Dignity in Dying, the former Voluntary Euthanasia Society,
who are backing Falconer, claim that everything is wonderful in Oregon. But is
that really true?
In fact, 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 Oregon Act, a patient must be
an Oregon resident, 18 years of age or
older, capable of making and communicating health care decisions for
him/herself and have been diagnosed with a terminal illness that will lead to
death within six months.
It is up to the attending physician to determine whether
these criteria have been met.
A similar law came into effect in the neighbouring state of
Washington in 2009. Annual reports can be accessed here.
So what can we learn about the Oregon/Washington model? Here
are ten disturbing facts:
1. There has been a
steady increase in annual numbers of people undergoing assisted suicide in
Oregon
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. The
number of assisted suicide deaths in Washington
State, increased by at least 43% in 2013.
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).
2. The Oregon health
department is funding assisted suicide but not treatment for some cancer
patients
Barbara Wagner had recurrent lung cancer and Randy Stroup
had prostate cancer. Both were on Medicaid, the state’s health insurance plan
for the poor that, like some NHS services, is rationed. The state denied both
treatment, but told them it would pay for their assisted suicide! ‘It dropped
my chin to the floor,’ Stroup told the media. ‘[How could they] not pay for
medication that would help my life, and yet offer to pay to end my life?’
(Wagner eventually received free medication from the drug manufacturer. She has
since died. The denial of chemotherapy to Stroup was reversed on appeal after
his story hit the media.)
Despite Wagner
and Stroup's cases, advocates continue to insist that Oregon proves
assisted suicide can be legalised with no abuses. But the more one learns about
the actual experience, the shakier such assurances become.
If AS were to be legalised in the UK end-of-life care would be likely to worsen under financial pressures
because it costs on average £3000 to £4000 a week to provide in-patient hospice
care, but just a one-off cost of £5 to pay for the drugs which would help them
commit suicide. Cancer treatments like chemotherapy, radiotherapy or surgery
cost much more. Do we really wish to place that temptation before families, NHS
managers and Health Secretaries in cash-strapped Britain?
3. Patients are
living for many years after having been prescribed lethal drugs for ‘terminal
illness’ showing that the eligibility criteria are being stretched
The Oregon and
Washington laws, like Falconer’s proposed law, have ‘six months to live’
criteria. But doctors’ estimates of lifespans can be wildly out. Consider
Oregon resident, Jeanette Hall, who was diagnosed with cancer and decided to
‘do’ Oregon's law. Her doctor, Kenneth Stevens, didn't believe in assisted
suicide and encouraged her to be treated instead. It is now 14 years later and
she is ‘thrilled’ to be alive. This is Dr
Steven's affidavit filed by the Canadian government in Leblanc v.
Canada, now dismissed, discussing Jeanette. This is Jeanette's
affidavit, also filed by the Canadian government in the same case.
The Oregon
statistics record patients killing themselves up to 1,009 days after the
first request for lethal drugs – almost three years – showing just how hard
doctors are pushing the boundaries - and/or how bad they are at guessing
lifespans.
4. The vast majority
of those choosing to kill themselves are doing so for existential reasons
rather than on the basis of real medical symptoms
The main argument advanced for assisted suicide is
unremitting pain. But the Oregon
data show that those people citing ‘inadequate pain control or (even) concern
about it’ constitute just 23.7% of cases overall. So what are the main reasons
given for taking one’s life? In 2013 93% cited ‘loss of autonomy’, 89% said
they were ‘less able to engage in activities making life enjoyable’ and 73%
listed ‘loss of dignity’. These are not physical but existential symptoms. But should lethal drugs be prescribed to
people who feel their lives no longer have meaning and purpose?
The fact that almost a quarter of patients dying under the
Act report inadequate pain control or concerns about pain also shows that
palliative care provision in Oregon is unsatisfactory. But surely this is an
argument for better care rather than AS.
5. Many people in
Washington and Oregon give ‘fear of being a burden on others’ as a reason for
ending their lives
I have frequently argued that any change in the law to allow
assisted suicide or euthanasia would place pressure on vulnerable people to end
their lives for fear of being a financial, emotional or care burden upon
others. This would especially affect people who are disabled, elderly, sick or
depressed and would be most acutely felt at a time of economic recession when
many families are struggling to make ends meet.
This fear is again borne out by the American data. In Washington
in 2013, 61% of people opting for assisted suicide give the fear of being a
burden to family, relatives and caregivers as a key reason. 13% cited ‘financial
implications of treatment’. In the same year in Oregon
the equivalent figures were 49% and 6%.
6. Fewer than three
per cent of patients are being referred for formal psychiatric or psychological
evaluation
In an article for The Telegraph, former president of the
Royal College of Psychiatrists Baroness Sheila Hollins has voiced concern that
proposals to license doctors to supply lethal drugs to mentally competent,
terminally ill patients fail to take account of the complex process involved in
assessing a patient's mental capacity. According to Baroness Hollins, assessing
mental capacity ‘isn't like checking the oil or water level in a car’ or ‘the
sort of thing that can be done in a single consultation, especially
if the decision in question - as it is in this case - is one with life-or-death
consequences.’
Commenting on the US State of Oregon, where less
than 3% of cases were referred for a formal psychiatric assessment in 2013
she writes: ‘Researchers have found that some patients who have ended their
lives under the terms of Oregon's assisted suicide law had been suffering from
clinical depression. Depression impairs decision-making capacity, it is common
in elderly people and it is treatable. But in some cases in Oregon it has not
been diagnosed by the doctor who assessed the patient's capacity and prescribed
lethal drugs. Oregon's law requires referral for psychiatric examination in
cases of doubt but in some cases that has not happened.’
7. A substantial
number of patients dying under the Oregon Act do not have terminal illnesses
In Oregon in 2013 16.9% of those killing themselves under the
Act did not have cancer, heart disease, chronic lung disease or motor neurone
disease but were classified as having ‘other illnesses’. What were these? A
footnote in the annual
report tells us that this ‘includes deaths due to benign and uncertain
neoplasms, other respiratory diseases, diseases of the nervous system
(including multiple sclerosis, Parkinson's disease and Huntington's disease),
musculoskeletal and connective tissue diseases, viral hepatitis, diabetes
mellitus, cerebrovascular disease, and alcoholic liver disease.’
Many of these conditions might be considered life-shortening
but it beggars belief that all these cases were terminal (with less than six
months to live). These are in the main chronic conditions, again falling
outside the bounds of the Act. And yet
the doctors went ahead and signed the forms anyway – further evidence of how
medical practitioners cannot be trusted to keep to the legal boundaries.
8. It is virtually
certain that there is underreporting of assisted suicide cases in Oregon
The Lancet recently published a long awaited
meta-analysis study which indicated that in 2010 in the Netherlands,
23% of all euthanasia deaths were not reported. 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-type law like Falconer’s 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 under-reporting.
9. Some doctors know
the patient for less than a week before prescribing the lethal drugs
In order to assess whether a patient is being coerced or
not, it surely must be necessary for the prescribing doctor to know them
personally and understand their family situation. But in Oregon there were
patients who knew their doctor for less than a week before he/she prescribed
them the lethal drugs – further evidence of doctor shopping.
10. The presence of
no independent witnesses in over 80% of cases is a recipe for elder abuse
In Oregon
in 2013 there was no doctor or other healthcare professional present at the
time of ingestion of the lethal drugs in 81% of cases. Also the duration of
time that elapsed between the request for the drugs and the actual death ranged
from 15 to 692 days with a median of 52 days.
During this time the drugs were kept at the patient’s home.
But without an independent witness how can we be sure that the drugs were taken
voluntarily and not administered forcefully or secretly by a relative with an
interest financial or otherwise, in the patient’s death? If they struggled who
would know? And any investigation into possible foul play would have to
traverse the substantial hurdle of the key witness (the patient) being dead.
We know that in Britain, according to ‘Action on Elder Abuse’,
there are half a million cases of elder abuse annually, many of which involve
financial abuse by family members or close relatives. The Oregon law, and by
implication Falconer’s proposed law, is a recipe for elder abuse of the very
worst kind – killing for money.
Conclusions
The lessons from Oregon are clear. We should not go there.
Keep Britain safe for vulnerable people.