This is the text of a presentation by Dr. Thomas Pitre, M.D., a
member of the board of Physicians for Compassionate Care, which he
gave in Arizona. A modification of this presentation has been
published as: Pitre, Thomas, Lessons from Oregon, The Linacre
Quarterly, 71:114-125, May 2004. It is an excellent review
of the lessons learned regarding physician-assisted suicide in Oregon. This
documents many of the dangers and problems with assisted suicide
Lessons from Oregon
Thomas M. Pitre, M.D., N. Gregory Hamilton, M.D.,
and William Toffler, M.D.
I would like to thank Dr. Mike Rock and Arizona Right to Life for
the privilege of addressing you this morning on the ever-threatening
topic of euthanasia. It is, indeed, an honor to be sharing the podium
with Arizona's own Dr. Carolyn Gerster whose dedication and service
to the pro-life cause is a tremendous inspiration to me.
I bring you greetings from the Pacific Northwest where I am a practicing
urologist in the only state in the nation to have legalized physician-assisted
suicide (PAS). I am a on the board of Physicians for Compassionate
Care (PCC), which arose in response to the passage of Oregon's Measure
16 in 1994 or as it is better known as the "Oregon Death with
Dignity Act." Although assisted suicide and euthanasia were
practiced in the Netherlands for more than twenty years, it was never
legalized, and Oregon thus became the first jurisdiction in the world
to legalize PAS. Since then Oregon has become the "model" for the
assisted-suicide and euthanasia activists who moved the headquarters
for the Compassion in Dying Federation, an outgrowth of the Hemlock
Society, into Portland, just after the election. The Dying Federation
was directly involved in 79% of the assisted-suicide deaths in the
first year the law was in effect.1
I, along with hundreds of my colleagues, who believed in the more
than 2000 year old tradition of the Hippocratic Oath - "Thou shall
not give any deadly medicine.even if asked," didn't believe, until
it was too late, that a public referendum could change the long held
ethics of my profession. We came together as PCC, which now has more
than 2000 members in over 40 states, and subscribes to the simple
ethic that all human life is inherently and equally valuable. PCC
puts on annual Compassionate Care Conferences to educate professionals
on how to improve pain treatment and palliative care at the end of
life while warning of the dangers of PAS and euthanasia. For more
information about PCC and how to become a member, which is free,
I refer you to our website: www.pccef.org or
there are some brochures and a sign up sheet in the back.
At the outset I would like to acknowledge Drs. Greg Hamilton2 and
Bill Toffler, co-founders of PCC, for their untiring and ongoing
leadership in this battle against the evil of PAS and euthanasia.
I am also indebted to Rita Marker3 for her timely article "An Inside
Look at the Right to Die Movement," just published in the Autumn
2001 edition of the National Catholic Bioethics Quarterly from
which I draw frequently in the remarks that follow. Dr. Daniel Sulmasy4,
Wesley J. Smith5, and numerous others have been a tremendous source
of inspiration to me and I'm sure to anyone trying to articulate
a reasoned argument against the emotional poster cases of intolerable
suffering used to argue for the legalization of "aid in dying." The
recent position paper of the American College of Physicians-American
Society of Internal Medicine with over 90,000 members just published
in the August 7, 2001 issue of the Annals of Internal Medicine6
is extremely clear, well written and contains an encyclopedic bibliography
of more than 100 current references documenting their position against
PAS. I have included some of these references in your handout.
Before I begin I would like to clarify our understanding of the terms
PAS and euthanasia. Although they are frequently joined
together they are not the same and they differ significantly in the
final act, without which, the intended death will not occur.
PAS refers to the act of a physician in providing the patient
with a legal means of ending their life, for example, prescribing
a lethal dose of barbiturates with which the patient then
ends his or her life.
Euthanasia differs in that the physician performs
the final act that kills the patient, for example, by administering
or ordering the administration of a lethal injection.
Many of you here today I am sure are familiar with the background
leading up to the passage of Oregon's Death with Dignity Act,
but let me review what I consider some of the more important events
from which we can begin to draw 12 "lessons from Oregon."
One of the first things that happened, quietly and unknown to most
of us in 1980 was the arrival of Derek Humphry in Eugene, Oregon
and the formation of the Hemlock Society. Their clear agenda was
to legalize euthanasia. After efforts to legalize assisted suicide
and euthanasia in numerous state legislatures failed, they turned
their efforts to voter initiatives. Around that same time Derek Humphry
published his famous suicide manual, Final Exit7, in 1991.
Voter initiatives to legalize the new euphemism "aid in dying" were
first tried in our northern neighbor, the state of Washington, in
1991 and our southern neighbor, California, in 1992. Both of these
pioneer initiatives included both PAS and euthanasia. Successful
campaigns defeating them were able to counter their pleas for "choice
in determining a peaceful death" as a way out of intractable pain
and suffering, by depicting a sinister doctor with a syringe about
to kill someone in a nursing home. Also key in the defeat of these
earlier initiatives was the clear opposition of their state medical
societies, which had significant credibility with the voters who
looked to the medical profession for guidance. The verbal engineering,
which always precedes social engineering, was well underway even
though their first initiatives failed.
Activists from the Hemlock Society went back to the drawing boards
and crafted a "softer, gentler" bill for Oregon explicitly prohibiting
euthanasia in general and lethal injection in particular to overcome
objections raised by the successful campaigns that defeated them
in Washington and California. They did this knowing full well that
lethal injection would have to follow through legal challenges for
those who could not ingest lethal medication, as I will illustrate
with an actual case from Oregon shortly. The illusion of patient
control was conveyed and numerous so-called "safeguards" were touted
to protect voters from the "slippery slope" arguments that could
be so well made from the Dutch experience. A quiet but carefully
orchestrated resolution was brought before the Oregon Medical Association
by a few doctors, who later became outspoken proponents of Measure
16, that led the OMA not to take a stand on the ballot measure. This
in effect conveyed the message that the doctors were questioning
the American Medical Association's ethical prohibition against assisted
suicide and euthanasia..
Opponents of Measure 16 were portrayed as religious zealots while
the proponents portrayed themselves as kind, compassionate and wanting
nothing but the right to end intolerable pain by gentle legal means.
One of the most compelling ads of their campaign was a 60 second
TV commercial that featured Patty A. Rosen, a former nurse who told
a story of helping her daughter, who was in intractable pain from
advanced thyroid cancer, die peacefully with a lethal overdose of
pills she obtained illegally. The problem with the ad was that it
wasn't true. Three days before the election it was discovered that
she was lying in the ad and that the pills didn't work. She had admitted
two years earlier that she had to finish "euthanizing" her daughter
with a lethal injection. The voters, however, believed the ads and
with a narrow 51-49 % victory enacted the Oregon Death with Dignity
Lesson # 1:
Know your enemy.
The people who will bring physician-assisted suicide and euthanasia
to Arizona have been planning their strategies and learning from
their mistakes since the formation of the Hemlock Society in 1980.
They are well organized, well funded, and committed for the long
The Compassion in Dying Federation is a national organization
with paid staff, which is carefully looking for their next target
and planning their best strategy. The Sunbelt states of Florida and
Arizona with their significant elderly populations are quite logical
As we learned from the Patty A. Rosen story, assisted-suicide
proponents are capable of deceit.
For numerous other well-documented examples of their deception I
refer you to Rita Markers article referenced in your hand out.
Lesson # 3:
Pro-life members of the Arizona State Medical Association
need to be networked, vigilant and prepared to act, before legislative
action is proposed. They must affirm the clear ethic upheld by
the American Medical Association and recently affirmed by the American
College of Physicians - American Society of Internal Medicine against
Many pro-life doctors in Oregon had dropped their membership in
the OMA when the threat first arrived, because of the OMA's stance
on abortion. It is vital that we stay involved in our state medical
societies, even though they may espouse some positions contrary to
our beliefs. Our voices need to be heard when it comes to life and
death issues even if it seems at times that we are "crying in the
Oregon experience 1994-1997:
Before the Oregon Death with Dignity Act could be enacted
as law, a successful legal challenge blocked its implementation for
nearly three years before the Oregon Supreme Court finally dismissed
the case for "lack of standing."
In the interim Oregon Right to Life and PCC began working hard to
get the legislature to repeal Measure 16. PCC members joined their
state society and were then able to get the OMA to reverse its previous
neutral position and pass a resolution to officially come out in
opposition to the existing law as "seriously flawed." Their vote
was nearly unanimous 121-1. This played a key role in the legislature,
as did the individual and personal testimony of PCC physicians, in
convincing members of the Oregon House and Senate of the serious
flaws in the Oregon Death with Dignity Act. The result was
a legislative recommendation for repeal and a return to the voters
in 1997 as Measure 51.
Measure 51 required a "yes" vote for passage, which began the uphill
struggle. Major funding came from the Catholic Church. The opposition
formed a committee called "Don't Let Them Shove their Religion Down
your Throat Committee" against Measure 51 which was the sign off
of their sound bite commercials aimed at the Catholic Church, which
they claimed wanted to "impose their morality on Oregonians." The
Catholic Hospital system in Oregon (which was heavily involved in
managed care) was opposed to the use of the managed care argument
that assisted suicide costs much less than palliative care. This
appears to have been misguided. In retrospect this argument has proved
one of the most thought provoking in the overall debate. After considering
this reality, many individuals who previously had been enthusiasts
for assisted suicide at least experience second thoughts. They denounced
the legislature as not listening to the will of Oregonians in the
Oregon is one of the least churched states in the nation, a major
point for the Hemlock Society locating its headquarters in the heart
of the Northwest. Oregonians pride themselves as innovators and trendsetters,
particularly in healthcare, and saw "aid in dying" as progressive.
They were successful in getting one of the more persuasive ads against
PAS pulled, which undermined the credibility of the entire ad campaign.
They played their euphemisms of "death with dignity," "peaceful death," "the
right to die," and their ultimate sound bite "choice in dying" like
a violin. Despite the fact that we were able to raise nearly five
million dollars, to their $800,000, Measure 51 went down even worse
than before - 60-40.
The overwhelming rejection of the recall effort, the dismissal of
the legal injunction by the Supreme Court, and Janet Reno's misguided
interpretation that lethal prescriptions where not a violation of
the Federal Controlled Substances Act, finally allowed for legalized
killing in our state to begin.
Lesson # 4:
Confused voters favor "choice."
Lesson # 5:
Outside of the liberal media and the politics of a campaign,
well-reasoned dialogue can take place and arguments against the
evils of assisted suicide and euthanasia can prevail as they did
in 1997 at the Oregon Medical Association and the Oregon House
and Senate leading to the recall referendum.
The truth of this lesson was also reflected by the example of well-reasoned
arguments made before the US Senate leading to a 99-0 vote to ban
Medicare funding of assisted suicide and the 9-0 decision of the
US Supreme Court finding that there is no constitutional right to
Lesson # 6:
Broad-based coalitions of support and funding can diffuse
the argument of the imposition of religious or moral values.
The example of strong grassroots opposition to California's 1999 "California
Death with Dignity Act" illustrates the effectiveness of this strategy,
as do the broad based coalitions that were successful in rejecting
PAS in Maine and Michigan- again see Rita Marker's article8. In Oregon,
we lacked such a broad-based coalition, and were vulnerable to anti-catholic
and anti-religious attacks.
Oregon experience since 1997:
Even before the defeat of Measure 51, a task force on the "Oregon
Death with Dignity Act" had completed a 91-page implementation
handbook for healthcare providers. The taskforce was convened by
our pro assisted-suicide governor, and consisted of individuals
such as Barbara Coombs Lee, one of the law's chief petitioners
and now at the helm of the well-funded national organization, "Compassion
in Dying," as well as other pro-suicide members. In it the groundwork
for allowing lethal injection or "infusions" was already laid9
despite repeated reassurance to Oregonians during the campaign
that this could never happen.
Governor Kitzhaber's nationally watched pilot Oregon Health
Plan, that rations healthcare to the poor, in February, 1998,
then included funding of assisted suicide under "comfort care" while
refusing to provide adequate funding for mental health services
including depression. Oregon tax dollars are now funding PAS just
as they fund abortions for the poor.
Next I would like to share a few cases that have occurred since
legalized PAS has become law in Oregon that are real, documented
and illustrate just a few of the problems with assisted suicide.
Individuals suffering from depression and other mental illnesses,
who have been singled out by the label terminally ill, are
made especially vulnerable by laws favoring assisted suicide. This
fact is particularly important, since medical studies have demonstrated
that seriously ill individuals who desire an early death are usually
afflicted with a treatable depressive disorder.
The first publicly reported case of doctor-assisted suicide
in Oregon was a woman who had been diagnosed as depressed, yet she
was given assisted suicide in two-and-a-half weeks from the time
she was referred to the Compassion in Dying Federation.10 This woman
had a more than twenty-year history of breast cancer. When she eventually
developed metastases in her lungs, her physician told her these metastases
may eventually prove fatal. At that time, her state had been saturated
by frightening portrayals of the normal dying process as exaggeratedly
grotesque and terrifying. When she reportedly requested assisted
suicide, her regular physician declined to give her a lethal overdose.
A second opinion was sought. This doctor, however, concluded that
the patient was depressed and needed treatment of her depression,
not assisted suicide. He gave her antidepressant medication. She
never took it.
Instead of insisting that the patient follow through on treatment
likely to alleviate feelings of hopelessness associated with depression,
a family member, not the patient herself, sought yet another opinion,
this time from the Compassion in Dying Federation. Dr. Peter Goodwin,
medical director of that organization, determined over the telephone
that he thought the patient was "rational" without ever having
actually examined her himself.11 He then gave the patient a referral
to a doctor who, like him, had been active in a political campaign
promoting the legalization of assisted suicide, Dr. Peter Reagan.12
Oregon law, similar to the Dutch practice, does not require patients
to receive psychiatric evaluation before being given assisted suicide.
When such an evaluation is obtained, it is at the discretion of the
assisted-suicide doctor him- or herself. Even then, the presence
or absence of depression or other mental disorder itself is not considered
the crucial factor. The Oregon law states that the depression must
be thought by the physician to cause "impaired judgment" before the
assisted-suicide decision is called into question or postponed. This
qualification that the depression must be impairing judgment is unusual
since "impairment of judgment" is often a basic characteristic of
the disorder. Depression typically causes feelings of hopelessness,
either-or thinking and a tendency to overlook possible solutions
The doctors to whom this woman, diagnosed with depression, was referred
to by the Compassion in Dying Federation, however, apparently did
not consider the patient to have been depressed or to have impaired
judgment. So, the eventual psychiatric referral appears to have been
made to counter the opinion of the original doctors or because this
first case of PAS was destined to be publicized as a so-called "model" case.13
The evaluating psychiatrist was chosen by the same doctor who planned
to give the overdose. This psychiatrist approved the assisted suicide
after only one visit. This quick judgment was made despite the fact
that another doctor had already diagnosed the patient as depressed
and there is no indication that the physician who attempted to treat
her depression was consulted to consider the basis of his diagnosis
and treatment. Studies show only 6% of Oregon psychiatrists are very
confident they can determine in a single visit when depression may
be affecting decisions to commit assisted suicide in the absence
of a long-term relationship.14 Nevertheless, this life and death
decision was made in a single visit by a psychiatrist chosen by the
assisted-suicide doctor himself. None of the doctors who carried
out the assisted suicide had a long-term relationship with the patient.
Because she was labeled "terminally ill," she could be given assisted
suicide by doctors who barely knew her, instead of being given treatment.
Standard medical practice requires doctors to respond to suicidal
wishes with a thorough evaluation of possible causes of the suicidal
wishes and an attempt to remove those causes. Depression is the most
common cause of suicidal ideas and feelings15 even among the seriously
ill. There has been no demonstrable difference in the causes of suicide
in the elderly or ill than in anyone else.
Lesson # 7:
The legalization of PAS stigmatizes those labeled "terminally
ill" and exempts them from legal protections of society. It deprives
them of the protections against suicidal despair that the rest
of us enjoy.
Let me give you another example from Oregon. Mrs. Kate Cheney16
was an elderly, Oregon woman with growing dementia and the diagnosis
of a potentially terminal cancer. When her daughter accompanied her
to her doctor's appointment to formally request assisted suicide
under Oregon's new law allowing such a practice, the doctor did not
agree with that course of action.17 It was the daughter, not the
patient, who then insisted the mother have a new doctor within her
health maintenance organization, Kaiser Permanente. The doctor change
for the mother was granted to the daughter. This second doctor was
willing to give Mrs. Cheney assisted suicide and arranged for psychiatric
for evaluation, because it was standard procedure at this health
maintenance organization (HMO) in its assisted-suicide protocol.
The psychiatrist, who released a written report to the newspaper,
found that Mrs. Cheney had short-term memory deficits and dementia.
He also said the assisted-suicide request appeared to be the daughter's "agenda." The
daughter who also accompanied Mrs. Cheney to this appointment, "coached
her" in her answers, even when the psychiatrist asked her not to
do so. The psychiatrist said, "She does not seem to be explicitly
pushing for this." She was deemed lacking sufficient capacity to
weigh options about assisted suicide; thus, she was not eligible
for doctor-assisted suicide. The patient accepted this assessment.
Her daughter, however, "became angry." It was the daughter, not the
patient, who then "decided on a second competency evaluation." Kaiser
HMO apparently authorized this second off- panel mental health evaluation.
This new psychologist admitted the patient could not even remember
when she was diagnosed with terminal cancer, although it had only
been within the last three months. She also wrote that the patient's "choices
may be influenced by her family's wishes and her daughter, Erika,
may be somewhat coercive." Nevertheless, she approved the assisted
With two conflicting mental health opinions, the final decision,
far from being an "autonomous" decision made in "private" by the
patient, came down to yet another Kaiser HMO doctor-administrator,
Robert Richardson, who approved giving a lethal overdose to this
elderly woman under pressure from her family. Kaiser Permanente is
a fully capitated HMO with a profit sharing plan for its doctors.
Such organizations receive compensation for the number of patients
enrolled in their system regardless of the cost of their medical
care, and it allowed repeated second opinions until the very lowest
cost care of all was given-that is no care, but assisted suicide
instead. Dr. Richardson may or may not have directly thought of the
economic advantages to his organization and his own profit sharing
plan in making his decision about Mrs. Cheney. Nevertheless, the
existence of an economic incentive program put in place purposefully
to induce doctors to reduce medical costs, an incentive system that
in this case favored doctor-assisted suicide over expensive medical
care, did exist. And why are these profit sharing plans favoring
less care set up in managed care companies? Because they work. They
influence doctors' decisions.
Outside pressure or influence for assisted suicide is not at all
uncommon, once assisted suicide becomes legalized. In fact, in the
Netherlands, over half the doctors feel it is fine to actually suggest
to a patient who has not requested it, that assisted suicide is an
option. The mere inclusion of the option for PAS to a potentially
terminally ill patient says to that patient that the doctor no longer
sees any value in their life.
Mrs. Cheney was pressured into suicide instead of medical care,
because she had been stigmatized by being labeled "terminal." A demented
patient who was not labeled "terminal" would have been protected
against assisted suicide regardless of any pressure from the family.
The designation of having a "terminal" illness is an arbitrary one,
defined in Oregon law as a prediction according to the doctor's judgment
that the patient will die within six months. This prediction is notoriously
difficult to make. All physicians have known patients who were thought
to have a lethal condition for whom the diagnosis was mistaken or
who unexpectedly recovered entirely and went on to live productive
Lesson # 8:
Financial incentives for doctors favor assisted suicide.
Lesson # 9:
There are no real safeguards, particularly for the elderly.
The state of Oregon has failed to provide any meaningful oversight
of assisted suicide and has done virtually nothing to protect the
vulnerable. There have been only three reports and all have been
used to whitewash assisted suicide, not to protect patients. 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."18 It carefully avoided
providing any useful information. The first publicly reported case
of assisted suicide was noted to have been diagnosed with depression,
yet the report failed to reveal this fact. Neither did the report
mention a known case where finances were one motivating factors in
her decision for assisted suicide. The OHD overlooked these problems
and other problems, because it only interviewed the doctors who prescribed
the lethal drugs and who therefore had a vested interest in justifying
their behavior. The second OHD report also interviewed some family
members, but those family members were chosen by the assisted-suicide
doctors themselves and were also motivated to justify their recent
collusion in a patient suicide.
At least one assisted-suicide attempt resulted in such disturbing
symptoms that the family called 911.19 The patient was taken to the
hospital and resuscitated. This case apparently was never reported.
This instance when a known failed assisted-suicide case was not reported
suggests that there is skewed reporting with complications being
hidden. The OHD also failed to mention documented dementia in the
Kate Cheney case. It did not mention known, multiple and conflicting
mental health opinions. Neither did the OHD report that there were
any instances of family pressure or coercion, despite the fact that
two mental health professionals were known to have found such factors
present in the Kate Cheney case. It is not known how many other cases
in which such pressures may have played a part. Concerning the issue
of economic pressures, OHD only asserted that all the assisted-suicide
cases were insured. It provided no information about what the financial
arrangements of the insurance companies might be. It did not mention
the capitated and profit sharing plan of the Kaiser HMO where Mrs.
Cheney died. It did not mention the rationing of health care and
the barriers to mental health care on the OHP upon which four cases
had to rely. And, it said nothing about how many patients belonged
to HMOs which put limits on payments for in-home palliative care
at very low amounts, yet fully fund assisted suicide, as Qual Med
HMO is reported to do. Instead of gathering useful information, the
OHD once again overreached its data and provided unsubstantiated
One of the more significant findings in the third report deals with
patients' reasons for choosing induced death. As in the previous
two reports, fears about loosing autonomy, the ability to participate
in enjoyable activities, and control over bodily functions topped
the list of reasons. However, for the first time, a clear majority
(63%) of those whose deaths occurred in 2000 said they feared becoming
burdens on their families, friends and caregivers, compared to 26%
in the previous year.
In Oregon the "right to die" is becoming the "duty" to die.
Another very disturbing trend is the undermining of palliative care
and pain management that has resulted from the erosion the doctor-patient
and nurse-patient relationship. The insidious but real practice of "slow
euthanasia" or more properly "terminal sedation" wherein
increasing doses of morphine render a patient unconscious and dead
within days are going on unnoticed and unreported. This practice
distorts the principle of "double effect" by claiming the harmful
effect of morphine infusion i.e. death was not the intended effect
which was rather the amelioration of pain and suffering.
In a notable exception to appropriate use of morphine, five seriously
ill patients in a Sheridan, Oregon, hospice were given excessive
doses of morphine by a Michael J. Coons, between November, 1997 and
January, 1998, just after the Oregon assisted-suicide law was implemented.
These events were reported in the Oregonian, a local newspaper.
The overdoses resulted in the deaths of four of the five patients.
Some patients were determined by investigators to have refused pain
medication and were given it nonetheless. Another was given repeated
narcotic doses when he was unconscious or unresponsive. The one woman
who survived had been placed on hospice, which meant that she had
been determined to be "terminally ill" and to have less than six
months to live, by the nurse who eventually gave her a life threatening
overdose. She turns out not to have met criteria for "terminal illness" after
all, because two years later, she is still alive. Her experience
with the attempts to kill her with a lethal overdose, however, have
undermined her trust in the medical care system and at night she
makes sure her door is always locked. The other four patients did
not live to struggle with their fears.
In Oregon, where the lives of the seriously ill have been devalued
by the acceptance of giving some patients overdoses, there was an
inordinate delay in the investigation of these cases. Complaints
were dismissed by agency after agency, until the persistence of the
daughter of one of the victims, finally succeeded, one-and-a-half
years later in demanding an inquiry. The daughter of the single survivor
said she did not know about the overdose of her mother until it was
published in the newspaper, two years later. She was outraged. It
is clear then that the erosion of the conditions of trust in the
doctor-patient relationship, and more broadly in the complex medical
system in which people are actually treated has already begun in
the state of Oregon has it has in the Netherlands. And it is already
undermining Oregon's pain treatment and palliative care systems.
Lesson # 11:
When doctors and nurses have the ability to kill as well
as heal, confidence in the 'doctor-patient' and 'nurse-patient'
relationships are compromised.
The US Supreme Court was right when it predicted: ..".what is couched
as a limited right to 'physician-assisted suicide' is likely, in
effect a much broader license, which could prove extremely difficult
to police and contain."20
Let me share one last case. Another of the complications
the OHD failed to report. This case reveals the inevitability of allowing
lethal injection once protection against assisted suicide is removed.
With lethal injection, it is even more obvious than with assisted suicide
that power and control is given to doctors, nurses and a complex medical,
economic, and social system, not to a patient acting in a hypothetically "autonomous" and "private" manner.
Patrick Matheny21 was a man with amyotrophic lateral sclerosis (ALS),
who received through the mail a huge quantity of barbiturates prescribed
by an assisted-suicide doctor. When he undertook his assisted suicide
with no doctor in attendance, he had difficulty swallowing the contents
of the large number of capsules, because of his medical condition
and his suicide attempt failed. He tried again the next morning.
After he could not complete the second attempt, his brother-in-law
said he "helped" him die and complained that Oregon's suicide law
discriminates against those who cannot swallow. The body was cremated
within a day; consequently, no autopsy could ascertain the cause
Doctors and other citizens demanded that the prosecutor investigate
the death, because illegal suffocation of the patient has been the
most frequent method of "helping" patients whose attempts fail. The
Coos County prosecutor, however, refused to pursue the case, while
making comments that individuals who are disabled by being unable
to swallow should have the "right" to assisted suicide, as long as
they are otherwise qualified. It is clear that the assistance the
prosecutor had in mind could include either the plastic bag or lethal
injection. In response to further inquiry, Oregon's Deputy Attorney
General issued an opinion indicating that lethal injection may need
to be accepted once assisted suicide is accepted, because Oregon's
assisted-suicide law does not provide equal access to its provisions
by disabled people who cannot swallow and may violate the Americans
with Disabilities Act. He issued this opinion much to the dismay
of advocates for the disabled in Oregon.
What is so important about failed assisted-suicide cases is that
they are bound to bring in lethal injection. That is what has happened
in the Netherlands.22 That is what the Hemlock Society's Derek Humphry
has been demanding as a solution to the problem of inability to swallow
and failed attempts. That is the dilemma Dr. Sherwin Nuland raised
in the New England Journal of Medicine23-if doctors are going to
start carrying out assisted suicides, they will need lethal injection
to finish the job-and lethal injection clearly gives power and control
to doctors, nurses, and health care systems, not to the patient.
Lesson # 12:
Once the door is open to physician-assisted suicide lethal
injection or euthanasia will follow.
The painful lessons I have shared with you today have been shared
in the hope that Arizona will never have to suffer the devastating
effects of legalized assisted suicide that we endure in Oregon. Don't
let your state go down the dangerous path my state alone has gone
down. Follow the example of the many, many states that have rejected
the deceptions of assisted suicide in their courts and their legislatures
and their ballot boxes. Look to the example of courts in Washington
state and New York and Florida and Alaska which upheld their laws
protecting patients against the dangers of assisted suicide. Follow
the example of Michigan, Maine, California and again Washington,
which have rejected highly publicized out-of-state assisted-suicide
campaigns. Follow the examples of the numerous states that, in the
past ten years, have strengthened laws protecting citizens against
the seductions of assisted suicide
Affirm the sanctity of life in Arizona and protect your state against
the evils of PAS and euthanasia.
12 Lessons from Oregon
Thomas M. Pitre, M.D., N. Gregory Hamilton, M.D.,
and William Toffler, M.D.
Physicians for Compassionate Care
Lesson # 1: Know your enemy.
Lesson # 2: Assisted-suicide proponents are capable of deceit.
Lesson # 3: Pro-Life doctors need to stay involved in organized
Lesson # 4: Confused voters favor "choice."
Lesson # 5: Well-reasoned dialogue can be effective.
Lesson # 6: Broad based coalitions of support and funding work the
Lesson # 7: Physician-assisted suicide (PAS) deprives the terminally
ill of protections the rest of us enjoy.
Lesson # 8: Financial incentives for doctors favor assisted suicide.
Lesson # 9: There are no real safeguards, particularly for the elderly.
Lesson # 10: In Oregon the "right to die" is becoming the "duty" to
Lesson # 11: When doctors and nurses have the ability to kill as
well as heal, confidence in the 'doctor-patient' and 'nurse-patient'
relationships are compromised.
Lesson # 12: Once the door is open to physician-assisted suicide
lethal injection or euthanasia will follow.
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
- 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.
This very effective flyer couldn't be challenged in Maine and it
is equally true for the law that exists in Oregon.
1 Hamilton, N.G. "Oregon's Culture of Silence," in The Case Against
Assisted Suicide: For End of Life Care, edited by K. Foley
and H. Hendin, (Baltimore: John's Hopkins Press, 2002).
2 Hamilton, N.G., Boehnlein, J.K., and Hamilton, C.A. "The Doctor-Patient
Relationship and Assisted suicide," American Journal of Forensic
Psychiatry,. 1998, 19:58-95;
Hamilton, N.G. and Hamilton, C.A. "Therapeutic Response to Assisted
suicide Request." Bulletin of the Menninger Clinic, 1999;
3 Marker, Rita. "An Inside Look at the Right-to-Die Movement," The
National Catholic Bioethics Quarterly - Physician-Assisted Suicide
and Euthanasia, Vol. 1 No. 3. Autumn 2001; 363-394.
Marker, Rita, Deadly Compassion (New York: William Morrow,
4Sulmasy, Daniel P, Snyder, Lois. "Physician-Assisted Suicide
- Position Paper of the American College of Physicians-American Society
of Internal Medicine." Annals of Internal Medicine.
Vol. 135 No. 3. August 7, 2001;.209-216.
5 Smith, W. The Culture of Death (San Francisco: Encounter
6 Ibid., note 4.
7 Humphrey, D, Final Exit (Eugene, Oregon: Hemlock Society
8 Ibid., note 3.
9 Hamilton, N.G., "Lethal Injection, Not Suicide, Key to Measure." Eugene-Register
Guard, May 6, 1997.
10 Ibid., note 2, "Therapeutic Response to Assisted-Suicide Request."
11 Hendin, H., Foley, K., and White, M., "Physician-Assisted Suicide:
Reflections on Oregon's First Case." Issues In Law and Medicine,
12 Regan, P., "Helen," Lancet, 1999, 359:1265-1267.
13 Ibid., note 11.
14 Ganzini, L. et al., "Attitudes of Oregon Psychiatrist
Towards Assisted Suicide," American Journal of Psychiatry,
15 Hamilton, N.G., "Suicide Prevention in Primary Care," Postgraduate
Medicine, 2000, 108:81-84.
16 Hamilton, C.A., "The Oregon Report: What's Hiding Behind the
Numbers," Brainstorm, March, 2000, 36-38.
17 Ibid., see notes 1 and 5.
18 Foley, K. and Hendin, H., "The Oregon Report: Don't Ask, Don't
Tell," Hastings Center Report, 1999,29:37-42.
19 Ibid., see note 16.
20 Glucksberg v. New
21 Ibid., see note 2.
22 Hendin, H., Seduced by Death (New York: W.W. Horton, 1998).
23 Nuland, S.B., "Physician-Assisted suicide and Euthanasia in Practice." New
England Journal of Medicine, 2000, 342:583-584.