Assessing the Impact of Oregon's Law

While Oregon's law allowing physician-assisted suicide took effect last fall, its long-term impact remains unclear. There is even some confusion about its immediate impact.

The first confusion involves the actual number of assisted suicides, due to the veil of secrecy drawn by state officials across the practice. Two cases were announced by pro-suicide groups in late March, but details were sparse and the cases were not confirmed by state officials [see March Life at Risk]. Reports of a third case occurring in April reached news outlets in May, but no one directly involved could confirm the report. The Oregon Health Division says it will release some statistical information only after ten completed cases are officially reported [The Oregonian, 5/9/98].

Together the Hemlock Society and Compassion in Dying say they have received 42 requests for assisted suicide. Hemlock says it was contacted by 27 people, of whom 18 were ineligible (because they were not terminally ill or not Oregon residents), four obtained hospice care after talking with Hemlock, two died before obtaining a lethal prescription, and two still wanted assisted suicide but had not begun the formal process. Compassion in Dying says it received 15 requests from seriously ill patients, of whom four died of natural causes, three were ineligible, and seven are at some stage of the process [Id., 4/24].

Noting that even this information is hearsay from ideologically committed groups, many observers have called for more better reporting of assisted suicides, arguing that this is needed to assess the practice and prevent coercion of vulnerable patients. The Oregon legislature has assigned a joint committee to study the law and suggest changes; co-chair Senator Ken Baker says he favors better reporting, as well as mandated psychological review of patients and notification of families [Catholic Sentinel (Portland), 5/15].

Oddly, the Oregon Medical Association, which favored rescinding the entire assisted suicide law during last year's statewide campaign, now opposes even minimal reforms of this kind. At its House of Delegates meeting in late April, the association voted to oppose mandated psychological review and to favor keeping prescriptions under the act "confidential" -- making it difficult for pharmacists to know a drug's purpose or to exercise a right of consci-entious objection [American Medical News, 5/25].

The state legislative committee has held no hearings as yet on these issues, saying that they may be rendered moot by federal action. U.S. attorney general Janet Reno still has not ruled on whether prescribing controlled substances for assisted suicide is contrary to federal drug laws. Even if she rules that it is not, the issue may be addressed by Congress: 138 House members and 37 Senators have written to Reno urging her to uphold the Drug Enforcement Administration's authority to prevent the use of federal prescribing licenses to assist suicides.

The DEA's legal case was strengthened on May 14 when a U.S. District Court upheld its authority to close down "cannabis clubs" in California, despite passage of a state referendum allowing the medical use of marijuana. "Federal law supersedes state law," says Justice Department spokesman Gregory King [Chicago Tribune, 5/27].

Assisted suicide advocates in Oregon are not taking this lying down. The Oregon Death with Dignity Legal Defense and Education Center, founded by the sponsors of the Oregon assisted suicide initiative, has hired the Washington D.C. public affairs firm Bass and Howes to lobby against congressional action on this issue [Washington Post, 5/21]. The firm was previously best known for its "abortion rights" efforts, including a campaign to have the abortifacient drug RU-486 manufactured and approved in the United States.

News Briefs

Michigan May Vote on Suicide Aid

On November 3, Michigan voters may have to vote on whether to legalize physician-assisted suicide. On May 26 the pro-euthanasia group Merian's Friends, named after one of Jack Kevorkian's clients, presented state election officials with 82 boxes of petitions to place its proposal on the state ballot. Supporters needed 247,000 valid signatures to qualify; they say they have 379,000 [Detroit News, 5/27/98].

A poll by the Detroit News suggests the campaign may face an uphill battle. It shows 44% of likely voters favoring the proposal, with 39% opposed and 20% undecided. Women are more opposed to it than men. Earlier polls showed more support for legalization. Pollster Steve Mitchell, who conducted the survey, says that at present the measure is unlikely to pass, because "undecided voters tend to vote 'no' on ballot proposals...You really need to start with 60 to 65 (percent of support) to ensure victory" [Detroit News, 5/31].

The measure already faces strong opposition. Michigan's medical, hospice and osteopathic societies oppose it. On May 7 a coalition of Christian, Jewish and Muslim religious leaders in southeastern Michigan signed a joint statement opposing assisted suicide and favoring medical, psychological and spiritual help for dying patients [PR Newswire, 5/6]. On May 26 a physicians' group called Advocates for Better Care appealed to medical colleagues "to speak out in defense of our vulnerable patients and the integrity of our profession" [PR Newswire, 5/26].

Sentencing in Two Assisted Suicide Cases

Two men convicted of aiding suicides have received sentences that some see as too lenient.

In Canada, Dr. Maurice Genereux was sentenced to two years in jail and three years' probation on May 14 for giving lethal doses of Seconal to two HIV-positive men in 1996. Genereux was released on $5,000 bail while he appeals his sentence. Prosecutor Michael Leshner says he will "vigorously" recommend appealing the sentence, because a stronger message against assisted suicide is needed in this first case of its kind [CP, 5/15]. Genereux has already lost his medical license [see March Life at Risk].

In Buffalo, New York, 58-year-old John Bement was sentenced on May 12 to two weeks in jail, followed by five years' probation and 400 hours of community service, for assisting his wife's suicide in 1996. Convicted of second-degree manslaughter, he could have received 15 years in prison. The defendant's daughter, Susan Randall, feels the punishment did not fit the crime. She had worked with police to obtain evidence that Bement planned his wife's death to rid himself of the burdens of caring for her. "She wanted love, compassion and support from her husband, but what she got was a plastic bag over her head," Randall says [AP, 5/12].

Kevorkian Spends a Night in Jail

Jack Kevorkian has put in some jail time -- but not for assisting over 100 suicides.

On May 7, police officers at the ambulance entrance to a Detroit-area hospital saw Kevorkian and associate Georges Reding deliver another dead body -- that of 26-year-old Matthew Johnson of Aptos, California, who had been paralyzed by a motorcycle accident last August. The officers say that when they approached Kevorkian, he tried to shove them aside; he and Reding then struggled with the officers and had to be subdued. After a night in jail they were arraigned for assault, resisting arrest and interfering with a police officer; they were released on personal bond and are due in court June 2 [AP, 5/8 and 5/9].

On May 19, Kevorkian delivered the body of Emma Kassa, 68, of Xenio, Ohio to the same hospital. She had lung cancer [AP, 5/21]. County officials have also confirmed the identity of a woman Kevorkian delivered to another hospital on April 24: she is Lucille Alderman of Oxford, Michigan. Cause of death was an injection of cyanide -- the first time Kevorkian seems to have used this poison [Detroit Free Press, 5/14].

Assisted Suicide: Cure for Disabilities?

Supporters of physician-assisted suicide often claim to favor it only for cases of terminal illness. Yet some disability rights advocates, including the group "Not Dead Yet," have warned that this agenda threatens the lives of people with mental or physical disabilities.

This debate has intensified in recent months, in part due to a December 1997 statement by Faye Girsh, executive director of Hemlock Society USA [see December 1997 Life at Risk]. In the context of a murder trial in Louisiana involving a man who had killed his father with Alzheimer's disease, Girsh issued a statement on euthanasia and assisted suicide for people with disabilities generally:

"Some provision should be made for a situation in which life is not being sustained by artificial means but, in the belief of the patient or his agent, is too burdensome to continue... A judicial determination should be made when it is necessary to hasten the death of an individual whether it be a demented parent, a suffering, severely disabled spouse or a child" [PR Newswire, 12/3/97].

Not Dead Yet vigorously objected to the statement and launched a protest at Hemlock's Denver headquarters, prompting a "clarification" in the latest issue of Hemlock's newsletter TimeLines. Hemlock says that the statement was "Girsh's own opinion" as an individual, and that "press reports" had omitted references making it clear that she was only citing a model proposed by a Canadian expert as one approach among others. In fact the original Hemlock press release, issued through PR Newswire and listing Hemlock's national public relations director as the contact for media inquiries, does not substantiate either point [see January/February 1998 Life at Risk].

Clearly Hemlock sees this as a sensitive point, and has posted "An Answer to the Disabled" on its Web site. This "Answer" may itself raise new questions. It says that Hemlock "takes issue" with groups like Not Dead Yet regarding "the right of dying patients to seek help from their doctor in hastening their death." But it proceeds to blur this line -- "Indeed, having a chronic, terminal illness generally renders a person disabled" -- and declares that "it is up to each individual to determine for themselves when their quality of life is unendurable." The bottom line: "Disabled persons have every right to protect their interests -- but not at the expense of the rest of us" [www2.privatei.com/hemlock/disabl.html].

Jack Kevorkian's recent assistance in the suicides of two men who were not terminally ill but rendered quadriplegic by accidents -- Roosevelt Dawson, 21, in February and Matt Johnson, 26, in May -- has sharpened the debate further. Asked about the Johnson case, Ms. Girsh again provided a justification for assisted death in cases of disability: "Many people with severe, disabling chronic illnesses do suffer in many ways worse than people with terminal illnesses because there's no end in sight," she says [San Francisco Examiner, 5/10]. Another leading assisted suicide group, Compassion in Dying, has openly expanded its agenda to cover "incurable or terminal illness" [CID fundraising letter, 4/3; emphasis added].

Hemlock's "Answer" also claims that "we have no evidence" that "health care professionals are too quick to assume that disabled people are 'better off dead'." But at the recent annual meeting of the American Academy of Neurology in Minneapolis, researchers released survey results indicating the opposite. The poll of 1000 neurologists showed that in considering whether to offer a risky, expensive but possibly life-saving treatment, 46% would take the patient's physical condition into account; 26% would be influenced by the patient's age, 20% would withhold the treatment based on ability to pay, and almost half would be influenced by the amount of brain damage the patient already had. Among those commenting on the survey was Dr. Kathleen Foley of Memorial Sloan-Kettering Cancer Center, who said many studies show doctors assuming that patients with physical limitations have lives not worth living -- even when the patients themselves enjoy life [UPI, 4/28].

Background: Doctors and Patients Surveyed on End of Life

Two new surveys -- one polling cancer specialists, the other polling their patients -- shed new light on the realities of dying and assisted suicide. The physicians' survey suggests a sharp drop in support for doctor-assisted suicide since 1994.

The largest survey ever of cancer specialists in the English-speaking world, polling 3200 oncologists in the U.S., Britain and Canada, was released May 16. Among the findings:

• 22% of oncologists support physician-assisted suicide for terminally ill patients in unremitting pain. A similar question had garnered 45% support from U.S. oncologists in 1994.

• 13% of oncologists said they had ever performed assisted suicide or euthanasia (with 4% performing one or both in the past year), and 64% said they had received requests for them. A recent survey published in the New England Journal of Medicine, polling physicians from a wider variety of specialties, showed 18% having received a request for assisted suicide and 11% having received one for euthanasia, with 6% having engaged in either or both [see April Life at Risk].

• 56% of U.S. oncologists report difficulty in obtaining palliative care consultations for their dying patients. 40% find lack of insurance coverage for unskilled home care services to be the most troublesome problem in access to palliative care, and 31% find it a frequent problem. Doctors citing such problems are more likely to have performed euthanasia or assisted suicide in the past year.

• 95% of oncologists feel competent to manage pain; yet more than half report that over 20% of their patients die in pain, and responses to a case study presented in the survey suggest that 25% do not provide optimal pain management. [Press Release, American Society for Clinical Oncology, 5/16/98].

A landmark nationwide study of about 1000 dying patients was also released on May 19. It found:

• About 10.5% of terminally ill patients (and 12% of dying cancer patients) contemplate suicide. This goes up to 20% among patients who are depressed all or most of the time; it is only 4% among patients who do not have depression. Contrary to a popular assumption, patients in pain were no more likely to consider suicide than those who were not.

• Suicidal thoughts are also more likely among those who require daily help with nursing or personal needs, afflicting 16% of this group. The survey authors expressed concern that lack of access to home care, which may be worsened by more restrictive Medicare reimbursement rules to be implemented this summer, may add to patients' despair and feelings of being a "burden" [Boston Globe, 5/20].

Both studies were co-authored by Dr. Ezekiel Emanuel, a Boston cancer specialist and ethicist now employed at the National Institutes of Health in Washington, D.C. They were released in Los Angeles at the annual meeting of the American Society for Clinical Oncology.

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