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Frequently Asked Questions About Physician-Assisted SuicideQ1. What is physician-assisted suicide? Q2. Is the proposed "Death With Dignity" suicide or not? Q3. What is the public's opinion on physician-assisted suicide? Q4. What Vermont organizations support or oppose legalization of physician-assisted suicide? Q5. Does legalization of physician-assisted suicide improve the quality of end-of-life care? NOTE: MS Word format of this document is available. 1. What is physician-assisted suicide (called by supporters "Death With Dignity")? The Oregon "Death With Dignity" law (and the proposed Vermont bill) allows a patient's physician to write a lethal prescription for a competent patient who has less than 6 months to live if the patient is competent, not depressed, and not coerced. The law requires that the patient self-administer the lethal drug. 2. Is the proposed "Death With Dignity" suicide or not? Proponents of this bill prefer to call it "death with dignity" or "physician aid-in-dying" or "hastening death" or "an end-of-life choice". They get inordinately upset when opponents call it "physician-assisted suicide". AN ACT RELATING TO THE VERMONT DEATH WITH DIGNITY ACT ---------First sentence of the bill: "Statement of purpose: This bill proposes to allow a mentally competent patient who is expected to die within six months to end his or her life in a humane and dignified manner by prescription medication." Last sentence of the bill: "Action taken in accordance with this act shall not be construed for any purpose to constitute suicide, assisted suicide, mercy killing, or homicide under the law." Webster's Collegiate Dictionary: Sui-cide: noun Etymology:
Latin sui (general) of oneself + English -cide; akin to Old English & Old
High German sIn his, Latin suus one's own, sed, se without,
Sanskrit sva oneself, one's own Bishop Angell statement on Vermont "Death With Dignity" proposal (January 30, 2003) "The Oregon Death with Dignity Act is based on a moral lie that even Webster's dictionary exposes. Suicide is simply defined as "the intentional taking of one's own life." The legislators and people of Oregon have rewritten the definition of suicide to soothe their social conscience. The Oregon Death with Dignity Act attempts to exonerate and absolve the patient from the sin of suicide. By filling out the proper forms this law says a person will not be committing an act of suicide when they take their own lives with medication furnished by their physician. Furthermore, the doctor has been declared innocent of assisting in the patient's suicide, even though he has completely facilitated his patient's suicide with forms and furnishing of the death pills. But the law says it is not suicide. The law says it is death with dignity, and that the doctor is not aiding a suicide. There is nothing sadder or more injurious to our ethical balance than when we lie to ourselves." Most Reverend Kenneth A. Angell, Bishop of Burlington 3. What is the public's opinion on physician-assisted suicide? Public opinion polls are an important tool in making decisions on public policy. However, poll results often reflect a person's first impression, not necessarily his or her thoughtful belief. For example, Oregon polls on physician-assisted suicide done just before the referendum vote in 1994 showed 60-70% support, but the actual referendum passed 51.3% to 48.7%. In addition, poll results are greatly influenced by the way the poll question is worded. For example, one poll found that 72% favored allowing a physician to "end the patient's life by some painless means", but only 62% favored allowing the physician to "assist the patient to commit suicide." With those caveats, let's look at some actual poll results, both national and in Vermont. CBS News Poll "If a person has a disease that will ultimately destroy their mind or body and they want to take their own life, should a doctor be allowed to assist the person in taking his or her own life or not?"
Gallup Poll "Regardless of whether or not you think it should be legal, tell me whether you personally believe doctor assisted suicide is morally acceptable or morally wrong."
Charlton Research Co. (1997) "Do you think a person has the moral right to end his/her life when they are experiencing . . .
WCAX Channel 3 (2003 poll by "Research 2000") "Do you favor a law that would allow doctors to help terminally ill patients die?" YES 44% / NO 45% Death With Dignity Poll (2004 poll by Zogby International) Q1: "Which of the following 2 options most closely represents your belief.
Option A 72.0% / Option B 23.8% Q2: "Would you support or oppose legislation to allow a mentally competent adult, dying of a terminal disease, the choice to request and receive medication from a physician to peacefully end suffering and hasten death?" SUPPORT 77.7% / OPPOSE 17.0% Last Acts 1999 poll (US) "In your opinion, how should we deal with the problem of end-of-life pain and suffering?" Improve care for the dying: 65% Make physician-assisted suicide legal: 23% 4. What Vermont organizations support or oppose legalization of physician-assisted suicide? Almost all organizations of healthcare professionals, disability rights advocates and religious leaders who have taken official positions on the issue are opposed to legalization of physician-assisted suicide in Vermont. Healthcare Professionals
Disability Rights Groups
Religious Groups
5. Does legalization of physician-assisted suicide improve the quality of end-of-life care? Oregon has widespread availability and high utilization rates for hospice services. Their advances in hospice/end-of-life care began in 1990, but the law allowing physician-assisted suicide didn't go into effect until 1997. Supporters of legalization of physician-assisted suicide in Vermont suggest that if our state legalizes PAS, our utilization of hospice services and quality of end-of-life care will improve. However, some research data raises significant questions about this assertion. "If we want to improve Vermont's end-of-life care, we would do well to imitate those who have already achieved the goal we seek. The model for this effort is Oregon." James Brooks, Barre, in letter to editor, June 11, 2004 "Increased Family Reports of Pain or Distress in Dying Oregonians: 1996-2002" by Erik Fromme, MD; Virginia Tilden, RN, Linda Drach, MPH, Susan Tolle, MD (Oregon Health Sciences University and Oregon Department of Human Services). Journal of Palliative Medicine 2004; volume 7, Number 3; pages 431-442 Abstract: "The aim of this study was to compare the prevalence of family-reported pain or distress during the last week of decedents' lives during two times: November 1996 to December 1997 and June 2000 to March 2002. [note: physician-assisted suicide became legally available in Oregon in late 1997.] We telephone-surveyed family caregivers of Oregonians who had died 2 to 5 months previously in private homes, nursing homes, and other community-based settings. Caregivers were asked to rate the level of pain or distress during the decedent's final week of life on a four-point scale. Data were collected from 340 respondents from 1996-1997 and 1384 respondents from 2000-2002. We found that the prevalence of family-reported moderate or severe pain or distress (compared to comfortable or mild pain or distress) in Oregon decedents increased from 30.8% in 1996-1997 to 48% in 2000-2000." [emphasis added] 6. Have the safeguards included in the Oregon law allowing physician-assisted suicide worked to protect vulnerable patients from abuse or expansion of the criteria? CASE 1: Michael Freeland requested and received a lethal prescription from Dr. Peter Reagan, a suicide advocate, a few months after being diagnosed with lung cancer. Dr. Reagan offered to refill it when he outlived his 6 month limit. Over a year after receiving the first prescription, he was admitted to a psychiatric treatment facility with depression and suicidal intent. He was treated and improved. His professional caregivers ensured that all of his 32 guns and ammunition were removed from his home before he was allowed to return, but they knowingly allowed him to keep his lethal prescription. His treating psychiatrist wrote a letter to the court the day after his discharge saying he was not competent and needed a guardian. Mr. Freeland called Physicians for Compassionate Care (he called them accidentally; he was actually trying to contact the suicide advocacy organization Compassion in Dying). PCC volunteers helped him through his last several months of life, saw that his depression and his symptoms were treated appropriately, and assisted him in reconciling with his estranged daughter. He died naturally and comfortably nearly 2 years after receiving his first lethal prescription. Before he died, he signed an authorization releasing his medical records for public review. Summary:
REF: Smith WJ. The Oregon tale: The creepy underside of legal assisted suicide. Weekly Standard 5/17/04; 9(34) Hamilton NG, Hamilton C. Competing paradigms of responding to assisted suicide requests in Oregon: Case report. Presented at the American Psychiatric Association Annual Meeting in New York City, 5/6/04 CASE 2: Kate Cheney, 85, had terminal cancer and told her doctor she wanted assisted suicide, However, he was concerned that didn't meet the required criteria for mental competence because of dementia. So he declined to write the requested prescription and instead referred her to a psychiatrist as required by law. She was accompanied to the psychiatric consultation by her daughter, Erika Goldstein. The psychiatrist found that Kate had a loss of short-term memory. It also appeared that her daughter had more interest in Cheney's assisted suicide than did the patient herself. The psychiatrist wrote in his report that while the assisted suicide seemed consistent with Kate's values, "she does not seem to be explicitly pushing for this." He also determined that Kate did not have the "very high capacity required to weigh options about assisted suicide." Accordingly, he declined to authorize the lethal prescription. Kate seemed to accept the psychiatrist's verdict, but her daughter did not. Ms. Goldstein viewed the guidelines protecting her mother's life as obstacles, a "roadblock" to Kate's right to die. Ms. Goldstein demanded that Kate's HMO, Kaiser Permanente, provider a second opinion. This was provided by a clinical psychologist rather than a MD-psychiatrist. He also found Kate had memory problems. For example, she could not recall when she had been diagnosed with terminal cancer. The psychologist also worried about familial pressure, writing that Kate's decision to die "may be influenced by her family's wishes." Still, despite these reservations, the psychologist determined that Kate was competent to kill herself and approved the writing of the lethal prescription. The final decision about the assisted suicide was left to a Kaiser physician-administrator named Dr. Robert Richardson. He interviewed Kate, and she told him she wanted the pills not because she was in irremediable pain but because she feared not being able to attend to her personal hygiene. After the interview, satisfied that Kate was competent, Richardson gave the okay for the lethal prescription. Kate didn't take the pills right away. At one point, she asked to die when her daughter had to help her shower after an accident with her colostomy bag, but she quickly changed her mind. Then, she went into a nursing home for a week so that her family could have some respite from care giving. After she returned home, she declared her desire to take the pills. After grandchildren said their good-byes, Kate took the lethal drug. She died with her daughter at her side, telling her what a courageous woman she was. Deviations from the letter and/or intent of the law:
REF: Barnett EH. Is Mom capable of choosing to die? Oregonian 10/17/99 CASE 3: Patrick Matheny, 43, had Lou Gehrig's disease (ALS). For several months, he struggled with a decision to end his life using a lethal prescription. He would set arbitrary deadlines, then, when the time came, would set new deadlines. At first, it was to be after his 15-year-old son came to visit last Thanksgiving. Then it was to be when he could no longer dress and wash himself. As an article in the Oregonian put it, "Pat felt he would rather be dead than accept help to bathe and dress." But when the time came, he was able to handle having his mother and hospice nurses help him-so he set new deadlines. On 3/10/99, Matheny tried to swallow the barbiturates mixed into a chocolate nutrition drink, sweetened with a boxful of sugar substitute. Reportedly, he experienced difficulty swallowing the concoction. The only person Methany had asked to be with him in his trailer was his brother-in-law, Joe Hayes. Hayes told the Oregonian that he had to "help" Matheny to die, but would not say how. According to Hayes, it was too personal. "It doesn't go smoothly for everyone," Hayes explained. "For Pat it was a huge problem. It would have not worked without help," he added. Coos County District Attorney Paul Burgett called for an investigation of Matheny's death after reading Hayes' comments in the Oregonian. His body had been cremated, so was not available for examination. Burgett then quickly dropped the inquiry, saying, "We think the purpose of the law was served and we have no further questions." The county investigator did not question Hayes at all, yet Burgett told reporters that he was satisfied that Hayes simply assisted Matheny in a legal act which Matheny intended to commit. He went on to say he thought disabled people who cannot swallow should have an equal right to assisted suicide as long as they meet the requirements of the law. After reading Burgett's comments, State Senator Neil Bryant asked Deputy Attorney General Schuman for his opinion. "The Death with Dignity Act does not, on its face and in so many words, discriminate against persons who are unable to self-administer medication. Nonetheless, it would have that effect," Schuman wrote. "It therefore seems logical to conclude that persons who are unable to self-medicate will be denied access to a 'death with dignity' in disproportionate numbers," he added. Deviations from the letter and/or intent of the law:
REF: Oregonian, 10/27/99, 1/17/99, 3/17/99 * * * End of page. * * * |
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