Oregon's public health division has released statistics on deaths under its physician-assisted suicide (PAS) legislation. It shows a steady increase in the number of lethal prescriptions and in the number of deaths. In 1998, the first year after PAS was legalised, there were 24 prescriptions and 16 deaths. In 2011, there were 114 prescriptions and 71 deaths. A total of 935 people have had lethal prescriptions and 596 have died.
The Physicians for Compassionate Care Education Foundation, a staunch foe of the legislation, analysed the 2011 figures. Here are some of its comments:
62 doctors wrote 114 prescriptions, with some writing up to 14 prescriptions each. Some doctors knew the patient for only one week before writing the prescriptions. It is known that some doctors are prominent prescribers of lethal barbiturates for assisted suicide.
The report states "9 people with prescriptions written in previous years ingested medication during 2011". The term "previous years" indicates that some received prescriptions during multiple years prior to 2011 (such as in 2010, 2009 or earlier). In short, some individuals had the prescription for longer than a year before ingesting the drugs, far longer than the law's 6-months life expectancy guidelines. Some patients lived as long as 872 days after requesting assisted suicide. Clearly, the law's guidelines are meaningless; not all who receive these prescriptions are terminal.
As has occurred in prior years, not all who attempt to take the drugs will die. Two patients ingested the medication but failed to die. Each regained consciousness and died more than a day later, 30 hours and 38 hours respectively, of their underlying illness; they were not considered to have died from the ingested drugs. These are not easy drugs to take, they are bitter and foul-tasting, and vomiting does occur despite anti-emetics.
As in previous years, there was virtually no formal evaluation for underlying depression, anxiety or other serious mental health issue. Only one of the 71 patients was referred for psychiatric evaluation. OHSU researchers in 2008 reported that 25% of patients requesting assisted suicide were considered to be depressed. Are we failing to recognize and address the despair that is frequently found in patients near the end of life? What are we doing to protect these vulnerable Oregonians?
As in previous years, pain has not been a major concern; only one third of patients had inadequate pain control or concern about it. The most commonly expressed concerns of those dying from physician-assisted suicide were unchanged from previous reports: less able to engage in activities making life enjoyable, losing autonomy, and loss of dignity.
In only 6 cases was the prescribing physician present at the time of ingestion, in 3 other cases another provider was present. Thus, very little is known or reported regarding events at the time of ingestion of the medications. For 62 patients there was either no provider present or the information regarding presence of a provider was unknown. Physicians appear to be disengaged with patients at the end.
In essence then, complications were unknown for 59 patients, and any information regarding minutes between ingestion and unconsciousness and death was unknown for 63 patients.
The shroud of secrecy surrounding assisted suicide is heavier than ever. With each passing year, Oregonians know less and less about what is really happening with assisted suicides in the state. The proper practice of all aspects of medicine requires adequate oversight and peer review. We do not have that with physician-assisted suicide in Oregon.
Related reading: Timo Konietzka Died by Assisted Suicide; Assisted Suicide Booms in Switzerland