X-Message-Number: 8728 Date: Thu, 06 Nov 1997 11:10:40 -0700 From: David Brandt-Erichsen <> Subject: More on Oregon Note: Still unresolved is what constitutes a "resident" of Oregon. Only Oregon residents may seek physician-assisted death under the new law. A copy of the Oregon Death With Dignity Act can be found at http://www.oregondwd.org/dwdm16.htm From the PORTLAND OREGONIAN (Thurs Nov 6/97) PATIENTS, DOCTORS SEEK ANSWERS The suicide law leaves health field scrambling to provide guidance Erin Hoover, Patrick O'Neill and Steve Woodward of The Oregonian staff ---------- As one of the biggest ethical shifts in health care history became reality Wednesday, one point became clear: Patients and doctors, for the time being, are on their own to decide how to proceed with physician-assisted suicide. The message from hospitals and health plans to patients wanting to pursue physician-assisted suicide: Talk to your doctor. The message, for now, to doctors: It's up to you to figure out how to follow the law if a patient requests aid in dying. And the recognition dawning for many in health care, as voiced by Dr. William Toffler, who supported repeal of the Oregon Death With Dignity Act, known to voters as Measure 16: "It's a different world today, November 5, 1997." Despite a legal dispute about whether the law is in effect and politicians weighing in on whether to have a special legislative session, the medical field proceeded as though physician-assisted suicide is an option. Health care leaders scrambled to offer guidance to doctors. But they acknowledged the process would take time to evolve. In the meantime, doctors will have to consult whatever resources are available and handle their legal responsibilities as best as they can. "For everybody -- doctors, this organization -- this is all new ground," said James Kronenberg, spokesman for the Oregon Medical Association. Legal assisted suicide "has never been done before. It's kind of a scary time." The Task Force to Improve the Care of Terminally Ill Oregonians, a group of 25 hospitals and medical professional organizations that formed after voters approved Measure 16 in 1994, is writing a guidebook to help caretakers navigate the ethical maze of assisted suicide. But it won't be ready for months. EXPECTING MORE LEGAL ACTION Dr. Susan Tolle, a medical ethicist and task force leader, said the group expects another court injunction to block the law from taking effect. Court challenges had held up the law since its approval, but the 9th U.S. Circuit Court of Appeals lifted an injunction against it Oct. 27. "We've counted on that throughout this process, that we'd have more time," Tolle said. Tolle said in the meantime it is critical that Oregon continue to improve care for the dying, an area in which the state has become a national leader, particularly since Measure 16 passed. She raised some of the immediate issues not addressed in the law, such as what to do with patients who take a lethal dose but do not die right away, and how to deal with patients who might choose suicide because they can't afford medical or hospice care. Tolle said the task force will push for legislation creating universal access to hospice and health care. The Oregon Medical Association is considering writing a pamphlet outlining physicians' legal responsibilities. Many doctors "don't know specifically what their responsibilities are in terms of the waiting time, signed consent, obtaining a second opinion and a psychological evaluation and so forth," Kronenberg said. If the association writes recommendations, they could be ready within a week or two. SOME WON'T GET INVOLVED Some health insurance plans and hospitals are taking a hands-off approach. The state's largest insurer, Regence BlueCross BlueShield of Oregon, has no special procedures for assisted suicide and will process claims for lethal prescriptions no differently than for any other prescription it covers. "This issue is still a doctor-patient issue," said Ken Strobeck, public affairs director. He said the insurer's role is to pay claims that are submitted. Providence Health System, a Roman Catholic organization whose operations include six hospitals and a hospice program, is staunchly opposed to assisted suicide, said Denece Boyer, Providence Portland Medical Center spokeswoman. "We will not be participating in physician-assisted suicide, but we will be looking at other other things: supportive care teams, hospice care, pain management," she said. Patients who see doctors employed by Providence Health Systems would have to seek outside medical advice if they want to pursue physician-assisted suicide. Kaiser Permanente, with about 300,000 members in Oregon, is waiting for guidance from the Oregon Health Division before deciding what to do, said Jim Gersbach, a spokesman. But the division views its role under the law as tracking the number of physician-assisted suicides, not setting rules for implementation. The division filed rules Wednesday setting regulations for reporting physician-assisted suicides, a tally of which the agency will publish annually with confidentiality of patients strictly enforced, said Dr. Katrina Hedburg, deputy state epidemiologist. "We see our role as providing information," she said. The state Board of Medical Examiners, which regulates doctors, will oversee doctors' compliance with the law. Family members or patients concerned about a doctor's actions can contact the board, said Kathleen Haley, the board's executive director. Licensing boards for other health care providers also will define their regulatory roles. Pharmacists, who would be called upon to dispense life-ending drugs, are unhappy that the law does not require them to be told the purpose of prescriptions. The state Board of Pharmacy will hold a telephone conference call today to discuss formulating a temporary rule requiring such notification. SOME INFORMATION AVAILABLE The six-page Oregon Death With Dignity Act, which was printed in the state's 1997 Voters' Pamphlet, provides some instruction to doctors on how to handle requests for suicide. It includes telling the patient about options for adequate pain medication and hospice care, and requesting, but not requiring, that the patient notify a relative. The Mid-Valley Physician Assisted Suicide Interest Group, a group of 24 doctors, wrote guidelines in August that doctors can refer to. They make suggestions such as: A lethal prescription should not be written until the day a patient plans to take it, and if a patient's suicide attempt fails the first time, he or she should be allowed to recover from the side effects and try again, if desired. Dr. Peter Goodwin, a Physicians for Death With Dignity leader who fought for assisted suicide, said having the law take effect doesn't signal a paradigm shift for the medical profession. He said doctors have been helping terminally ill patients die for decades by using extreme amounts of pain medication with the intention of relieving suffering and the additional effect of hastening death. The only difference now is that the process is out in the open and the patient has more control, he said. "It's a small step. But it's a step in the empowerment of patients," Goodwin said. Health care leaders' overall message to patients, including those in hospice care, is to talk with their doctors. Patients also can use an advance directive and a physician's orders for life-sustaining treatment to specify preferences in end-of-life treatment, besides doctor-assisted suicide, said Dr. Patrick Dunn, a member of the Task Force to Improve the Care of Terminally Ill Oregonians. SOME PATIENTS CAUTIOUS But patients are not waiting for the medical field to sort out its process before coming to grips with their feelings about Oregon's new state of affairs. Some people are taking steps to protect themselves against the possibility of assisted suicide. A Northeast Portland woman, for example, called Providence Health System's regional office Wednesday seeking a recommendation for a physician. Her criteria: "A primary care physician who not only would not recommend physician-assisted suicide to her as an option, but in general would not even be practicing physician-assisted suicide," said Dianne Danowski-Smith, marketing director for the Providence Medical Group. Mickey O'Brien, 49, who lies dying at Hopewell House in Southwest Portland from a weakened heart, said she supports assisted suicide as an option. "I probably won't choose that, and most people won't choose that, but the fear is so great that to have the option is so important," she said. ---------- Suicide law reporting rules filed By CHARLES E. BEGGS The Associated Press 11/06/97 3:39 AM Eastern PORTLAND, Ore. (AP) -- The state Health Division has filed rules on how doctors are to make confidential reports to the agency in cases of physician-assisted suicides. The rules, filed Wednesday, have been in the works since voters first passed the measure in 1994, but were held up because of court challenges. Physicians' reports are required but confidential under the assisted-suicide law, said spokeswoman Katrina Hedberg of the Health Division. The agency does not plan to divulge even when someone has requested a lethal prescription, Hedberg said. "We're not intending to release information on a case-by-case basis," she said. The rules require doctors to send notices to the division when they write fatal prescriptions. When a death certificate is filed in such cases, the doctor will complete a second form regarding circumstances of the patient's death. The division filed temporary rules Wednesday and now has six months to adopt permanent rules, which will require a public hearing. The law requires the agency to collect information on how it is being administered. The law's only provision for releasing data says the agency is to publish an annual statistical report. Aims of the reporting requirements include determining how often assisted suicide is being used and whether safeguards are being followed. Hedberg discussed the rules at a news conference held by a task force that has been working since 1994 on guidelines for health care professionals in dealing the with the law. The panel plans to publish a guidebook soon. Dr. Susan Tolle, a task force member, said the next step is gaining universal access to health coverage so people don't feel pressured toward assisted suicide for financial reasons. Tolle, director of the Center for Ethics in Health Care at Oregon Health Sciences University, said health care coverage is universal in the Netherlands, where euthanasia is not legal but is widely tolerated. She said Oregonians also should remember that the state leads their country in end-of-life comfort care and that "by far the majority of people will not use this law." Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=8728