The Oregon Death with Dignity Act
Six Years of Data
A Document Prepared for:
Vermont Legislative Council
115 State Street
Montpelier, VT 05633-5301
Submitted by
Death with Dignity
Vermont
Contact: Dick Walters
708
Wake Robin Drive
Shelburne, VT 05482
802-985-9473
E-mail: info@deathwithdignityvermont.org
www.deathwithdignityvermont.org
End-of-Life
Choices Vermont
Contact: Dr. Robert C. Ullrich,
Ph.D.
69 Ashe Road
Charlotte, VT 05445
(802) 425-3215
email: choices@gmavt.net
July 12, 2004
Background, Introduction and
Overview
The
proposed Vermont Death with Dignity (DWD) Act is based point by point on the existing Death with
Dignity Act in Oregon.[1]
The Oregon Act has been responsibly implemented since 1997, with successful
utilization of the safeguards built into the Act and with no indication of
abuse documented by the Oregon Department of Human Services or any other authority.
The entire process proposed by the bill is within the patient-doctor
relationship. It is patient initiated and patient driven at every stage.
At its
core, Oregon’s Act is about acknowledging that the practice of assisted dying
happens in every state[2]. The difference in Oregon is that the state has chosen to
acknowledge the practice and regulate it, ensuring that safeguards against abuse are
in place and that
the process is reported on so that it can be monitored. Oregon’s medical
community has taken this responsibility very seriously – recognizing that
Oregon is the only place in the country where this legal option exists,
researchers have meticulously followed and reported on the implementation and
practice of the Act both through the state’s official annual reports[3]
and through independent research published in the country’s most prestigious
medical journals.[4]
Public opinion polls in Vermont have shown that a death
with dignity law containing appropriate safeguards is supported by more than
two-thirds of us.[5] The experience in Oregon indicates that for
most people, simply knowing that the option exists is enough. Each year, hundreds of Oregonians explore
the death with dignity option—and most of them find the comfort they need
without using Oregon’s law.[6]
The Act
has also served as a catalyst for improving end-of-life care; Oregon is a
universally recognized leader in end-of-life care across the entire continuum
of options and the Death with Dignity Act is a part of that success. In fact, since the debate concerning death
with dignity began in 1994, care for the terminally ill has improved in
substantial and quantifiable ways.[7] With the passage of the Death with Dignity
law, Oregon could be considered the leader in the nation because it offers a
fuller range of options in end-of-life care.
Local and national media, both friendly and unfriendly to the law, have
recognized Oregon’s improvement in the care of the terminally ill.
In
Oregon:
·
Hospice
utilization is double the national average;[8]
·
More
people die at home than in hospitals or care facilities;[9]
·
Oregon
consistently ranks in the top three for the medical use of morphine to control
pain.[10]
To
better inform their deliberations on the proposed Vermont Death with Dignity
Act, Vermont lawmakers have requested that Legislative Council investigate
Oregon’s experience with the nation’s only Death with Dignity Act to
independently establish a foundation of facts.
Supporters
of the Death with Dignity Act are submitting a package of materials to support
this investigation. This material
identifies areas where facts are in dispute and provides contacts and resources
in Oregon and nationally that can assist Legislative Council’s resolution of
these matters.
The Act
has spawned a great public discussion about the need for both comprehensive
improvements to Vermont’s end-of-life care continuum and adoption of the
Vermont Death with Dignity Act. The
state medical society has engaged in a spirited discussion of the matter,
dozens of local organizations have sponsored public forums where supporters and
opponents of the Act have made presentations, and the Legislature has held
public and expert hearings.
Additionally, both supporters and critics of the Act have distributed
written materials about the Act to lawmakers, to the public, and in the
press.
In
Oregon, the Death with Dignity Act is accepted as one option along a continuum
of options for care at the end of life.
We encourage the researchers to spend some time in Oregon in order to
understand that the Act is no longer a hotly debated issue; it is simply a
personal matter that is discussed openly in the context of the doctor-patient
relationship. The law is supported by nearly seven out of ten Oregon voters[11]
and by key statewide officials, including the current Governor[12]
and former Governor John Kitzhaber, MD[13],
the Secretary of State[14],
and the State Treasurer.[15]
Six of Oregon’s seven congressional delegates have rigorously defended Oregon’s
Act in Congress.[16]
What
follows is an enumeration of the points of contention subject to debate among
those pro and con on DWD in public discussions. Accompanying each item is a listing of published sources that
document the facts that pertain to that item and a list of contacts
knowledgeable about the issues because of direct involvement with medical,
legal or governmental practice as it pertains to the Oregon DWD experience and
law.
Overview
The
following is a compilation of information prepared in response to the
Legislators’ request for Vermonters interested in the Death with Dignity Law to
identify the specific facts that supporters and opponents of the Act dispute.
As
supporters of the Act, we’ve identified eight general topics where factual
matters should be resolved so that Vermonters can continue the dialogue about
enacting the Oregon patient-initiated and controlled end-of-life choice law
based on a common set of accepted facts.
For
each of these eight general topics, we concisely articulated the supporters’
basic factual observation and identified the opponents’ claim on the
matter. To assist with the resolution
of these specific facts, we suggest questions to answer, provide a package of
resources to substantiate our factual observations and list suggested contacts
who can offer valuable information on the specific matters raised.
The
eight general topics where factual matters should be resolved are:
1)
The
Oregon Death with Dignity Act’s Impact on End-of-Life Care
2)
Patient
Utilization of the Oregon Death with Dignity Act
3)
Safeguards
Govern the Proper Application of the Act
4)
Patients’
Right to Select A Medical Care Provider
5)
The
Act is About Patient Choice and Control.
It Does Not Authorize Euthanasia
6)
Government
and Independent Monitoring of the Act’s Application
7)
Oregon
Medical Providers’ Views of the Act
8)
Legal
Issues Related to the Death with Dignity Law
Factual Matters
to Resolve
I.
Oregon Death with Dignity Act’s
Impact on End-of-Life Care
a.
Factual Observation: Oregon, which for
many years has excelled in end-of-life care, has demonstrated significant
further improvement since Death with Dignity became law.
Opponents Claim: Opponents claim
the adoption of the Oregon Act has not coincided with improvements in
end-of-life care options and that adoption of the Act in Vermont would decrease
hospice use and referrals as patients choose assisted dying.
i.
Questions to be Resolved by
Legislative Council:
1.
Do
Oregon experts and government officials believe adoption of the Act coincided
with system-wide improvements in end-of-life care?
2.
Has
adoption of the act reduced the utilization of any of the most common
end-of-life care options, such as hospice care, aggressive pain management
evidenced by the medical use of morphine to control terminally-ill people’s
pain, or the percentage of people dying at home instead of in a hospital or a
health care facility?
ii.
Resources+:
1.
Tolle,
S.W. [1]
2.
Spann,
Jeri [2]
3.
Death
with Dignity National Center [3]
4.
Ganzini,
Linda, MD, 2002 [4]
5.
Bascom,
Paul B., MD [5]
6.
Ganzini,
Linda, MD, 2001 [6]
7.
Ostrum,
Carol [7]
iii.
Contacts: *
1.
Susan
Tolle, director of Oregon Health & Science University’s (OHSU's) Center for
Ethics in Health Care
2.
Linda
Ganzini, associate professor of psychiatry at Oregon Health & Science
University (OHSU), Director of Geriatric Psychiatry at the Portland Veterans
Affairs Medical Center, senior scholar at OHSU Center for Ethics in Health Care
3.
Ann
Jackson, Executive Director, Oregon Hospice Association
4.
Pat Dunn, MD, Chair, The Task Force to Improve
the Care of Terminally-Ill Oregonians
5.
Susan Hedlund, MD, Cancer Care Resources, member of the Task Force to
Improve the Care of Terminally-Ill Oregonians
II.
Patient Utilization of the
Oregon Death with Dignity Act
a.
Factual Observation: The Oregon Death
with Dignity Act provides terminally-ill people struggling with serious suffering
such as loss of autonomy, loss of control of body function, etc., or
intolerable pain the choice of controlling the timing and manner of their
death. It gives dignity to people at the end of a terminal illness
through increased choice and control.
Opponents Claim: Opponents make a number of allegations
aiming to demonstrate the law is unnecessary or utilized for improper reasons.
i.
Question
to be Resolved by Legislative Council:
1.
What are the complete statistics regarding
utilization of the Act?
ii.
Resources:
1.
Oregon
Department of Human Services [8]
2.
Ganzini,
Linda, MD, 2002 [4]
iii.
Contacts:
1.
Darcy
Niemeyer, Oregon Department of Human Services, Office of Disease Prevention
& Epidemiology
b.
Factual Observation: Most terminally-ill people interested in
the Act only make an initial request with their doctor regarding utilization of
the Act, but they do not complete the rigorous process required to actually
acquire a prescription. For most, the
law provides them the comfort of knowing they could control the timing and
manner of their death.
Opponents Claim: Opponents of the Act make allegations
criticizing utilization of the Act using loose or partial statistical
comparisons.
i.
Questions
to be Resolved by Legislative Council:
How many terminally-ill
Oregonians each year are estimated to make an initial request with their
doctors to consider hastening their death through the Act?
1.
How many terminally-ill Oregonians each year fill
prescriptions written under the Act?
2.
How many terminally-ill Oregonians each year hasten
their deaths through self-administration of a prescription written under the
Act?
ii.
Resources:
1.
Oregon
Department of Human Services [8]
2.
Ganzini,
Linda, MD, 2002 [4]
3. Ganzini, Linda, MD, 2001 [6]
4.
Schwartz,
J. [9]
iii.
Contacts:
1.
Darcy
Niemeyer, Office of Disease Prevention & Epidemiology, 503-731-4023
2.
Ann
Jackson, Executive Director, Oregon Hospice Association
3.
Linda
Ganzini, associate professor of psychiatry at Oregon Health & Science
University (OHSU), Director of Geriatric Psychiatry at the Portland Veterans
Affairs Medical Center, senior scholar at OHSU Center for Ethics in Health Care
c. Factual Observation: In the face of a terminal illness, many patients experience pain,
suffering and loss of dignity that is multi-dimensional. While the intolerable, untreatable pain that
some terminally-ill people suffer from is a factor for some who use the Act, it
is not the most common; loss of autonomy and loss of control of bodily
functions are among the more important factors.
Opponents claim: The Act is unnecessary because the
medical profession has the means to control pain and people who choose to use
it have not been properly cared for.
i.
Questions
to be Resolved by Legislative Council:
1.
What are the actual, primary motivating factors patients
cite when they utilize the Oregon Death with Dignity Act?
2.
Are there indications that those who use the law do
not have access to proper care such as hospice services?
3.
Are there any factual indications that patients who
use the Oregon Death with Dignity Act may not have access to proper care
because of their income level, level of education, availability of health
insurance, or disability?
ii.
Resources
1.
Hedberg, Katrina, MD,
MPH, 2003 [10]
2.
Hedberg, Katrina, MD,
MPH, 2002 [11]
3.
Colburn, Don [12]
4.
Oregon
Department of Human Services [8]
5.
Quill, Timothy E., MD,
1997 [13]
iii.
Contacts
1.
Katrina
Hedberg, Oregon Department of Human Services
2.
Darcy
Niemeyer, Oregon Department of Human Services, Office of Disease Prevention
& Epidemiology
3. Ann Jackson, Executive
Director, Oregon Hospice Association
4. Barbara
Glidewell, Director and Ombudsman, Patient Advocate, OHSU Department of Patient
Relations
5. Barry
Heath, D.Min., Director
of Pastoral Care, Salem Hospital
d.
Factual Observation: The Oregon Act has been carefully implemented,
rarely used, and there have been no instances of abuse or coercion as
documented by the Oregon Department of Human Services. Many patients and their
family members have shared their experience with the law publicly – there has
never been a complaint from a family member about any individual’s use of the
law.
Opponents claim: Despite the lack of any reliable evidence
or complaints from people directly involved in their loved ones’ use of the
Oregon Act, opponents continue to misrepresent the facts in a number of cases.
i.
Question to be Resolved by
Legislative Council:
1.
In each specific case that opponents or critics of
the Act cite to allege the safeguards are inadequate, what are the complete,
actual facts relating to the patient’s utilization of the Act?
ii.
Resources:
1.
Kate
Cheney
a.
Barnett, Erin Hoover, October 17, 1999 [14]
b.
Duin, Steve [15]
c.
Weiland, Dr. Allan [16]
2.
Joan Lucas
a.
Kettler,
Bill [17]
3.
Pat Matheny
a.
Barnett, Erin Hoover, March 17, 1999 [18]
b.
Barnett, Erin Hoover, March 13, 1999 [19]
4.
“Helen”
a.
Reagan,
Peter, MD [20]
5.
Michael Freeland
a.
Schwartz, John [21]
6.
Additional resources on individual’s experience with
the Act
a.
Yeoman, Barry [22]
b.
Rollin, Betty [23]
c.
Van Loon, Adam [24]
iii.
Contacts:
1.
Kate
Cheney
a.
Dr.
Robert Richardson, Head of Kaiser Permanente NW Ethics Service
b.
Dr.
Allan Weiland, Kaiser Permanente Northwest regional
medical director
2.
Joan Lucas
a.
Bill
Kettler, reporter, The Medford Mail
Tribune
3.
Pat Matheny
a.
Erin
Hoover Barnett, reporter, The Oregonian
b.
Paul
Burgett, District Attorney, Coos County, Oregon
4.
“Helen”
a.
Dr.
Peter Reagan, Portland Family Practice
5.
Michael Freeland
a.
Dr.
Peter Reagan, Portland Family Practice
6.
ALL
Cases
a.
Hardy
Myers, Oregon Attorney General, Oregon Department of Justice.
b.
Michael
Sims, Executive Assistant, Oregon Board of Medical Examiners.
III.
Safeguards Govern the Proper Application of the Oregon Death With
Dignity Act
***FORMAT
NOTE: The observations and claims in
Section III can be explored using a common set of resources and contacts which
are listed at the end of this section.
a.
Factual Observation: The Oregon law contains a strict set of
safeguards to ensure the law is properly applied. These safeguards work to ensure patients electing to utilize the
Act are terminal, competent, and making a free decision.
Opponents Claim: Seeking to undermine the efficacy of the
safeguards, opponents of the Act make a number of unsubstantiated allegations
that it is abused.
i.
Questions
to be Resolved by Legislative Council:
1.
What are the safeguards built into the law to ensure
it is properly applied?
2.
According
to Oregon state officials, are the safeguards working well?
3.
What state or federal enforcement or legal actions
have substantiated allegations that the law was abused? What are the complete, actual facts relating
to any such actions?
b.
Factual Observation: One requirement of the Act is that the
patient be diagnosed with a terminal illness with a prognosis of six months or
less (accepted by Medicare). Proponents
of the law acknowledge a medical determination that a person’s illness will
produce death within six months cannot be determined with an exact certainty,
but instead must be based on a reasonable medical judgment. While there is considerable variation in the
time between acquiring a prescription and hastening death, patients wait as
long as possible before using the medication.
Opponents Claim: Opponents of the law claim the safeguard
that a patient be in a terminal condition does not provide adequate protection
because the six-month prognosis is not infallible.
i.
Questions
to be Resolved by Legislative Council:
1.
According to medical experts, what is the generally
accepted medical definition of a terminal condition?
2.
Is the Oregon Act’s definition of a terminal
condition consistent with the generally accepted medical definition of a
terminal condition?
3.
What are the facts relating to the length of time
between a terminally-ill person’s initial election to utilize the Act,
acquisition of a prescription provided under the Act, and actual
self-administration of a prescription under the Act?
c.
Factual Observation: Thorough reporting of actions governed by
the Act is required of all doctors.
Doctors do not qualify for the legal safe harbor provided by the Act if
they do not fully account for their actions and they face professional
disciplinary action and criminal charges for failure to report. There is no
incentive for physicians not to report.
Opponents Claim: Opponents claim that some doctors may not
adequately report their activities governed by the law and therefore the data
about utilization of the law are not accurate.
i.
Questions
to be Resolved by Legislative Council:
1.
What are the patient confidentiality considerations
that govern the detail and content of doctor reporting of actions taken
relative to a specific patient?
2.
What are the incentives built into the law to ensure
full reporting by doctors of activity governed by the Act?
3.
Are there any incentives to fail to report activity
regulated by the Act?
4.
If a doctor fails to report activity governed by the
Act, what penalties, sanctions and liabilities are applicable to the doctor?
5.
What are the facts relating to enforcement or legal
actions doctors have faced for failure to report activity governed by the
Act? According to Oregon state
officials, what are the complete, actual facts relating to any such action?
d.
Factual Observation: The Act requires
a second opinion to confirm the terminal diagnosis and six-month prognosis. It
further requires that the patient be deemed capable (defined as able to make and
communicate health care decisions).
Depression renders one
incompetent only in its most extreme manifestations. Depression per se does not necessarily preclude
competence. If either physician
determines that the patient's judgment is impaired, the patient must be
referred for a psychological examination.
Opponents Claim: Opponents claim
that second opinions are easily obtained from a few doctors and that the fact
that the psychological consultation is not required is evidence that the
safeguards are inadequate.
i.
Questions to be Resolved by
Legislative Council:
1.
How
many different doctors have been involved with providing the consulting second
opinions?
2.
How
many patients who have used the law have undergone psychiatric or psychological
evaluations?
e.
Factual Observation: Even with the best care, end-of-life pain
cannot be sufficiently relieved in some cases without rendering the patient
unconscious. For these individuals, the choice between agony and terminal
sedation is cruel, a violation of their belief system and concept of a
well-lived life. For still others,
there are weighty existential concerns that are raised by a terminal illness. Modern medical technology may ameliorate many things but there is no way
to alleviate the loss of dignity, autonomy, and the control of bodily functions
– some of the chief reasons people choose to avail themselves of the Oregon
Death with Dignity law.
Opponents Claim: The Act is unnecessary because the
medical profession has the means to control pain and people who choose to use
it have not been properly cared for.
i.
Question
to be Resolved by Legislative Council:
1.
What are the actual, primary motivating factors
patients cite when they utilize the Oregon Death with Dignity Act?
f.
Resources:
i.
Oregon
Death with Dignity Act [25]
ii.
Oregon
Department of Human Services [8]
iii.
Hedberg, Katrina, MD,
MPH, 2003 [10]
iv.
Lee, Daniel E. [26]
v.
Quill, Timothy E. MD,
2003 [27]
vi.
Ganzini,
Linda, MD, 2002 [4]
vii.
Bascom,
Paul B., MD [5]
viii.
Ganzini,
Linda, MD, 2001 [6]
ix.
Colburn, Don [12]
g.
Contacts:
i.
Darcy
Niemeyer, Oregon Department of Human Services, Office of Disease Prevention
& Epidemiology
ii.
Dr.
Tim Quill, practicing primary care physician, Professor of Medicine,
Psychiatry, and Medical Humanities at the University of Rochester
iii.
Hardy
Myers, Oregon Attorney General, Oregon Department of Justice
iv.
Michael
Sims, Executive Assistant, Oregon Board of Medical Examiners
v.
Barbara Glidewell, Director and
Ombudsman, Patient Advocate, OHSU Department of Patient Relations
vi.
Barry Heath, D.Min., Director of Pastoral Care, Salem
Hospital
vii.
Pat Dunn, MD, Chair, The Task Force to Improve
the Care of Terminally-Ill Oregonians
viii.
Susan Hedlund, MD, Cancer Care Resources, member of the Task Force to
Improve the Care of Terminally-Ill Oregonians
IV.
Patients’
Right to Select a Medical Care Provider
a.
Factual Observation: A general, basic principle governing
health care in America is that each patient chooses his or her doctor. Patients interested in a particular medical
procedure at times must find a doctor whose practice will respond to the
patient’s legitimate medical choices.
Opponents Claim: Opponents of the Act claim that it is
inappropriate for terminally-ill patients to seek out a doctor who will make
available to them all their legal end-of-life options.
i.
Questions
to be Resolved by Legislative Council:
1.
What are the complete, factual statistics relating
to terminally-ill people in Oregon’s utilization of their right to be cared for
by a doctor who will make available to them all their legal end-of-life
choices, including utilizing the Act?
2. What
is the usual procedure in other fields of medicine
when a doctor declines to provide an indicated
procedure?
ii.
Resources
1.
Ganzini,
Linda, MD, 2002 [4]
2. Ganzini, Linda, MD, 2001 [6]
iii.
Contacts
1.
Linda
Ganzini, associate professor of psychiatry at Oregon Health & Science
University (OHSU), Director of Geriatric Psychiatry at the Portland Veterans
Affairs Medical Center, senior scholar at OHSU Center for Ethics in Health Care
2.
George
Eighmey, Executive Director, Compassion in Dying of Oregon
V.
The
Death with Dignity Act is about patient choice and control. It does not authorize euthanasia.
a.
Factual Observation: While the entire process of utilizing the
Act is within the patient-doctor relationship, it is patient initiated and
patient driven at every stage. The
Oregon Act does not authorize euthanasia.
To qualify for the Act and to take the final step of hastening their
imminent death, terminally-ill persons must be able to self administer and
swallow the prescribed medication.
Opponents Claim: Opponents of the Act claim it opens the
door for doctors to commit illegal euthanasia.
i.
Questions
to be Resolved by Legislative Council:
1.
Does the Act allow anyone other than the patient to
administer a lethal prescription?
2.
Does the Oregon Act legalize euthanasia?
3.
What are the differences between the patient driven
and controlled Oregon Act and euthanasia?
4.
According to Oregon state officials, what are the
complete, actual verified facts to substantiate claims that doctors in Oregon
are administering lethal measures to patients, with or without their consent?
5.
Has Oregon taken any steps to legalize euthanasia?
6.
Opponents of the Act in Vermont have circulated to
lawmakers printed material on the Oregon Act.
Pictures on the materials show hands holding hypodermic needles,
intimating that needles are used to administer a prescription provided through
the Act. Does the Act authorize a patient or anyone else to use a hypodermic needle to
administer a prescription provided through the Act?
ii.
Resources:
1.
Oregon
Death with Dignity Act [25]
2.
Oregon
Department of Human Services [8]
iii.
Contacts:
1.
Darcy
Niemeyer, Oregon Department of Human Services, Office of Disease Prevention
& Epidemiology
2. Barbara
Glidewell, Director and Ombudsman, Patient Advocate, OHSU Department of Patient
Relations
3. Kate
Brown, Oregon Senate Democratic Leader
4. Neil
Bryant, former Oregon State Senator (Republican)
VI.
Government and Independent
Monitoring of the Act’s Application
a.
Factual Observation: The Oregon
Department of Human Services monitors and reports annually on the Act’s
implementation. A number of independent
studies have been conducted on the Oregon experience with the Act, including
independent research conducted by researchers at Oregon Health Sciences
University. This monitoring shows the
law is working well.
Opponents Claim: Opponents claim
government monitoring of the law is inadequate and a failure.
i.
Questions to be Resolved by
Legislative Council:
1.
What
information is collected by the State of Oregon to monitor implementation of
the Act?
2.
What
procedures does Oregon use to collect monitoring information?
3.
Do
Oregon state officials believe there are additional data that should be
collected to more rigorously monitor implementation of the Act?
4.
Are
there any plans to modify the government monitoring of and information
collected about implementation of the Act?
5.
Have
epidemiological studies on the Oregon Act experience been conducted and
published? In summary, what do they
conclude?
ii.
Resources:
1.
Oregon
Department of Human Services [8]
2.
Hedberg, Katrina, MD,
MPH, 2003 [10]
3.
Ganzini,
Linda, MD, 2002 [4]
4. Ganzini, Linda, MD, 2001 [6]
iii.
Contacts:
1.
Katrina
Hedberg, Oregon Department of Human Services
2.
Darcy
Niemeyer, Oregon Department of Human Services, Office of Disease Prevention
& Epidemiology
3.
Linda
Ganzini, associate professor of psychiatry at Oregon Health & Science
University (OHSU), Director of Geriatric Psychiatry at the Portland Veterans
Affairs Medical Center, senior scholar at OHSU Center for Ethics in Health Care
4. Ann Jackson, Executive
Director, Oregon Hospice Association
VII.
Oregon Medical Provider’s Views
of the Act
***FORMAT
NOTE: The observations and claims in
Section VII can be explored using a common set of resources and contacts which
are listed at the end of this section.
.
a.
Factual Observation: Over the past six
years, an increasing number of Oregon medical providers have accepted or
supported the Act. The Oregon Medical
Association has taken several positions on the Act. In 1994, the OMA took a neutral position. In 1997, it adopted a position calling for
the law to be repealed because of several specific flaws in the original
language of the Act. Subsequently, the
Legislature specifically addressed the areas of concern identified in the 1997
OMA position. Since the legal flaws
cited in the 1997 position have been addressed to the satisfaction of the OMA,
the 1997 position, according to the Associate Executive Director of OMA, is for
all intents and purposes moot. The 1994
position of neutrality on the concept of the Act remains in place.
Opponents Claim: Opponents of the
Act claim the OMA remains opposed to the Act and that only a few doctors
support the measure.
i.
Questions to be Resolved by
Legislative Council:
1.
According
to Oregon experts, what percent of Oregon physicians whose practice includes
terminally-ill patients accept or support the Act?
2.
What
percent of all of Oregon end-of-life medical care providers accept or support
the Act?
3.
According
to the Oregon Medical Association, what is its position on the Act?
b.
Factual Observation: A diverse group
of doctors have cared for patients under the Act. Doctors get their information about the Act from a wide range of
sources, most commonly government agencies or publications.
Opponents Claim: Opponents argue
that primary physicians are unwilling to utilize the Act and that almost all
the lethal prescriptions written under the Act are by physicians associated
with Compassion in Dying of Oregon.
i.
Questions to be Resolved by
Legislative Council:
1.
How
many different doctors and in what specialties are those who have assisted
patients under the Act?
2.
Is
there any factual basis to verify claims that most of these doctors are
advocates for physician-aided dying?
3.
What
are the sources of information that doctors cite for their knowledge about the
Act?
c. Resources:
i.
Ganzini,
Linda, MD, 2001 [6]
ii.
Ganzini,
Linda, MD, 2002 [4]
iii.
Kronenberg,
Jim [28]
d.
Contacts:
i.
Linda
Ganzini, associate professor of psychiatry at Oregon Health & Science
University (OHSU), Director of Geriatric Psychiatry at the Portland Veterans
Affairs Medical Center, senior scholar at OHSU Center for Ethics in Health Care
ii.
Jim Kronenberg, CAE, Associate Executive Director, Oregon Medical
Association
iii.
Peter Rasmussen, MD, Oregon Oncologist
iv.
Peter Goodwin, MD, Oregon physician, cancer survivor
VIII.
Legal Issues Related to the
Death With Dignity Law
a.
Factual Observation: States have the
legal authority to regulate the practice of medicine within their jurisdiction
and to enact a Death with Dignity law.
Under current law, the federal government does not have authority to
restrict patient or doctor utilization of the Oregon Act.
Opponents Claim: Opponents claim
that states cannot exempt themselves from federal law and that the use of
medication to hasten death under a Death with Dignity law is not a legitimate
medical purpose.
i.
Questions to be Resolved by
Legislative Council:
1.
Does
Oregon have the legal authority required to enact its Death with Dignity Act?
2.
Has
the federal government taken action to limit or interfere with implementation
of the Act? Have those actions been
successful?
3.
Under current law, does an Oregon doctor face
federal liability for activities authorized under the Act?
ii.
Resources:
1.
United
States Court of Appeals for the Ninth Circuit, No. 02-35587: STATE OF OREGON v.
ASHCROFT [29]
2.
U.S. Supreme Court, No. 96-110:
WASHINGTON, et al, PETITIONERS v. HAROLD GLUCKSBERG et al [30]
iii.
Contacts:
1.
Hardy
Myers, Oregon Attorney General, Oregon Department of Justice
2.
Eli
Stutsman, Attorney representing Oregon physician and pharmacist in State of Oregon v. Ashcroft
Resources
[1]
Tolle, S.W. “Care of the Dying: Clinical and Financial Lessons from the Oregon
Experience.” (editorial) Annals of Internal Medicine 1998; 128: 567-68.
[2]
Spann, Jeri. State Initiatives in End-of-Life Care: Using Qualitative and
Quantitative Data to Shape Policy Change. A publication of the National
Program Office for Community-State Partnerships to Improve End-of-Life Care.
Issue 1. June 1998.
[3]
Death with Dignity National Center, “Improvements in End-of-Life Care Report,”
Death with Dignity National Center, 2002, http://www.dwd.org/pdf/finalimprovements_5year.pdf
(accessed June 25, 2004).
[4]
Ganzini, Linda, M.D., Theresa A. Harvath RN PhD, Ann Jackson MBA, Elizabeth R.
Goy PhD, Lois L. Miller PhD RN, and Molly A. Delorit BA. Experiences of Oregon Nurses and Social
Workers With Hospice Patients Who Requested Assistance With Suicide. The
New England Journal of Medicine, Vol. 347, No. 8. August 22, 2002.
[5]
Bascom, Paul B., MD, and Susan W. Tolle, MD.
Responding to Requests for Physician-Assisted Suicide. JAMA Vol. 288, No. 1. July 3, 2002.
[6]
Ganzini, Linda, M.D., Heidi D. Nelson MD MPH, Melinda A. Lee MD, Dale F.
Kraemer
PhD,
Terri A. Schmidt MD, and Molly A. Delorit BA.
Oregon Physicians’ Attitudes About and Experiences With End-of-Life
Care Since Passage of the Oregon Death with Dignity Act. JAMA, Vol. 285, No. 18. May 9, 2001.
[7]
Ostrum, Carol, “The War on Pain,” Seattle
Times, May 14, 2000.
[8]
Oregon Department of Human Services annual statistical reports on Oregon’s
Death with Dignity Act, www.dhs.state.or.us/publichealth/chs/pas/pas.cfm
(accessed June 30, 2004).
[9]
Schwartz, J. and Estrin, J., “In Oregon, Choosing Death Over
Suffering,” The New York
Times, June 1, 2004, D1.
[10] Hedberg, Katrina MD
MPH, David Hopkins MS, and Melvin Kohn MD MPH.
Correspondence: Five Years of Legal Physician-Assisted Suicide in
Oregon. The New England Journal of Medicine, Vol. 348, No. 10. March 6, 2003.
[11] Hedberg, Katrina MD
MPH, David Hopkins MS, and Karen Southwick MD MPH. Correspondence: Legalized Physician-Assisted Suicide in
Oregon, 2001. The New England
Journal of Medicine, Vol. 346, No. 6. February 7, 2002.
[12] Colburn, Don,
“People Requesting Assisted Suicide Reportedly Do So To Keep Control,” The Oregonian. August 22, 2002.
[13] Quill, Timothy E.
MD, Bernard Lo, MD, and Dan W. Brock, PhD.
Palliative Options of Last Resort: A Comparison of Voluntarily
Stopping Eating and Drinking, Terminal Sedation, Physician-Assisted Suicide,
and Voluntary Active Euthanasia. JAMA,
Vol. 278, No. 23. December 17, 1997.
[14] Barnett, Erin Hoover, “Is Mom capable of
choosing to die?” The Oregonian,
October 17, 1999.
[15] Duin, Steve, “Kate Cheney still doesn’t rest in
peace,” The Oregonian, November 11,
1999.
[16] Weiland, Dr. Allan, “Kaiser didn’t push
patient’s suicide,” The Oregonian,
November 18, 1999.
[17]
Kettler, Bill, “A death in the family:
‘We knew she would do it’,” The Medford
Mail Tribune, June 25, 2000.
[18] Barnett, Erin Hoover, “Coos County drops assisted-suicide
inquiry,” The Oregonian, March 17,
1999.
[19] Barnett, Erin Hoover, “Coos Bay inquiry finds
no evidence of foul play in assisted suicide,” The Oregonian, March 13, 1999.
[20]
Reagan, Peter, MD, “Helen,” The Lancet,
April 10, 1999, pp. 1265-1267
[21] Schwartz, John, “Opponents of Oregon Suicide
Law Say Depressed Man was wrongly given drugs,” The New York Times, May 7, 2004.
[22] Yeoman, Barry. Colleen’s
Choice. AARP Magazine.
March/April 2003.
[23] Rollin, Betty. Whose
Life Is It, Anyway? Oprah
Magazine. February 2003.
[24]
Van Loon, Adam, Rights of Passage, Portland
Monthly. May 2004.
[25]
Oregon Death with Dignity Act, Oregon Revised Statutes, secs. 127.800-127.995.
[26] Lee, Daniel E. Physician-Assisted Suicide: A
Conservative Critique of Intervention.
The Hastings Center Report, Vol. 33, No. 1. January 1, 2003.
[27] Quill, Timothy E.
MD, and Christine K. Cassel MD. Perspective: Professional Organizations’
Position Statements on Physician-Assisted Suicide: A Case for Studied Neutrality. Annals of Internal Medicine, Vol.
138, No. 3. February 4, 2003.
[28]
Kronenberg, Jim, CAE, Associate Executive Director, Oregon Medical
Association. Memo, dated September 30,
2003.
[29]
United States Court of Appeals for the Ninth Circuit, No. 02-35587: STATE OF
OREGON v. ASHCROFT. May 26, 2004. Summary available at: http://www.ca9.uscourts.gov/ca9/newopinions.nsf/68621B180CDD63F388256EA0005CDA07/$file/press-release-ORassistedsuicideb.pdf?openelement
(accessed July 2, 2004). Full text of decision available at:
http://www.ca9.uscourts.gov/ca9/newopinions.nsf/F63C3857EBE8263588256E9F007CAC71/$file/0235587.pdf?openelement
(accessed July 2, 2004).
[30] U.S. Supreme Court, No. 96-110:
WASHINGTON, et al., PETITIONERS v. HAROLD GLUCKSBERG et al. June 26, 1997. Summary available at: http://www.dwd.org/documents/Wash.doc
(accessed July 2, 2004). Full text of decision available at: http://caselaw.lp.findlaw.com/scripts/getcase.pl?court=us&vol=000&invol=96-110
(accessed July 2, 2004).
Contacts
CONTACT/FACILITATOR
IN OREGON JEANA FRAZZINI Death with
Dignity National Center 520 SW 6TH
Ave., Ste. 1030 Portland,
OR 97204 (503) 228-4415 E-mail: jfrazzini@deathwithdignity.org
|
Last |
Agency/Affiliation |
Phone |
Email |
|
|
Erin
Hoover |
Barnett |
Reporter,
The Oregonian |
w
(503) 294-5011 |
|
|
Kate |
Brown |
Oregon
Senate Democratic Leader |
(503)
963-9611 |
|
|
Neil |
Bryant |
Former
Oregon State Senator (Republican) |
|
|
|
Steve |
Duin |
Columnist,
The Oregonian |
w
(503) 221-8597 |
|
|
Patrick |
Dunn,
MD |
Chair,
The Task Force to Improve the Care of Terminally-Ill Oregonians |
w
(503) 413-7600 (Talk to assistant - Jennifer) |
|
|
George |
Eighmey |
Executive
Director, Compassion in Dying of Oregon |
w
(503) 525-1956 |
|
|
Jeana |
Frazzini |
Oregon
Director, Death with Dignity National Center |
w
(503) 228-4415 |
|
|
Linda |
Ganzini,
MD |
Associate
professor of psychiatry at Oregon Health & Science University (OHSU),
Director of Geriatric Psychiatry at the Portland Veterans Affairs Medical
Center, senior scholar at OHSU Center for Ethics in Health Care |
w
(503) 220-8262 x56492 |
|
|
Barbara |
Glidewell |
Director
and Ombudsman, Patient Advocate, OHSU Department of Patient Relations |
w (503)
494-7959 |
|
|
Peter |
Goodwin,
MD |
Oregon
Physician, cancer survivor |
h
(503) 223-5799 |
|
|
Barry |
Heath,
D.Min. |
Director
of Pastoral Care, Salem Hospital |
w
(503) 561.5562 |
|
|
Katrina |
Hedberg |
Deputy
State Epidemiologist, DHS |
w
(503) 731-4024 |
|
|
Susan |
Hedlund,
MD |
Cancer
Care Resources, member of the Task Force to Improve the Care of Terminally
Ill Oregonians |
w
(503) 528-5236 |
|
|
Ann |
Jackson |
Executive
Director, Oregon Hospice Association, member of the Task Force to Improve the
Care of Terminally Ill Oregonians |
w
(503) 228-2104 c (503) 539-7827 |
|
|
Bill |
Kettler |
Reporter,
Medford Mail Tribune |
w
(541) 776-4477 |
|
|
Jim |
Kronenberg |
Associate Executive Director, Oregon Medical Association |
w
(503) 226-1555 |
|
|
Hardy |
Myers |
Oregon
Attorney General, Oregon Department of Justice |
w
(503) 378-4400 |
|
|
Darcy |
Niemeyer |
Oregon
Department of Human Services, Office of Disease Prevention & Epidemiology |
w (503)
731-4023 |
|
|
Tim |
Quill,
MD |
practicing
primary care physician, Professor of Medicine, Psychiatry, and Medical
Humanities at the University of Rochester |
w
(585) 273-1154 |
|
|
Peter |
Rasmussen
MD |
Oregon
Oncologist |
w
(503) 561-6444 |
|
|
Peter |
Reagan,
MD |
Portland
Family Practice |
w
(503) 233-6940 |
|
|
Robert |
Richardson,
MD |
Head
of Kaiser Permanente NW Ethics Service |
w
(503) 813-2690 pgr (503) 904-7978 |
|
|
Michael |
Sims |
Executive
Assistant, Oregon Board of Medical Examiners |
w
(503) 229-5873, ext. 218 |
|
|
Eli |
Stutsman |
Attorney
representing Oregon physician and pharmacist in State of Oregon v. Ashcroft |
w
(503) 274-4048 |
|
|
Susan |
Tolle |
Director
of OHSU's Center for Ethics in Health Care |
w (503) 494-8311 |
|
|
Allan |
Weiland,
MD |
Kaiser Permanente Northwest regional medical director |
w
(503) 777-3311 |
|
[1] Oregon Death with Dignity Act, Oregon Revised Statutes, secs. 127.800-127.995.
[2] Emanuel, Ezekiel J, MD, PhD, Elisabeth R. Daniels, BA, Diane L. Fairclough, DPH, and Brian R. Clarridge, PhD. The Practice of Euthanasia and Physician-Assisted Suicide in the United States. JAMA, Vol. 280, No. 6. August 12, 1998.
[3] Oregon Department of Human Services annual statistical reports on Oregon’s Death with Dignity Act, www.dhs.state.or.us/publichealth/chs/pas/pas.cfm (accessed June 30, 2004).
[4] Ganzini, Linda, M.D., Theresa A. Harvath RN PhD, Ann
Jackson MBA, Elizabeth R. Goy PhD, Lois L. Miller PhD RN, and Molly A. Delorit
BA. Experiences of Oregon Nurses and
Social Workers With Hospice Patients Who Requested Assistance With Suicide.
The New England Journal of Medicine, Vol. 347, No. 8. August 22, 2002;
Bascom, Paul B., MD, and Susan W. Tolle, MD.
Responding to Requests for Physician-Assisted Suicide. JAMA Vol. 288, No. 1. July 3, 2002;
Ganzini, Linda, M.D., Heidi D. Nelson MD MPH, Melinda A. Lee MD, Dale F.
Kraemer PhD, Terri A. Schmidt MD, and Molly A. Delorit BA. Oregon Physicians’ Attitudes About and
Experiences With End-of-Life Care Since Passage of the Oregon Death with
Dignity Act. JAMA, Vol. 285,
No. 18. May 9, 2001.
[5] Macro Vermont Poll, February 2003 (INSERT DETAILS)
[6] J. Schwartz and J. Estrin, “In Oregon, Choosing Death Over Suffering,” The New York Times, June 1, 2004, D1.
[7] Spann, Jeri. State Initiatives in End-of-Life Care: Using Qualitative and Quantitative Data to Shape Policy Change. A publication of the National Program Office for Community-State Partnerships to Improve End-of-Life Care. Issue 1. June 1998.
[8] Jackson, Ann: personal communication citing Medicare data on hospice penetration (meaning access and use of hospice services): “Oregon is 41%; national average 19%.”
[9] Jackson, Ann: personal communication citing data
collected by Oregon Dept. of Human Services Center for Health Statistics and
reported by Oregon Hospice Association:
“Oregon’s home death rate in 1997 was 35 percent, the highest in the nation. Its hospital death rate was the lowest at 32.5 percent and nursing home death rate at 32.4 percent, among the highest. The hospital death rate in Oregon is estimated at less than 25 percent in 2001. It is estimated that 50 percent of Americans die in the hospital. It is estimated that only 24.9 percent of Americans die at home.”
[10] Jackson, Ann: personal communication citing data on the medical use of morphine reported by the US Drug Enforcement Agency (DEA): “Oregon’s rating fluctuates year to year, though has been 1, 2, or 3 for over five years.”
[11] P. Goodwin, “Findings from Post-Election Survey,” GLS Research memorandum, February 9, 1998.
[12] Oregon Death with Dignity State PAC Endorsement (2002), on file at Oregon Death with Dignity Political Action Fund, Portland; D. Hamilton, “Election 2002: Back Talk—Talk Back,” Portland (Ore.) Tribune, October 4, 2002, A4.
[13] Oregon Right to Die PAC Endorsement (1996), on file at Oregon Death with Dignity Political Action Fund, Portland.
[14] Oregon Right to Die PAC Endorsement (2000) and Death with Dignity FEC PAC Endorsement (2002), on file at Oregon Death with Dignity Political Action Fund, Portland, OR; S. Wolfe, “Candidate Bradbury Stumps in Ashland,” Daily Tidings (Ashland, Ore.), October 1, 2002, 1.
[15] Oregon Right to Die PAC Endorsement (2000), on file at Oregon Death with Dignity Political Action Fund, Portland, OR.
[16] Oregon Right to Die PAC Endorsement (1998), on file at Oregon Death with Dignity Political Action Fund, Portland, OR; “David Wu on Health Care: Voted No on Banning Physician-Assisted Suicide,” On the Issues, www.issues2000.org/House/David_Wu_Health_Care.htm (accessed March 4, 2004); “Blumenauer Testifies Against Proposed Legislation on Assisted Suicide,” press release, July 14, 1998, www.house.gov/blumenauer/press_releases/pr051.htm (accessed March 4, 2004); “Walden Opposes Efforts to Overturn Will of Voters: Keeps Commitment to Uphold Oregon Law on Assisted Suicide,” press release, October 26, 2000, www.walden.house.gov/press/releases/2000/oct/pf102600.html (accessed March 4, 2002); “Darlene Hooley on Health Care: Voted No on Banning Physician-Assisted Suicide,” On the Issues, www.issues2000.org/House/Darlene_Hooley_Health_Care.htm (accessed March 4, 2004); “DeFazio Blasts House Vote on Assisted Suicide: Remains Hopeful About Chances for Defeat in Senate,” press release, October 27, 1999, www.hous.gov/defazio/102799HCRelease.html (accessed March 4, 2004); “Standing Alone, Senator Wyden Kept the United States Senate from Overturning Oregon’s Twice-Passed Ballot Measure Legalizing Physician-Assisted Suicide,” www.wyden.senate.gov/meet/bio/pas.html (accessed March 4, 2004); S. Power, “Smith Backs Suicide Repeal,” Statesman Journal (Salem, Ore.), April 26, 2000, 1A.
+ Complete citations are provided for all Resources at the end of this document
* Complete contact information is provided for all Contacts at the end of this document