The Oregon Tall Tale
The creepy underside of legal assisted suicide.
May 17, 2004, Vol. 9, No. 34 • By WESLEY J. SMITH
A PAPER PRESENTED at last week's American Psychiatric Association meeting demonstrates once again that the legalization of physician-assisted suicide in Oregon was one of the great public policy con jobs of all time. Earnest euthanasia advocates--generally abetted by a compliant media--spun the myth that assisted suicide would invariably be a rational "choice," strictly regulated by the state, a last resort of dying patients when nothing else could be done to alleviate their suffering. But the more we learn about how doctor-facilitated death is actually being practiced in Oregon, the clearer it becomes that these assurances were false.
Getting access to this information isn't easy. Assisted suicide in Oregon is shielded from meaningful public scrutiny by a shroud of state-imposed secrecy. As a consequence, little is publicly known about the people who have died by swallowing massive overdoses of toxic drugs prescribed by doctors. Indeed, the assisted suicide law was written and later interpreted by state regulators to ensure that the Oregon Health Department is powerless to control the practice of assisted suicide before patients die.
What little oversight the department imposes consists primarily of collecting and publishing data received after the fact. And almost all of the information collected and regurgitated by the state in annual reports comes from the doctors who do the lethal prescribing. In fact, the department is so incurious about the facts and circumstances surrounding assisted suicides, that even when it learns that a lethal prescription request was previously refused, no one calls the nonprescribing doctors to find out why. Nor do the "regulators" usually interview close friends and family members of the patient, who may have information about the patient's circumstances unknown to the prescribing doctor.
Still, here and there, disturbing information about the actual practice of assisted suicide in Oregon has trickled into the public domain. One such case came to light May 6, when psychiatrist N. Gregory Hamilton and his wife Catherine presented their paper to the psychiatrists' meeting, vividly demonstrating the dangers Oregon-style assisted suicide poses to incompetent and vulnerable patients. The Hamiltons are affiliated with Physicians for Compassionate Care, an Oregon-based medical association that supports providing better services to the dying and opposes assisted suicide.
Even though legalized assisted suicide has been practiced for more than six years, this is the first case in Oregon in which the patient's medical records have been made available for review. And a sorry tale they tell: Not only was the patient apparently not terminally ill as defined by Oregon's law when he first received his lethal prescription, but he was allowed to keep his cache of suicide pills despite being diagnosed as having "depressive disorder," "chronic adjustment disorder with depressed mood," "intermittent delirium," and even after being declared mentally incompetent by a court.
Michael P. Freeland was diagnosed with lung cancer in 2000. He received a lethal prescription from Dr. Peter Reagan in early 2001. Reagan is a committed suicide activist; euthanasia advocacy groups often refer suicidal patients to him when the patients' physicians refuse to go along with their requests for suicide drugs. In other words, Reagan regularly takes on patients solely for the purpose of facilitating their suicides.
Freeland, as it happens, died naturally on December 5, 2002. Oregon law requires the patient to be reasonably expected to die within six months before receiving a lethal prescription. But Freeland's death occurred nearly two years after Reagan wrote the lethal prescription. Indeed, Freeland told the Hamiltons that Reagan contacted him after he didn't die in a timely fashion to reissue the prescription to make sure his assisted suicide remained legal!
On January 23, 2002, more than a year after receiving Reagan's poison script, Freeland was admitted to Providence Portland Medical Center for depression with suicidal and possibly homicidal thoughts. A social worker went to Freeland's home and found it "uninhabitable," with "heaps of clutter, rodent feces, ashes extending two feet from the fireplace into the living room, lack of food and heat, etc. Thirty-two firearms and thousands of rounds of ammunition were removed by the police." Amazingly, the "lethal medications" that had been prescribed more than a year before were left in the house--presumably in case Freeland wanted to use them.
Freeland was hospitalized for a week and then discharged on January 30. The discharging psychiatrist noted with approval that the guns had been removed, "which resolves the major safety issue," but wrote that Freeland's lethal prescription remained "safely at home." Freeland was permitted to keep the overdose even though the psychiatrist reported he would "remain vulnerable to periods of delirium." In-home care was considered likely to assist with this problem, but a January 24 chart notation noted that Freeman "does have his life-ending medications that he states he may or may not use, so that [in-home care] may or may not be a moot point."
The day after his discharge, the psychiatrist wrote a letter to the court in support of establishing a guardianship for Freeland, writing, "he is susceptible to periods of confusion and impaired judgment." According to the Hamiltons, the psychiatrist concluded that Freeland was unable to handle his own finances and that his cognitive impairments were unlikely to improve. He lived under supervision for a brief time, but was soon home alone with ready access to his suicide drugs.
Happily for Freeland, he had called Physicians for Compassionate Care for help, and as he neared his end, he had people surrounding him who were committed to helping him live his life rather than being committed to facilitating his death. Rather than dying alone by assisted suicide, he was instead cared for by the Hamiltons and by his friends--who assured the now imminently dying man "that they valued him and did not want him to kill himself." Freeland was properly treated for depression with medication. He received good pain control, including a morphine pump. Best of all, he was reunited with his estranged daughter and died knowing she loved him and would cherish his memory.
Freeland is not the first patient with a significant mental impairment known to have gained access to a lethal prescription in Oregon. A report in the October 17, 1999 (Portland) Oregonian described the assisted suicide of Alzheimer's and cancer patient Kate Cheney, age 85. Cheney received lethal pills from her HMO, Kaiser Permanente Northwest, despite one psychiatrist's reporting that she had lost much of her short-term memory and did not have the "very high capacity required to weigh options about assisted suicide." Worse, the person who seemed most intent on Cheney's suicide wasn't the elderly patient but her daughter. Accordingly, the psychiatrist recommended against writing the lethal prescription.
If death regulations truly protected the vulnerable against abuse in Oregon, the psychiatrist's veto would have ended the matter. But it didn't. While Cheney seemed to accept the psychiatrist's verdict, her daughter went doctor shopping.
Kaiser allowed Cheney to be seen by a psychologist who, like the psychiatrist, found that the elderly woman had significant 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 Cheney's decision to die "may be influenced by her family's wishes." Still, despite these reservations, the psychologist determined that Cheney was competent to commit assisted suicide.
The final decision to approve the death was made by a Kaiser HMO ethicist/administrator, Robert Richardson. Dr. Richardson interviewed Cheney, who told him she wanted the poison pills because she feared not being able to attend to her personal hygiene. After the interview, satisfied that she was competent, he approved the lethal prescription. Cheney died of an overdose sometime later, perhaps not coincidentally, on the very day she returned home from a one-week stay in a nursing home.
Assisted suicide advocates like to point to Oregon's law and declare that legally facilitated death there is well-managed. But the experiences of Michael Freeland and Kate Cheney demonstrate that Oregon's protective guidelines offer scant protection to vulnerable and depressed patients. Moreover, the meager safeguards that do exist evaporate once the lethal prescription has been issued, at which point no doctor is required to ensure that the patient remains competent, no doctor is required to be at the patient's bedside when the overdose is taken, and no one is responsible to ensure that patients are capable of understanding what they are doing when they actually take the lethal dose.
This leaves incompetent and vulnerable patients exposed to the worst potential abuses. Assisted suicide in Oregon isn't compassion: It is abandonment.
Wesley J. Smith is a senior fellow at the Discovery Institute, an attorney for the International Task Force on Euthanasia and Assisted Suicide, and a special consultant to the Center for Bioethics and Culture.