

Under Oregon's assisted-suicide law, a depressed or mentally ill patient can receive assisted suicide if the doctor believes the patient's judgment is not impaired. According to the last official Oregon report, physicians reported referring only 4 percent of assisted-suicide patients for psychological or psychiatric evaluation.

Assisted-suicide proponents also claim that the practice would never be expanded to anyone who is not terminally ill. However, in unguarded moments, they have often acknowledged that Oregon is only the "first step" toward death on demand. Nonetheless, they've been careful to keep those plans under wraps – until now.

To their dismay, Gardner has let the cat out of the bag. According to the December 2, 2007, New York Times Magazine cover story, "Death in the Family," about Gardner's campaign for assisted suicide:

Gardner wants a law that would permit lethal prescriptions for people whose suffering is unbearable, a standard that can seem no standard at all; a standard that prevails in the Netherlands, the Western nation that has been boldest about legalizing aid in dying; a standard that elevates subjective experience over objective appraisal and that could engage the government and the medical profession in the administration of widespread suicide… Gardner's campaign is a compromise; he sees it as a first step. If he can sway Washington to embrace a restrictive law, then other states will follow. And gradually, he says, the nation's resistance will subside, the culture will shift and laws with more latitude will be passed.

Compassion & Choices and other activists are none too happy about Gardner's candor. They'll desperately attempt to downplay any references to potential expansion of assisted suicide – until, as Gardner described, other states have joined Oregon and the nation's resistance has subsided.

Their success in achieving that goal will depend on keeping people ignorant of their agenda. Their failure depends upon an informed, concerned, and involved public.

Tempted to dismiss what's happening in Oregon? Wondering how Oregon-type laws in other states would affect you or your loved ones? Consider this:

• A doctor can prescribe a lethal dose of drugs to a person whose family may be totally unaware that a loved one is contemplating assisted suicide.
• Schools can inform students that assisted suicide is an acceptable medical choice.
• Medical students can be taught how to prescribe deadly drugs for patients to use to commit suicide.
• Insurance companies and state Medicaid can pay for assisted suicide, while denying coverage for wanted and needed medical care.

All of that is permitted in Oregon and could, if not effectively opposed, be coming soon to your state. The outcome of its assisted-suicide voter initiative will affect everyone across the country.

No matter where we live, we are all Washingtonians next year.

Rita L. Marker is an attorney and executive director of the International Task Force on Euthanasia and Assisted Suicide.