To Chair Arakaki, Vice-Chair Green, and Members of the House Health Committee

Hearing: HB 1454, Saturday, February 5, 2005, Hawaii State Capitol Building

From: Dr. William M. Petty, M.D.

STATEMENT OF POSITION: I am an Oregon physician and I urge you to reject HB 1454.

Chair Arakaki, Vice-Chair Green, and Honorable Members of the Health Committee My name is William M. Petty. I am a physician from Oregon and an Associate Professor of Gynecology at the Oregon Health & Science University. And I am speaking on my own behalf.

I have spent my entire medical career in Oregon, treating patients with life threatening, sometimes terminal cancer. The issues raised by this legislation are ones I have dealt with my entire professional life. But I don't speak to you today about issues. I speak today about patients and their lives and the effect of physician-assisted suicide in my state.

Opponents of assisted suicide will warn you that it will affect the most vulnerable. They are right. For me the vulnerable have faces. They are patients I remember. I remember the woman talked out of pursuing further cancer treatment by her son. I remember the elderly woman: agitated, disoriented, and incoherent after her operation. The attending medical personnel repeatedly suggested to her daughter that the elderly woman be "let go," that she would not recover. I'm grateful that my wife refused this advice and that my "terminal" mother-in-law is leading a content life 11 months later.

Not all the vulnerable are so lucky. Some people are dependent on caregivers. They often focus on pleasing the caregiver. They are not in a position of independence and real choice. They are the potential victims of subtle or not so subtle coercion. Manipulation of patients is a real problem when physician-assisted suicide becomes an option. And this manipulation can't be prevented by writing legislative statutes, no matter how well intended. Manipulation can be done by a family member or the doctor.

I have counseled the suicidal, people who feel that today is intolerable, and tomorrow will be worse. A diagnosis of cancer is a very difficult thing to deal with. Depression is a reaction that can accompany that diagnosis. Depression does impair judgment. And that patient is vulnerable and not herself. This is not the time to abandon the person to physician-assisted suicide. Yet, in my state, doctors are giving suicide drugs to depressed patients. And there is nothing that requires that a patient be treated for depression before getting a lethal prescription. Psychiatric referrals have fallen each year the law has been in effect in Oregon until they are approaching zero.

This troubles me about my profession. In Oregon, it seems that physician attitudes are changing. Doctors are not trying to keep patients alive during the critical times. A friend with bladder cancer, which had spread, went to an oncologist and was told there was nothing more to do. Yet a second doctor said, "You have about an 80% chance of responding to treatment.' My friend later asked about the first oncologist, "Do you think he is a 'death doctor'?" That was a question that wouldn't have been asked in my first 25 years of practice.

What is involved for the patient in assisted suicide? What happens? The patient needs to rapidly take 90 capsules worth of a barbituric acid, like Nembutal / pentobarbital. It takes this much to be lethal. It is extremely bitter. I've tasted it. It often causes severe abdominal pain and may cause nausea, vomiting abdominal pain and other problems.

Does physician-assisted suicide fail? Yes it does. It fails about 20% of the time. In the book, "Drug Use in assisted Suicide and Euthanasia," discussing what has happened in the Netherlands, Kimsma reports, ".in 20% of the patients who received a barbiturate, a muscle relaxant was needed to end his life after the 5-hour period." What this means is that a lethal injection was given because the barbiturate didn't work. But in the years that physician-assisted suicide has been legal in Oregon, a suicide failure has never been officially reported.

There is a case from Oregon where a Portland man ingested the prescription at home with his wife and other family members present. He began having physical symptoms. It was not stated whether he was having abdominal pain, nausea & vomiting or what. His wife was greatly distressed and called 9-1-1-. The man was taken to a local hospital and revived. He had completed all the paperwork the Oregon law required and was using a registered prescription. Yet this failure appeared in no report by the Oregon Department of Health. It became public only because it was discussed by an attorney at a meeting at Portland Community College. Pro-suicide activists, including the attorney, have publicly denied this case happened. But there was a tape recording of the meeting and I have a copy of it here. Does Hawaii want 911 calls for botched suicides?

Why is this important? Because it is a physician-assisted suicide failure in Oregon. This failure should have been reported. But it wasn't. There are other things not reported by authorities in Oregon, abuses or violations of the law that are now independently documented. The Washington Post reported Dr. Peter Rasmussen had a patient who took the suicide drugs. When he came back 11 hours later she was still alive. Why is this significant? Because the medications either cause death within 31/2 - 4 hours or the effect of the drug wears off. That is why doctors in the Netherlands give a lethal injection at five hours. The newspaper reports "the patient later died". How? No one is saying. Yet no one at Oregon's Department of Health has investigated. The law in Oregon doesn't provide for investigation. Nor does the law proposed in Hawaii.

There are more instances of abuse of the law in Oregon. So to say the law is successful is a fairytale. If no problems, abuses, or violations are ever reported, even if they occur, this doesn't mean the law is a success. It just means that the reports are unreliable.

The law is not successful for vulnerable patients. The law is not successful for the medical profession because it has compromised the care provided by some physicians and protected other physicians who probably should have been investigated.

Let me close by telling you about two of my patients who did want suicide. I have had a plaque on the wall of my office, a part of the Hippocratic Oath, that says "I will give no poison nor recommend the same, but will hold all life to have inherent value." I have had many patients comment favorably on it, but two women objected to it.

The first woman had recurrent cancer and said she wanted to die. I asked her why. It turned out she had been stoically living with persistent pain. She wasn't completely responsive to her medication. When her pain medication was adjusted, her pain came under control. And she no longer wanted to die. She did die later, a natural death, and without pain. Modern medicine can control pain. We need to educate ourselves as physicians to be able to do this and for our patients to expect that this be done.

The second woman said she didn't like my plaque. I asked her why. It turned out she thought that if I were against physician-assisted suicide I would insist on keeping her on a respirator or artificial life support. I assured her that I would not do that. I would keep her comfortable, but her choice of treatments was her own. After this discussion, she understood that I would honor her wishes and she would control the course of her care. She later died a natural death at home.

My professional life has been involved in treating individual patients. The basis of our medical profession has been the innate value of each individual life. In Oregon we have now degraded medical care for thousands of individuals because 30 to 40 individuals annually legally kill themselves. We have certain doctors repeatedly involved in these suicides. The incomplete reports from Oregon falsely indicate that the law is a success.

I thank the Chair, Vice-Chair and members of the committee for allowing me this time to testify. I came from Oregon to give this testimony because physician-assisted suicide has harmed patients, my profession, and my state. It would not benefit the people of Hawaii either. I urge you to reject this legislation for the people of Hawaii.