Euthanasia: A doctor or other person administers a lethal agent, such as an overdose of medication or gas, to another person, with the intent of causing the other person's death.
Physician-assisted suicide: A doctor prescribes a drug or other agent for the express purpose of a patient's committing suicide.
Palliative Sedation: A patient is sedated for the purpose of relieving his or her pain prior to death. When properly used, palliative sedation is not euthanasia. There have, however, been reports of misuse, especially in the UK. Palliative sedation is sometimes referred to as "continuous deep sedation" (CDS) or "terminal sedation."
- Who gets the Rights and Protection with Assisted Suicide?
The legalization of physician-assisted suicide in Oregon does not give any new
rights to patients. The Oregon Law only protects physicians from criminal and
civil prosecution for medical killing. This immunity for physicians does not
apply to any other medical practice. By asking for a "right to die" Oregonians
have given physicians the "power to kill".
- What about Cancer and Pain and Assisted
There is an inverse relationship between cancer patients experience
with pain and their favoring assisted suicide. People with cancer are less
in favor or assisted suicide than is the general public. Patients with pain
want doctors to treat the pain, not kill the patient. In Oregon, a small minority
of patients dying of assisted suicide chose it because of fear of pain in the
future, not because they were actually having pain.
- What is the relationship between Depression and Physician-assisted Suicide?
Thinking about suicide is a cardinal feature of depression, and there is a direct
relationship between depression and favoring physician-assisted suicide. Depression
is frequently overlooked in patients with serious physical illness and Oregon
has high rates of depression and suicide to begin with, especially among the
elderly. Between 1999 and 2002, Oregon had a rate of suicide (excluding the
physician assisted suicides) among those >65 years of age, that was 6th highest
in the nation and 156% that of the national average. [Elder Suicide in Oregon.
CD Summary. Oregon Dept. of Human Services. Feb. 22, 2005]
- Does Physician-assisted Suicide lower the standard of medical care?
Once a patient has the means to take their own life, there can be decreased incentive
to care for the patient's symptoms and needs. The case of Michael Freeland
is an example. Michael had been given a lethal prescription and when his doctors
were planning for his discharge to his home from the hospital, one physicians
wrote that while he probably needed attendant care at home, providing additional
care may be a "moot point" because he had "life-ending medication". His assisted
suicide doctor did nothing to care for his pain and palliative care needs.
This seriously ill patient was receiving poor advice and medical care because
he had lethal drugs. [Hamilton & Hamilton, Competing paradigms or response
to assisted suicide requests in Oregon. Am J Psychiat 2005;162:1060-1065]
- Does Physician Assisted Suicide Destroy the Trust between Patient and Doctor?
This is a personal story of Dr. Ken Stevens. "We had been married for 18 years
and had 6 children. For three years my wife had been suffering from advancing
malignant lymphoma. It had spread from the lymph nodes to her brain, to her spinal
cord and to her bones. She had received extensive chemotherapy and radiation
treatments. She required considerable pain medication, antidepressants and other
supportive measures. In late May, 1982, we met again with her physician to review
what more could be done. It was obvious that there was no further treatment that
would halt the cancer's progressive nature. As we were about to leave his office,
her physician said, "Well, I could write a prescription for an 'extra large'
amount of pain medication for you." He did not say it was for her to hasten her
death, but she and I both felt his intended message. We knew that was the intent
of his words. We declined the prescription. As I helped her to our car, she said, "He
wants me to kill myself." She and I were devastated. How could her trusted physician
subtly suggest to her that she take her own life with lethal drugs? We had felt
much discouragement during the prior three years, but not the deep despair that
we felt at that time when her physician, her trusted physician, subtly suggested
that suicide should be considered. His subtle message to her was, "Your life
is no longer of value, you are better off dead." Six days later she died peacefully,
naturally, with dignity and at ease in her bed, without the suggested lethal
drugs. Physician-assisted suicide does destroy trust between patient and physician.
- How Do People in Oregon Die with Assisted Suicide?
In Oregon, we are dependent on self-reporting of physicians, and since physicians
are rarely present at the time of the lethal ingestion, we really don’t know.
The Oregon Department of Human Services publicly states that they do not have "authority
to investigate individual Death with Dignity cases”. The Oregon law actually
prohibits investigation of many details of these deaths.
- Are the Assisted Suicide "Safeguards" in Oregon being
The stated "safeguards" in the Oregon law include: being capable, not being depressed,
no coercion, self-administration, and life expectancy of less than 6 months.
Yet, reports in the public press have described that among those who have died
from assisted suicide there are: patients who are depressed; patients who are
demented; patients and families "doctor-shopping" until they find a doctor who
will write a prescription; patients with swallowing problems requiring assistance
in taking the medication (not self-administered); coercive family members; doctors
being coerced/intimidated into writing the lethal prescription; patients living
as long as a year after being determined eligible. There is no protection for
the depressed or mentally ill. Between 2003 and 2005, less than 5% of those dying
from assisted suicide had a mental health consultation. There are published reports
of a patient diagnosed by a psychiatrist as having dementia, and still receiving
a prescription for lethal drugs. The drug is supposed to be self-administered
and we have newspaper reports of patients being assisted in taking the drugs,
because they were not able to be self-administered.
- Is Physician Assisted Suicide a "policy of privilege"?
Proponents of assisted suicide tend to be upper middle class or higher; white,
well educated, and have high income. African-American and Hispanic organizations
are very opposed and fearful of the legalization of assisted suicide because
of their minority status and more limited resources. The arguments favoring
assisted suicide are demeaning to people with disabilities: Proponents of legalizing
assisted suicide say, "there are situations that are worse than death." This
has mobilized the disability community against the legalization of assisted
suicide. People with disabilities have expressed fear that they may become
the next targets of the assisted-suicide movement.
- Are there Financial issues in Physician Assisted Suicide?
The financial and societal dangers; assisted suicide may become the only choice
for some patients. There is concern nationally and within Oregon regarding
the rising costs of health care. Financial conditions may lead to assisted
suicide as an answer to those rising costs. Oregon Medicaid, the Oregon Health
Plan, covers the costs of assisted suicide with state dollars, but it does
not cover the costs for curative or local medical treatment for patients with
cancer with a less than 5% chance of living 5 years, even when that treatment
can prolong valuable life. In 2003, the Oregon Health Plan stopped paying for
medicines for 10,000 poor Oregonians; this included patients with AIDS, bone
marrow transplants, mentally ill and seizure disorders. In 2004 and the first
half of this year, an additional 75,000 Oregonians were cut from the Oregon
Health Plan, to keep the state budget balanced. Assisted suicide may become
the "only choice" for some vulnerable patients. Even if a patient has Medicare
or Medicaid health coverage, there is limited access to health care in Oregon.
Sixty percent of Oregon physicians limit or do not see Medicaid patients, forty
percent of Oregon physicians limit or do not see Medicare patients. Seventeen
percent of Oregonians are without health insurance, and the share of Oregonians
without health insurance has grown faster than in any other state over the
past four years.
- Does Physician Assisted Suicide lead to Euthanasia?
The prospect of euthanasia was raised by Mr. David Schuman, then an Oregon Deputy
Attorney General in 1999, in a letter to a state senator. He wrote that Oregon's
assisted suicide law would in effect be discriminatory because of the Americans
with Disabilities Act, because the Oregon law requires self-administration
and not everyone is capable of that. "The assisted suicide law would be treated
by the courts as though it explicitly denied the 'benefit of a 'death with
dignity' to disabled people," Mr. Schuman wrote. Many doctors are writing
prescriptions for lethal drugs to patients for whom they have not previously
cared. Dr. Rasmussen had reported that "75% of the patients who come to him
regarding assisted suicide are patients he has never seen before." Regarding
the "slippery slope" of assisted suicide, Dr. Rasmussen said, "I think all
involved in the Oregon law must recognize that we are on a slippery slope,
and we have to be careful with every step. But just because it's a slippery
slope doesn't mean we shouldn't go there. [Robeznieks. Oregon sees fewer numbers
of physician-assisted suicides. American Medical News. April 4, 2005]
- Is PCCEF affilicated with a religious
No. Physicians for Compassionate Care Education Foundation is not affiliated
with any religious or political organization. What unites PCCEF members
is the conviction that human life has value and the physician-assisted suicide