the truth about
Assisted Suicide
The Oregon Department of Human Services has recommended active screening for depression in the elderly as an important factor in reducing suicides.
Background on Physician-Assisted Suicide
In November 1994, Oregonians voted to pass an initiative measure which allowed terminally ill patients to request a prescription of lethal drugs from a physician by which they could commit suicide. With the passage of Measure 16, Oregon became the first jurisdiction in the world to legalize physician-assisted suicide.
The measure was quickly challenged in court. In August of 1995, it was declared unconstitutional based upon the equal protection clause of the 14th Amendment.
The judge’s opinion stated that Measure 16 created a classification of people (terminally ill, diagnosed with less than six months to live) who were treated differently by no longer qualifying for protection against suicidal impulses as do the rest of Oregon citizens.
His decision asked, “Where in the Constitution do we find distinctions between the terminally ill with six months to live, the terminally ill with one year to live, paraplegics, the disabled, or any category of people who have their own reasons for not wanting to continue living?”
The district court’s decision was appealed to the 9th Circuit Court of Appeals, who dismissed the case in February 1997. The appellate court’s ruling was based not on the merits of the case, but on the decision that the plaintiffs lacked standing to challenge Measure 16. The case was then appealed to the U.S. Supreme Court.
The 1997 Oregon Legislature returned Measure 16 back to the November 1997 ballot for reconsideration and repeal as Measure 51. The repeal effort lost. The U.S. Supreme Court declined to hear the case. Assisted suicide became legal in Oregon in November of 1997.
Immediately following the repeal defeat, Congressman Henry Hyde released a letter from Thomas Constantine from the Drug Enforcement Agency (DEA). Constantine, in response to questions from Congressman Hyde, interpreted the DEA’s responsibility if controlled substances were to be used for something other than a “legitimate medical purpose.” The DEA’s assessment was that “delivering, dispensing or prescribing a controlled substance with the intent of assisting a suicide would not be under any current definition a ‘legitimate medical purpose.’ As a result, {assisted suicide} would be, in our opinion, a violation of the CSA (Controlled SubstanceAct).”
In June of 1998, Attorney General Janet Reno issued her opinion which overturned the findings of Thomas Constantine. In August of 1998, Senator Don Nickles and Congressman Henry Hyde introduced the Lethal Drug Abuse Prevention Act which would have outlawed controlled substances being used for assisted suicide. The bill received a hearing in the House and the Senate, but was not voted on.
Assisted suicide has been legally allowed in Oregon since November 1997.
Description of Physician Assisted Suicide
The process of physician-assisted suicide (PAS) is rather lengthy and complicated. The patient must be diagnosed with a terminal illness and have six months or less to live. A second doctor must confirm this diagnosis. There is no requirement for a psychiatric examination. If the doctor thinks the patient is suffering from depression he can order a psychiatric exam. In 1994, a survey showed 94% of doctors cannot recognize depression. In 2004, only 5% of PAS victims had psychiatric exams.
After qualifying as a candidate for PAS, the patient must verbally request assisted suicide drugs twice. These requests must be separated by at least 15 days. The patient then signs a written request, witnessed by 2 people. The doctor can then write the prescription.
After getting the prescription filled, the patient may take the drugs at any time, immediately or at a later date. The doctor may not administer the drugs. The patient must take the drugs by himself with the help of no one. The doctor is not required to be present when the drugs are taken. A report must then be filed with the state by the attending physician, but no oversight is permitted in the matter.
In 2019, the Oregon Legislature passed Senate Bill 579. This bill eliminated the waiting period for those diagnosed with two weeks or less to live.The journalMayo Clinic Proceedings, in a November 2005 article, printed that survival predictions were made, as part of a study, for 468 patients in hospice programs. Only 20 percent of the predictions were accurate. “While it is incredibly hard for physicians to accurately prognosticate someone’s life expectancy,” says Anderson, “It is not incredibly hard for a person in a position of influence to bully a sick person into obtaining lethal drugs. Eliminating the waiting period will make this even easier.”
Depression & Physician Assisted Suicide
An estimated 90% of suicides in the U.S. are associated with mental illness, most commonly depression.
Diagnosing depression can be challenging, even in patients with cancer and other serious illnesses. A survey of 1109 cancer patients and their physicians reported that the physicians accurately classified only 20 of the 159 moderately to severely depressed patients, and rated 78 of these patients as having essentially no depressive symptoms. In other words, the patients’ cancer physicians were accurate in diagnosing moderate or severe depression only 13% of the time.
Suicide is a leading cause of death in Oregon, particularly among the elderly. Oregon ranks sixth in the nation for our annual rate of elderly suicide, and has an elderly suicide rate that is 156% of the national average. The Oregon Department of Human Services has recommended active screening for depression in the elderly as an important factor in reducing suicides.
With that background, it is extremely troubling that none of the 49 patients who were reported to have died of physician-assisted suicide in Oregon in 2007 were referred for psychiatric evaluation. Overall, between 1998-2007, only 11% (36/341) of the reported physician-assisted suicide deaths in Oregon were referred for psychiatric evaluation.
It is a tragedy that none of these 49 physician-assisted suicide patients received such an important evaluation. None of these patients, who were considered to be terminally-ill by their physicians, were granted the standard of health care that other patients are expected to receive. In that sense, they were discriminated against. This is another example of how physician-assisted suicide patients in Oregon are receiving inadequate and sub-standard care from their physicians.
