Physicians and P-AS: Some Things Just Don’t Go Together

February 17, 2011 • Posted in Blog

In January, Oregon released their data from 2010 regarding the so-called “Death with Dignity Act.”   The number of people opting for “physician-assisted suicide” (P-AS) has steadily increased since its inception in 1998.  That year, twenty-three persons asked for and received prescriptions for life-ending medications.  Fifteen of those died from the lethal dose of medication; six died from their illnesses, and two survived at least into 1999.  Last year, a total of 65 people died through P-AS in Oregon.  At least, that was the report as of 7 January 2011.  The data set is often amended in the following year due to a variety of reasons, including the fact that not everyone who obtains a prescription for such medication uses it quickly, or even in the year it is prescribed.  So the full number of persons opting for P-AS in Oregon during 2010 may not be known until 2012.

It is important to understand what constitutes P-AS.  In Oregon, P-AS is legal for the terminally ill.  The law denies, however, that this is “suicide.”  Government documents describe the process:

To request a prescription for lethal medications, the Death with Dignity Act requires that a patient must be:

— An adult (18 years of age or older)

— A resident of Oregon;

— Capable (defined as able to make and communicate health care decisions);

— Diagnosed with a terminal illness that will lead to death within 6 months.  (“Oregon’s Death with Dignity Act:  The First Year’s Experience,” pp. 1-2.)

Patients who meet the above criteria may request medication for “assisted suicide” in this way:

— The patient must make two verbal requests to their physician, separated by at least 15 days
— The patient must provide a written request to their physician
— The prescribing physician and a consulting physician must confirm the diagnosis and prognosis. The prescribing physician and a consulting physician must determine whether the patient is capable. If either physician believes the patient’s judgment is impaired by a psychiatric or psychological disorder, such as depression, the patient must be referred for counseling
— The prescribing physician must inform the patient of feasible alternatives to assisted suicide including comfort care, hospice care, and pain control
— The prescribing physician must request, but may not require, the patient to notify their next-of-kin of the prescription request.

(Ibid, p 2.)

Behind the numbers lies much to be discovered; here are a few of the details, summarized from the collected reports available at the website.  

Year                                                               1998                          2010

Pts. Referred for counseling                              4                                  1

P-AS Prescriptions Written                               24*                              96

# Physicians prescribing lethal  meds               14                                59

# Deaths from P-AS                                       16*                               65

* Numbers amended from 23 and 15, respectively, in subsequent reports (Oregon’s Death with Dignity Act:  The Second Year’s Experience, p. 9.)

Physician Kenneth R. Stevens, a radiation oncologist, posed some questions in a Guest Commentary for Dr. Stevens noted that for 15 patients who received prescriptions, no follow-up was available when the report was compiled.  Why was the 2010 report released in January, when other reports have been released in March? Further, he asked why only one patient had been referred for counseling, when a 2008 study by Oregon Health & Science researchers showed 25% of such patients were considered depressed.  He did find some interesting inclusions in the report:

The report did reveal, however, that two patients who attempted to take the supposedly lethal drugs did not die. The reports’ sparse information states that one person regained consciousness within 24 hours and died of the underlying illness five days later, a second person regained consciousness three days after ingestion of the drugs and died of the underlying illness three months later. Dr. Stevens wonders in print why these two individuals did not choose to repeat the dose of “lethal medication.”  (“Doctor-assisted suicide: Annual report raises more questions than answers,”, 11 February 2011).

Dr. Stevens asks some very cogent questions.  I look forward to reading the answers.  He is not reassured that all is well in Oregon regarding physician-assisted suicide.   In Oregon, Washington, and now, Montana, medicine has been turned on its head.   People who have been trained and licensed as healers are — by law — turned into killers.   Dr. Stevens finds it ” . . . strange to live in a society where a failed suicide is considered to be unsuccessful and an accomplished suicide is considered a success.”  (Ibid.)

A thought experiment is in order.  Consider that the chefs of a particular city are given permission to poison people who request such.  The license, hanging on the wall for all the patrons to see, does not differ between those who poison upon request, and those who do not.  Now consider that you are visiting a restaurant in that city.  How assured do you feel when you pick up your fork to taste your salad?

Chefs and poison; physicians and P-AS:  some things just don’t go together.