Oregon's first-in-the-nation law empowers doctors to give life-ending drugs to people if they are judged to be within six months of death. Oregon's law is widely used as the standard for similar measures proposed this year in at least 20 states.
Barely noticed, however, is the desire of a key Oregon physician-assisted suicide legislator to double the "likely-to-die" window for death medicine to a full year.
The chair of Oregon's House Health Care Committee, Rep. Mitch Greenlick introduced HB 3337 which would widen the end-of-life expectation enabling physicians to assist in suicide.
Current Oregon law says a person must be judged likely to die within six months in order to be prescribed suicide medicine. HB 3337 would double the "likely-to-die" threshold for prescribing death medication to a full year.
Greenlick asserts that people with ALS, commonly known as Lou Gehrig’s disease, need more time to end their lives. "By the time you get within six months, you often don't have the manual dexterity to swallow a pill or even still have the reflex to swallow," asserted Greenlick. He is a retired health researcher.
But the ALS Association's Lance Christian told media that the six-month limit in current Oregon law has not been an issue. Christian said that he had helped several ALS patients end their lives under Oregon's existing six-month window.
So far Greenlick has not moved his bill forward to a hearing.
An indication of the challenge facing assisted suicide advocates was Oregon ALS patient Thomas Middleton, who set up a trust with realtor Tami Sawyer. Middleton moved into her home in 2008. Less than a month later Middleton died under the Oregon assisted suicide law. Two days after his death Sawyer sold Middleton's home and pocketed $200,000. She later pleaded guilty to charges of bilking several people and in 2013 was sent to prison.
Greenlick's effort to expand eligibility for physician-assisted suicide follows the well-documented history of doctor-aided suicide in Europe, where it was first promoted as an option that would be used rarely and only in limited circumstances.
In Europe those initial limits have rapidly been removed, to the point where such non-time-sensitive conditions as depression and hearing impairment now are used to authorize suicide drugs. Today in Europe proximity of death is hardly a consideration. (See History of Physician Assisted Suicide Is Not Encouraging.)
While people seeking medical help to end their lives presumably can get medical assistance for suicide, few are evaluated for their mental condition.
The most recent Oregon state report on assisted suicide shows that only three of the 105 Oregonians who died under the law in 2014 were referred for psychiatric or psychological evaluation.
“This constitutes medical negligence,” argues Dr. Aaron Kheriaty, of UC Irvine School of Medicine. “To abandon suicidal individuals in the midst of a crisis—under the guise of respecting their autonomy—is socially irresponsible. It undermines sound medical ethics and erodes social solidarity.”
Oregon's experience shows a steady increase in its use, starting with 16 deaths in 1998, its first year.
Moreover, people who use it to end their own lives do not fit the overall profile of Oregon's population.
Two-thirds were 65 or older, with 72 the median. They were whiter--95 per cent--and more highly educated--48 per cent had college degrees--than the general population. All had health insurance.
Consistently Oregonians who used the law to end their own lives were mostly concerned with loss of autonomy (91 per cent), decreasing ability to do things (87 per cent) and loss of dignity (71 per cent).
In neighboring Washington where assisted suicide also is legal, the Department of Health explicitly prohibits any reference to assistance in death.
The state's instructions to medical providers state:
"If you know the decedent used the Death with Dignity Act, you must comply with the strict requirements of the law when completing the death record:
"1. The underlying terminal disease must be listed as the cause of death.
"2. The manner of death must be marked as 'Natural.'
"3. The cause of death section may not contain any language that indicates that the Death with Dignity Act was used, such as:
"b. Assisted suicide
"c. Physician-assisted suicide
"d. Death with Dignity
"f. Mercy killing
"h. Secobarbital or Seconal
"i. Pentobarbital or Nembutal
"The Washington State Registrar will reject any death certificate that does not properly adhere to the requirements of the Death with Dignity Act."
Washington's 2013 report says that 171 Washingtonians used the assisted suicide law to end their lives. Some 97 per cent were white; 76 per cent had some college education. One was just 29 years old at the time of death.
Neighboring Idaho offers a sharp contrast to the Oregon/Washington push for suicide facilitation. Idaho took a strong stand against suicide help in 2011. By wide margins the Legislature passed and the governor signed into law SB 1070, making it a felony to assist in a suicide.
Idaho's law provides safeguards, including protection for doctors who provide pain abatement treatment that may hasten death or who withhold medication in conformance with a patient's living will.
Notably, Idaho borders three states that have legalized assisted suicide--Oregon, Washington and Montana.