X-Message-Number: 8469
Date: Sun, 17 Aug 1997 08:23:13 -0700
From: David Brandt-Erichsen <>
Subject: Oregon Measure 51

        SUICIDE METHODS COME INTO QUESTION
        MARK O'KEEFE and GAIL KINSEY HILL of the Oregonian Staff

        from the "Portland Oregonian" (Aug 15/97; page A01)

        Summary: Measure 51, the proposed repeal of 1994's assisted-suicide 
        law, generates debate about which life-ending practices are allowed

        In 1994, nearly everyone agreed Oregon's doctor- assisted suicide
        law prohibited the kind of lethal methods Dr. Jack Kevorkian made
        famous.

        In 1997, two months before Oregon voters will consider a
        referendum repealing the law, no one seems to know for sure.

        Even Barbara Coombs Lee and Eli Stutsman, the chief spokespeople
        for the Oregon law, are now suggesting "inhaled gas" and
        intravenously delivered drugs -- not just swallowed pills -- might
        be permitted.

        Their comments appear in the most recent issue of Oregon Health
        Law Manual and have invigorated attacks from those fighting for
        the law's repeal.

        The debate illustrates how Oregon's assisted - suicide law is ripe
        for a variety of conflicting interpretations, each with medical
        and political fallout. Should voters uphold the law they passed
        three years ago, the courts ultimately might decide what means the
        terminally ill can use to kill themselves.

        Derek Humphry, founder of the Hemlock Society and head of the
        Oregon-based Euthanasia Research and Guidance Organization, said
        the public is "ready for whatever works best."

        But opponents, such as Dr. Kenneth Stevens, a Sherwood oncologist,
        disagree.

        "I think it's going to backfire on them," said Stevens, a member
        of the anti-suicide group Physicians for Compassionate Care. "I
        don't think that when the voters voted in 1994 they were
        contemplating lethal gases."

        Coombs Lee, a lawyer and former nurse, remains solid in her
        opposition to Kevorkian's practices. She bristles at those who
        suggest otherwise.

        "Raising the specter of Kevorkian is such an inflammatory thing,"
        she said. "This is the opposite of Kevorkian; this law would be
        the state's greatest defense against Kevorkian."

        Voters will receive mail ballots in mid-October for Measure 51,
        which the 1997 Legislature placed on the ballot. They will have
        until Nov. 4 to vote.

        The election's outcome is considered critical for the assisted -
        suicide movement, which in June lost a U.S. Supreme Court decision
        that could have made assisted suicide a constitutional right. The
        Oregon law, blocked by a lawsuit now before the high court, has
        never gone into effect.

        But should the law clear the court and the ballot box, it would
        make Oregon the only state with a "right to die." The unanswered
        question will be "how to die?" 

        What the law says.

        The law prohibits "lethal injection." What it permits is a
        decision by a qualified terminally ill patient to "make a written
        request for medication for the purpose of ending his or her life
        in a humane and dignified manner."

[Comment from DBE:  The law only prohibits lethal injection if administered
by somebody else.]

        Kevorkian, the Michigan doctor who has assisted in at least 46
        deaths, has long argued his techniques are humane and dignified.
        Yet his methods are controversial and politically charged, and
        many right-to-die advocates think he hurts their efforts.

        Coombs Lee argues that his devices, made specifically to help
        patients commit suicide, aren't allowed under Oregon's law.

        Kevorkian's preferred method uses a machine that has three
        bottles, each with a syringe that connects to a single intravenous
        line in the patient's arm. The first bottle contains saline, the
        second has barbiturates, and the third has potassium chloride,
        which immediately stops the heart.

        The person who wants to die must deliver the medication by
        throwing a switch or pulling a string.

        His other method connects a cylinder of carbon monoxide by a tube
        to a mask that has been placed over a patient's nose and mouth.
        The patient turns a valve that delivers the deadly gas.

        In the 1994 campaign, opponents initially charged that
        Kevorkian-style "suicide machines," and even "death clinics,"
        would be prevalent in Oregon. But they dropped that tack when
        Stutsman and Coombs Lee, who helped write the law, insisted that
        Kevorkian's methods would be prohibited.

        Now, critics contend that the article, in a volume titled "Life
        and Death Decisions," legitimately reopens the debate. 

        Considering other methods

        In the article, published by the Oregon State Bar, Coombs Lee and
        Stutsman publicly consider, for the first time, other methods of
        death besides oral ingestion.

        In a section that discusses medications, they pose a provocative
        question:

        "Would a delivery method such as inhalation be eligible . . .
        since the act does not expressly mention `devices' and some sort
        of delivery system would be needed for an inhaled gas?"

        The two lawyers and co-author Kelly Hagan, a Portland attorney,
        don't answer their question. They do, however, write that "one
        might reasonably interpret a prescription for an `infusion' as
        distinct from an `injection.' . . . The critical question is
        whether the medication, by whatever route, is self-administered."

        Coombs Lee said she stands by the article and sees no
        contradiction with her previous positions. She doesn't think the
        law allows infusions but admits that they are not specifically
        banned.

        What if a doctor already had inserted an intravenous tube and
        lethal drugs were substituted for prior medications? If the
        patient squeezed a pump or pulled a lever to begin the drip, would
        the death be legal?

        "There's nothing in the act that authorizes that," Coombs Lee
        said. Neither, she added, "was it contemplated by the act. . . .
        That's one of those things the (state) Board of Medical Examiners
        or prosecutors would have to address." 

        Concerns about pills

        Coombs Lee said the drafters of the law intentionally focused on
        oral medication because they thought it was the most acceptable
        method to the public.

        Yet, after the 1994 election, the use of pills came under renewed
        attack. Dr. Pieter Admiraal, a leading physician in the
        Netherlands, where euthanasia has been practiced, said a study he
        conducted showed oral medication, such as barbiturates, alone is
        unreliable. It fails to quickly kill about one out of five
        patients, he found.

        In the Netherlands, such patients are given a fast-acting
        injection to finish the job. In Oregon, that would be illegal.

        Concerns about the effectiveness of oral medication worried the
        Legislature, which conducted hearings earlier this year.

        Joseph Schnabel, a pharmacist at Salem Hospital, told legislators
        in March that an "infusion device" -- pushing medication
        intravenously into the bloodstream through a patient-controlled
        pump -- might be the best method.

        Stutsman firmly disagreed, saying such a device "would not be
        permitted."

        But Cheryl Smith, an attorney who co-authored the Oregon law with
        Stutsman and Coombs Lee, approved of such a device and said the
        law "allows a machine like Kevorkian's."

        Attorneys outside the storm of the political debate also said the
        law leaves plenty of room for interpretation.

        "Obviously, this is an area where there are no experts," Hagan
        said.

        Hagan is a member of the Task Force to Improve the Care of
        Terminally Ill Oregonians, an organization assembled in part to
        address how the law should work. The group is not political and is
        neutral on the repeal measure.

        Intravenous infusion might come under the scope of the law, Hagan
        said: "That seems in keeping with the spirit of the measure."

        But Valerie Vollmar, a Willamette University law professor, is
        uncomfortable with such scope.

        "It's conceivable that the language of the law could be
        interpreted to include some methods of taking medication other
        than literally swallowing pills," she said. "It seems to me at
        least a patch or suppository is permissible."

        But, she added, "I'd have a bit more questions when using a
        device."

        For Vollmar, "the only thing that's clear" about the law "is that
        it's a little muddy."

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