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." Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=8469