Oregon Death with Dignity Law beats Bush Juggernaut by Dr. Rick Bayer
Earlier this year, the US Supreme Court upheld Oregon’s Death with Dignity Law. Specifically, the US Supreme Court agreed with lower courts that former Bush Administration Attorney General John Ashcroft exceeded his authority when he threatened to punish doctors who prescribe lethal doses of drugs to terminally ill patients under Oregon law.
When a President tells physicians how to practice medicine by censoring what we discuss or how a medicine may be used, patients should watch out. Then they should vote that party out of office during the next election cycle.
The Oregon Death with Dignity Act was approved by voters through ballot initiative in 1994 and reaffirmed in 1997 after a referendum from a hostile Republican legislature that asked voters to overturn it. Oregon is the only state with this law. It says a physician can prescribe a lethal dose of medicine to a terminally ill patient of sound mind who is determined to be eligible by the prescribing physician and a consulting physician. The patient makes two oral requests at least 15 days apart and a written request witnessed by 2 other people. If the patient is not of sound mind, a mental health consult is mandated.
Very importantly, the patient must ingest the medicine on his/her own. This law specifically forbids euthanasia—the administration of a lethal medicine by another person such as a physician.
The law was designed to promote patient self-determination or autonomy. This means a person of sound mind should have free will to take action that will determine one’s own fate. This is a relatively new concept in society, like democracy or human rights. At one time determining one’s own fate was considered blasphemous. (Of course, saying the world was not the center of the universe a few short centuries ago was also considered blasphemous. Consider Galileo’s fate before the Inquisition.)
I became a spokesperson for the Death with Dignity Act in 1997 after physicians in our Oregon Medical Association House of Delegates voted to overturn the law saying, “The pills don’t work; patients will suffer”. That was inconsistent with my internal medicine education and seemed to be only smoke and mirrors to hide the fact that some doctors value religion over science. The spectacle of physicians ignoring scientific medicine to follow orders from their religious masters stunned me. Fortunately, Oregon voters reaffirmed 60 to 40% to keep the law and since that time it has worked well.
Every Oregonian who takes pain medi-cine benefits from this law, because it focuses attention on end of life care, including pain management. Patients most commonly cite, “loss of dignity, loss of autonomy and decreasing ability to participate in activities that make life enjoyable,” rather than poor pain control as the reason to seek a lethal dose of medicine.
Specifically, 246 Oregonians have used the Act since 1997. The numbers initially rose as people learned about the new law but in the last 4 years the annual deaths have ranged between 37 and 42. There has been only one case in which the person allegedly took the entire dose but woke 65 hours later to die of natural causes within two weeks. Patients who use the law account for about one in 800 deaths in Oregon.
There has always been tension between the scientific secular world and non-scientific religious world. It did not start with President Bush or even Galileo, but goes back to the evolution of science as an alternative model of how the world works. This is why we continue to have political contests between scientific evolution by natural selection versus the biblical Earth that was made in one week.
The most important outcome is not that science “wins” over religion but that we learn to respect each other and allow self-determination for those who value it. Another benefit from our respect for autonomy is that Oregon is a national leader in end-of-life care as measured by Oregonians who die at home with hospice care compared to those in other states. We are also a national leader in pain medicine prescribing and we have a medical marijuana law that allows an herbal option for pain management.
While the law has been most important for the 246 reported so far, it has helped every Oregonian who seeks medical care. It should be valued and protected. If other states pass a Death with Dignity Act, it will almost certainly be modeled on our Oregon law. The US Supreme Court got this decision correct. For more information see http://compassionoforegon.org
Dr. Bayer practiced internal medicine in Oregon for many years gathering extensive clinical experience about end of life care.