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Supporting
info to the case against PAS Oregon style
A Grand
Illusion: Oregon's
Attempt to Control Death Through Physician-Assisted Suicide
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Jerome R. Wernow, Ph.D., R.Ph. is Executive Director
of the Northwest Center for Bioethics in Portland, Oregon |
by
Jerome R. Wernow
2002 |
http://www.tocquevillian.com/articles/0072.html
Oregon Physician-Assisted Suicide Theory
vs Practice Prepared by Robert D. Orr,
MD,CM, President Vermont Alliance for Ethical Health Care, March
13, 2004
http://www.vaeh.org/resources/OR/PAS/TheoryvsPractice.doc
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]
http://www.pccef.org/articles/art28.htm
OFFICIAL
REPORTS DO NOT TELL THE WHOLE STORY
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.
http://www.internationaltaskforce.org/orrpt6.htm
RELIGIOUS
TOLERANCE.ORG BY Ontario Consultants on Religious Tolerance,
Last updated 2005-MAR-27 Author: Bruce
A
Robinson
PHYSICIAN
ASSISTED SUICIDE: ACTIVITY IN OREGON
A clear breakdown of the path Oregon’s law took
with legal challenges and actual outcomes.
http://www.religioustolerance.org/euth_us1.htm
THE MEDICAL MANAGEMENT OF PAIN
There
are barriers to pain relief. They include:
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Some
types of pain in some individuals cannot be adequately controlled
with current technology and medications that are now available. |
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Some
patients and their physicians are concerned about the possible
side effects of pain medication, including addiction. |
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Inadequate
training of medical professionals. |
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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.
http://www.religioustolerance.org/euth_pai.htm
MAKING THE UNACCEPTABLE ACCEPTABLE
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 |
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Financial
implications of treatment |
6 |
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Burden
on family, friends/caregivers |
74 |
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Losing autonomy |
177 |
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Decreasing
participation in activities |
172 |
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Losing
control of bodily functions |
121 |
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Inadequate
pain control |
45 |
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Loss
of dignity |
60 |
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.
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Education |
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Less than high school graduate |
18 |
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High school graduate |
102 |
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College graduate 4 |
88 |
One hundred and ninety of two hundred and
eight completed school and/or college
|
Insurance coverage |
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Private |
129 |
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Medicare/Medicaid |
74 |
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None |
2 |
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Unknown |
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.
http://www.pccef.org/articles/art29LessonsFromOregon.htm
Misreporting?
“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
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