Oregon & Washington Suicide Study
A suicide study, published in the Southern Medical Journal, found an increase (6.3%) in total suicides, with a larger increase (14.5%) among individuals 65 or older, in Oregon and Washington after doctor-assisted suicide was legalized.
Moreover, there was no decrease in non-assisted suicides, even for those over 65. The findings counter claims by prescribed-suicide advocates that legalizing the practice reduces the overall number of non-assisted suicides.
Instead, according to the researchers, the introduction of doctor-assisted suicide “seemingly induces more self-inflicted deaths than it inhibits.” [Jones & Paton, “How Does Legalization of Physician-Assisted Suicide Affect Rates of Suicide?” Southern Medical Journal, 10/15, pp. 599-604]
In a commentary that accompanied the study, Dr. Aaron Kheriaty, a psychiatry professor at the University of California-Irvine School of Medicine, wrote that the study’s findings point to a phenomenon called suicide contagion, when one suicide generates other copycat suicides.
He suggests that the media attention given to doctor-prescribed suicides can encourage copycat suicides particularly for vulnerable individuals. Dr. Kheriaty described the widely-publicized assisted suicide of Brittany Maynard, the young, attractive newlywed with brain cancer who moved to Oregon to end her life using doctor-prescribed lethal drugs, as a case that could easily encourage copycat behavior.
But suicides don’t need to be publicized to be “contagious,” Kheriaty wrote. “[R]esearch suggests that behaviors like suicide, whether assisted or nonassisted, influence the behaviors of not only one’s friends but also of one’s friends’ friends’ friends.” [Southern Medical Journal, 10/15, pp 605-606]
[ http://www.patientsrightscouncil.org/site/update-078-volume-29-number-4-2015-4/ ]
Assisted Suicide Laws in Oregon and Washington: What Safeguards? (17 Aug 2015)
[Comment: This factual analysis should be read by everyone and kept for reference. It is extremely well done and crucial for any discussion of medicalized assisted suicide.
Unfortunately, even my home state of Missouri which has laws against assisted suicide had a case similar to the one referenced here about the Oregon physician who gave a lethal overdose. This Missouri case involved a nurse. The nurse gave a lethal overdose without a doctor’s order to a patient who had a stroke the day before but wouldn’t stop breathing when taken off a ventilator. After the patient’s son voiced support for the nurse, she was only sentenced to 5 years’ probation. See: “Missouri Nurse Only Gets Probation After Euthanasia Death”, online at http://www.lifenews.com/2003/12/03/bio-162/
My point is that when so-called “safeguards” are accepted (and ignored) in assisted suicide states, the mindset can affect prosecutions in other states even when those states reject assisted suicide. Thus, assisted suicide can affect any of us. N. Valko RN, 19 Aug 2015]
Assisted Suicide Laws in Oregon and Washington: What Safeguards?
Oregon’s law allowing doctors to prescribe lethal overdoses for some patients’ suicides was first approved in 1994; after a court challenge it took legal effect late in 1997. Supporters later modeled Washington’s 2008 law on Oregon’s law, saying that its safeguards are operating well and have prevented abuse. In fact the data suggest that the “safeguards” are largely meaningless, and the death toll in Oregon has greatly increased over the years.
In Oregon, 1327 lethal prescriptions have been written and at least 859 patients have used the drugs to take their lives; in 2014 there were 105 deaths, a 44% increase over the previous year and almost seven times the deaths in the law’s first full year.
In Washington, in less than six years, 725 prescriptions have been written for lethal drugs and at least 585 patients have died from the drugs; these numbers have steadily risen each year, so the number ingesting lethal drugs in 2014 (126 patients) is over twice the number in 2010 (51 patients), the first full year of the law’s operation.
Note: Unless noted otherwise, all data are from the official annual reports of Oregon’s and Washington’s health departments, referenced at end of this document; each year’s report also provides a summary of past years’ data for comparison.
Reporting or Concealing?
All reporting about doctor-assisted deaths is self-reporting by the doctors prescribing lethal drugs. Ore. Rev. Stat. 127.855 (7) and 127.865; Rev. Code Wash 70.245.120 and 70.245.150.
The Oregon Health Division noted in 1999: “There are several limitations that should be kept in mind when considering these findings…. For that matter, the entire account [by prescribing physicians] could have been a cock-and-bull story. We assume, however, that physicians were their usual careful and accurate selves.” Center for Disease Prevention & Epidemiology, Oregon Health Division, CD Reports, March 16, 1999, at 2.
These doctors have usually been members of, or close collaborators with, “Compassion and Choices” (formerly The Hemlock Society), which adamantly supports assisted suicide and promoted the new law. By C&C’s own figures, in the law’s first twelve years the group played an active role in 78% of Oregon’s assisted deaths; in 2009 they were involved in 97%. See K. Stevens, “The Proportion of Oregon Assisted Suicides by Compassion & Choices Organization,” March 4, 2010, at www.patientsrightscouncil.org/site/oregon-assisted-suicide-deaths/.
Doctors cannot report reliably on what happens at the time patients actually ingest the lethal overdose or at the time they die, as nothing in the law requires them to be present – and no one else who may be present is required to report.
In Oregon, the prescribing physician was known to be present at the time of death in only 11% of cases in 2013 and in 14% in 2014, compared to an average of 16.5% of cases in previous years. In both years, no health care provider was present in over 80% of cases (40% in previous years).
In Washington in 2014, the prescribing physician was known to be present in only 6% of cases (7 out of 126); in 38% of cases (48 out of 126), no health care provider was known to be present when the drugs were ingested.
These deaths are not allowed to be considered suicides or assisted suicides for any legal purpose. Ore. Rev. Stat. 127.880; Rev. Code Wash. 70.245.180.
In Oregon, doctors list patients’ underlying illness as the cause of death on death certificates; in Washington this falsified report is explicitly required by law. See M. Dore, “‘Death with Dignity’: A Recipe for Elder Abuse and Homicide (Albeit Not By Name),” 11.2 Marquette Elder’s Advisor 387-401 (Spring 2010) at 395; http://scholarship.law.marquette.edu/cgi/viewcontent.cgi?article=1027&context=elders.
The death certificate may be signed by the doctor who prescribed lethal drugs, completing this closed system for controlling and hiding information. Ore. Rev. Stat. 127.815 (2); Rev. Code Wash. 70.245.040 (2).
A Free Choice?
Despite medical literature on the frequent role of depression and other psychological problems in choices for suicide, the prescribing doctor (and the doctor he selects to give a second opinion) are free to decide whether or not to refer suicidal patients for any psychological counseling.
Even if such counseling is provided, its goal is to determine that the patient is not suffering from “a psychiatric or psychological disorder or depression causing impaired judgment.” Ore. Rev. Stat. 127.825; Rev. Code Wash. 70.245.060.
The doctors or counselor can decide that, since depression is “a completely normal response” to terminal illness, the depressed patient’s judgment is not impaired. See H. Hendin and K. Foley, “Physician-Assisted Suicide in Oregon: A Medical Perspective,” 106 Michigan Law Review 1613-45 (2008) at 1623-4; available at https://docs.google.com/file/d/0BwDPETL1NPnAMmFjZTNjNzctOGU4NS00MTUwLTgxZjAtM2I4NDhlMjA2OTFj/edit?hl=en&pli=1
From 1998 to 2012, on average only 6.2% of patients who died under the Act in Oregon were referred for counseling to check for “impaired judgment.” In 2013-2014 this declined to less than 3%. Of 108 patients who died under the Act in 2007 and 2009, none was referred for psychological evaluation.
In Washington, only 4% of patients are known to have been referred for such counseling in 2014 (six of the 167 who died from any cause after receiving the prescription); the state does not report whether any of those who actually ingested the lethal drugs had been referred for counseling.
Physicians are to encourage patients requesting a lethal prescription to notify their next of kin, but they are to proceed even if this does not occur. Family notice is optional. Ore. Rev. Stat. 127.835; Rev. Code. Wash. 70.245.080.
Physicians are to certify that the patient is “capable” (or in Washington, “competent”) and is “acting voluntarily.” Ore. Rev. Stat. 127.855; Rev. Code Wash. 70.245.040. But only “good faith” compliance with these and other requirements of the Act is necessary, ignoring physicians’ usual obligation not to act negligently. Ore. Rev. Stat. 127.885 (1); Rev. Code Wash. 70-245-190 (1). See Hendin and Foley, op. cit., at 1629-30.
Once lethal drugs have been prescribed the Act has no requirements for assessing the patient’s consent, competency, or voluntariness. No witnesses are required at the time of death.
Despite the law’s efforts to prevent public scrutiny, a few cases have become known in Oregon:
– One woman with cancer received doctor-assisted death although she had dementia, was found mentally incompetent by some doctors, and had a grown daughter described as “somewhat coercive” in pushing her toward the lethal prescription. See Hendin and Foley, op. cit., 1626-7.
– A man received the prescription although he was well known to have suffered from depression and suicidal feelings for decades; guns had been removed from his house because he was so prone to suicide, but authorities left the lethal prescription in his home. He had already arranged to take the lethal overdose when other physicians averted this outcome by offering to address his pain and other concerns; he died comfortably of natural causes a few weeks later after reconciling with his daughter. See Physicians for Compassionate Care Education Foundation (PCCEF), “Five Oregonians to Remember,” at www.pccef.org/articles/art60.htm.
In Oregon, fewer patients had cancer in 2013 and 2014 (65% and 69% respectively) than in past years (80%).
More patients instead had other, chiefly chronic conditions with a less predictable future: chronic lower respiratory disease (10% in 2013), ALS or “Lou Gehrig’s disease” (16% of patients in 2014), MS, Parkinson’s disease, diabetes, heart disease, etc. Many of these are health problems commonly associated with aging; in 2014 the median age of those dying under the Oregon law was 72.
Of the 105 patients who took the lethal drugs and died in 2014, eleven had been diagnosed as having less than six months to live, and given the lethal prescription, in 2013 or 2012.
Since 1998 there have been three Oregon patients whose illnesses were “unknown” – that is, the physician named no illness at all, but the case was still listed as meeting the law’s requirements.
From Assisted Suicide to Homicide
Can others take an active role in ending the patient’s life? Oregon law speaks of the patient as “ingesting” medication to end his or her life. Ore. Rev. Stat. 127.875. Washington law says patients will “self-administer” the drugs, but defines “self-administer” to mean “ingesting.” Rev. Code Wash. 70.245.020; 70.245.010 (12). But “ingesting” ordinarily means absorbing or swallowing; so this does not seem to bar others from administering the drugs. If such action is in accord with the Act, it may not be treated as a homicide. Ore. Rev. Stat. 127.880; Rev. Code Wash. 70.245.180 (1). See M. Dore, op. cit., 391-3.
After an Oregon patient with physical disabilities was “helped” by a relative to take the lethal overdose, the Oregon deputy attorney general wrote that if the law does not allow such active assistance it may violate laws guaranteeing equal access to health care such as the Americans with Disabilities Act. Letter of Oregon deputy assistant general David Schuman to state legislator Neil Bryant, March 15, 1999.
An Oregon emergency room physician was asked by a woman to end the life of her mother who was unconscious from a stroke. He tried to stop her breathing or heartbeat in several ways, finally giving a lethal dose of a paralyzing drug to the older woman who died minutes later. The state board of medical examiners reprimanded the doctor but he faced no criminal charges for this direct killing — which news reports called a case of “assisted suicide” — and he later resumed medical practice. See PCCEF, op. cit.
Consistently, most of those dying under the Oregon law have not been married or in another formally committed relationship; in 2013, 11% of the patients had never been in such a relationship (compared to 8% in previous years). Those dying under this law were also more likely to have no or only governmental health insurance in 2013 and 2014 (56% and 60% respectively, compared to 35% in past years).
In 2013, more were likely to cite being a “burden” on others as a reason for taking the drugs (49% compared to 39% in previous years).
It seems solitary, dependent and chronically ill patients are becoming prime candidates for assisted suicide in Oregon. In Washington, 57% of the patients for whom this information is known (82 out of 143) were dependent solely on Medicare or Medicaid in 2014, and 59% (85 out of 143) cited being a “burden” on others.
In all, 22 patients in Oregon are known to have regurgitated some of the lethal dose, and six regained consciousness after taking the drugs and died later, apparently from their underlying illness (see Oregon Report for 2012, Table 1 and note 13).
In Washington there have been at least 7 cases of regurgitation and 2 cases of waking up after ingesting the drugs.
For Oregon data, including archived annual reports from past years, see Oregon Health Authority, “Death with Dignity Annual Reports,” at http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignity Act/Pages/ar-index.aspx.
For a direct link to the two most recent years:
Oregon Health Authority, “Oregon’s Death with Dignity Act – 2014,” at http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignity Act/Documents/year17.pdf
Oregon Health Authority, “Oregon’s Death with Dignity Act – 2013,” at http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignity Act/Documents/year16.pdf
For Washington data, see Washington State Department of Health, “Death with Dignity Act,” at http://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/DeathwithDignityAct
A direct link to the Department’s “2014 Death with Dignity Act Report”: http://www.doh.wa.gov/portals/1/Documents/Pubs/422-109-DeathWithDignityAct2014.pdf.
[8/17/15, http://www.usccb.org/issues-and-action/human-life-and-dignity/assisted-suicide/to-live-each-day/upload/Oregon-and-Washing-euthanasia-2013.pdf ]