X-Message-Number: 8767
Date: Wed, 12 Nov 1997 13:24:01 -0700
From: David Brandt-Erichsen <>
Subject: Oregon update & FAQ
From the PORTLAND OREGONIAN
(Sunday Nov 9/97; page A01)
ASSISTED SUICIDE TURNS FROM THEORY TO DETAILS
PATRICK O'NEILL and STEVE WOODWARD of the Oregonian Staff
Summary: As procedures are fine-tuned, patients probably will be
looking for answers
In the world of medicine, specialists are a dime a dozen.
But the sudden reality of Oregon's Death With Dignity Act has left
a huge gulf of expertise in the newest medical field:
physician-assisted suicide.
On Tuesday, Oregonians overwhelmingly affirmed the 1994 law, which
allows terminally ill people to seek life-ending medications.
Theory now will give way to practice. Doctors, pharmacists and
legislators are huddling over the nitty-gritty details --
everything from what to write in the patient's medical record to
the exact wording on the prescription itself.
And the patients themselves are left wondering: What do I do now?
Assisted suicide boasts no comforting voice of experience. There
are no veteran suicide doctors, no stacks of scientific studies,
no support groups for people contemplating the act.
Moreover, the law is fraught with unknowns.
Patients, for example, must give oral notification of their desire
to die by lethal prescription. But what constitutes oral
notification? Does a voice-mail message on the doctor's answering
machine qualify?
What, for another example, is the responsibility of paramedics who
could be called by relatives to the scene of a patient dying by
choice?
The new Oregon pioneers must blaze a trail through a medical and
ethical wilderness.
For the patient, these are the steps you probably will take:
1. You make the decision.
Do you really want to end your life? You discuss your feelings and
thoughts with your doctor, and the two of you talk about all of
your options. To qualify under the Oregon Death With Dignity Act,
you must:
* Be 18 or older.
* Be an Oregon resident.
* Have a terminal illness.
Further:
* Your doctor and one other physician must determine that you have
fewer than six months to live.
* You must be free of mental illness, particularly depression,
that impairs your decision to commit suicide.
2. You tell your doctor you want the medication necessary to
commit physician-assisted suicide.
This oral notification is the official beginning of the
physician-assisted suicide process. According to the law's timing
provisions, the soonest you could receive a lethal dose of
medication is 15 days from this beginning.
3. Your doctor can do one of three things:
* If assisted suicide is against his principles, he or she can
refuse your request. You either must find another doctor yourself,
or your doctor might help you find a physician willing to
participate.
* Your physician can talk you out of your decision. The law
requires the doctor to tell you about alternatives to suicide,
such as pain management, comfort care and hospice care. This
discussion might persuade you to change your mind.
* The physician can grant your request by allowing you to proceed.
4. The law requires the doctor to enter your request into your
medical records and tell you that you can drop your request at any
time and in any manner. Your doctor must then refer you to the
second physician, who will determine whether the diagnosis is
correct, that you have less than six months to live, that you are
making the request voluntarily and that you are mentally capable
of making the request.
5. If either doctor thinks you have a mental illness that impairs
your decision, you will be referred to a psychologist or a
psychiatrist who will examine you.
6. If the doctors find that you are acting voluntarily, your next
step is to present a written request for life-ending medicine. The
law includes a sample form to be used. It has blanks for your
name, the disease and whether you have informed family members of
the decision.
Your signature must be witnessed by two people. Neither can be a
doctor who is attending you. One witness must not be related to
you by blood, marriage or adoption, must not be entitled to any
part of your estate and must not own, operate or be employed by a
health care center where you are a patient or resident. The
witnesses are asked to declare that they know you, that you signed
the document in their presence and that you appear to be making
the request voluntarily and are not mentally ill or under undue
influence from someone else. The document is entered in your
medical records.
7. You have to wait at least 48 hours after the written request
and at least 15 days after the oral request before you can get the
prescription. Once the 15-day waiting period has passed, you must
make a second oral request, and then the doctor must offer you an
opportunity to back out. If you don't rescind your request, the
doctor will write a prescription. The doctor will note on the
prescription that it is written in accordance with the Death With
Dignity Act.
8. You ask your doctor to discuss your case with the pharmacist
before taking the prescription to the pharmacy. The pharmacist has
the option of filling the prescription or declining to
participate. The pharmacist who fills your prescription will
counsel you on use of the medication.
9. After you receive your medication, you're on your own. The law
doesn't require that your doctor be with you when you take the
lethal dose.
Undoubtedly, as you travel through the vast wilderness of
physician-assisted suicide, these and other questions could occur:
Q: Do I have to go to a doctor who specializes in
physician-assisted suicide?
A: No. You should go to your own "attending physician." The law
defines that physician as the doctor who has primary
responsibility for your care and the treatment of your terminal
disease. If you are dying of cancer, for example, your attending
physician is likely to be your oncologist.
Q: My doctor refuses to participate in assisted suicide. Who can I
turn to?
A: Ask your doctor to refer you to another who can assume primary
responsibility for your care and who is willing to work with you.
Doctors are deeply divided on the issue of physician-assisted
suicide, so be prepared to interview several doctors before
finding one appropriate for your situation. If you have difficulty
finding one, you can contact the Oregon chapter of the Hemlock
Society, 1-503-297-1722.
Q: My primary doctor is a naturopath. Can he perform
physician-assisted suicide?
A: No. The law allows only doctors of medicine or osteopathy (M.D.
or D.O.) to write lethal prescriptions.
Q: If I don't like the second opinion, can I get another?
A: There's nothing in the law that prohibits you from seeking as
many second opinions as you want. The only requirement is that you
must have a second opinion that matches your attending physician's
opinion that you are an appropriate candidate for assisted
suicide.
Q: Can I change my mind after I make the initial request?
A: Absolutely. The law requires the physician to tell you on at
least two different occasions that you have the right to rescind
your request for lethal medication. You can withdraw your request
at any time in any manner for any reason. And even after you get
the medicine, you don't have to take it if you don't want to.
Q: What happens if my doctor says I need counseling before
proceeding?
A: To write a lethal prescription, your doctor and your consulting
physician must be convinced that your judgment isn't impaired by
depression or another psychiatric or psychological disorder. Why?
Depression is a mental disorder that can give you suicidal
tendencies. Your doctors want to ensure that you are making an
informed decision, not acting on impulses induced by mental
disorder.
Q: How do I find the right counselor?
A: Ask your doctor for a referral to a trusted psychiatrist (M.D.
or D.O.) or a psychologist (Ph.D.). These counselors can confirm
or rule out a diagnosis of mental illness. If a counselor finds
that your judgment is impaired, your doctor will not be allowed to
give you a lethal prescription.
Q: What kind of medicine will my doctor prescribe?
A: The medicine will vary among patients and doctors, depending on
individual circumstances. Nevertheless, doctors have said that an
overdose of barbiturates probably would be used along with a drug
to reduce nausea. Barbiturates depress the central nervous system,
depress breathing, affect heart rate and decrease blood pressure
and temperature.
Q: Is there such a thing as a suicide pill?
A: No. All medications are developed to cure disease and relieve
symptoms and pain. Only when used inappropriately or in excess do
some become deadly.
Q: I'm homebound. Can someone else pick up my prescription for me?
A: With regard to prescriptions, the law goes only up to the point
at which the doctor writes the prescription. The law does not
address the pharmacists' or the patients' responsibilities after
the prescription is written. But there is nothing in the law to
keep someone else from picking up your prescription for you.
Q: Will the medicine hurt?
A: Under normal circumstances, you will simply become unconscious
and expire. Barbiturates have a bitter taste that is difficult to
conceal. And you might become nauseated. But your doctor can give
anti-nausea medication to take before consuming the lethal drugs.
Q: Can I die in my home?
A: Of course. The effect of the law is to allow patients to choose
the time and circumstances of their deaths. You can choose to die,
for example, surrounded by friends and family, or you can die
alone.
Q: May I choose to take the medicine in a hospital just in case
something goes wrong?
A: You should check first with a hospital representative. Some
hospitals, particularly those operated by the Catholic Church,
oppose assisted suicide and forbid their staffs and employees from
being involved in any way. In any event, there is little that
medical personnel could legally do to end your life if the suicide
doesn't go as planned. The law forbids anyone from giving you a
lethal injection, for instance, in case the prescription doesn't
work. Medical personnel could provide the therapy they normally
give for drug overdoses, however.
Q: What if I can't swallow pills?
A: In most cases the medication won't come in the form of pills.
Normally, the pharmacist will open a large number of capsules and
remove the powdered barbiturate. You would be told to mix the drug
with some food -- pudding or applesauce -- to cloak the bitter
taste.
Q: Can I request a lethal injection?
A: No. The law specifically prohibits lethal injections, mercy
killing or active euthanasia.
Q: What if I change my mind right after taking the medicine?
A: Call 9-1-1 immediately.
Q: Should I tell my family what I'm planning to do?
A: That's up to you. Your doctor is required by law to ask you to
notify your next of kin. But you are not required to comply with
the request.
Q: My mother is terminally ill, but she is too sick and
disoriented to speak for herself. Does the law allow me to request
physician-assisted suicide on her behalf?
A: No. The requests must be made by the patient herself. The law,
however, does not specifically address situations in which
patients have signed over power-of-attorney to another person who
has the legal authority to make decisions on his or her behalf.
Q: My 18-year-old, terminally ill son wants to commit suicide. How
can I stop him?
A: You can't. Under the law, any Oregon adult resident, including
18-year-olds, can request lethal medication. But there's nothing
in the law to prevent you or anyone else from counseling your son
against taking his life.
Q: Will my assisted suicide be covered by my health insurance?
A: From a private insurance standpoint, there's no difference
between office visits and prescriptions for physician-assisted
suicide and for other medical purposes. As long as legitimate
office visits and prescriptions are covered by a patient's
insurance plan, the insurer is obligated to process the claims in
the usual manner. The federal Medicare and Medicaid programs,
however, probably will not cover the procedure, because the U.S.
government has banned federal spending on assisted suicide, mercy
killing and euthanasia.
Q: Will my beneficiaries have any trouble collecting on my life
insurance policy?
A: Framers of the law have said they did not want assisted suicide
to stand in the way of life insurance benefits. But there is no
assurance of that other than a provision of the law stating that
"a qualified patient's act of ingesting medication to end his or
her life" shall have no "effect upon a life, health, or accident
insurance or annuity policy."
Q: I feel as though my doctor is trying to push me into assisted
suicide against my will. What should I do?
A: Physician-assisted suicide is entirely a matter of patient
choice. If your physician's actions or words make you
uncomfortable, contact the Oregon Board of Medical Examiners,
1-503-229-5770. The state licensing board regulates physicians in
Oregon and will oversee physician activity under the Death With
Dignity Act.
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