X-Message-Number: 9184 Date: Fri, 20 Feb 1998 17:41:18 -0700 From: David Brandt-Erichsen <> Subject: Oregon update Published in the PORTLAND OREGONIAN (Feb 19/98) ------------------------------------------------------------------- PATIENTS FIND ROADBLOCKS TO SUICIDE by ERIN HOOVER of the Oregonian Staff Summary: Some have found pursuing provisions of the Death With Dignity Act takes a large dose of determination At least 10 terminally ill patients have formally requested physician- assisted suicide in the nearly four months since the law has been in effect, according to anecdotal reports from doctors and counselors. Of those 10 patients, at least one has completed the law's requirements to obtain a lethal prescription, but none has yet used the drugs to die. Five of the patients died during the law's 15-day waiting period before obtaining the lethal dose. The Oregon Health Division will not release the number of completed assisted suicides and where they occurred until the end of the year or earlier, if enough cases are reported that patients' identities could not be tracked. That critical mass of patients has not been reached, said Dr. Katrina Hedberg, deputy state epidemiologist for the Health Division. The Death With Dignity Act requires that two doctors certify that a terminally ill patient has less than six months to live. The patient must see a counselor if either doctor thinks the patient's judgment is impaired by depression. But the law does not mention what is emerging as an important requirement for pursuing the assisted - suicide option: undaunted determination. Since Oct. 27, when an injunction against the law was lifted, the act has withstood conflicts and attempts to neutralize or overturn it. The U.S. Drug Enforcement Administration has threatened to sanction doctors who write lethal prescriptions under the law. National Right to Life has tried to tie up the case in court. The Oregon Medical Association and the Board of Pharmacy have haggled about how to label lethal prescriptions. "Those who are timid are easily dissuaded. For patients who really are of a mind that `I want this. This is my right,' I think they're finding that the act is accessible," said Barbara Coombs Lee, co-author of the Death With Dignity Act and executive director of the Compassion in Dying Federation. One such patient was Ray Frank, 56, a computer programmer and engineer in Portland. Frank had long held the belief, which he discussed with family and friends, that a person should not have to linger in suffering near death. When he was diagnosed with swift-moving kidney and lung cancer in October, he told a friend about his desire for assisted suicide if treatment failed. When the law went into effect, he persevered until he found a doctor -- Tualatin oncologist Nancy Crumpacker -- who would help him. He formally requested a lethal prescription. But two days after doctor and patient met, Frank died. In the past several weeks, Dr. Peter Rasmussen, a Salem oncologist and assisted - suicide proponent, has received formal requests for lethal prescriptions from four patients. "So far, every patient has died before the 15-day waiting period, which is fine because we've been able to keep them comfortable" using adequate pain medication, Rasmussen said. By the time these people were ready to think about ending their lives, they were already close to death, he said. "In every case of these recent individuals, they were quite clear and confident. If anything, there's been substantial disappointment with all the hoops that have to be jumped through," Rasmussen said. The assisted - suicide process under the law "is quite limiting and quite cumbersome, but I personally think it needs to be that way. It's not perfect, but I would feel frightened if people could make snap decisions," he said. Patients pursuing assisted suicide are those comfortable with asserting control over and planning for their dying, a process that many people believe is not and should not be within their control. Doctors and counselors describe these patients as people who believe they've achieved much of what they set out to do in life, have loved ones who support their decision, and believe that life in some cases is over before one dies. A Portland man who is dying of AIDS said he first considered finding a way to hasten his death in 1989 when he developed nonmalignant lesions on his brain. Medical advances extended his life, but now his health is flagging again. He endures vicious bouts of diarrhea and vomiting. He contracted viral pneumonia that left his lungs so damaged that he needs oxygen from a tank to breathe. His liver is so enlarged that even bending over to make the bed is difficult. The man and his partner, who also has AIDS, have stockpiled a lethal combination of drugs for use if necessary, a method well known among people with AIDS. But this month, the dying man began talking with his physician about his candidacy for assisted suicide under the law. "I will choose the time, place and manner of my death," said the man, who wished to protect his identity. "As far as I'm concerned, I've earned that right." At least two patients with pulmonary diseases have been denied access to the law, in part because they do not appear to be near death. One of these patients, a 56-year-old Portland woman, said her doctor denied her request for a lethal prescription. "He feared he would be helping me murder myself if I was not as sick as I thought," said the woman, who worried that using her name would identify her doctor. "Many, many doctors are afraid," she said. "They could lose their license. They could lose the job they have. They could lose clients. They didn't become a doctor to just take care of one person. They want to do as much good as they can. How much good can they do if they've lost their power to act?" An 81-year-old Grants Pass woman with lung cancer also was not able to pursue assisted suicide . In late November, the woman asked her doctor how she could end her life without enduring the final miseries of her disease, said the patient's half-sister, Lela Radovich of Portland. Although the assisted - suicide law was in effect, the doctor told the patient that the best way to die was simply to stop eating, Radovich said. Hospice care kept the woman comfortable with medication while she refused food throughout December. In early January, the patient's husband told Radovich that his wife said she wanted to die quickly; but the husband said he feared the doctor would be penalized for participating in an assisted suicide . "That was a concern, and I'm sure my sister's concern would be that there would be no liability for her husband or her doctor," Radovich said. The husband and the doctor could not be reached for comment. Radovich talked with the Hemlock Society and Compassion in Dying; both were willing to find a doctor to help. But by then, Radovich's sister had stopped drinking fluids and she likely would not have been able to ingest a lethal dose of medications. A week later, the woman died. She had gone 11 days without fluids and 51 days without food. Dr. James Sampson, a Portland internist who does HIV research and treats HIV-positive patients, said he thinks that knowing how to safely and responsibly aid a person in dying under the law is a bigger issue for most doctors than whether they will be sanctioned by the DEA. "I'm not sure that what happens inside the Beltway is really the driving concern that's keeping people from pursuing this," said Sampson, a former member of the Oregon Board of Medical Examiners. Dr. Richard Ellerby, an oncologist in Coos Bay, said he has not had requests for assisted suicide but feels besieged by forces trying to bring down the law. "The patients expect us to have our act in gear and we don't, and the reason we don't is this threat from . . . the DEA and all these various and sundry organizations who are just waiting" to block the law or otherwise target participating doctors, Ellerby said. "The last thing you want is for someone to be bombing the front door of your clinic." Dr. William Toffler, an outspoken opponent of assisted suicide , denounced such violence and said he thinks such a scenario is unlikely. But he does think doctors who participate in the law will suffer consequences. "I think there are people who will vote with their feet and go to health-care providers who will provide a consistent ethic of doing no harm and supporting the health and well-being of their patients," Toffler said. So far, doctors willing to help patients die under the law are the right-to-die activists. Because such activists wrote the law, they are familiar with how to proceed and have access to a lethal medications recipe. A formula is available through Compassion in Dying of Oregon to any doctor working with a terminally ill patient under the assisted suicide law. Compassion is also establishing a counseling network for dying patients who want to discuss end-of-life options, including assisted suicide . Hemlock Society volunteers also continue to help patients with questions about aid in dying. Toffler worries that the Health Division's extreme efforts to protect patient confidentiality will hinder the public scrutiny needed to ensure patient safety and doctors' diligence under the law. "There is a great danger of doctors who don't follow appropriate protocols," Toffler said. But no one, including Toffler, thinks that assisted suicide is an option that most patients or physicians will face. Those active in the right-to-die movement acknowledge that acceptance of this end-of-life option will come slowly. "It will be years and years before a lot of people feel really comfortable about it and I think it will really be incremental," Rasmussen said. "I think there will slowly be more and more doctors willing to provide this service for their patients." Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=9184