Update: Year 2008, Volume 22, Number 3

Message to Washington:
Oregon assisted suicide is NOT abuse free

   In the weeks leading up to the November 4, 2008, general election, Washington State voters are considering whether their state should follow Oregon’s lead and approve an initiative to legalize physician-assisted suicide (PAS). Increasing numbers of newspaper articles, editorials, TV news features, and on-line blogs are grappling with claims made by both sides of the issue. The question is: Are those claims factual? The answer: Not always.

Take, for example, the rationale behind The Olympian’s recent endorsement of the "Washington Death with Dignity Act" (Initiative 1000), a measure virtually identical to Oregon’s PAS law. The editorial board of this capitol city newspaper had gone to great lengths to appear open minded and committed to ferreting out the truth about what would happen if the initiative passed. It also wanted its position-taking process transparent for the public to see, so 150 people were invited to witness the five-member board’s deliberations. TV cameras were there to record the event. After hearing the arguments from the "Yes on 1000" and the "No on 1000" camps, the board voted. The result was a 4 to 1 vote in favor of the initiative. Those who voted for the paper’s endorsement of I-1000 indicated that the "No" camp had failed to show that there have been significant problems in Oregon after 10 years of legalized assisted suicide. One of those board members, Publisher John Winn Miller, commented, "There has been no documented abuse of the system. And believe me, if there was any, some one would have found it and be screaming about it now." [Adam Wilson, "The Olympian’s opinion on I-1000", 9/10/08]

Chronicle of abuses

Well, the International Task Force, for one, has found it and has been "screaming" about it ever since that law took effect. The significant loopholes in the law and the individual cases of abuse have been chronicled and documented on the ITF website and within the pages of this publication, the ITF Update.

For some people, though, it’s just easier and more "compassionate" to believe that Oregon’s law is working well—after all, that’s what assisted-suicide advocates have been claiming for years. They point to the state’s annual statistical reports and the law’s "safeguards" as proof for their claim.

Annual reports: Not a true reflection of PAS practice

Under the PAS law, a doctor who participates in an assisted suicide must comply with the law’s guidelines and file a report with the state. In turn, the state takes the data the lethally prescribing doctor provides, and, at the end of the year, compiles the data into an annual statistical report. As ITF Executive Director Rita Marker recently observed, "First they help the person commit suicide and, afterwards, they report whether their actions complied with the law." "It would be nifty," she added, "if the Internal Revenue Service allowed such unverified and unverifiable self-reporting." [Marker, "Oregon’s Suicidal Approach to Health Care," American Thinker, 9/14/08]

As the law is written, PAS practice is cloaked in secrecy. Public scrutiny is not allowed, and independent data verification is prohibited. Not even the state has authority to investigate whether the data provided by the doctor is accurate, and it has absolutely no authority to investigate individual assisted-suicide cases for abuses. In addition, the state has no way to know if there were additional PAS deaths that went unreported.

No real safeguards

The law’s safeguards are equally problematic. While these provisions in the law appear protective, what is NOT in the law can truly be deadly.

Let’s say, a physician complies with one of the PAS law’s safeguards by refusing an assisted-suicide request from a patient with early-stage dementia. The doctor’s assessment is that this patient doesn't have the mental capacity to make an informed death request, a requirement under the law. But her daughter is persistent, and "doctor shops" until she finds one who will prescribe her mother a lethal drug overdose. There is nothing in Oregon’s assisted-suicide law to prevent this total circumvention of what appears to be a protective safeguard in the law. (This is not a hypothetical case. The patient’s name was Kate Cheney.)

Perhaps the most compelling flaw in the law is that its safeguard provisions only apply up to the time that the physician writes the prescription for lethal drugs. That is a fact that has been acknowledged by Dr. Katrina Hedberg, the lead author of the majority of Oregon’s annual PAS reports. "The law itself only provides for writing the prescription," she said, "not what happens afterwards." [Hedberg, Testimony before House of Lords Select Committee, 5/4/05.] So during the most critical time—when the patient possesses the fatal medication—no safeguards or provisions apply, not even the provisions against coercion. Greedy heirs can coerce a vulnerable patient into taking the drugs prematurely or slip them into the unsuspecting patient’s food or drink, and the PAS law doesn’t prevent this from happening. The heirs can then inform the doctor that the patient had a peaceful and dignified death at the time of his or her choosing; the doctor (who is not required to be present at the time of death) includes the heirs’ account in the report he submits to the state; and no one is the wiser. Does this happen a lot? We have no way of knowing, but it CAN happen.

One difference in Washington

Washington’s I-1000 does differ from Oregon’s law in one respect. It adds a layer of unprecedented deception by forcing doctors to lie about the cause of death on the assisted-suicide patient’s death certificate. It mandates that the physician "shall list the underlying terminal disease as the cause of death." [I-1000, §4(2)] In other words, even if a doctor knows for sure that his patient took the prescribed lethal drug overdose, the doctor is required to write down, let’s say, bone cancer, if that was the patient’s underlying condition. According to Dr. Brian Wicks, president of the Washington State Medical Association (which opposes I-1000), "To my knowledge there’s no other situation in medicine in which the death certificate is deliberately falsified—and in which this falsification is mandated by law." [WSMA, Press Release, 7/2/08]

An open invitation

Since space here is limited, ITF extends an open invitation to the Washington State media (including The Olympian’s editorial board), and to anyone interested in documented facts on the Oregon PAS experience, to contact us by phone (800-958-5678)or through our web site. Now is the time to get the information needed for a truly informed decision on Washington’s I-1000. 

Oregon newspaper says No to I-1000

Oregon’s largest newspaper, The Oregonian, has decided not to endorse Washington’s assisted-suicide initiative. While it may appear that Oregon’s assisted-suicide law is working, the paper’s editorial board wrote, "Washington voters should be aware, however, that this state’s experience has been mixed." "Oregon’s physician-assisted suicide program has not been sufficiently transparent. Essentially, a coterie of insiders run the program, with a handful of doctors and others deciding what the public may know….[W]e’d feel more confident with more sunlight on the program." The editorial concluded, "[O]ur basic unease with physician-assisted suicide has not changed, and we cannot exhort Washington voters to take the same path." [The Oregonian, 9/20/08]

The PAS advocacy group Compassion & Choices and its network of doctors facilitate approximately 75% of all assisted-suicide deaths in Oregon.      

Costly treatment: No
Assisted suicide: Yes

From the earliest failed attempts by the Hemlock Society (now called Compassion & Choices) to legalize euthanasia and physician-assisted suicide (PAS) in targeted states—California in 1988 and 1992, Washington State in 1991—the International Task Force (ITF) has consistently argued that, if legalized, these induced-death practices would not occur in a vacuum. Rather, they would be practiced within a health care system all too often pressured to cut costs at the expense of patient care. After all, for HMOs and health insurance providers particularly, patients cost less if they die sooner rather than later. Recent revelations regarding two terminally-ill patients in Oregon (the only state in the U.S. to legalize PAS) prove the merit of this argument.

In May, Barbara Wagner, 64, found out that her lung cancer had returned after two years of being in remission. Her oncologist prescribed the drug Tarceva because, he told her, it could extend her life by slowing the cancer’s progression.

But, her health care insurer, the Oregon Health Plan (the state’s rationed Medicaid program for the poor), refused to pay the drug’s $4,000-a-month price tag. According to the unsigned letter she received from the plan, "Treatment of advanced cancer that is meant to prolong life, or change the course of this disease, is not a covered benefit of the Oregon Health Plan." What the letter said it would cover, however, is palliative or comfort care that, includes physician-assisted suicide.

"I think it’s messed up," Wagner tearfully told the Eugene, Oregon, reporter who broke the story in the Register-Guard. "To say to someone, we’ll pay for you to die, but not pay for you to live, it’s cruel," she explained. "I get angry. Who do they think they are?"

Another patient, Randy Stroup, 53, also received a letter from the Oregon Health Plan informing him that the chemotherapy drug prescribed for his prostate cancer would not be covered, but assisted suicide would be. While the prescribed drug, mitoxantrone, would not cure Stroup’s cancer, it could extend his life by several months and make that time more comfortable by decreasing his pain. "What is six months of life worth?" Stroup asked. "To me it’s worth a lot. This is my life they’re playing with." [Register-Guard (Eugene, OR), 6/3/08] Stroup later told Fox News that the treatment rejection letter "dropped my chin to the floor." "[How could they] not pay for medication that would help my life, and yet offer to pay to end my life?" [Fox News, 7/28/08]

According to Oregon Health Plan administrators, any treatment that does not give a patient at least a five percent chance of survival for five years is not covered by the state. Commenting on this policy and Barbara Wagner’s case, ITF Medical Consultant Eric Chevlen, M.D., a cancer and pain control specialist, said, "Under the Oregon Medicaid rules, no patient with metastatic lung cancer would be treated because such patients have less than a five-year life expectancy. However, current chemotherapy of the disease has been shown to both prolong survival and (importantly) to improve quality of life."

Tragically for Oregon’s poor patients, if a costly cancer treatment provides a terminal-stage patient with pain/symptom control and real comfort care rather than a cure, it will not be covered—but lethal drugs for an assisted suicide (officially listed under the category "Comfort Care" on the state’s covered treatment list) will be covered. Why? Because cancer treatment can cost thousands of dollars a month; assisted-suicide costs are usually under $100.

"We can’t cover everything for everyone," explained Dr. Walter Schaffer, medical director of Oregon’s Division of Medical Assistance Programs, which administers the Oregon Health Plan. Most cancer treatments are covered, Schaffer said, "[b]ut there’s some desire on the part of the framers of this list to not cover treatments that are futile, or where the potential benefit to the patient is minimal in relation to the expense of providing the care." [Register-Guard, 6/3/08]

In an attempt to control the public relations disaster caused by the Wagner case, Dr. Som Saha, head of the commission that determines the health plan’s policies, told an Oregon TV news station that Barbara Wagner made an "unfortunate interpretation" of the treatment rejection letter she received. He said that no one was telling her that the state would only pay for her to die. [KVAL News, 7/31/08] Another health plan bureaucrat, Dr. John Sattenspiel, concurred. "The reality is, at some level [physician-assisted suicide] could be considered as a palliative or comfort care measure. We had no intent to upset her, but we do need to point out the options available to her under the Oregon Health Plan," he said. [Register-Guard, 6/3/08]

The statements by Drs. Saha and Sattenspiel point to the crux of the problem in Oregon, said ITF Policy Analyst Kathi Hamlon. "The intent of well-meaning Plan executives is not the issue," she explained. "If assisted suicide was not legal in Oregon in the first place, there would be no letter from the state offering death over life. There would not even be the temptation to use intentionally lethal, but legal, assisted-suicide drugs as the ultimate cost-cutting treatment option."

The experiences of Barbara Wagner and Randy Stroup should provide insight to Washington State voters, who are currently considering an initiative (I-1000) to legalize assisted suicide. A fact sheet—"The Oregon Experience: Ten Years of Oregon Results Show Aid-in-Dying is Working"—posted on the "Yes on 1000" web site, claims: "The poor, disabled or minority population [in Oregon] were not adversely impacted in any manner because all of the patients who chose the [assisted-suicide] option had health care coverage." (Emphasis added.)

That claim prompted ITF’s executive director, Rita Marker, to comment:

________________________________________________________________________

Editor’s note: After Barbara Wagner found out that the Oregon Health Plan would not pay for the drug her oncologist, Dr. Jae Lee, had prescribed, Dr. Lee appealed directly to Genentech, the company that markets Tarceva. The company agreed to immediately provide the drug to Wagner free of charge for one year, after which she could re-apply to extend the coverage. Because Randy Stroup fought the Plan’s denial of his prescribed cancer drug, state bureaucrats changed their minds and now cover his costs for the drug."[A]s state budgets get tighter," one commentator wrote, "other people may not be so lucky." [Editorial, mercatornet.com, 8/15/08]

________________________________________________________________________

"Right to Know" bill passes CA legislature;
 likely to come to a state near you

The California "Right to Know End-of-Life Options Act"(AB 2747) has passed both houses of the legislature and will soon be on Governor Arnold Schwarzenegger’s desk for either his approval or veto. As of this writing, it is not known which way the governor will go. But, even if Schwarzenegger vetoes it, clones of the bill will likely surface in state legislatures across the country. Barbara Coombs Lee—president of the national assisted-suicide advocacy group Compassion & Choices (C&C), the measure’s chief sponsor—said as much on the organization’s website: "This bill serves as a national model for patients to receive the necessary information and power to influence the manner of death." ["Right to Know Act passes California Senate," compassionandchoices.org, 8/20/08]

AB 2747 mandates that, upon receiving a terminal diagnosis, an enquiring patient must receive information on all end-of-life treatment options. But AB 2747 is clearly a bill intended to erode resistance to future attempts to legalize physician-assisted suicide (PAS) in California, a state with a long history of failed attempts by C&C and its predecessor, the Hemlock Society, to legalize the practice. The most recent attempts—bills authored by Assembly Members Patty Berg (D-Eureka) and Lloyd Levine (D-Woodland Hills) in close collaboration with C&C—failed in 2005, 2006, and 2007. Reeling from those defeats, C&C opted to use Berg and Levine one more time before their terms end this year to author AB 2747, a foot-in-the-door measure they spun as being only a hospice/end-of-life information bill that had absolutely nothing to do with assisted suicide. "It’s about information," Berg told one newspaper in her district. "Nothing more and nothing less." [Lake County News, 8/22/08] To another local paper, she claimed, "The bill does not make anything legal that isn’t legal now." [Times-Standard, 6/27/08]

Since the term "assisted suicide" appears nowhere in the bill, many, especially the media, were fooled into believing the information-only spin as well as the authors’ argument that AB 2747 would be a huge victory for patients’ rights. But the bill in its original form wasn’t about giving patients new rights to information—California already has laws and established practice guidelines ensuring those rights—as much as it was about establishing a legal definition of "palliative sedation" to include the withholding of all food and fluids while the patient is rendered unconscious (referred to in the bill as "voluntary stopping of eating and drinking" or VSED). The intentional outcome, of course, would be death within one to three weeks, setting the stage for assisted-suicide advocates to argue later that a doctor’s prescription for lethal drugs—which is legal under Oregon’s PAS law—would be far more humane than forcing patients and their loved ones to endure weeks of unnecessary suffering while the patient starves and dehydrates to death.

Berg and Levine know that argument well. In 2005, when they were trying to convince legislators to pass their bill to legalized assisted suicide (AB 654), they distributed a handout laying out that precise rationale:

AB 2747 amended in Senate, but still objectionable

After passing the Democrat-controlled Assembly on May 28, 2008, by a vote of 42-34, the bill headed to the Senate Health Committee for a hearing on June 25. When it became apparent that the bill wasn’t going to pass out of that committee, Berg was forced to significantly amend sections of the bill in order to assure its passage. Included in those amendments was the deletion of all references to palliative sedation and VSED.

While that was a victory for the many organizations and individuals who actively opposed the bill, two equally objectionable provisions remained unchanged:

These two seemingly innocuous provisions establish C&C and other assisted-suicide groups with "factsheets" and a web site (like Final Exit Network) as professional, end-of-life counseling services to which health care providers can refer vulnerable patients. There is nothing in the amended bill that would prohibit these groups from imparting information on suicide methods or from encouraging patients to opt for starvation and dehydration while sedated. Nor are there any state oversight or accountability requirements in the bill, and absolutely no credentialing requirements for the individual death counselors, most of whom are volunteers.

The abandonment & cruelty of euthanasia

by Wesley J. Smith

A diary account of the euthanasia death of Dutch cancer patient Mieneke Weide-Boelkes, written by her son Marc Weide, was published in the August 23, 2008, edition of the British newspaper The Guardian.* It is an account so awful, that public comment is warranted.

What occurred prior to Weide-Boelkes’ death amply demonstrates the abandonment that euthanasia/assisted-suicide consciousness generates in society, within medicine, and among families. It proves clearly that the touted "protective guidelines" and "safeguards" of Dutch euthanasia practice are utterly meaningless. It also demonstrates that once mercy killing is sanctioned, families become almost remote bystanders to their loved one’s demise.



One of the supposed requirements of Dutch euthanasia is that there can be no other way to alleviate suffering other than killing the patient. Yet, in this actual case, the woman who would soon be dead wants to die for fear of going bald during life-extending chemotherapy. From the diary account:

Despite the ability to extend Weide-Boelkes’ life, and the driving motives of worries that she will not be pretty (and hence not worthy of being loved?), and fears about losing the ability to engage in enjoyable activities as the reasons for wanting euthanasia, the doctor, identified only as Martin, agrees to kill her by lethal injection.

And here are two things so often seen in euthanasia/assisted-suicide cases that are reported publicly: We have created a "choice" culture so pervasive that even in the face of impending killing, families feel they are not entitled to resist their loved one’s desire for induced death. Second, the patient’s fear of the future—precisely what happens in Oregon with assisted suicide—is what most often leads to the killing, not the actual experience of intractable pain and suffering:

"None of us is to say anything"! And yet he did! It was Weide, not his mother, who found the words to justify the euthanasia. When she asked what the family thought, where were their kisses? Where were the assurances of always being there for her? Where were the phone calls to doctors to assure the patient her suffering could be alleviated through palliative care. Where were the efforts to obtain proper mental health interventions to help alleviate the woman’s terror of the future? Instead, a clearly struggling woman was left to sink or swim in the midst of an emotional crisis! I know we are not supposed to "judge" in these matters, but what an abdication of a son’s responsibility to his mother—what I call terminal nonjudgmentalism in action.

Most revealing is that, on the day she dies (February 11, 2008), she is physically fit enough to do heavy housecleaning, starting a 6 a.m.!

Perceiving hesitancy on the part of the patient, the doctor offers to come back at another time, but is easily convinced that Weide-Boelkes wants to die at the designated time.

This is beyond awful. Euthanasia is like a parasitic infection. Once it enters the body—e.g., society, families, etc.—it takes the focus away from healthy approaches to illness, death, and making the patient’s remaining life better, and instead makes prematurely ending the patient’s life the top priority. In this sense, euthanasia is cold. It is estranging. And it is dehumanizing. The ugly truth is right before our very eyes, if we will just see.

_________________________________________________________________ 

Wesley J. Smith is a legal consultant for the International Task Force on Euthanasia & Assisted Suicide, a senior fellow in human rights and bioethics at the Discovery Institute, and a special consultant to the Center for Bioethics and Culture. His blog is Secondhand Smoke: Your 24/7 Bioethics Seminar.

_________________________________________________________________

* Diary quotes taken from Marc Weide, "I'm going to die on Monday at 6.15 p.m.," The Guardian, 8/23/08.

Dutch foundation targets those not eligible under euthanasia law

A group of Dutch doctors and researchers has published a book for the general public detailing the best ways to commit suicide. Calling itself the Foundation for Scientific Research into Careful Suicide, the group justified the book’s release by arguing that "a requirement exists within society for responsible information about an independent and dignified ending of life." The book, entitled Information about the Careful Ending of Life, includes detailed advice on starvation and dehydration and on the best combination of drugs to bring about coma and death.

The Dutch Medical Association (DMA) has endorsed the book, calling it balanced in relation to the unreliable information currently on the internet and suggesting that doctors could refer patients to the manual as part of their obligation to provide information to patients.

The foundation admits that the book is targeted at those in society who do not qualify for euthanasia and assisted suicide under Dutch law, such as patients who are not suffering unbearably or physically healthy elders who are just tired of living. It is not intended, the foundation said, for suicidal young people who should seek professional help.

According to the foundation’s research, there are approximately 4,400 cases a year of "autoeuthanasia" (where doctors are not involved)—about twice the number of reported doctor-assisted, euthanasia deaths. Most often the autoeuthanasia cases involve elderly or chronically-ill patients who stop their intake of food and fluids.

"Many people stop eating and drinking," said the foundation’s chairman, Dr. Pieter Admiraal, "but doctors have never had any training in these cases. This book provides a guide to what doctors should do without becoming actively involved." [British Medical Journal, 6/20/08]

Admiraal, a retired anesthesiologist, is a longtime activist for euthanasia practice in the Netherlands and around the world. Noted for insisting there can be no terminal care without the possibility of euthanasia, Admiraal is often referred to as the "father of Dutch euthanasia."

News Notes…

• Members of the Swiss-German right-to-die organization, EXIT, have voted overwhelmingly to adopt a resolution requiring that a vote be taken at its 2009 general membership meeting on whether to extend its suicide services to people who are simply tired of living. EXIT claims to have 50,000 members, all of whom live in Switzerland. [ERGO Right-to-Die ListServ, 7/31/08]

• Baroness Mary Warnock strikes again! Lady Warnock, 84, is considered to be Britain’s leading moral philosopher and an expert in medical ethics and education. In 2004, she made headlines by suggesting that the elderly should kill themselves rather than be a "nuisance" to their families. [London Times, 12/12/04] Now, she has taken aim at people with dementia. In an interview published in the October 2008 issue of Life and Work, the Church of Scotland’s magazine, Lady Warnock bluntly states:

• According to the Dutch euthanasia group Right-to-Die–NL (NVVE), there was a ten percent increase in the number of euthanasia and assisted-suicide deaths reported to the Regional Euthanasia Review Committees in 2007, jumping from 1,923 in 2006 to 2,120 in 2007. The deaths were reported by general practitioners. In three cases, a review committee found that the doctors involved had not followed the set guidelines or the requirement of "due care" for the patient. While those cases were referred to the Inspection of Health Care, there has been no indication that any action was taken against those doctors. [Relevant (Magazine of the NVVE), 8/08]

• Colombia has taken one more step toward legalized euthanasia and assisted suicide. On September 17, a congressional commission voted 11 to 3 to approve a legislative draft of a measure intended to establish guidelines for those practices. According to the draft, only the patient can initiate the induced death process and only Colombians or those from other countries who have resided in Colombia for at least one year can be euthanized or assisted in committing suicide. Both practices would be regulated by the country’s Minister of Protection.

• In Australia, the upper house of the Victorian Parliament has defeated the Medical Treatment (Physician Assisted Dying) Bill by a vote of 25 to 13. The bill would have given legal protection to doctors who assist in the deaths of patients suffering "intolerably from a terminal or advanced incurable illness." (The latter category could include "incurable" conditions such as diabetes, HIV, paraplegia, or debilitating arthritis.) The conscience vote followed months of heated and sometimes emotional debate by members of parliament. The bill’s co-sponsor Greens MP Colleen Hartland told reporters, "I’m very disappointed because we’ve put a lot of effort into this…." [The Age, 9/11/08; AAP, 9/10/08]

• The Kerala Law Reforms Commission in India has proposed a draft bill in favor of legalized euthanasia. The commission recommended that euthanasia practice should include the written approval of three state-recognized doctors stating that the patient is an appropriate candidate for induced death. According to the commission, "The victim of suffering and his closest relatives, after taking responsible medical opinion about the irrecoverability of pain-free normality, creates the right to euthanasia." [The Hindu, 9/21/08]