Oregon – steady annual increase in assisted suicide cases sounds warning to UK

Lord Falconer wants to legalise assisted suicide for adults who are mentally competent and have less than six months to live based on the ‘Oregon model’.

Since assisted suicide was legalised in Oregon there has been a steady annual increase in the number of prescriptions written for lethal drugs and in numbers of people killing themselves.

In 1998 there were 24 prescriptions written and 16 assisted suicide deaths. By 2012 these numbers had risen to 116 and 85 respectively. This is a 380% increase in prescriptions and a 430% increase in assisted suicide deaths in 15 years.

In 2013 there were 71 deaths – an apparent fall. But this was number that had been reported by 22 January 2014 and there were still 31 patients for whom ‘ingestion status’ was unknown.

For 2012 it was initially reported in January 2013 that there were 77 deaths – but also 25 whose ‘ingestion status’ was unknown - this increased to 85 once all figures were in so we can expect the 2013 figures to go up by at least a similar level.     

How would this translate to the UK?

There were 56.6 million people in England and Wales in 2012 but only 3.9 million in Oregon. So 85 assisted suicide deaths in a year in Oregon would equate to 1,232 in England and Wales (14 times that of Oregon).

Overall since the Oregon Death with Dignity Act (DWDA) was passed in 1997, a total of 1,173 people have had DWDA prescriptions written and 752 patients have died from ingesting medications. 

So over a similar time period, all other things being equal, we would expect 10,528 assisted suicide deaths in England and Wales.

This pattern of steady annual increase in number is also evident in other jurisdictions which have legalised either assisted suicide or euthanasia.

The number of assisted suicide deaths in neighbouring Washington State, increased by at least 43% in 2013.

There were 119 known assisted suicide deaths in 2013, up from 83 in 2012, 70 in 2011, and 51 in 2010. Assisted suicide was legalized in March 2009, after a ballot measure.

According to Dutch media reports, euthanasia deaths in the Netherlands in 2012 increased by 13% to 4188.

In fact from 2006 to 2012 there has been a steady increase in numbers each year with successive annual deaths at 1923, 2120, 2331, 2636, 3136, 3695 and 4188 – an overall increase of 118% in just six years. 2013 figures are still awaited but expected to show similar trends.

The number of reported euthanasia deaths in Belgium increased by 26.8% in 2013 to 1816 reported deaths. Figures for 2012, 2011 and 2010 were 1432, 1133 and 954 respectively and the increase since the first full year in 2003 is over 600%.

There is also widespread evidence of under-reporting. The Lancet recently published a long awaited meta-analysis study which indicated that in 2010, 23% of all euthanasia deaths were not reported meaning that the total number of deaths last year may not have been 4,188 but rather 5,151. 

Could similar under-reporting be happening in Oregon? It is a virtual certainty.

Oregon officials in charge of formulating annual reports have conceded ‘there’s no way to know if additional deaths went unreported’ because Oregon DHS ‘has no regulatory authority or resources to ensure compliance with the law’.

The DHS has to rely on the word of doctors who prescribe the lethal drugs. Referring to physicians’ reports, the reporting division admitted: ‘For that matter the entire account [received from a prescribing doctor] could have been a cock-and bull story.  We assume, however, that physicians were their usual careful and accurate selves.’

So with an Oregon law we can expect to see steadily increasing numbers of assisted suicide cases year on year in England and Wales, along with an unknown level of underreporting.

But that’s just one disturbing fact about assisted suicide in Oregon. There’s much much more to come.

Let’s not follow Oregon’s lead.

Twelve reasons to think twice about going the Oregon route on assisted suicide

Lord Falconer’s Assisted Dying Bill, due for a second reading in the House of Lords on 18 July, is purportedly based on the US state of Oregon’s Death with Dignity Act (DWDA).

Dignity in Dying, the former Voluntary Euthanasia Society, who are backing Falconer, claim that everything is wonderful in Oregon. But is that really true?

Over the next few weeks in the lead up to the bill being debated I will examine in more detail what is happening in Oregon and show that, far from being reassuring, the Oregon experience sounds a loud warning to the UK not to follow suit.

On 27 October 1997, Oregon enacted the DWDA which allows terminally-ill Oregonians to end their lives through the voluntary self-administration of lethal drugs, expressly prescribed by a physician for that purpose.

The Oregon DWDA also requires the Oregon Health Authority to collect information about the patients and physicians who participate in the Act, and publish an annual statistical report.

These annual reports are all available on the Oregon government website and there is plenty of other relevant information in the public domain to draw on.

In order to qualify under the Act, a patient must be:

1. 18 years of age or older

2. A resident of Oregon

3. Capable of making and communicating health care decisions for him/herself

4. Diagnosed with a terminal illness that will lead to death within six (6) months.

It is up to the attending physician to determine whether these criteria have been met.

I have many concerns about the Oregon law which I will unpack in subsequent blog posts. Here is a list of twelve for starters:

1. There has been a steady increase in annual numbers of people undergoing assisted suicide in Oregon

2. The Oregon health department is funding assisted suicide but not treatment for some cancer patients

3. Patients are living for many years after having been prescribed lethal drugs for ‘terminal illness’ showing that the eligibility criteria are being stretched

4. There is strong circumstantial evidence of suicide contagion in Oregon with a disproportionate number of (un)assisted suicides

5. The vast majority of those choosing to kill themselves are doing so for existential reasons rather than on the basis of real medical symptoms 

6. Fewer than three per cent of patients are being referred for formal psychiatric or psychological evaluation

7. More than ten per cent of patients dying under the Act do not have terminal illnesses

8. Some doctors know the patient for less than a week before prescribing the lethal drugs

9. The fact that almost a third of patients dying under the Act report inadequate pain control or concerns about pain shows that palliative care provision in Oregon is unsatisfactory

10. The presence of no independent witnesses in over 80% of cases is a recipe for elder abuse

11. The demographic of patients dying under the Act is that of those susceptible to financial and elder abuse – white, well-educated and wealthy

12. According to research 25% of cases of assisted suicide in Oregon involve people who are clinically depressed 

Freedom of conscience in medicine is under sustained attack but is worth fighting for

I have previously highlighted the case of two Glasgow midwives who were disciplined by their NHS Trust for refusing to participate in abortion.

Their Trust was found to be in the wrong by the Scottish Court of Appeal and the case has been referred to the UK Supreme Court where a further hearing is still awaited.

A single act of physician refusal to abort a patient can evoke headlines around the world, especially in nations targeted by the pro-abortion industry.   

Conscientious objection on the part of Hippocratic physicians is a major obstacle now under concerted attack worldwide.

The Center for Reproductive Rights (CRR) has recently submitted its wish list to the UN to be incorporated in the Sustainable Development Goals  (SDG’s)  now under negotiation.

Especially interesting is the direct targeting of rights of conscience.  The CRR document encourages nations to track  ‘Rates of implementation of judicial or administrative decisions concerning violations of reproductive rights, including through the unregulated use of conscientious objection…’

Because many  physicians have stubbornly refused to kill their unborn patients,  the UNFPA (United Nations Fund for Population Affairs) has decided to recruit midwives to fill the void of abortion providers. 

The report states:  ‘The definition of “midwifery” used in this report is: the health services and health workforce needed to support and care for women and newborns, including sexual and reproductive health and especially pregnancy, labour and postnatal care. This includes a full package of sexual and reproductive health services, including preventing mother-to- child transmission of HIV, preventing and treating sexually transmitted infections and HIV, preventing pregnancy, dealing with the consequences of unsafe abortion and providing safe abortion in circumstances where it is not against the law.’ (emphasis mine)

In biblical thinking, the conscience is one of the most fundamental aspects of what it means to be a human being. The conscience is part of our created humanity and it is present in all, not just those who are believers. The conscience is seen as, in some sense, an internal reflection of God's law for all mankind. The Apostle Paul, writing of the Gentiles who did not receive the Mosaic law, states that 'what the law requires is written on their hearts' 

Freedom of conscience is not a minor or peripheral issue. It goes to the heart of medical practice as a moral activity. Current UK law and professional guidelines respect the right of doctors to refuse to engage in certain procedures to which they have a conscientious objection.

The right of conscience helps to preserve the moral integrity of the individual clinician, preserves the distinctive characteristics and reputation of medicine as a profession, acts as a safeguard against coercive state power, and provides protection from discrimination for those with minority ethical beliefs.

It is worth fighting for.

Sources – AAPLOG and CMF Files 

Might the large disparity in premature birth rates between black and white women be partly explained by abortion?

Prematurity is associated with a wide variety of health risks. In the UK, 7.8% of babies are born prematurely (60,000 per year) and this number is on the rise. 

The total cost of preterm birth to NHS is £2.9 billion a year, equivalent to that of smoking, alcohol and obesity. 

Reducing the rate of preterm birth even by a small amount will therefore have a significant impact on reducing this cost.

It is a well-established fact that, both in the US and the UK, black women have preterm birth rates of 15–18%, more than double than that of the white population. But although we know a lot about the causes of prematurity this specific disparity is as yet unexplained.

If you search on pub med you will find a whole host of articles looking at possible explanations. But research attributing the link to factors as diverse as infection, inter-pregnancy interval, nutrient deficiency and inequality remains inconclusive.

Might abortion perhaps play a role?

According the 2013 abortion statistics for England and Wales, published just last week, ‘Black or black British people’ only make up 3.3 per cent of the population but accounted for 9 per cent of abortions.

Furthermore, the percentage of women having an abortion in 2013 who had one or more previous abortions also varied by ethnic group. 49% of Black women having abortions in 2013 had previously had an abortion compared with 36% of White women.

The link between abortion and premature birth is well established but largely underplayed or denied by British authorities including the Royal College of Obstetricians and Gynaecologists (RCOG).

Most doctors and women are therefore not aware of it.

I have previously summarised the medical evidence for the link on this blog and have also highlighted major Finnish, Danish and Scottish studies confirming it.

Last year I drew attention to a paper from North Carolina which has reviewed all the available data on the association between abortion and preterm birth.

In fact there are now over 130 scientific articles reporting on the link between abortion and preterm birth in the subsequent pregnancy and two well-designed meta-analyses now demonstrate that just one prior abortion increases by 36% the risk for a future ‘preterm’ birth and by 64% for a ‘very preterm’ birth. Two or more abortions increase the risk for a future ‘preterm’ birth by 93%.

So might the large disparity in preterm birth rates between black and white women be partly explained by the fact that black women have more abortions?

One would have thought it was an obvious avenue of research. So why isn’t anyone looking into it?

Now there’s a question. 

Scotland Yard apologises for wrongfully threatening to arrest women in prayer vigil at London abortion facility

The Metropolitan police have apologised for wrongfully threatening to arrest pro-life campaigners for holding a prayer vigil outside a London abortion facility.

Police used a draconian ‘riot law’ legislation usually employed to disperse rioters and football hooligans to force the three women to move away from the BPAS clinic in Twickenham.

Officers issued the group with Section 14 Public Order Act notices on grounds that they posed a ‘serious risk of disruption to the life of the community’.

But the Metropolitan Police later admitted its officers had made a mistake and said the ‘riot law’ should not have been used.

The protesters, members of the Good Counsel Network (GCN), said they were acting within the law and only spoke to women who are willing to talk.

Justyna Pasek, 33, said she felt like a criminal when her small team was stopped by the police.

‘We hand out leaflets to pregnant women and speak to women who want to speak to us,’ she said, adding: ‘We don’t chase after women, we don’t stop anyone from going into the clinic and we never block the gates.

 ‘We just pray all the time and hand out leaflets. But we were made to feel like criminals when the police forced us to move away from the clinic. The officers were very aggressive and I felt very harassed and mistreated by them.’

‘I thought this was a free country, but this reminds me of the communist rule I used to live under when I was a little girl in Poland.’

A Scotland Yard spokesman said: ‘We have acknowledged the concerns raised by those affected by our actions. Following a review of the decisions taken on those days, we now acknowledge that the implementation of Section 14 notices under the Public Order Act 1986 was incorrect.’

It is bitterly ironic, at a time when doctors involved in sex selection abortions or illegal pre-signing are not being prosecuted, that police are instead misusing the law to intimidate peaceful protesters.

It is reminder that police can themselves be affected by societal prejudice in their judgements and of how commonplace abortion has become.

It seems not matter what the law says. Whilst those who blatantly disregard the Abortion Act get off scot-free, those who protest about the injustice risk police intimidation and arrest.

There have been over eight million abortions in Britain since the passing of the Abortion Act in 1967. 

But during this time there has been only one successful prosecution for illegal abortion, in spite of the fact that 98% of abortions are technically illegal.

This latest incident poses a challenge for Christians to get more involved in prayer over this matter, even in the face of the threat of wrongful arrest.

‘Rescue those being led away to death; hold back those staggering toward slaughter.’ (Proverbs 24:11)

Care Not Killing – June 2014 Update on euthanasia and assisted suicide

The final year of this current Parliament opened today with the Queen's Speech, in the wake of which we expect Lord Falconer's 2013 Assisted Dying Bill to be retabled. In Scotland, Holyrood's Health and Sport Committee are accepting evidence on Margo MacDonald's Assisted Suicide Bill until Friday 6 June. And the ruling of nine Supreme Court justices who sat last December on the Nicklinson case is expected any day now. With more appalling evidence pouring in from abroad, this is one of those weeks when the euthanasia threat is palpable.

Westminster

Lord Falconer's Assisted Dying Bill, first introduced in May 2013, fell at the close of the Parliamentary year last month, but he is set to reintroduce his proposals in coming days, following the State Opening of Parliament. Disability activists have initiated a petition calling on David Cameron to act on his personal opposition to assisted suicide, which we encourage you to sign; debate has been ongoing, and carer Colin Harte's recent radio interview is very much worth listening to.

Holyrood

Following the death of Margo MacDonald in April, the Green MSP Patrick Harvie has assumed responsibility for the Assisted Suicide (Scotland) Bill. The Bill's underlying principles constitute a counsel of despair, while a meeting of lawyers in Scotland recently agreed that 'the Bill as drafted... would be unworkable'. The Health and Sport committee are taking evidence until 6 June: read the call for evidence here, CNK's submission here and our brief overview of the bill here.

Supreme Court

Despite most Supreme Court rulings being handed down around three months after the relevant hearing, the nine justices who heard the appeals in the cases of Nicklinson/Lamb and 'Martin' are yet to rule five and a half months on. This, it is to be hoped, is a sign that the gravity of the cases is being fully acknowledged. The ruling's delivery will be streamed live online; until we know when, remind yourself of some of the key questions.

Foreign news

Reports last week suggest that Belgian euthanasia deaths rose 26.8% in 2013 to 1,816, representing five people every day having their lives ended, and a Brussels nurse has recently written of 'what really happens in Belgium's healthcare system with euthanasia'. The head of the regulatory commission, Wim Distelmans, who is already the subject of high profile official complaints, has sparked controversy by announcing an instructional tour of Auschwitz. If you are concerned about the situation in Belgium, please sign EPC Europe's petition calling for the suspension of the euthanasia law there.

In Switzerland, meanwhile, extraordinary cases of non-terminally/chronically ill patients undergoing assisted suicide are increasingly becoming part of standard practice. EXIT, one of the more prominent assisted suicide organisations, has recently announced that it will now accept non-terminally ill elderly people, in a worrying but sadly unsurprising move.

Care

Our Campaign Director, Dr Peter Saunders, raised over £5,000 for Help the Hospices running the London Marathon - you can still donate here. A number of very positive reports have highlighted the value and dynamism of care for those with terminal and progressive conditions, including a BBC feature on hospice care and press coverage given to a new initiative concerning dementia.

There have however been less agreeable reports concerning failings in care for elderly and dying people, further careless celebrity endorsements of euthanasia and evidence of a need for more frank discussion of death and dying. A challenge for all of us is: how do we build up a culture of care which not only responds to the needs and rightful expectations of those around us but which also guards against attempts to offer death as a 'sensible alternative'?

In a foreword to a recent photo project featuring dying people, Alain de Botton wrote: 'The dying are the great appreciators... They notice the value of the sunshine on a spring afternoon, a few minutes with a grandchild, another breath… And they know what spoilt ingrates we are, not stopping to register the wonder of every passing minute. They were once like us of course. They wasted decades but now they are in a position to know of their folly and warn us of our own.'

For Rosa Monckton, patron of Together for Short Lives (the umbrella organisation for children's palliative care), charity fundraiser Stephen Sutton was the epitome of de Botton's idea, and an example to us all.