Hawaii House of Representatives
Committee on Health
Rep. Dennis A. Arakaki, Chair
Rep. Josh Green, M.D., Vice Chair
Hearing on HB 1454 - Relating to Death with Dignity
February 5, 2005
Hawaii State Capitol Auditorium
Testimony of Kenneth R. Stevens, Jr., M.D.
Physicians for Compassionate Care Education Foundation
have been in the practice of Radiation Oncology, treating cancer
patients, for 38 years in Oregon. I have been Professor and
Chair of the Department of Radiation Oncology at Oregon Health & Science
University for over 15 years. [I speak for myself;
I do not speak for the university.]
am opposed to the legalization of assisted suicide and euthanasia. Since
the passage of Oregon's assisted-suicide law, I have learned the
significant harm and danger of assisted suicide to the vulnerably
ill and to society.
HOW DID ASSISTED SUICIDE COME TO OREGON?
1994, the organization Compassion in Dying (CID) came into Oregon. Leaders
of CID wrote the Oregon assisted-suicide law, and were able to
get "Measure 16" (the assisted-suicide ballot measure) on the
Oregon ballot. By a 2% margin (51% to 49%), Measure 16 passed
in 1994, and physician-assisted suicide became legal in Oregon. Since
that time CID has been very involved with assisted suicide in Oregon. CID
leaders have instructed doctors about what drugs to prescribe and
how to do the assisted suicide. CID leaders report that 80%
of those dying from assisted suicide in Oregon are clients of CID.
CID CONTROLS THE ASSISTED SUICIDE INFORMATION IN OREGON
was announced earlier today at this hearing by one of the assisted-suicide
proponents that there were 206 assisted suicide deaths in Oregon
in the past 7 years (1998-2004), and that there were 210,000 people
who had died in Oregon in the past seven years. From where
did that information come? The Oregon Department of Human
Services, which has the responsibility to report on what is happening
regarding assisted suicide in Oregon, has not released any information
regarding the 2004 year. That information appears to have
come from CID leaders. A communication from the CID Oregon
executive director on this past Monday, January 31, 2005, reports
that there were 35 assisted-suicide deaths in Oregon in the year
2004.  It
was also reported that of those 35 deaths, 29 (83%) were helped
by CID. Of the 29 deaths helped by CID, CID personnel were
present when 18 of the patients took the lethal medication, but
the prescribing doctor was present at the time the lethal medication
was taken for only 8 patients.
is noteworthy that this initial information came from the leadership
of CID, and not from the Oregon Department of Human Services that
has responsibility to inform the public on such matters. And
how does CID know that there were 6 deaths of non-CID patients? How
do they know there were 210,000 Oregonians dying in the past seven
George Eighmey, executive director of CID Oregon, told a New York
Times reporter in April 2004 that he had been personally present
at 25 assisted suicide deaths in Oregon. That
is about one in every 7 physician-assisted suicide deaths in Oregon
up to that time.
CID leaders are also working to legalize assisted-suicide in other
states, including Hawaii.
AUTONOMY AND THE CONTROLLING ELITE
great majority of those dying of assisted suicide in Oregon have
been upper-middle class Caucasians. Oregon assisted-suicide
patients have been described by their doctors as being fiercely
independent and controlling. Society should always fear laws
that are established by and for the controlling elite. History
has taught us that once such laws are established, the poor and
vulnerable are discriminated against.
is not surprising that the black community is much less likely
to favor assisted suicide compared to the white community. Families
of Oregonians dying between June 2000 and March 2002 were interviewed
regarding assisted suicide. Whereas 18% of the dying whites
personally considered assisted suicide (none of these people used
assisted suicide), there was not one of 62 blacks that considered
have been no black deaths among the 171 deaths in Oregon between
1998 and 2003.
PAIN, DEPRESSION AND DISABILITIES
There is not one instance in Oregon of assisted suicide being
used because of actual untreatable pain. It has been used
for psychological and social concerns. Depression is the
leading cause of suicide, and depressed people have received lethal
medication in Oregon.
suicide proponents demean and demonize those with disabilities
by suggesting to seriously ill people that there are conditions "worse
than death". Those with disabilities fear they may be the
next targets of assisted suicide. They have formed organizations
such as "Not Dead Yet!".
THE PROBLEMS WITH "SAFEGUARDS"
suicide proponents talk about the "safeguards" with Oregon's
assisted suicide law. The fact that the word "safeguard" is
used is an indication that assisted suicide is dangerous and unsafe
for the general public. We have realized that the "safeguards" are
really boundaries or restrictions around assisted suicide. They
may be considered as a means of protection against abuse, but they
also act as a barrier or restriction to those who find themselves
outside those boundaries.
a person desiring assisted suicide finds themselves outside the
boundaries that are written in the law's safeguards, they want
to bypass or stretch the boundaries. This is especially true
of people who have been described by their doctors as being extreme
in their desire for control of their lives and death.
The "safeguards" or boundaries in the Oregon law are:
of a terminal illness; less than 6 months to live.
years of age.
drugs self-administered and taken by mouth.
injection not permitted.
OREGON'S ASSISTED SUICIDE "SAFEGUARDS" ARE NOT BEING FOLLOWED
virtually every case that has come to public light, the closer
one looks at individual cases, the uglier is the reality.
assisted suicide law provides no protection for the depressed or
mentally ill. Only 5% of those dying from assisted suicide
in 2003 had a mental health consultation. 
Oregon, patients with mental disorders can receive lethal drugs
to kill themselves. Nationally, the majority of forensic
psychiatrists believe that the presence of major depressive disorder
should result in an automatic finding of incompetence. 
Cheney was a woman in her 80s with cancer who requested
assisted suicide. After a psychiatric evaluation determined
that she had dementia and was not mentally capable, she and her
family sought a psychologist's evaluation that felt that she
was capable. This is an example of "doctor-shopping" to
get a desired opinion. She finally received the prescription
for lethal drugs from a Kaiser HMO doctor. 
Freeland was a 62-year old man newly diagnosed with
lung cancer, and with a history of depression and prior suicide
attempt. He received lethal drugs from a CID doctor without
a mental health consultation. He was later admitted to
a psychiatric ward. When he was discharged from the psychiatric
ward, the doctors and court judged him incompetent. Yet
this man had a bottle of lethal drugs in his house.  Was
this safe? Where were the safeguards?
Harris was a man with multiple tumors in his brain,
whose thinking was slipping and parts of his brain were blinking
off. And in that condition he received the lethal medication. 
Matheny  and Barbara
Houck  were
patients with ALS (Amyotropic Lateral Sclerosis), who had
problems swallowing and being able to self-administer the medication. Mr.
Matheny had to be "helped" by his brother-in-law because of his
trouble swallowing. Mrs. Houck had the lethal medication
spoon-fed into her mouth. Where was the self-administration
in these cases?
Oregonians who have received the lethal medication have lived far
longer than 6 months, some for more than 2 years.
1996, a doctor in Corvallis, Oregon had a patient die form lethal
injection. He was not criminally prosecuted and his medical
license was suspended for only two months. 
2003, a patient drank only one-half of the lethal medication, and
then vomited one-third of what he had taken, and he lived 48 hours
before finally dying.  What
was the true cause of death, since he had received a less-than-lethal-dose
of short-acting barbiturate?
are dependent on self-reporting by doctors, and in over 70% of
assisted-suicide deaths in 2003, the prescribing doctors were not
there when the patients took their lethal medications.  So
how do they know what happened at the time of death? The
Oregon state Dept. of Human Services has commented that what they
receive from doctors might be a "cock and bull story". 
We really do not know what is going on in Oregon.
DOCTORS DO NOT TELL THE TRUTH ON THE DEATH CERTIFICATE
When a patient dies from assisted suicide, Oregon doctors do not
indicate on the death certificate that the patient died from a
drug overdose. They record the underlying disease (cancer,
heart disease, etc.) as the cause of death. There is nothing
on the death certificate that identifies the death as an assisted
suicide death, this is because of concern regarding confidentiality.
Oregon, I and other doctors, regularly receive notices that many
important medical services and medications for our patients won't
be coved by Medicaid (Oregon Health Plan). Yet assisted suicide
is fully covered and sanctioned by the state of Oregon and by Oregon
Medicaid. In 2003, Oregon Medicaid stopped paying for medicines
for 10,000 Oregonians who had been on Medicaid. This included
patients with AIDS, bone marrow transplants, mentally ill and those
physician member of Physicians for Compassionate Care received
a phone call in the spring of 2003, from a man requesting assisted
suicide. The man said, "The state of Oregon has stopped paying
for the pain meds I take for my chronic back pain. If they
won't pay for my pain meds, they might as well pay for my suicide."
December 2004, the Oregonian newspaper reported that 50.000 Oregonians
had been cut from the Oregon Health Plan, and that the state plans
to cut another 25,000 Oregonians from the plan by June 2005, to
keep the state budget balanced. 
cutbacks in medical-care financial support are killing Oregonians. It
was reported in The Oregonian newspaper in December 2002 that there
had been 94 mental health-related deaths because of the state cutback
in mental health services. 
vulnerable poor of Oregon have very limited access to health care. Sixty
percent of Oregon doctors limit or do not see Medicaid patients. More
than 40% of Oregon physicians limit or do not see Medicare patients. 
all of these problems with reduction in health care to the vulnerably
poor in Oregon, the Oregon Health Plan (Medicaid) continues to
pay for physician-assisted suicide.
END-OF-LIFE CARE IS MIXED IN OREGON
ranked high in per capita use of morphine before assisted suicide
became legal. Many other states have enacted or strengthened
laws to ban assisted suicide, and per capita use of morphine in
those states has increased in every case. 
national organization, "Last Acts", issued a "report card" in November
2002 to states regarding their end-of-life care. Oregon was
given a "D" grade for hospice (less than 1/3rd of dying Oregonians
used hospice), and an "E" grade for palliative care programs. 
a 2003 Oregonian newspaper interview, Ann Jackson, Executive Director
of he Oregon Hospice Association, said, regarding assisted-suicide
patients, "In effect, they've said no to hospice, either because
they don't believe we in hospice can meet their needs, or we're
not meeting their needs." 
four years of assisted suicide in Oregon, there were twice as many
dying patients in moderate or severe pain or distress, as there
had been prior to Oregon's assisted suicide law being used. 
COMPARISON OF ASSISTED SUICIDE RATES BETWEEN STATES
has been a false report that Oregon has a lower assisted suicide
rate than that of other states.  There
is no truth to that report. Dr. William Toffler and I have
published a report that shows that we do not know what the assisted
suicide rate is in states other than Oregon. 
TRUST BETWEEN PATIENT AND DOCTOR
suicide represents a reversal of the proper role of physician as "healer,
comforter, consoler", to an improper role of helping patients commit
false message of assisted suicide proponents is that doctors can
do a better job of killing patients than they can of caring for
their medical needs.
citizens of Hawaii should learn from the problems with physician-assisted
suicide in Oregon.
citizens of Hawaii should continue to improve your end-of-life
care and palliative-care programs.
suicide is not needed, and it puts vulnerable people at risk.
I came on the plane to Hawaii yesterday, I signed a Hawaii state
government form that certified that I was not bringing a snake
into Hawaii. Assisted-suicide is like a snake, you do not
want it here in Hawaii.
J. A woman ends her life among her friends. New York Times,
June 1, 2004.
SW, Tilden VP, Drach LL, Fromme EK, Perrin NA, Hedberg K. Characteristics
and proportion of dying Oregonians who personally consider
physician-assisted suicide. J
Clin Ethics 2004;15:111-118.
Annual Report on Oregon's Death with Dignity Act, Oregon Department
of Human Services, March 10, 2004, www.ohd.state.or.us/chs/pas/ar-index.cfm.
L, Leong GB, Fenn DS, Silva JA, Weinstock. Evaluation of competence
to consent to assisted suicide: Views of forensic psychiatrists. Am
J Psychiatry. 2000; 157:595-600.
EH. Is Mom capable of choosing to die? The Oregonian.
October 17, 1999.
NG, Hamilton C. Competing paradigms of responding to assisted
suicide requests in Oregon: Case report. American Psychiatric
Association Annual Meeting Symposium on Ethics and End-of-Life
Care: New Insights and Challenges, New York City, May 6, 2004. To
be published in Am J Psychiatry, April, 2005. (available at www.pccef.org,
May 6, 2004)
S. Jake Harris, in Compassion in Dying, edited by
BC Lee (Troutdale, Oregon, NewSage Press), 2003, p 102.
EH. Man with ALS makes up his mind to die. The Oregonian,
March 11, 1999.
J. A death in Oregon: One doctor's story. Washington Post,
November 3, 1999.
Medical News. Board sanctions physician for 'active euthanasia'.
August 11, 1997.
Summary, A year of dignified death, Oregon Health Division,
March 16, 1999, Vol 48, No. 6.
CE. Governor proposes small school aid boost, new lottery games. The
Oregonian. The Associated Press. December 1, 2004.
M. Did they have to die? The Oregonian. December 29,
shows patient access problem grows. The Scribe. Published
by the Medical Society of Metropolitan Portland. November 19,
for Integrity in Palliative Care: Written testimony presented
to the American Medical Association Annual Meeting, June 10,
Acts, Press Release, November 18, 2002.
D. Suicide: Study is based on interviews. The Oregonian.
June 12, 2003.
EK, Tilden VP, Drach LL, Tolle, SW. Increased family reports
of pain or distress in dying Oregonians: 1996 to 2002. J
Palliative Med 2004;7:431-442.
L, Dobscha SK. Clarifying distinctions between contemplating
and completing physician-assisted suicide. J Clinical Ethics 2004;15:119-122.
KR, Toffler WL. Comparing Oregon's physician-assisted suicide
rate with that of other states. J Clinical Ethics 2004;
vol. 15, no. 4 (accepted for publication).