One year down: Oregon's assisted-suicide law

Commonweal, March 12, 1999 by James D. Moore

Contrary to the utopian dreams of ardent supporters and the dire predictions of some opponents, assisted suicide was a little-used option among the terminally ill in Oregon in 1998, the first complete year under the state's new assisted-suicide law. The questions raised by assisted suicide, however, continue to be a part of political, social, cultural, and religious discussions throughout the state.

According to the Oregon Health Division's first annual report on assisted suicide, issued an February 17, 1999, by the end of 1998, twenty-three people had received legal drugs to end their lives under the provisions of the law. Of these twenty-three, fifteen had actually used the drugs and died; six others had died from their illnesses; and two were still alive. Contrary to expectations, AIDS cases accounted for only two of the twenty-three. Most of those who applied for the drugs had cancer, with heart disease coming in second place. The Oregon Health Division will be sending out surveys to doctors throughout the state in 1999 to gauge how many requests have been made for information on assisted suicide, whether or not doctors suspected depression among those requesting assisted suicide, and what might have caused patients to drop their request for assisted suicide.

Oregon's largest newspaper, the Oregonian, which has strongly opposed assisted suicide editorially, has printed a number of articles examining the lives and the decisions of patients as they agonize over whether or not to invoke the assisted-suicide law. These stories, coupled with the low number of people using the law, indicate that a middle way is developing between the extreme predictions of the two sides in the assisted-suicide debate.

The fight against assisted suicide in Oregon has shifted since the overwhelming November 1997 vote, in which 60 percent of those who cast ballots favored the measure. Several members of Congress, led by Senator Orrin Hatch (R-Utah) and Congressman Henry Hyde (R-Ill.) raised issues concerning the role of federal agencies regulating the prescription of lethal drugs by Oregon's doctors. But in April 1998, Attorney General Janet Reno ruled that Oregon's law fell within federal guidelines and that doctors who prescribed the drugs were not in danger of losing their licenses to dispense controlled substances. Both Hatch and Hyde have promised to revisit this issue during the 106th Congress.

In Oregon itself, opposition to the law has come from two fronts. First, the Oregonian has maintained its editorial attacks, focusing on the potential problems, the lack of respect for human life, and the regulatory murkiness of the law. Second, the groups that opposed the law have raised a number of issues about it in the context of health care throughout the state.

For example, in October, William Toffler, M.D., the director of Physicians for Compassionate Care and a faculty member at Oregon Health Science University (Oregon's medical school), published an op-ed essay in the Oregonian in which he noted that a pain medication, Oxycontin, had been capped in its dosage by the Oregon Health Plans prescription company. The implication was that the Oregon Health Plan, which prioritizes medical procedures for coverage in order to provide the widest care possible to the poor, had approved assisted suicide for coverage but denied coverage for pain management. This may have been a good political ploy (although very few people noticed the issue), but it played loose with the facts. The plan's decision to cap the amount of Oxycontin was based on the simple fact that there are other effective pain-control alternatives that are one-tenth as expensive per dose as Oxycontin.

Attempts to change Oregon's law have now shifted to the biennial Oregon legislature where several pending bills would tinker with the rules for assisted suicide. However, none would attempt to repeal assisted suicide itself. Following the resounding 1997 vote, no state legislator wants to be seen as trying to overturn the law.

The annual report had a couple of surprises. Of the fifteen who chose assisted suicide, only one cited the lack of pain control as the reason. Most said they chose death because of a fear of a loss of autonomy, the inability to participate in important roles, or the loss of control over bodily functions. Since the debate over the assisted-suicide law has often focused on pain control, this information from the survey raises new important issues. Another surprise was that only two of those who took their own lives were married at the time. Four of the fifteen had never been married and the other nine were widowed or divorced. This may indicate that family support groups are important to those who decide against assisted suicide.

Anecdotal evidence and the 1998 annual report paint a picture of a procedure that is just starting to be accepted and used. The number of patients who chose this option last year was so small that virtually no conclusions can yet be drawn from the Oregon experience. To date, however, Oregon has not become the magnet for suicide seekers opponents claimed it would. We will have to wait to see if that remains the case in the future. The annual reports will be watched closely.