Under Oregon’s assisted suicide law, a doctor who suspects that depression is the cause of a patient’s wish to die is supposed to refer the patient for a psychiatric evaluation before prescribing lethal drugs. However, a recent study shows that “safeguard” is not being followed.

In the study published in the British Medical Journal, OHSU researchers evaluated 58 Oregonians who asked for help with assisted suicide. Psychiatrists found that 15 suffered from depression and 13 suffered from anxiety. However, none of those 28 patients received a psychiatric evaluation, even though some received prescriptions for lethal drugs and at least three used them to kill themselves. The study concluded, “The current practice of the Death with Dignity Act may fail to protect some patients whose choices are influenced by depression.” The study’s authors called for “increased vigilance and systematic examination for depression among patients who may access legalized aid in dying.”

According to state records, not one of the 46 Oregonians who died in 2007 by taking a lethal prescription was evaluated by a psychiatrist or a psychologist. A total of 341 Oregonians have died by physician-assisted suicide.

Study leader Linda Ganzini, an OHSU professor of psychiatry, explains the lack of screening by saying she thinks physicians believe that depression is rarely a factor in a suicide request and, therefore, do not look for it. William Toffler is an OHSU professor of family medicine and the national director of Physicians for Compassionate Care, an organization opposed to physician-assisted suicide. Toffler asserts that the study points out the reality of “the deterioration of end-of-life care as a result of physician-assisted suicide.” It is Toffler’s opinion that Oregon’s Death with Dignity law has “desensitized” doctors toward end-of-life patients. He believes that all patients should be required to have mental health assessments before they can receive prescribed suicide drugs. He says that if patients who are depressed were to receive treatment, many would withdraw their suicide requests. “There’s absolutely incontrovertible evidence that people change their minds when they are given support and care,” explained Toffler.

The study has heightened significance in light of the state of Washington’s passage of a similar measure legalizing assisted suicide. Wesley Smith, a bioethics expert on euthanasia and assisted suicide observes (see accompanying article on this page), “The guidelines are not actually there to protect the vulnerable, but merely to give the appearance of control. And if one doctor says no, the patient just goes doctor shopping until one is found who will prescribe [the lethal drugs]. . .So, there is no protection of depressed patients in Oregon, and none is really intended. Beyond that, the guidelines in Oregon and Washington do not require actual treatment of the depressed before a prescription is issued. Of course, when doctors and mental health professionals abandon depressed patients to death, who will protect them?”