Friday, March 15, 2019

Oregon's response to the Opioid crisis may increase requests for assisted suicide.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

I have written about the goal of the Oregon Health Plan to reduce Opioid prescriptions for people on medicaid by 2020. There is significant concern that chronic pain patients who require prescriptions for opioids will more likely ask their physician for assisted suicide as a response to insufficient pain control.
Will Oregon's plan to eliminate opioid prescriptions for chronic pain medicaid patients increase requests for assisted suicide?
An article by Markian Hawryluk published in the Bulletin on March 13 examines the response in Oregon to chronic pain patients. He writes:
Oregon’s efforts to prevent opioid overdoses have reached a difficult impasse: what to do with the chronic pain patients who are on high doses of opioids now considered unsafe. 
While some experts are warning about the potential harms of forcing stable pain patients off opioids, others insist reductions will benefit patients whether they want to make the change or not.
According to Hawryluk, Dr. Arian Nachat, a palliative care physician who claims that some chronic pain patients are asking for assisted suicide in response to unresolved chronic pain, Hawryluk writes:
Dr. Arian Nachat, a palliative care physician with Legacy Health, spoke about patients who sought out assisted suicide after being cut off of their opioids cold turkey. 
“I hear this story happening more and more,” she said. “We can’t force people off opioids.” 
Many medical professionals are also questioning the policy of the Oregon Health Plan.
In an article published by Governing.com Sharon Wrona, the immediate past president for Pain Management Nursing writes:
Patients with chronic pain often have limited treatment options because insurers refuse to cover many non-opioid treatments. In some states, laws prevent patients from getting medication for more than seven days at a time. These kinds of restrictions add further stress to people who are already suffering. Some patients say they'd rather die than live with the alternatives they've been given.
Pharmacist Steven Arians states in an article published in the Pharmacist:
Also, Oregon is one of a handful of states that has a “death with dignity” law allowing terminal patients to elect to end their life with assistance from their prescriber. When pain is not treated, bad things can happen. It can delay healing, decrease appetite, increase stress, disrupt sleep and ultimately cause anxiety and depression While these adverse physical health outcomes may make the patient eligible for using Oregon’s “death with dignity law”. Of course, if a Medicaid patient elects to go down this path, the Medicaid system stands to save untold tens of thousands of dollars in expenditures for these patients if they did not exercise for this option.
People who oppose believe in caring and not killing recognize that systems of limiting opioids cannot be based on a one size fits all formula. People who live with chronic pain need to have their pain controlled.

There are some people who will ask their doctors to end their life by assisted suicide if they are not provided adequate pain control. This is an example of how assisted suicide is not about compassion, choice or autonomy but rather assisted suicide threatens the life of people who are living through difficult circumstances.

We believe in caring not killing.

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