Frequently Asked Questions

The legalization of assisted suicide does not give any new rights to patients—in fact, it undermines the foundation for patient autonomy. Although tragic and ill-advised, patients can take their lives without assistance. Laws only protects physicians and other health care professionals from criminal and civil prosecution for medical killing. This immunity for health care professionals does not apply to any other medical practice. By asking for the “option to die” citizens have given physicians and other health care professionals the “power to kill” and the power to divide patients into protected and marginalized groups based on subjective criteria. The standard of care for patients who prematurely want to end their lives is mental health services, but assisted suicide laws allow practitioners to put some patients with the disability of terminal illness into a disadvantaged group that can be given means to harm themselves instead of help. This violates the foundational principle of equality of persons which is the basis for medical ethics and our rights to life, liberty, and autonomy.

People with cancer are actually less in favor of assisted suicide than is the general public. Patients with pain want doctors to treat the pain, not kill the patient. In Oregon and other states where records are kept, a minority of patients named pain or fear of pain in the future as the reason for their request for lethal drugs. The top five concerns for which patients request lethal drugs are feeling less able to engage in enjoyable activities, feeling a loss of autonomy or dignity, feeling like a burden, and loss of control of bodily functions. The first four of these can all be symptoms of depression. Depression and cognitive deficits are common but underdiagnosed and depression undertreated in the terminally ill. The major reasons for requesting lethal drugs can be symptoms of depression or disability-related psychological reactions. In the US, lethal drugs are being prescribed for depression and/or disabilities associated with terminal illness. [E. Kolva, B. Rosenfeld, and R. Saracino, “Assessing the Decision-Making Capacity of Terminally Ill Patients with Cancer,” Am J Geriatr Psychiatry 26, no. 5 (May 2018): 523-31; William Breitbart et al., “Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer,” Journal of the American Medical Association 284, no. 22 (2000): 2907-11; HM Chochinov et al., “Desire for death in the terminally ill,” Am J Psychiatry 152, no. 8 (August 1, 1995): 1185-91.]

No. Ethically these are different, and both the motivation (or aim) of the practitioner and the cause of death are different. Patients have the right to refuse treatment. If treatment is never provided or withdrawn because the patient does not want it, the motivation of the practitioner is to end unwanted or burdensome treatment. The patient then dies from his/her underlying disease. With assisted suicide or euthanasia, the motivation and goal of the practitioner is to kill the patient; the cause of death is lethal drugs and the health care practitioner is complicit in causing the patient’s death. Pain and symptoms of terminally ill patients can be treated without killing the patient, so it is ethically inadequate to use the excuse that the motivation for providing lethal drugs is to “end suffering.”

The other problem with assuming that a patient is near death is that health care professionals can be wrong about prognosis and patients may live longer (or shorter) than expected. Sometimes patients do not die after support is withdrawn.

Thinking about suicide is a cardinal feature of depression, and there is a direct relationship between depression and favoring assisted suicide. Depression is frequently overlooked and undertreated in patients with serious physical illness. 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] In contrast to claims that legalization of assisted suicide would be expected to lower rates of suicide in general (because terminally ill patients who get legal lethal drugs have falsified death certificates that hide the true cause of death), studies have shown that legalizing assisted suicide is associated with an increase in overall suicide rates. [Jones DA. Suicide Prevention: Does Legalising Assisted Suicide Make Things Better or Worse?: The Anscombe Bioethics Centre, 2022; Jones DA, Paton D. How Does Legalization of Physician-Assisted Suicide Affect Rates of Suicide? South Med J 2015; 108(10): 599-604.]

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 was later hospitalized for depression and suicidal ideation. When his doctors were planning for his discharge home from the hospital, one physician 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]

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. Assisted suicide does destroy trust between patient and physician (or other health care professional).

In all US jurisdictions where assisted suicide is legal, there is no independent review of the process, which is dependent on self-reporting of health care professionals. Since physicians and other health care professionals are rarely present at the time of the lethal ingestion, we really don’t know what happened at the time of death. 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. We do know that complications such as vomiting, aspiration, mouth and throat burning, and failure to die occur, but the frequency is unknown.

Because no evaluation of patient capacity must be done when patients actually take the lethal drugs, and no one is required to be present, it is unknown if patients are ingesting drugs after they have lost capacity or how often a greedy heir might hurry death along in a frail, vulnerable patient. Unfortunately, tired caregivers or family sometimes express a desire to deny routine care to sick patients (with months or years of life remaining) to end their burden, not that of the sick patient. Assisted suicide laws provide a cover-up for elder abuse and even murder.

The stated “safeguards” in the Oregon law and most other state laws 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 with dementia diagnosed by a psychiatrist and another physician; 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 well beyond their 6-month prognosis (up to 3 years in Washington). There is no protection for the depressed or mentally ill. Less than 5% of those dying from assisted suicide have a mental health consultation.

Another “safeguard” requires physicians and pharmacists in Washington to turn in forms to the Department of Health that document a terminal illness and prognosis, patient consent, and other legally required elements of the process. According to the latest 2019-2021 reports, many physicians have ignored the legal requirements. Of 2704 lethal doses provided in Washington since 2009, 476 physicians’ forms and 264 patient request forms are missing; half of the missing reports are in the last three years. Yet nothing is done to halt this violation of the law.

Proponents of assisted suicide tend to be upper middle class or higher; white, well-educated, and have high income. In general, more 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. There is evidence that minorities, the uninsured, those on Medicaid, and those living in disadvantaged communities may encounter barriers to receiving palliative care [https://www.capc.org/blog/increasing-awareness-palliative-care-minorities/]. It would be a tragedy for these populations if laws made lethal prescriptions more accessible than palliative care. 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 fear that they are the targets of the assisted-suicide movement–a terminal illness is technically a disability itself and is often associated with progressive development of further disabilities.* Legalization of lethal drugs requires health care professionals to use subjective, error-prone criteria to classify people who want to hasten their deaths into two groups: a protected group (who get the standard mental health services) and a marginalized group (who can be harmed and have standard care withheld because they have a disability associated with a projected reduction of lifespan).

*The primary reasons for seeking lethal drugs are all directly or indirectly associated with development of disabilities: feeling less able to engage in enjoyable activities, feeling a loss of autonomy or dignity, feeling like a burden, and loss of control of bodily functions. Health care professionals who agree with patients that their disabled state makes their life worthless, and eligible for lethal drugs, has marginalized that patient due to disability. [See OR and/or WA “Death with Dignity” annual reports for reasons given to seek lethal drugs.]

It is cheaper to pay for lethal drugs than prolonged palliative care, so financial forces favor premature death. This shifts the balance of power away from the patient, and the option to die may become the duty to die. Assisted suicide may feel like the only choice for some patients with financial or social pressures. There is concern nationally regarding the rising costs of health care. Financial conditions may lead to assisted suicide as an answer to those rising costs. For example, 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.

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.” [Robeznieks. Oregon sees fewer numbers of physician-assisted suicides. American Medical News. April 4, 2005]

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 that assisted suicide and euthanasia are unethical and not valid medical treatments.