Oregon’s experiment, which is limited to assisted suicide, raises a particular concern as there is no witness known to be present in two out of three cases in which the lethal poison is ingested.
It may have been administered to them by a family member or other person under duress, surreptitiously or violently. Such is the design of this assisted suicide scheme that we can never know.
What we do know is that assisted suicide is being chosen more for existential reasons, including feeling a burden on family and friends (54% of cases) than because of any concern about inadequate pain control (mentioned by 25% of people).
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 21 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 168 in 2018 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 213 deaths of persons aged 18 or more in Oregon in 2018.
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 one in four (25.7%) of those who died from ingesting a lethal dose of medication in 2018 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 (54.16%) 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 2018 only 3 out of 168 (1.78%) 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. This means it is likely that about 25 people with clinical depression were prescribed and took a lethal poison without being referred for a psychiatric evaluation.
Of those who died from ingesting a lethal dose of medication in 2018, more than one in twenty (5.35%) 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 rapid and peaceful death
The lethal drugs prescribed for assisted suicide do not always result in a swift and peaceful death.
In 2018 one in nine (11.11%) of those for whom information about the circumstances of their deaths is available either had difficulty ingesting or regurgitated the lethal dose or had other complications or regained consciousness and died subsequently from the underlying illness. In 2017 two people had seizures after ingesting the drugs.
The interval from ingestion of lethal drugs to unconsciousness has been as long as four hours (in 2017). In 2018 for one person the interval from ingestion of lethal drugs to unconsciousness was as long as 60 minutes.
The time from ingestion to death has been as long as 104 hours (4 days and 8 hours). One person in 2018 took 14 hours to die.
Eight 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.
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 2018 one person ingested lethal medication 807 days (2 years and 2 1/2 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 11 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 2018, in half the cases the doctor-patient relationship was of 10 weeks duration or less.
Who administers the lethal medication?
In 2018 a physician or other healthcare provider was known to be present at the time the lethal medication was ingested on only half the cases. And in one in five of those cases the provider left before death occurred. This means that in 50% of cases there was no physician or other healthcare provider known to be present at the time of ingestion and in 61.3% of cases there was no physician or other healthcare provider known to be present at the time of death.
In half the cases there is therefore 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.
Oregon’s 21 year experiment with an assisted suicide law, far from providing a model that other jurisdictions should follow, serves as a warning that such a law cannot guarantee that all deaths from assisted suicide are either voluntary or peaceful, or limited to those who actually meet the eligibility criteria.