e-mail gill@willtolive.co.uk

 Don't go down the Oregon Trail



Supporting info to the case against PAS Oregon style



A Grand Illusion: Oregon's Attempt to Control Death Through Physician-Assisted Suicide

Jerome R. Wernow, Ph.D., R.Ph. is Executive Director of the Northwest Center for Bioethics in Portland, Oregon

by Jerome R. Wernow





Oregon Physician-Assisted Suicide Theory vs Practice Prepared by Robert D. Orr, MD,CM, President Vermont Alliance for Ethical Health Care, March 13, 2004





Competing Paradigms Of Responding To Assisted-Suicide Requests In Oregon: Case Report (Revised May 3, 2004)


"No group of suicidal patients has been more ignored than those who become suicidal in response to serious or terminal illness" (1, p558), concludes the "Suicide, Assisted Suicide, and Euthanasia" section of The Harvard Medical School Guide to Suicide Assessment and Intervention. Herbert Hendin, author of this chapter, [and our discussant in this Symposium] points out that these individuals are no different from other suicidal individuals. While physical illness may be a precipitating cause of despair, these patients usually suffer from a treatable depression, he reminds us. Patients considering assisted suicide are deeply ambivalent about their desire for death, just as are other suicidal patients. This conclusion is consistent with evidence that poor health is not an independent risk factor for death by suicide but is correlated with depression or other mental illness as a key intervening variable (3,5). A noted, large scale study [published in JAMA]




The only physicians interviewed for the official reports are those who prescribed lethal drug doses for patients. [OHD 2nd Year Report, p.7, DHS Report, 3/10/04, p.9]

According to OHD official Dr. Katrina Hedberg, the division has to rely on the word of doctors who prescribed the drugs. [Oregonian, 2/24/00]

Referring to physicians' reports, the OHD admitted: "For that matter, the entire account could have been a cock-and-bull story. We assume, however, that physicians were their usual careful and accurate selves." [OHD, CD Summary, 3/16/99, p. 2]

The OHD has no regulatory authority or resources to ensure compliance with reporting requirements. [American Medical News, 9/7/98]

The law contains no penalties for doctors who do not report prescribing lethal doses for the purpose of suicide.



RELIGIOUS TOLERANCE.ORG BY Ontario Consultants on Religious Tolerance, Last updated 2005-MAR-27 Author: Bruce A Robinson


A clear breakdown of the path Oregon’s law took with legal challenges and actual outcomes.




There are barriers to pain relief. They include:


Some types of pain in some individuals cannot be adequately controlled with current technology and medications that are now available.


Some patients and their physicians are concerned about the possible side effects of pain medication, including addiction.


Inadequate training of medical professionals.


Pain management is not universally available, particularly to the over 40 million Americans who lack health insurance, and as many as 80 million who are under-insured.

Dr. Robin Bernhoft comments: 

"Experience consistently shows that patients often want to die because of  under treated pain. Yet with good medical care their pain is almost always manageable, and they almost always regain their desire to live. Pain relief typically can be achieved without impairing mental ability..." 8

Referring to doctors who "simply don't know how to treat depression and pain." Dr Bernhoft states:

"According to many studies, between 50 and 70 percent of U.S. doctors fit that description." 8

Dr Bernhoft, and many others, believe that if terminally ill people were given access to adequate pain management, then requests for physician assisted suicide would be greatly reduced.

Reference  8   Robin Bernhoft, MD, "How we can win the compassion debate," Focus on the Family, Citizen Magazine, 1996-JUN-24.


Physician ignorance:

Everyone is aware of the extremely addictive properties of drugs such as morphine and heroin. But what is less known is that these drugs' addictive properties are primarily seen among healthy people who are not in pain. They become addicted when they use these drugs illegally for the feeling of euphoria that they generate. If a person who is in severe pain properly uses these narcotics for the relief of pain, they do not feel euphoria; they do not become addicted; they simply have relief from intense pain. A wide range of people are in need of such medication; they include from individuals who are suffering from advanced cancer, untreatable back pain, and limb amputations.

Unfortunately, most physicians are not trained in the use of opioid therapy for the relief of intense pain.




Recording reasons why people wanted to and did die, means that those reasons automatically become acceptable for anyone else wanting to die and their doctors.

All the concerns listed in Oregon’s DHS Annual report are bordering on the unacceptable.

They were;-

Reasons for wanting to die

7 year totals

Financial implications of treatment


Burden on family, friends/caregivers


   Losing autonomy


Decreasing participation in activities


Losing control of bodily functions


Inadequate pain control


Loss of dignity



All figures taken from http://www.oregonlive.com/pdfs/special/oregonian/asst_suicide_stats.pdf


On face value these might seem plausible reasons but are they really and would or should they be relevant in the UK?


I suspect the financial concerns were originally included because everyone expected that those with poor education, leading to low paid jobs and low or no health cover would ask for help to die more often. But if the statistics are correct, that hasn’t been the case at all.




Less than high school graduate


High school graduate


College graduate 4



One hundred and ninety of two hundred and eight completed school and/or college


Insurance coverage









             3             3


While one hundred and twenty four of two hundred and eight had their own insurance and a very large majority of the rest were covered by state run schemes.


Financial concerns were surfacing from health funders 



The successful "No on One" campaign recently waged in Maine against a law modeled after Oregon's law circulated a flyer titled:

The Top 10 Dangers: It's Not What you Think

  • No family notification required.
  • No direct state supervision required to prevent abuse.
  • No real safeguards to ensure that a request was voluntary.
  • No safeguards to ensure that requests for physician-assisted suicide would be based on sound well informed decisions.
  • No safeguards to ensure that only terminally ill patients could request and receive a physician's assistance in committing suicide.
  • No safeguards to ensure that the lethal medication was properly handled and distributed.
  • No requirement that physicians be present when their patients take lethal medications, leaving them unattended should complications arise.
  • No requirement that a patient actually learn about options other that physician-assisted suicide.
  • No requirement that complications, violations, or abuses be reported to law enforcement regulatory authorities.
  • Because physician-assisted suicide is inexpensive, health maintenance organizations (HMOs) could encourage a patient to take his/her own life rather than request more expensive palliative care options.

Appended to Lessons from Oregon by Thomas M. Pitre, M.D., N. Gregory Hamilton, M.D.,and William Toffler, M.D.




“In 21 of 114 Dutch cases where the original intent was to provide assisted suicide, doctors stepped in to give a lethal injection when things went badly.”


Yet according to the Oregon’s Department of Human Services Seventh Annual Report on Oregon’s Death with Dignity Act “None of the patients regained consciousness after ingesting the lethal medication nor were emergency medical services called”

DAVID REINHARD   “The pills used in Oregon's assisted-suicide experiment don't always kill”

Again with feeling, the pills didn't kill  The OREGONIAN, Thursday, March 10, 2005


Failings of the Death With Dignity Law

“The Oregon Department of Human Services (DHS) has no regulatory authority or resources to ensure compliance with reporting requirements.

[American Medical News, 9/7/98]


“The law contains no penalties for doctors who do not report prescribing lethal doses for the purpose of suicide.”

International Task Force on Euthanasia and Assisted Suicide Six Years Of Assisted Suicide In Oregon.


 “The Oregon Health Division review of 1998 reported cases was particularly criticized by national medical experts because of "its failure to address the limits of the information it has available, overreaching its data to draw unwarranted conclusions.”

"The Oregon Report: What's Hiding Behind the Numbers," Brainstorm, March, 2000, 36-38.l


Patients ‘Concerns’ Reasons for Wanting an Early Death Unchallenged - Making the Unacceptable Acceptable.

Burden on family, friends/caregivers


In the 7 years that  Oregon’s PAS law has  operated 45 of 208 people who used PAS to die early cited inadequate pain control as a reason.  Yet in the footnote it says that patients discussing these concerns were not necessarily experiencing pain .Is fear of pain a good enough reason? 

Palliative Care is Getting Better yet this doesn’t  appear to enter into the equation.


Writing People Off

People with chronic illnesses and severe disabilities are, with the right levels of care and equipment can continue to have enjoyable lives


PAS costs less than continuing care