Dear PCC Member:
The following article from Brainstorm magazine is as thought-provoking
as it is sobering. It contains quotes from a Kaiser administrator
as well as a number of our members (including the directors of
Not Dead Yet and the American Foundation for Suicide Prevention).
Please share this with anyone who may find it of interest.
William L. Toffler MD
Physicians for Compassionate Care
KILLING GRANDMA Editorial, Brainstorm Magazine, November,
Debate, stifled by secrecy for the past year that Oregon's assisted
suicide law has been in effect, has finally spilled over with the
publication of a story about 85-year-old Kate Cheney's assisted suicide.
The Oregonian's Erin Hoover Barnett chronicled Cheney's demise by
lethal prescription. The October 17, 1999 article touched off a chain
of responses that illustrate problems with the continuing debate,
or lack thereof, on assisted suicide.
Following publication of the article, Dr. Gregory Hamilton of Physicians
for Compassionate Care (PCC) broadcast emailed a letter about the
potentially flawed decision-making process in Cheney's death. In
particular he questioned the aspect of her physician evaluations: "This
doctor had been assigned to Mrs. Cheney when her disgruntled daughter
demanded a different physician for her mother, after her original
doctor appeared less than enthusiastic about assisted suicide for
Hamilton, whose PCC group advocates against assisted suicide, continued: "When
the psychiatrist said she was not eligible for assisted suicide,
the daughter and the new doctor did not accept the opinion as the
safeguard it was supposed to be. Instead, they sought another opinion
from a second mental health professional, since there is nothing
in the Oregon law to stop them from doing so... The final call came
down to a single administrator, Dr. Robert Richardson... He gave
the go-ahead for giving a lethal overdose to this elderly woman under
pressure from her family. It was his call...Kaiser Permanente is
a fully capitated HMO with a profit sharing plan for its doctors," Hamilton
E-mail responses to Hamilton flew fast and furious. Here's a sampling:
"Dr. Hamilton's comments, implying that a desire to save money motivates
our physicians' decisions regarding terminally ill patients' mental
capabilities, are both deeply offensive and have no basis in fact...
We feel sorrow that Kate Cheney's family and her caregivers were
subjected to this mean-spirited, misinformed and undeserved attack. "Kaiser
Permanente does not take a stand either for or against physician
assisted sucide, but we respect the decision that Oregon voters have
made. As such, Kaiser Permanente complies with Oregon's Death with
-- Robert H. Richardson, M.D., Kaiser Permanente Ethics Services
"Equally confusing is your (Richardson's) statement, as a supposed
ethicist, that one can participate in an activity without taking
a stand for or against it. It is possible in Oregon to 'comply with
the Death with Dignity Act' by refusing to participate. Kaisier Permanente
health care providers are not merely complying with the act, they
are supporting and participating in physician assisted suicide."
-- Karen L. Brauer M.S., R.Ph.
It was no accident that Barnett's article appeared before a key
vote in Congress on assisted suicide. That legislation, sponsored
by Rep. Henry Hyde, R-Ill., eventually passed the U. S. House of
Representatives - overwhelmingly, as news reporters like to write.
(This time it really was overwhelmingly - 271-156.) If passed by
the Senate and signed by the President, it would essentially strike
down Oregon's landmark initiative by outlawing the use of controlled
substances to effect death, even while promoting their aggressive
use for end-of-life pain management.
Predictably, responses to Hyde's bill were also fast and furious.
And also predictably, responses to both Hyde's bill and Hamilton's
e-mail shared a common theme: How dare you question? How dare you
question the Oregon law? How dare you question the way we carry out
the Oregon law?
The talk shows buzzed -- the voters of Oregon had spoken. So shut
up. No more discussion.
Many Oregonians rely on the argument that because the law passed,
it is now somehow inappropriate to continue to discuss the hot-button
issue of assisted suicide. Too few Oregonians understand that such
an incredible, radical experiment in government social policy should
signal just the beginning of rigorous scientific, ethical, and physical
It is a uniquely Oregon response. We passed the Bear-Cougar initiative
- so don't even think about bringing it back up. No matter how many
cougars are prowling your back yard, eating your cats, mauling your
children. No more discussion.
We passed the lottery initiative. DO NOT bring that back up -- no
matter how dependent our schools are on poor Oregonians throwing
their money away on vain hopes of big payoffs, no matter how many
Oregon lottery addicts commit first person suicide. No more discussion.
Yes we voted on assisted suicide, twice. But if Oregonians thought
that ended the discussion, they made a serious mistake. Oregon alone
of the United States opened the door to assisted death and they will
be looking hard in the face of death issues for some time to come.
The most pressing problem still is the lack of scrutiny built into
Oregon's law, With the details of assisted deaths in Oregon shrouded
in secrecy, discussion and evaluation of the law's successes or failures
is effectively squelched. What does the public know of the 15 assisted
suicides in Oregon? Next to nothing. Other states would most certainly
be unwise to proceed on the Oregon precedent with such inadequate
documentation of the law's efficacy.
Which brings us back to the article by Barnett on Cheney's death.
Poor Oregon. We are left to rely on the whims of a newspaper editor
to select the story, a reporter to properly tell the tale, and a
family to volunteer to go public. In this way, and only in this way,
crucial public policy discussion begins and ends. Somehow it's hard
to believe this is what the U.S. Supreme Court had in mind when they
said that the states should engage in an "earnest and profound debate
about the morality, legality, and practicality" of assisted suicide.
Questions that arose before Cheney's death must and will still linger
long afterward. Questions like these from the e-mailed messages:
"Just how much dementia and how much coercion must be present before
a vulnerable individual can be protected? How much opinion shopping
may have been taking place? And why?" - Dr. Greg Hamilton, Physicians
for Compassionate Care
"Mrs. Cheney makes her final decision after returning home from
a nursing home where she was sent because of the strain of the situation
on her daughter. Never does her daughter say 'Mom you are not a burden,
we love you and we want you around as long as possible.' Would this
have made a difference?" - Herbert Hendin
A woman with a severe neuromuscular disability who has used a motorized
wheelchair since the age of eleven wrote, "Ms. Cheney appears to
have been given the message that she had three choices - to be a
burden on family, to go to a nursing home, or to die. After a week
in a nursing home, an experience I wouldn't wish on my opponents
except perhaps to educate them, it appears that Ms. Cheney felt she
had only one option. How is this a voluntary and uncoerced decision
based on informed consent?" - Diane Coleman, J.D., Pres. Not Dead
These are the questions the Supreme Court of the United States says
we should all still struggle to answer. How many of us can answer
them with dead certainty?