Under Oregon's iron shroud: Real people, real deaths

Killing is most easily done in the shadows, behind closed curtains, under cover of darkness where nobody can see. So it isn't surprising that Oregon bureaucrats imposed an iron shroud of secrecy over assisted suicide, which that state's voters legalized in 1994. Shortly before the law went into effect, state bureaucrats were publicly threatened with firing if they ever leaked details of assisted suicides. The law even requires death certificates to be falsified so that no one can trace assisted suicides through the public records. Would that our national security were as tightly protected as is information about assisted suicide in Oregon!

All of this secrecy has a point, of course. Proponents of legalizing assisted suicide hope to use their beachhead in Oregon as the first step toward national acceptance. State-imposed secrecy serves this purpose in several ways.

First, secrecy prevents the state from truly becoming a national "test tube" for assisted suicide, an approach in which each case would have to be thoroughly studied and investigated before as well as after the hastened death.

Proponents of assisted suicide would never stand for this. It would expose the false premises at the heart of their movement, stripping bare their claim to a monopoly on compassion. It would permit a detailed exploration of the causes that lead people to request assisted suicide, disproving the assertions of the assisted-suicide movement that these cases are "last resorts" when nothing else can be done to alleviate unbearable suffering. For example, studies show that the three primary causes of suicidal tendencies in terminally ill people are lack of effective pain control, clinical depression, and poor family support.1 The good news is that the first two are eminently treatable and the third is ameliorable with concerted intervention by community and church organizations. Another key point is that desires to die are often transitory;2 that is, a dying person may wish to "get it all over with" today, and be glad still to be alive next Sunday. This presents great opportunity for effective suicide prevention. Imagine the image of a once-suicidal person telling 60 Minutes that he is now glad he did not take the poison pills. Imagine the impact on the public debate if scores of suicidal persons chose instead to embrace life after receiving appropriate treatment and community interventions. The assisted-suicide movement's worst nightmare would be realized.

Second, official secrecy permits proponents-many of them working in the Oregon government-to mount a national propaganda campaign about the virtues of assisted suicide by controlling the flow of information and the spin on news stories. This advocacy campaign is abetted by the uncritical media which swallow whole the positive reports issued annually by the Oregon Health Department, a version of which is then published in the New England Journal of Medicine (NEJM)-a publication that is so blatantly in favor of assisted suicide that some critics have taken to calling it the "New Euthanasia Journal of Medicine."

The primary emphasis of the first year's report about assisted suicide was the small number of people whose deaths were legally facilitated by doctors: fifteen. Of course, even one physician-assisted death would be a significant violation of the Hippocratic Oath and the sanctity-of-life ethic. But a closer look at the report revealed even more about which to be concerned. Assisted suicide was sold to Oregon voters as the escape valve to help those very rare cases where, allegedly, nothing can be done to alleviate severe pain while dying. Yet, according to the study of the fifteen reported assisted suicides of 1998, published in the NEJM, 3 none of the cases involved people who were in unrelenting and intolerable pain. Rather, "the decision to request and use a prescription for lethal medication was associated with concern about loss of autonomy or control of bodily functions."4 It also appears that many of the assisted deaths did not take place in the context of a meaningful relationship between the patient and the doctor who wrote the lethal prescription. Six of the fifteen asked more than one doctor for the lethal prescription. At least one, perhaps more, had been in contact with the prescribing physician for only 15 days.5 Judging by the few cases we do know the details of, it is highly likely that at least some of the doctors had close affiliations with assisted-suicide advocacy groups.6 Moreover, the report was as notable for what it didn't cover as for what it did. The best sources of information about the deceased patients-treating physicians who did not lethally prescribe and family members-were not interviewed. This raises the question: what did the investigators not want to know?

The number of assisted suicides in the second full year of legalization (1999) nearly doubled, with 27 reported cases. Other than that disturbing trend, there was not much different in the second year's NEJM assessment.7 The primary reasons people killed themselves remained the same: worries about needing help with daily life and the loss of the ability to engage in enjoyable activities. Perhaps in reaction to the criticism of the first year's reports, this time some family members were interviewed, but only those recommended to the researchers by the lethally prescribing doctors. Even so, these people added another disturbing statistic to the report. According to family respondents, 47 percent of the people who committed assisted suicide did so, in part, because they were worried about burdening their families.

Advocates for the disabled are rightly appalled by the NEJM reports. In testimony before the California Assembly's Judiciary Committee in opposition to an assisted-suicide bill that ultimately failed, activist Paul Longmore addressed this crucial aspect of the Oregon experience, pointing out that assisted suicide wasn't about dying but about becoming disabled:

Fear of disability typically underlies assisted suicide.... The advocates play on that horror of "dependency..... If needing help is undignified and death is better than dependency, there is no reason to deny assisted suicide to people who will have to put up with it for 6 or 16 years, rather than just 6 months. Not that we favor assisted suicide if it is limited to terminally ill people. We simply want to ask, has this country gotten to the point that we will abet suicides because people can't wipe their own behinds?8

Longmore's blunt assessment speaks volumes not only about why assisted suicide is wrong but also about why it is so dangerous.

Real people, real deaths

Statistical recitations are bloodless affairs that fail to adequately convey the flesh-and-blood tragedy of the Oregon law. Fortunately, despite the best efforts of assisted-suicide advocates and state bureaucrats to control the flow of information, we know enough about real cases to demonstrate that legalization has been bad medicine and even worse public policy.

The information provided below comes from a variety of sources. Some comes from the heart of the beast, released at news conferences by devoted assisted-suicide advocates, whose ideology blinded them to the harsh reality of what they described. Other information comes from various news reports, much of it leaked to the press by family members of assisted-suicide victims. Some was uncovered by anti-assisted-suicide advocates who have been able to peer beneath the iron shroud.

The first reported legal assisted suicide was of Mrs. A-a woman diagnosed with terminal breast cancer. Information released by the assisted-suicide advocacy group Compassion in Dying (CID) disclosed that it was not because of unbearable suffering and agony that the woman took the prescribed poison. Rather, in her own words played posthumously on audiotape at a CID news conference, she wanted to "be relieved of all the stress I have."9 But stress caused by growing debilitation, while certainly a very real and substantive medical issue, is a treatable condition that does not require killing to alleviate.

A subsequent in-depth analysis of this case by medical and bioethics experts gave an even more detailed account of these troubling events. Upon receiving her terminal diagnosis, the woman asked her treating doctor to assist her in committing suicide. The doctor refused. She consulted with a second doctor, who also declined and diagnosed her as depressed. She then contacted CID, whose medical director, Dr. Peter Goodwin, spoke with her twice on the telephone, after which he decided that she wasn't depressed but merely "frustrated." Goodwin then referred her to a doctor he knew would be willing to prescribe lethally. That doctor referred her to a psychiatrist, who saw her only once, and a second doctor who confirmed the terminal diagnosis. He also conducted a "cursory" discussion with the patient about alternatives to assisted suicide. When she voiced fears of being kept alive by artificial nutrition if she did not kill herself, the death doctor failed to assure her that she had the right to refuse such care-perhaps a crucial factor in her decision to swallow the prescribed poison. The woman died a mere 2 1/2 weeks after her first meeting with the prescribing physician, at a time when she was not in pain and still looked after her own house.10

That was not careful medical practice. It was pure Kevorkianism.

The Kate Cheney case, reported in the (Portland) Oregonian,11 provided a disturbing glimpse of how easily the guidelines designed to protect the vulnerable are circumvented. Cheney, age 85, was diagnosed with terminal cancer and sought assisted suicide. But there was a problem: she was probably in the early stages of dementia, raising significant questions about her mental competence. So, rather than prescribe lethal drugs, her doctor referred her to a psychiatrist.

Her daughter, Ericka Goldstein, accompanied her to the psychiatric consultation. The psychiatrist found that Cheney had a loss of short-term memory. Even more worrisome, it appeared that her daughter had a greater interest in Cheney's assisted suicide than did Cheney herself. The psychiatrist wrote in his report that while the assisted suicide seemed consistent with Cheney's values, "she does not seem to be explicitly pushing for this." He also determined that she did not have the "very high capacity required to weigh options about assisted suicide." Accordingly, he nixed the lethal prescription.

Advocates of legalized assisted suicide might, at this point, smile happily and point out that such refusals are the way the law is supposed to operate to protect the vulnerable. But that isn't the end of Kate Cheney's story. According to the Oregonian report, Cheney appeared to accept the psychiatrist's verdict but her daughter did not. Goldstein shopped for another doctor.

Goldstein's demand for another opinion was acceded to by Kaiser Permanente, Cheney's HMO. This time, the consultation was with a clinical psychologist rather than an MD psychiatrist. Like the psychiatrist, the psychologist found that Cheney had memory problems. For example, she could not recall when she had been diagnosed with terminal cancer. The psychologist also worried about familial pressure, writing that Cheney's decision to die "may be influenced by her family's wishes." Still, despite these reservations, the psychologist determined that Cheney was competent to commit suicide.

The final decision to approve the death was made by a Kaiser ethicist/ administrator named Robert Richardson. Dr. Richardson interviewed Cheney, who told him she wanted the poison pills not because she was in irremediable pain but because she feared not being able to attend to her personal hygiene. After the interview, satisfied that she was competent, he approved the lethal prescription.

Cheney did not take her poison right away. At one point she asked to die when her daughter had to help her shower after an accident with her colostomy bag, but she quickly changed her mind. Then she went to a nursing home for a week so that her family could have some respite from caregiving. The time in the nursing home seems to have pushed Cheney into wanting immediate death. As soon as she was brought home she declared her desire to take the pills. After grandchildren were called to say their goodbyes, she took the pills. She died with her daughter at her side, telling her what a courageous woman she was. If she was depressed, there was no doctor to diagnose it. If she was coaxed (which was not contended in the Oregonian story) there were no witnesses from outside the family to protest. The assisted-suicide law's "safeguards" give absolutely no protection once the lethal prescription is written.

Then there is the case of Patrick Matheny. When Patrick Matheny committed assisted suicide, his brother-in-law claimed he had to "help" him die because Matheny's ALS (Lou Gehrig's disease) left him unable to self-administer the lethal drugs he had received a few months before via Federal Express-so much for "compassion."12 A cursory investigation by the local district attorney, in which the brother-in-law wasn't even questioned, quickly concluded that no illegalities had occurred.

What happened next confirmed opponents' predictions about where legalization of assisted suicide must eventually and logically lead. Oregon's Deputy Attorney General, David Schuman, claimed in a letter to a state senator that, in order to avoid "discrimination" against disabled people, Oregon might have to offer "reasonable accommodation"13 to people like Matheny who want to commit assisted suicide but cannot self-administer their prescribed lethal drugs. (Self-administration is assumed to be the core "protective" guideline of the assisted-suicide law.) What might the term "reasonable accommodation" mean? If you have a "right" to be made dead, but because of disability cannot effect this end yourself, then somebody is going to have to do the deed for you: in a word, killing. Active euthanasia may just be a lawsuit away in Oregon, despite the repeated promises of proponents to the contrary.

Meanwhile, there is one more snag in the way of painless and dignified death: as opponents of assisted suicide warned, not every attempt at selfkilling works. Instead, the suicidal person might end up with terrible vomiting, or comatose but still alive. Proponents branded such arguments lies and alarmism, although Hemlock Society founder Derek Humphry had warned publicly in 1994 that up to 25 percent of assisted suicides under the Oregon law could "fail."14 State secrecy helps prevent such failed attempts from being made public, but strong evidence of at least one such case has been uncovered. Catherine Hamilton, of Physicians for Compassionate Care, a medical group opposed to the Oregon law, attended a class at Portland Community College entitled "Physician-Assisted Suicide: Counseling Patients/Clients." The speaker was Cynthia Barrett, a pro-assisted-suicide elder-law attorney. In the public-affairs magazine Brainstorm, Hamilton described what happened:

Barrett broke from her outlined handout and gave an example of a [failed attempt]. "The man was at home; there was no doctor there," she said. The eight or nine students in the small classroom were silent, waiting to hear more. Barrett went on. "The wife was there. Other family were there. He [the patient] took the prescription. After he took it, he began to have some physical symptoms.... The symptoms were hard to handle. Well, she (the wife) called 911 ... The guy ended up being taken by 911 to a local hospital. Revived. ln the middle of it. And taken to a local nursing facility .... He died a short time after that time."15

When news of this failed assisted suicide received modest publicity in Oregon, Hamilton appeared on a talk-radio show opposite an assisted-suicide advocate who had also attended the class. When the man denied Hamilton's account of the failed suicide, she revealed that she had taped the session. The advocate then hung up, claiming he had other business to attend to.

Tellingly, the details of none of the four cases recounted here made the New England Journal of Medicine or the official reports published by the Oregon Health Division. These real flesh-and-blood cases demonstrate that assisted suicide is a tragic abandonment of people in difficult circumstances just when they need to have their lives valued the most. No wonder advocates want to keep the truth about doctor-facilitated killing buried under the deep darkness of Oregon's iron shroud.

NOTES

1. Harvey Max Chochinov, et al., "Desire for Death in the Terminally III," American Journal of Psychiatry, 152:8, August 1995, p. 1185.

2. Harvey Max Chochinov, et al., "Will to Live in the Terminally Ill," The Lancet, Vol. 354, September 4, 1999, pp. 816-819.

3. Chin, Hedberg, Higginson, Fleming, "Legalized Physician Assisted Suicide in Oregon-The First Year's Experience," NEJM 1999, 340: 577-583.

4. Id., 577. 5. Id., 581.

6. The authors of the NEJM study asked the prescribing doctors if they were affiliated with assisted suicide groups. However, they did not reveal the answers in the published report.

7. Amy D. Sullivan, et al., "Legalized Physician-Assisted Suicide in Oregon-The Second Year," New England Journal of Medicine, February 23, 2000, pp. 588-604.

8. Paul Longmore, Testimony before the California Assembly Judiciary Committee opposing AB 1592, April 20, 1999.

9. Kim Murphy, "Death Called 1st Under Oregon's New Suicide Law," The Los Angeles Times, March 26, 1998.

10. Hendin, Foley, and White, "Physician-Assisted Suicide: Reflections on Oregon's First Case," Issues in Law & Medicine, Vol. 14, No. 3, 1998.

11. Erin Hoover Barnett, "Is Mom Capable of Choosing to Die?" The Oregonian, October 17, 1999.

12. Erin Hoover Barnett, "Man With ALS Makes Up His Mind to Die," The Oregonian, March 11, 1999.

13. Correspondence from David Schuman, Oregon Deputy Attorney General, to State Senator Neil Bryant, March 15, 1999.

14. Derek Humphry, "Oregon's Assisted Suicide Law Gives No Sure Comfort to Dying," Letter to the Editor, New York Times, December 3, 1994.

15. Catherine Hamilton, "The Oregon Report: What's Hiding Behind the Numbers?" Brainstorm, March 2000.

Wesley J. Smith is an attorney for the International Anti-Euthanasia Task Force. His next book will be Culture of Death: The Destruction of Medical Ethics in America, to be published in the fall by Encounter Books.

Copyright Human Life Foundation, Incorporated Spring 2000
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