NCCB Secretariat for Pro-Life Activities
On February 26, the Oregon Health Services Commission voted 10-to-1 to add assisted suicide to the priority list of treatments provided to Medicaid patients under the Oregon Health Plan. Lethal drugs will be funded as an integral part of "comfort care," ranking 260th on Oregon's priority list of 745 services. While federal law prohibits use of federal Medicaid funds for assisted suicide and related expenses or for any benefits package that includes it, the Commission said it could integrate the practice into its health plan so long as it is paid for solely with state funds [The Oregonian, 2/27/98].
While the Commission said denial of public funds for assisted suicide would "discriminate" against the poor in a state where the practice is legal, this stance was challenged from several directions. No one representing poor Oregonians or those who serve them testified in favor of the funding, while some -- such as Catholic Charities and the Northwest Seasonal Workers Association -- testified against it. In an opinion piece in the state's largest newspaper, Archbishop John Vlazny of Portland and Robert J. Castagna of the Oregon Catholic Conference asked: "What could be more discriminatory to a class of poor people, dependent on a public health program, than to suggest to them that the public is willing to help pay for their deaths rather than their continued medical care?" [The Oregonian, 3/15]. Even Ron Adkins, pro-suicide activist and husband of Jack Kevorkian's first assisted suicide client, agreed: "Many Oregonians believe suicide, in any form, is morally wrong," he wrote. "To force them to pay for my choice, or yours, is also morally wrong" [The Oregonian, 3/3].
Institutionalization has nonetheless continued, with the state's largest academic health center preparing a "guidebook" for health professionals and six health experts planning a fact-finding trip to the Netherlands to garner advice on how to move further [The Oregonian, 3/6].
On March 25 the pro-suicide group Compassion in Dying announced that a woman with breast cancer in her mid-80s had become the first person to die from a drug overdose prescribed in accord with the Oregon law. In an audiotape released by the group, the woman said she could not see herself "living a few more months like this," because she was once active but had become too weak for gardening or other favorite activities. Compassion in Dying said she died in her Portland home, surrounded by family and attended by a physician located by the group. Reportedly the woman's own physician had refused to prescribe lethal drugs, and a second physician she consulted had concluded that her request for death was due to depression. While pro-euthanasia forces in Oregon gave subdued reactions to the woman's death, Hemlock Society USA was less restrained: "Hooray for the people of Oregon," said Hemlock executive director Faye Girsh on hearing the news. "I'm in awe. This is an historic moment" [AP, 3/25; The Oregonian, 3/26].
The unnamed elderly woman's status as first patient to die under the law was soon questioned, as an unidentified Portland woman told press in a telephone interview that a close relative with cancer had died under the assisted suicide law before March 25. The physician in that case was provided by the state Hemlock Society. Because neither family wanted more publicity and state officials are committed to secrecy in such cases, only details selected by pro-suicide advocacy groups could be learned -- a fact that provoked new calls for more public accountability regarding assisted suicide cases. Barbara Coombs Lee of Compassion in Dying rejected calls for public scrutiny: "The public doesn't deserve to know anything except to know the law is available and the rules are being followed" [The Oregonian , 3/29].
In March Jack Kevorkian attended his 100th assisted suicide, and expanded his practice to include a young quadriplegic man who had no life-threatening illness.
On February 23 Kevorkian and his apprentice, psychiatrist Georges Reding, attended the death of 76-year-old Muriel Clement of North Branford, Connecticut. Ms. Clement, who had Parkinson's disease, died from an injection of poison [Reuters, 3/24/98]. She was a "right to die" activist who had lobbied her home state's legislature on the issue the week before visiting Kevorkian [Id., 3/25].
On February 26 Kevorkian attended the death of a young African-American man who had been rendered quadriplegic by a spinal infection. Roosevelt Dawson, 21, of Southfield, Michigan had checked himself out of a Grand Rapids hospital that same day, after Kevorkian's attorney Geoffrey Fieger won a court case against the hospital which had tried to detain Dawson because of his suicidal depression. Disability groups and social service providers, including the Detroit Archdiocese's Project Life, learned of the case through an article in the February 26 Oakland Press and tried to reach Dawson with offers of help; but relatives helped him to make the three-hour trip to Southfield immediately after leaving the hospital and he was dead that night [UPI, 3/26]. The Oakland County medical examiner ruled the death a homicide by lethal injection [UPI, 2/27].
On March 5 Kevorkian dropped off two more bodies of people with non-terminal conditions at Detroit-area hospitals. William Connaughton, 42, of Boston had a muscle disorder known as fibromyalgia, while Patricia Greyham, 61, of Roanoke, Virginia had rheumatoid arthritis [Reuters, 3/7; Detroit News, 3/9]. On March 13 Kevorkian attended the death of a man described by Fieger as his "100th patient": Waldo Herman, 66, of Detroit, who had lung cancer [Detroit News, 3/14]. On March 26 Kevorkian dropped off the body of 67-year-old Mary Judith Kanner of Southfield, Michigan, who had Huntington's disease [UPI, 3/27].
Despite a busy schedule Kevorkian had time to attend Time magazine's 75th anniversary celebrity gala in New York on March 3, escorting Fieger employee Rebecca Eaton. Eaton says that "everyone wanted to talk to Dr. Kevorkian," and actor Tom Cruise went out of his way to tell Kevorkian that he supports what he is doing. Because Eaton wanted to meet actor Kevin Costner at the gala, Kevorkian approached him and said: "If you don't come meet my date, I'm going to kill you." Costner came over [Detroit News, 3/7].
"Angel of Death" at California Hospital?
Jack Kevorkian may have some competition in Los Angeles, where a respiratory therapist claims to have performed 40 to 50 "mercy killings" at Glendale Adventist Medical Center since 1989. Efren Saldivar, 28, confessed the killings to police on March 11, but has not been arrested due to insufficient evidence; the California State Respiratory Care Board suspended his professional license for 30 days on March 27 pending further investigation.
Reportedly Saldivar had three criteria for killing patients by suffocation or lethal injection: "They had to be unconscious, have a do-not-resuscitate order, and they had to look like they were ready to die" [Seattle Times, 3/28; Reuters, 3/30].
Canadian Doctor Loses License
The first Canadian physician convicted of assisting a suicide lost his medical license at a disciplinary hearing in Ontario on March 12. Dr. Maurice Genereux, 50, pled guilty in December to criminal charges that he prescribed drugs to help two HIV-positive men commit suicide in 1996. One patient died, while the other recovered after a friend found him and called an ambulance; the survivor has testified that Genereux should be banned from ever writing another prescription. Genereux's license was also temporarily suspended in 1994 after allegations of sexual misconduct with patients. He will be sentenced in criminal court next month [CNews, 3/13].
We recognize the controversy regarding terms to describe the provisions of the Oregon Death With Dignity Act. While some professionals use the term "physician-assisted suicide," others prefer the term "physician aid-in-dying."... Because of our neutral position, the Task Force does not intend to fuel this debate... We have chosen to use the term "physician-assisted suicide" because it underscores both the physician's responsibility in providing medication to end life under the Act and the patient's voluntary choice to end his/her life by self-administering the medication. (p. 4)
Although requests for physician-assisted suicide are often attributed to uncontrolled pain, research has shown that other physical symptoms, psychological or existential distress may be equally or more important... The attending physician should seek to understand what constitutes unacceptable suffering in the patient's view. (p. 5)
An individual provider, such as a physician or a hospice nurse, who is opposed to physician-assisted suicide may want to refrain from discussing it with an inquiring patient. However, the desire to avoid discussion of what is morally reprehensible to the provider may prematurely stifle discussion of the patient's overall needs.... If, after a full discussion with the patient, the provider cannot continue to care for the patient, the provider must transfer care so that the needs of the patient can be met and the continuity of the patient's care maintained. To do otherwise would be abandonment. (p. 7)
No hospice in Oregon will refuse to admit or care for a patient or deny support to a patient's family because the patient intends to end his/her life under the Death With Dignity Act. While hospices differ in the extent to which they will participate, some hospices have established policies that will allow their employees to be at the bedside of a patient at the time a lethal dose of medication is self-administered... Many hospices are developing guidelines to support patients who choose to discontinue nutrition and hydration as a means of hastening death. (p. 12)
Under the Act, physicians are not allowed to provide a lethal injection if the patient's self-administered medication does not result in death. Such an act could leave the physician open to homicide charges and disciplinary action... A health care provider may be present when the patient takes the medication to end life, but the level of assistance he/she may give to the patient is not clear. (pp. 25, 27)
Although the Act calls for a decision that the patient is or is not competent to request a lethal prescription, in clinical practice, competency exists on more of a continuum. Competency standards specific to the decision to seek a prescription to end life have not been developed.... The presence of depression does not necessarily mean that the patient is incompetent. (pp. 30, 31)
Predicting an effective lethal dose and the speed with which it will cause death for an individual with any degree of certainty is difficult.... The patient and anyone else who will be present when the patient self-administers the medication must be informed of the expected time line with oral ingestion; specifically, of the possibility of coma for several hours before death or that, on rare occasions, death may occur up to 24 hours after ingestion of the medication. (p. 33)
[I]nformation regarding the identity of patients, health care providers, and health care facilities obtained by the [Oregon Health] Division with respect to compliance with the Act shall be confidential. (p. 44)
In Virginia, both chambers of the legislature have agreed on final language for a new ban on assisted suicide. As approved by the Senate 34-to-6 on March 11, and by the House 89-to-6 on March 12, the new law provides for civil penalties for assisting a suicide as well as revocation of the professional license of any health care provider involved. The bill ran into trouble last month when the Senate approved an amendment to allow penalties only against health professionals [see Jan./Feb. Life at Risk]; the final version provides for injunctions and civil penalties against anyone who assists a suicide.
In Michigan, where House and Senate have been unable to agree on language for a permanent ban since a temporary ban expired in 1996, the impasse ended this month with approval of S.B. 200. On March 12, the House defeated a bill to legalize assisted suicide, 69-to-38, then approved S.B. 200 to ban the practice, 66-to-40. The bill had been approved by the Senate in December, 28-to-7 [see Jan./Feb. Life at Risk]. The final bill does not contain a provision referring the issue to a statewide ballot which the House had insisted on in earlier debates. It is still not known whether a separate referendum campaign, led by the group "Merian's Friends," will gather enough signatures to place the issue on the ballot this November.
In Maryland, another impasse was partly overcome on March 23 when the Senate approved a new ban 27-to-20. Such bills had died in committee in both chambers in previous years.
In other states, bills to legalize assisted suicide remain unwelcome. In Connecticut, a state targeted by the national Hemlock Society for attention, a bill to create a task force to reconsider current penalties for assisted suicide died in the Judiciary Committee in March without a hearing.
In Congress, news of the deaths in Oregon has intensified interest in a clarification of federal drug laws. The first assisted suicide in Oregon where details are known involved an overdose of barbiturates, which can only be legally obtained using a federal prescribing license from the Drug Enforcement Administration (DEA). Attorney General Janet Reno has not yet decided whether such a license may be revoked when it is misused to assist a suicide; to date at least 34 Senators and 84 House members have urged her to find in favor of revocation, as the DEA itself did in November.