11

When Oregon residents passed the Oregon Death with Dignity Act on November 8, 1994, the state became the first jurisdiction in the world to make physician-assisted suicide legal. The act's success focused national attention on the growing momentum of several physician-assisted suicide initiatives and set in motion legal activity that may bring the issue before the U.S. Supreme Court. Although implementation of the Oregon law has been held up in the courts, the public vote was an historic moment that significantly raised that stakes in the ongoing debate over assisted suicide. Many supporters of the measure now claim the time has come to stop asking "whether" assisted suicide will be legal and to start asking "when."

The court battle over the implementation of the new assisted suicide law began immediately after the final votes were counted. Motions attempting to block and to uphold the law have poured into Oregon courts. At present, the law remains on hold while a federal judge considers these issues. If the constitutionality of the Death with Dignity Act eventually is upheld, terminally ill patients in the state of Oregon will be able to request lethal drugs from their physician for the purpose of committing suicide.

What Does The Oregon Death With Dignity Act Allow?

The Oregon Death with Dignity Act was modeled on two physician-assisted suicide initiatives in Washington (1991) and California (1992) that lost by small margins. The Oregon measure, which passed by a similarly small margin, has a more narrow scope and contains several "safeguards" that were not a part of the two failed initiatives.

The Oregon law specifically allows any adult Oregon resident suffering from a terminal disease to request medications from a physician for the purpose of ending his or her life. To safeguard against possible abuses, the act:

• applies only in the last six months of life

• mandates a second opinion about the patient's medical condition from another physician

• requires multiple requests (oral and written)

• requires two waiting periods

• narrowly defines the type of "aid" that a physician can offer to prescribing, not administering, medications.

Concerns

Despite the specificity of the Oregon law, many health care professionals are concerned about how the response to a patient's request for lethal drugs will be honored. Pharmacists, for example, have questions about what advice they should give patients who arrive with a prescription and what liability might be involved in filling the request. Other concerns focus on the definition of Oregon residency and the possibility that the measure may conflict with existing federal laws.

Even if these technical issues can be resolved, many people are concerned that the push for legal physician-assisted suicide has obscured the availability of existing resources to serve the needs of dying patients. Ann G. Jackson, Executive Director of the Oregon Hospice Association prefers to emphasize a continuum of care when considering end-of-life decisionmaking and the relationship between assisted suicide, pain management and hospice. "I think it is important to emphasize options that appear along the way, including hospice. The real tragedy is that not everyone knows all of their options at the end of life. It seems that people think they have two choices—suffer or die at their own hand. And that just isn't true."

One final concern that inevitably is raised about legalizing physician-assisted suicide is that, for disempowered populations, the opportunity to choose suicide will become a "duty." Judge Hogan cited this argument as a primary reason for blocking implementation of the law: ". . . Although the status quo will be regarded as a hardship by some terminally ill patients who want the `option' of physician-assisted suicide to be immediately available, the public interest in protecting vulnerable citizens from irreparable harm of death is greater."

Whose Life Is It?

Several Oregonians could not have disagreed more strongly with Judge Hogan's conclusion. The delay of the Oregon Death with Dignity Act deeply affected the lives of many terminally ill patients who had hoped the act would offer a compassionate and legal way to retain control over their final days.

Emerson Hoogstraat was an ardent supporter of the movement to pass Ballot Measure 16. A resident of Beaverton, Oregon, Mr. Hoogstraat participated in drafting the Death with Dignity Act and worked closely with members of Oregon Right to Die in their campaign to gain voter support to pass the measure. Mr. Hoogstraat suffered from prostate cancer which, by the time of the injunction, had spread to his bones.

"Emerson believed it was his right to say enough is enough, I have had enough of this suffering," said his wife Dorothy Hoogstraat, "We tried everything to control his pain, but even with all the medication, he still hurt terribly. It was a blow to have worked so hard and then be denied the right to end his suffering. " When Emerson Hoogstraat died in March of 1995, the court hearing to consider the constitutionality of the act was still one month away.

Mrs. Hoogstraat continues to speak in favor of the measure and reminds the public that terminally ill patients, and their families, may view the option of legal, physician- assisted suicide quite differently from healthy people who may not be able to imagine needing the option. "Once you see someone you love dying from an illness that cannot be cured and suffering from pain that does not stop, you see this issue in a different light. I simply can't imagine making a person suffer, like my husband suffered, when there is no hope of recovery."

What To Expect

Although Oregon recently has been the state to watch in the assisted suicide debate, other states are starting to tackle the issue. Supporters of legal physician-assisted suicide see a silver lining in the delay of the Oregon measure when they look at the proliferation of new initiatives.

"This is the first physician aid-in-dying legislation to pass in America so it should come as no surprise that the law would be challenged. Because this initial law is being forced to jump through legal hoops before it can become effective, future legislation in other states will be easier to implement," said Lee LaTour of the Hemlock Society.

Polls reveal that a growing number of Americans support physician-assisted suicide legislation. In a recent Harris poll, 67% of those polled said they would favor legislation similar to the Oregon act, while only 31% opposed it. A similar poll in 1982 had found only 53% of Americans in favor of physician-assisted suicide. Proponents of legalized physician-assisted suicide point to these figures in defense of initiatives like Oregon's Ballot Measure 16 that allow voters to decide on the fate of specific legislation for themselves.

Some critics, however, have questioned the quality of the public debate that ensues from such voter initiatives. George Annas, writing in the New England Journal of Medicine (Nov. 3, 1994), points out how quickly "contemporary initiative petitions tend to degenerate into televised sloganeering, " an environment ill-suited to the consideration of complex issues like physician-assisted suicide.

Regardless of who decides whether assisted suicide should be made legal, a lack of data to help inform these decisions remains. In a recent article in Generations, Sean Morrison, MD, and Diane Meier, MD, claim that "despite their strong convictions, neither proponents nor opponents of physician aid-in-dying have reliable data to support their allegations." Their point reminds us that, as long as questions about physician-assisted suicide remain unanswered, there can be no assurance that these new laws are in the best interest of dying patients and their families.

Courtesy of Choice In Dying, Inc. (1996).

Cancer patient commits suicide legally under new Australian law

Darwin, Australia- An Australian man with prostate cancer became the first person to die under a new voluntary euthanasia law Sept. 26.

With his wife and his physician by his side, Bob Dent responded to three questions on the screen of his computer, which was hooked up to a modified portable IV unit. The last question asked, " In 15 seconds, you will receive a lethal injection and die. Do you wish to proceed? Yes/No?"

Dent said, "Let's do it," and pressed the space bar, according to the Sydney Morning Herald. Within seconds the release of thiopental into his system through IV lines had put him to sleep; the first drug was followed by pentobarbital and finally atracurium, a muscle relaxant that stopped his breathing, according to the newspaper.

Dent, a 66-year-old pilot and carpenter had turned to Buddhism and therapeutic massage to relieve pain from the cancer. In a letter dictated to his wife, Dent outlined his suffering beginning with his diagnosis 1991. He wrote of the removal of both testicles, impotence, and the embarrassment of having to use a catheter and leg bag.

"The church and state must remain separate," Dent's letter read . "What right has anyone, because of their own religious faith (to which I don't subscribe), to demand that I behave according to their rules until some omniscient doctor decides that I must have had enough and goes ahead and increases my morphine until I die?" 

Last year, the Northern Territory's legislature legalized voluntary euthanasia with a law that went into effect July 1. The Rights of the Terminally Ill Act requires two physicians and a psychiatrist to evaluate the terminally ill person; a nine-day waiting period is required between the physician's evaluation and administration of the lethal injection.

Several court challenges of the law are planned for November. Lawmakers in the national parliament are scheduled to debate legislation that seeks to overturn the right of Australia's states and territories to pass euthanasia legislation.