The Oregon Tall Tale
The creepy underside of legal assisted suicide.
May 17, 2004, Vol. 9, No. 34 • By WESLEY J. SMITH
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.