Troubling History of Physician-Assisted Suicide in Oregon

By Elenor K. Schoen

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In 2006, Dr. William Toffler, National Director of Physicians for Compassionate Care Education Foundation (PCCEF) in Oregon, made a statement to the BBC concerning an upcoming vote in Britain's House of Lords on a physician-assisted suicide bill (later defeated 148 to 100).

He said: "There has been a profound shift in attitude in my state since the voters of Oregon narrowly embraced assisted suicide 11 years ago. A shift, I believe, that has been detrimental to our patients, degraded the quality of medical care, and compromised the integrity of my profession."

Problems arising from the passage of assisted suicide in Oregon

Dr. Toffler noted that patients "with serious illnesses are sometimes fearful of the motives of doctors or consultants." One woman confided to him that she feared her oncologist "might be one of the 'death doctors.'"

Toffler reported that in his own practice, he regularly receives notices that "many services and drugs for my patients-even some pain medications-won't be paid for by the state health plan."

The health coverage has been reduced for in-home palliative care as well. At the same time, he says, "assisted suicide is fully covered and sanctioned by the state of Oregon and by our collective tax dollars," listing the procedure under "pain management."

Because of a state budget shortfall in 2003, the Oregon Health Plan dropped from their beneficiary list 10,000 low-income Oregonians - including patients with AIDS, those awaiting bone marrow transplants, the mentally ill, and those with seizure disorders. In the next two years, an additional 75,000 Oregonians were cut from the plan's list.

Sixty percent of Oregon physicians limit or do not see Medicaid patients; 40 percent limit or do not see Medicare patients. Seventeen percent of Oregonians are without health insurance, a statistic increasing at a rate faster than any other state over the past four years.

Even though Oregon has the sixth highest suicide rate among those over 65 years of age (excluding those who die from assisted suicide), less than 5 percent of assisted suicide recipients had mental health consultations between 2003 and 2005, and only two of the 46 patients who died by assisted suicide in 2006 were first referred for psychiatric evaluation.

The "safeguards" in the law insist that patients must be competent and capable of self-dosing, are not depressed, have made the choice without coercion, and have a life expectancy of less than six months. However, many patients have died who:

Patients and their family members have "shopped around" for physicians willing to prescribe high-dose barbiturates.

A study from June 2000 to March 2002 showed that there were twice the number of dying patients considered to be in moderate or severe pain and distress as there were prior to the passage of Oregon's physician-assisted suicide law.

In the March 18, 2008 "Death with Dignity" report, released by the Oregon Department of Human Services showed that:

Numbers of reported prescriptions and deaths tripled since the first year assisted suicide was legalized, with a 30 percent increase in just the past year.

Not one patient was referred for psychological evaluation, some patients were given lethal prescriptions after knowing the prescribing physician for less than a week, and one patient lived for a year and a half after receiving the lethal prescription, even though only patients with six months or less to live are allowed access to physician-assisted suicide.

These are the cases that are known, but, according to Shane Macaulay, M.D, a physician in Washington State, the real statistics "are shrouded in secrecy." He said: "There is no way to verify the reliability of the reports issued by the state.

Under Oregon's assisted suicide law, the state has no authority to investigate abuses or physician noncompliance. It's a listing of whatever was provided to them [by prescribing physicians] and nothing more."