Happy 21st Oregon? No reason to celebrate

Oregon’s Dying With Dignity Act which allows medical practitioners to prescribe lethal drugs to a person to use to commit suicide came into force on 27 October 1997.

Oregon publishes annual reports on the operation of the Dying With Dignity Act.  Although the data is limited nonetheless a careful analysis of the 20 annual reports published to date reveals significant issues with the practice of physician assisted suicide in Oregon.

• Increase in number of deaths

The number of deaths from ingesting lethal substances prescribed under Oregon’s Death With Dignity Act reached 143 in 2017 continuing a steady rise since 1998, the first full year of the Act’s operation when 16 people died under its provisions. Assisted suicide accounted for 1 in 250 deaths in Oregon in 2017.

• Pain is not a major issue but “being a burden” is

The Oregon annual reports indicate that pain is not a major issue for those requesting physician assisted suicide.  Only 21% of those who died from ingesting a lethal dose of medication in 2017 mentioned a concern about pain control (they were not necessarily experiencing pain) as a reason for requesting assisted suicide.

However, more one out of two people (55.2%) cited concerns about being a “Burden on family, friends/caregivers”.

• Mental health: No adequate screening

Research by Linda Ganzini has established that one in six people who died under Oregon’s law had clinical depression. Depression is supposed to be screened for under the Act. 

However, in 2017 only 3.5% of those who died under the Oregon law were referred by the prescribing doctor for a psychiatric evaluation before writing a script for a lethal substance.

• Financial considerations             

Of those who died from ingesting a lethal dose of medication in 2017, more than one in twenty (5.6%) mentioned the “financial implications of treatment” as a consideration.

In two notorious cases, those of Barbara Wagner and Randy Stroup, the Oregon Health Plan informed a patient by letter that the particular cancer treatment recommended by their physicians was not covered by the Plan but that the cost of a lethal prescription to end their life would be covered.

• The misleading notion of a peaceful death

The lethal drugs prescribed for assisted suicide do not always result in a swift and peaceful death.

In 2017 more than one in nine (11.63%) of those for whom information about the circumstances of their deaths is available either had difficulty ingesting or regurgitated the lethal dose, had seizures or other complications or regained consciousness and died subsequently from the underlying illness.

The interval from ingestion of lethal drugs to unconsciousness has been as long as four hours (in 2017) while the time from ingestion to death has been as long as 104 hours (4 days and 8 hours). One person in 2017 took 21 hours to die.

Seven people have regained consciousness after ingesting the lethal medication, including one patient in 2010 who regained consciousness 88 hours (3 days 16 hours) after ingesting the medication, subsequently dying from underlying illness three months later.  

• Faulty prognosis

The Death With Dignity Act provides that before prescribing a lethal substance a doctor must first determine whether a person has a “terminal disease”.  This is defined as “an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six months”.

In 2017 one person ingested lethal medication 603 days (nearly 20 months) after the initial request for the lethal prescription was made.  The longest duration between initial request and ingestion recorded is 1009 days (that is 2 years and 9 months). Evidently in these cases the prognosis was wildly inaccurate.

• Not a terminal illness

There have been a total of 8 people for whom the “underlying illness” has been listed as “Endocrine/metabolic disease [e.g., diabetes]”. Arthritis, arteritis, stenosis and sclerosis (none of which are usually terminal illnesses) have also been recorded as the underlying illness justifying assisted suicide. This suggests that even the central requirement that an illness be terminal may not be strictly applied.

• Short relationship with attending physicians

The Oregon statute specifies that lethal prescriptions only be written by a person’s “attending physician” who is defined as “the physician who has primary responsibility for the care of the patient and treatment of the patient's terminal disease.”

The data indicates that in some cases doctors have had a relationship with the patient of less than one week’s duration and that in 2017, in half the cases the doctor-patient relationship was of 10 weeks duration or less.

• Who administers the lethal medication?

In 2017 either the prescribing physician (16.78%) or another healthcare provider (16.78%) was known to be present at the time the lethal medication was ingested. For the remaining two out of three (66.43%) people there was no physician or other healthcare provider known to be present at the time of ingestion.

In other words for two out of three cases there is no independent evidence that the person took the lethal medication voluntarily. It may well have been administered to them by a family member or other person under duress, surreptitiously or violently. We can never know!

Conclusion

Put away the cake and birthday candles – there is absolutely no reason to celebrate the 21^st anniversary of Oregon’s dangerous and deadly assisted suicide law.