Abstract
Dear Editor:
Spokesmen for a group that lobbies to allow physicians to help end patients' lives have submitted revised clinical criteria for that process. 1 They cite a “substantial body of data” accumulated during 20 years of experience with Oregon's Death with Dignity Act (DDA) as the basis for their recommendations. This is the same statute about which a prominent legal scholar said, “Oregon's regulations are crafted in ways that make reliable and relevant data and case descriptions difficult to obtain. Given this, it is unclear whether and to what extent Oregon's experiment… will ever be able to provide the sort of guidance needed and wanted by other jurisdictions…” 2
The Oregon DDA and its reporting mechanism remain opaque, incomplete, and unenforceable. In 2015, 218 patients received prescriptions, 132 died from ingesting medication. Information about the circumstances of death is available for only 27. Of these, only 14 deaths were attended by physicians, 13 by other health personnel. The state has no information on the way the other 105 died, and the secrecy provisions of the statute ensure that no investigation will ever be conducted, even if the state had funding to do so. 3
The authors acknowledge that “…the statutes provide insufficient guidance for physicians in their assessment of the patient's decision-making process.” 1 However, they provide no greater guidance. Criteria are couched in “should” language, incapable of regulation or enforcement, and actually include no information about evaluating decision-making capacity. Nor do they emphasize referral to a mental health professional, although the Oregon Death with Dignity Act Guidebook repeatedly cautions that “The literature raises doubts about the ability of many physicians to diagnose a mental disorder or depression … [Although not mandatory], it will be the rare case when a referral [to a mental health professional] is not legally prudent.” 4 Last year in Oregon, only 5 of 132 patients who died after ingesting a lethal dose had been referred to a mental health professional. 3
This letter creates far too little space to enumerate the failings of Oregon's “safeguards,” to illustrate the incompleteness of data collection, or to document the absence of regulatory oversight. Oregon's statute is being used as the model for all other states that wish to enroll physicians in helping citizens end their lives, and thus its flaws metastasize across the nation. Requesting lethal drugs under this statute is less stringent than completing an advance directive. The DDA fails to protect vulnerable citizens, makes inappropriate death possible, and then blocks investigation.
Why so much effort to have doctors prescribe medications for death that they already prescribe for medically appropriate purposes? If family and friends can prepare lethal medication under this statute, why not the doctor? If they have prepared it, why not actually give it? Why not the doctor? Is there really much ethical difference between so-called assistance in dying (AID) and euthanasia? Why do these criteria from a lobbying group appear in a palliative care journal?