Assisted Suicide

A STUMBLING BLOCK OR A STEPPING STONE

I am very pleased have been invited to talk to you about one of the most important events in our lives, the end of our lives. Many of you may have already formed your ideas about how you will try to cope with the end of your life and the lives of your loved ones. Some of you may have already decided that you do not want any human assistance in dying. I respect that. I would ask you to then think of this talk in the following vein: although assisted dying is not what you want, perhaps, under some very special conditions, you could find it acceptable to help form a stepping stone to allow other people to get lawful assistance in dying. Making assisted dying legal under very special conditions is the major goal of the Hemlock Society.

Others of you may not have formed any definite ideas about the end of life and are open to what I and others have to say on the subject. The primary objective of what I now will be saying is to put into realistic perspective what I think is the proper role of assistance in dying. It seems to me a realistic perspective should be based on available information about what has happened in the US with respect to assisted dying.

Oregon is the only state were physician assisted death is legal. It is only legal under very special circumstances. While physician assisted death is legal in many other countries (the most well known is Holland), in the United States it has only been legal in Oregon and only for a little over two years in that State. Since many people are rightfully concerned about misuse of such a law, the Oregon results are of interest. Two important reports have recently been released describing the Oregon experience.

The Oregon Health Division interviewed family members of most of the families where physician assisted death had occurred under the Oregon law. Of the about 29,000 people who die each year in Oregon, only 27 people died under the "Death With Dignity" law. The median age of the 27 people was 71 and most had cancer. Loss of autonomy was the main reason patients chose to use the law. All of the patients had health insurance and 21 were enrolled in hospice care. A total of 22 different physicians were the ones that prescribed all of the medication that was used by the 27 patients. Six of the 22 physicians participated in the previous year. Other key characteristics of the 27 patients were: 26 were white, 16 were male, 25 had a high school education (about half of them had graduated from college).

Dr. Peter Rasmussen states in the February, 2000 Statesman-Journal: "the message from the report is that the concerns of problems that people have been worried about simply did not develop." The report also finds the end-of-life care improved last year. This improvement includes more patients using hospice services and physicians are learning better ways of treating terminally ill patients. Dr. Susan Tolle, co-author of the report states: "The most important thing I take from this report is we need to expand our vision of suffering to include fear of future suffering, and see how we can meet that need."

The second survey was of Oregon physicians. The survey was performed by: the Portland Veterans Affairs Medical Center, several Oregon Health Sciences University departments, and Providence Health Systems. Survey results were reported in the February 2000 issue of the New England Journal of Medicine. These results were consistent with the first study covered in the above paragraphs. In addition, the survey revealed that the responding medical professionals carefully screened patients and helped 148 patients requesting help to find alternatives. Some of the alternatives found by most of the patients included: hospice care, mental health support, and pain control. If a requesting patient perceived of themselves as a burden, their requests were less likely to be honored. On the other hand, patient's autonomy concerns were important in the physician's decision to proceed. Almost all of the responding physicians improved their knowledge of, and confidence in treating pain. In addition, about 4 out of 5 of the responding physicians improved their capability to diagnose depression. Dr. Linda Ganzini of the Portland Veterans Affairs Medical Center sums up the report by stating: "It appears that physicians are proceeding in a very careful and prudent manner. That should be reassuring regardless where you stand in this debate."

These are the perspectives that I have gained from the Oregon experience, other people I have talked to, and other things I have read.

1. MOST OF US WILL DIE A RESONABLY NATURAL DEATH. This is supported by the Oregon experience in that 29,000 people died during the second year that the Death with Dignity law was in effect and only 27 of those people used physician assisted death.

2. LESS THAN 1% OF US WOULD REQUEST ASSISTED DEATH IF IT WAS AVAILABLE. Again, from the reported Oregon experience, 165 formal request were reported as being made to physicians.

3. EFFECTIVE MEANS TO DEAL WITH ALMOST ALL OF THE REQUESTS ALREADY EXIST. Some of the alternatives found by most of the patients included: hospice care, mental health support, and pain control.

4. A VERY SMALL PERCENT (LESS THAN ONE TENTH OF 1%) OF DYING PEOPLE APPEARED TO NEED AND WERE PROVIDED PHYSICIAN ASSISTED DYING. Only 27 people out of 29,000 (0.0931%)

5. THUS IT APPEARS THAT THE NEED AND DESIRE FOR ASSISTED DEATH OCCURS VERY RARELY; BUT IN THOSE CASES, THE DIFFERENCE BETWEEN DEATH WITH DIGNITY AND THE ALTERNATIVE IS VERY GREAT. It is for these people, one of which I might become, that I work in the Hemlock Society and talk to people such as your self. Even if you are very unlikely to need and want this help and you are against it for yourself, I believe that such help, under strict control and conditions, is a legal option we all should support. I ask for your support.

Where can one go and who can one talk to about the above and related subjects? Hendersonville now has an new organization that you can turn to for discussions and presentations. The organization is the Hemlock Society of the Western Carolinas. It has about 100 people who have attended the first two meetings. The objectives of this organization are:

Assisting others to establish Living Wills and Durable Powers of Attorney for Health Care.

Providing information on problems connected with enforcing such documents among health care professionals or family members, and upon request, providing assistance in obtaining compliance.

Political activities, such as writing to government officials, promoting needed laws, and interfacing with candidates.

Providing speakers on a range of death-with-dignity and related issues, for presentations to requesting groups.

Encouraging coverage in print and broadcast media to better inform the public.

Creating occasional seminars and workshops.

Mailing information to members of The Society, and to interested members of the public.

Providing periodic educational programs for members and the public, and inviting the public to attend all regular meetings of The Society.

Developing and operating Caring Friends services.

Other such efforts as may promote our goals.

The next meeting is at 2:30 p.m. on Sept. 14, 2000 at the Unitarian Universalist church in Hendersonville. These meetings are open to the public. I hope to see you there.

Don Emon

Note:

There are over 260,000,000 people in the USA. If one tenth of 1% requested physician assisted death, this would mean that 2,600,000 people (over one lifetime) request it. Two million, six hundred thousand (2,600,000) divided by 75 years of life would mean that 34,667 people would request it every year on the average. Though the percentage is small, the numbers of people are quite large.