Smoke and mirrors: physician assisted suicide in Oregon
by Susan Brinkmann
CS&T Correspondent
Appearances can be deceiving.
Take the physician assisted suicide program in Oregon. On the surface, it appears to be going very well. The reports are glowing, the controls seem to be working, people are dying with dignity.
Well, perhaps not.
“There’s a lot that may not be as it appears,” says attorney Rita L. Marker, executive director of the International Task Force on Euthanasia and Assisted Suicide, a non-religious public policy advocacy group.
Marker, who has addressed audiences around the globe on the subject, warns that even though the people who are behind physician assisted suicide truly believe in what they’re doing, they have no idea how dangerous this proposal is for society.
“They truly believe this would be a ‘choice’ and no one would be forced into it if they didn’t want it” Marker said.
“What they don’t realize is that this is a public policy, and ethical ‘Rubick’s cube,’”she said. “When you change one part of it, you change everything. They don’t get that. It’s not that they’re going about it the wrong way. They’re promoting something that is really dangerous, but they assume that it’s not going to be harmful to people.”
For example, Marker, who has been involved with the movement for decades, said she’s never seen a poor person in an assisted suicide group.
“Not only are they opposed to this, they’re scared to death of it,” she said. “Most of them realize that what would be a choice for the rich will become the only so-called medical option the poor can afford.”
It doesn’t take much imagination to figure that out. In an age of HMOs and managed care, the least expensive options are always chosen. A lethal overdose of drugs costs about $50, compared to other options, such as hospice and nursing homes, which offer comfort care at prices beyond the reach of the poor.
Is that what is happening in Oregon?
“In a way, it is,” Marker said. “Oregon Medicaid provides healthcare for the poorest Oregonians, but it doesn’t cover a lot of the health care that poor Oregonians want and need — but it does cover assisted suicide.”
But aren’t there guidelines in place to prevent the potential for abuse?
“These protective guidelines are as protective as the emperor’s new clothes,” Marker said. “We often read something and think we know what it means. What’s not in a piece of legislation is as important as what is in it. Every word has meaning.”
For example, most people believe that if a person is depressed, he can’t be given a lethal overdose of drugs. Not true, Marker says.
“The only requirement for assisted suicide in the state of Oregon is that you be an adult, a resident, and that two doctors have diagnosed you as having six months to live. It has nothing to do with pain, or anything else. The law says that if your doctor believes you have a mental illness or depression that is causing impaired judgment, the doctor is to refer you for counseling, which is defined as one session with a psychiatrist or psychologist.”
And that only applies to people whose depression may be impairing their judgment — meaning they don’t know what they’re doing when they ask for the lethal prescription. Most doctors acknowledge they don’t always pick up on depression, and even when they do, many people can feel depressed without necessarily having clouded judgment.
The truth is that the law does not protect persons suffering from depression from being given a lethal overdose. In fact, state reports even indicate patients with dementia may have received the drugs.
Another common misunderstanding is that PAS is only supposed to be a last resort for people who are suffering from unrelenting pain.
In reality, pain was the least reported factor in why people chose PAS in Oregon. Losing autonomy was the most prevalent reason, at 85 percent; decreased ability to enjoy life was a factor in 77 percent; losing control of bodily functions was the reason for 63 percent, and being a burden on family was stated by 34 percent.
Guidelines in the law also say a doctor has to ask the patient if he wishes to notify his family.
However, as Marker points out, that doesn’t mean the family must be notified — only that the physician has to ask the patient if he wishes to do so. As a result, there are cases where a family has learned about a loved one’s death by PAS when a family member got a phone call asking where to send the patient’s body.
Another example of the “smoke and mirror” guidelines is the stipulation that doctors must inform patients of all their options.
“That doesn’t mean the patient can afford them all,” says Marker, who represents only low-income clients. “Even getting adequate pain-control costs money. But the law doesn’t say you have to make the options accessible to the patient. It just says you have to tell them about it.”
In other words, the “guideline” does nothing to prevent abuse of the poor by powerful HMOs.
Another deceiving guideline is that which is supposed to prevent abuse by greedy family members or exhausted care takers.
“The law says that at the time the patient requests the prescription, the patient must do this knowingly and voluntarily,” Marker says. “Well, this sounds really good. However, there’s nothing in the law that says the patient has to take the deadly drugs knowingly and voluntarily.”
In other words, a person may request PAS, and get the prescription, but change his mind and decide not to take it. Then a family member, for whatever reason, could decide to administer the pills without the patient’s knowledge.
The law also says you can’t coerce someone to take the overdose.
“But you can certainly urge, wheedle and coax them into it,” Marker said. In fact, the wife of the founder of the Hemlock Society, Anne Humphrey, who committed suicide, left a note saying her husband drove her to it.
It’s also untrue that people who chose PAS die peacefully, Marker says.
Many suffer a common complication associated with an overdoses of barbiturates, which is vomiting; that, in turn, leads to inhaling and choking, she said.
Feelings of panic, terror and assaultive behaviors are also known to have occurred with that type of death. Newspaper reports detail accounts of patients having to be suffocated with pillows or plastic bags, or even waking up days later and wondering why the drugs didn’t kill them.
Is that what is really happening in Oregon?
“We don’t know, because all of the reporting is done by the doctors who actually prescribe the overdose,” Marker says. “Do you really think they’re going to say, ‘Oh, by the way, I didn’t follow the law?’ This is why you have to preface everything you read in Oregon’s official reports with the word ‘reported’ number of deaths, ‘reported’ number of abuses, etc.”
When assisted suicide advocates say Oregon is proof that PAS can work, don’t believe them, Marker says: “No one can rely on those reports to say what’s really happening. I can’t tell you how many abuses there are, how many doctors are not abiding by guidelines. I can’t tell you if these statistics are correct or not.
“But,” she adds, “neither can they.”
For more information, visit the Web site at http://www.internationaltaskforce.org.