Wednesday, May 14, 2008

Physician-Assisted Suicide (PAS) in Oregon:

Dr. Herbert Hendin and Dr. Kathleen Foley have written a thorough report on the experience in Oregon after 10 years of legal assisted suicide.

Hendin is a Professor of Psychiatry and the Chief Executive Officer and Medical Director of Suicide Prevention International.

Foley is a Professor of Neurology, Neuroscience, and Clinical Pharmacology, Weill Medical College of Cornell University and the Medical Director, International Palliative Care Initiative of the Open Society Institute.

Hendin and Foley examine the Oregon experience based on case studies and research articles. They make recommendations to the Oregon Public Health Division (OPHD) as to how they could ensure that patients are properly protected under the law.

For instance, the case of Helen proved that the law is not effectively protecting patients when they are experiencing depression.

Helen’s personal physician refused to assist in her suicide but didn’t offer specific reasons. A second physician refused to assist Helen in suicide on the grounds that Helen was depressed.

Helen’s husband then called Compassion in Dying (now Compassion & Choices) who referred Helen to a physician who assisted her suicide.

Barbara Coombs Lee, then the executive director of Compassion in Dying stated “‘If I get rebuffed by one doctor, I can go to another...’”

The physician who assisted the suicide for Helen regretted his minimal communication with the physicians who refused to assist Helen’s suicide and stated “Had I felt there was a disagreement among the physicians about my patient’s eligibility, I would not have written the prescription.”

The article also examines the contention that palliative care has improved in Oregon since the implementation of assisted suicide.

Hendin and Foley provide information that contradicts this assessment. They state that
“A Study at the Oregon Health & Science University indicated that there has been a greater percentage of cases of inadequately treated pain in terminally ill patients since the Oregon law went into effect. However, among patients who requested PAS but availed themselves of a substantive intervention by a physician, 46% changed their minds about having PAS.”

Hendin and Foley bring up significant concerns about the correlation between depression and assisted suicide. They show that “researchers have found hopelessness, which is strongly correlated with depression, to be the factor that most significantly predicts the wish for death.”

A guidebook for health care professionals that is written by the Oregon University Center for Ethics advises physicians to refer all cases requesting assisted suicide for psychiatric evaluation, even though the physician is only required to refer patients that are suspected to be experiencing depression or mental a psychological disorder.

The reality is that only 13% of assisted suicide requests were referred for a psychiatric evaluation between 1998 - 2005 and no-one was referred for a psychiatric evaluation out of the 49 assisted suicide deaths in 2007.

It is also concerning that under the Oregon law the psychiatric assessment is only required to determine if the person has the capacity to decide. A person could be depressed and yet considered capable to consent to death.

The Oregon law doesn’t protect the person from being pressured. Kate Cheney’s case illustrates that even though Cheney was sent for a psychiatric assessment with the first psychiatrist suggesting that she was not capable of consenting, a second psychiatrist determined Cheney could consent even though it was noted that Cheney’s daughter appeared more interested in her suicide than Cheney herself.

Hendin and Foley suggest that this case questions what value Oregon’s prohibition on coercion really has.

Hendin and Foley also investigated the “lack of teeth” in the reporting system in Oregon. The OPHD have not addressed the issue of non-reporting, even though in the Netherlands and Belgium the issue of non-reporting is significant. The OPHD appear to be more concerned with patient-doctor confidentiality than with monitoring compliance or abuse.

The OPHD have admitted that they have no way of knowing how may assisted suicide cases are not reported.

The role of the assisted suicide advocacy group Compassion and Choices must be questioned. Compassion and Choices have been directly involved in 73% of all assisted suicide deaths in Oregon.

In 2006 Compassion and Choices lobbied the OPHD by threatening legal action if OPHD didn’t change the term assisted suicide to a term which was more palatable. The term assisted suicide has now been replaced by Death with Dignity.

How can the OPHD assure people that the law is being followed when the assisted suicide lobby group is also the referral agency for the majority of the assisted suicide deaths in Oregon.

Hendin and Foley conclude that “As the Oregon assisted suicide law is currently implemented, “Death with Dignity Act” is something of a misnomer.”

To receive a copy of the article - Physician-Assisted Suicide in Oregon: A Medical Perspective by Herbert Hendin and Kathleen Foley, simply contact Euthanasia Prevention Coalition at - 1-877-439-3348and request the article and we will send it to you.

http://www.spiorg.org/publications/HendinFoley_MichiganLawReview.pdf

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