Lessons from Ms. Jackson’s “laboratory”
In the recently published article entitled, “The final choice” (Hospital Doctor, 1 June 2006), Ms. Ann Jackson, Executive Director of the Oregon Hospice Association claims that neither she nor her organization either supports or opposes Oregon’s so-called “Death with Dignity” Act. She also claims that Oregon serves as laboratory—presumably allowing other states, and indeed the world, to learn from those of us in Oregon. Nevertheless, she unabashedly sings her praise of assisted suicide’s positive impact on Oregon.
As such, it is only fitting that we who actually live and practice in Oregon might also share our view of Ms. Jackson’s opinion. Most importantly, we wish also to share some facts and statistics that Ms. Jackson neglected to share.
First of all, her title “The Final Choice” might well be changed to “The Financial Choice” since we are well aware of the financial constraints of health care in Oregon. The state of Oregon’s health plan for the poor does not pay for many important health care services—for example, in-home health care, visiting nursing care, along with pain medication choices for patients with chronic pain and terminal illness have been restricted. Even local curative treatment for patients with cancers is not covered for patients deemed to have a 5% or less chance of living 5 years. At the same time, the State of Oregon pays 100% of the costs of doctor-assisted suicide.
Ms. Jackson claims that the practice is very limited and controlled yet restricts her comments to the “official” report by the State. At the same time, there are numerous cases that have come to public light that have violated both the spirit and the letter of the so-called “safeguards.” In fact, Oregon has even had a case of doctor-directed euthanasia since the introduction of assisted suicide. The doctor in that case was never legally prosecuted and still is in practice today.
Yet there are certainly many other cases that have never been reported. One such case was revealed only when a tape recording of a secret discussion by advocates of assisted suicide came to public light. In the tape, the advocates revealed a failed overdose by an Oregon patient. There have been others. Some are revealed such as the case of Michael Pruitt who awoke after more than 60 hours of unconsciousness. Thankfully, his brain wasn’t injured by the over sedation, and he died more than a week later—naturally, and with dignity. How many others have trouble is open to speculation—as doctors aren’t even present in over 70% of cases.
In truth, assisted suicide has been performed secretly with very little oversight by the state health department. We really don’t know what the numbers are. Were there 246 or ten times that number? More importantly are they all as “successful” as represented by Ms. Jackson? Did she mention even one case gone awry? Can anything in medicine be so flawless? Do the advocates and participating doctors have an agenda? As the Oregon Health Division candidly revealed, the data gleaned from such a second-hand reporting system could be nothing but “cock and bull.”
What little has been studied about assisted suicide in Oregon has not at all been reassuring. In fact, a well-done survey by Oregon Health & Science University researchers reported that there are now almost twice as many dying Oregonians who die in moderate or severe pain or distress compared to before passage of the assisted suicide law.
Furthermore, the Last Acts organization issued a “Report on Dying in America Today” giving low marks to many states including Oregon. Oregon received a “C” rating in seven categories—deaths at home, hospice use, days in hospice, hospitals with pain management, hospitals with palliative care, nursing home patients in persistent pain, and number of palliative care specialists, a “D” rating in state pain policies, and, an “E” rating in hospitals with hospice.
Of course, neither of these studies prove that doctor assisted suicide caused a deterioration in pain perception or end-of-life care experienced by Oregonians. At the same time, there is nothing in these studies that support Ms. Jackson’s claim that assisted suicide has benefited anything or anybody.
Ms. Jackson does acknowledge that only a handful (5%) of patients benefit from any formal psychiatric assessment. Yet, she quickly and casually dismisses this paucity of care as unnecessary as “psychosocial health is regularly assessed within hospice.” We beg to differ.
Perhaps Ms. Jackson is ignorant of the Michael Freeland story. Mr. Freeland had a known history of depression with recurrent suicidal thoughts and previous suicide attempts. Yet he received a lethal overdose from an assisted suicide doctor—without a psychiatric evaluation. This doctor did not even obtain a psychiatric history from Mr. Freeland before he prescribed the lethal overdose of sleeping pills. Furthermore, Mr. Freeland was declared by the courts to be incompetent—at the same time another doctor allowed the lethal medication to remain in his home!
Oddly enough, Ms. Jackson was quoted in the June 12, 2003 Oregonian (regarding people choosing assisted suicide), “In effect, they’ve said no to hospice. Either they don’t believe we in hospice can meet their needs, or we’re not meeting their needs.” Fair enough. Yet, now you tell us that patients “take comfort in the law” within hospice! Ms. Jackson, your perspective seems to have shifted. Which is it? We’re a bit perplexed.
We are also confused when you say, “it no longer matters whether assisted suicide is right or wrong because it is a legal option.” Do you really believe there is no difference between what is legal and what is ethical? Slavery was once legal both in the US and the UK. Did that make it ethical?
Sadly, Ms. Jackson ethical shifting is all too common among the “dying with dignity” crowd. Many other assisted-suicide enthusiasts also trivialize ethical concerns and quickly embrace whatever is legal. There is a consequence. Many of our patients find it chilling that some doctors and hospice workers so strongly support assisted suicide. As a consequence, many, especially the disabled, are now fearful of the motives of some doctors.
As practicing physicians in Oregon, we find this sad. We believe the practice by some doctors of assisted suicide has badly compromised our profession’s integrity. Assisted suicide is neither necessary nor a tonic for Oregon’s problems. Wisely the House of Lord’s, palliation specialists, and, indeed the majority of British doctors have rejected suicide’s siren song and have instead chosen to continue the UK’s long-standing tradition and successful focus on excellence in palliation and hospice. Having witnessed and worked in Ms. Jackson’s laboratory, it is we in Oregon who need to learn from you.
William L. Toffler MD, Professor of Family Medicine
3181 SW Sam Jackson Park Road
Portland, Oregon 97239
Kenneth Stevens MD, Professor Emeritus of Radiation Oncology