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Hawaii House of Representatives

Committee on Health

Rep. Dennis A. Arakaki, Chair

Rep. Josh Green, M.D., Vice Chair

 

Hearing on HB 1454 - Relating to Death with Dignity

February 5, 2005

Hawaii State Capitol Auditorium

 

Testimony of Kenneth R. Stevens, Jr., M.D.

Physicians for Compassionate Care Education Foundation

 

            I have been in the practice of Radiation Oncology, treating cancer patients, for 38 years in Oregon.  I have been Professor and Chair of the Department of Radiation Oncology at Oregon Health & Science University for over 15 years. [I speak for myself;

I do not speak for the university.]

 

            I am opposed to the legalization of assisted suicide and euthanasia.  Since the passage of Oregon's assisted-suicide law, I have learned the significant harm and danger of assisted suicide to the vulnerably ill and to society.

 

HOW DID ASSISTED SUICIDE COME TO OREGON?

 

            In 1994, the organization Compassion in Dying (CID) came into Oregon.  Leaders of CID wrote the Oregon assisted-suicide law, and were able to get "Measure 16" (the assisted-suicide ballot measure) on the Oregon ballot.  By a 2% margin (51% to 49%), Measure 16 passed in 1994, and physician-assisted suicide became legal in Oregon.  Since that time CID has been very involved with assisted suicide in Oregon.  CID leaders have instructed doctors about what drugs to prescribe and how to do the assisted suicide.  CID leaders report that 80% of those dying from assisted suicide in Oregon are clients of CID.

 

CID CONTROLS THE ASSISTED SUICIDE INFORMATION IN OREGON

 

            It was announced earlier today at this hearing by one of the assisted-suicide proponents that there were 206 assisted suicide deaths in Oregon in the past 7 years (1998-2004), and that there were 210,000 people who had died in Oregon in the past seven years.  From where did that information come?  The Oregon Department of Human Services, which has the responsibility to report on what is happening regarding assisted suicide in Oregon, has not released any information regarding the 2004 year.  That information appears to have come from CID leaders.  A communication from the CID Oregon executive director on this past Monday, January 31, 2005, reports that there were 35 assisted-suicide deaths in Oregon in the year 2004. [1]   It was also reported that of those 35 deaths, 29 (83%) were helped by CID.  Of the 29 deaths helped by CID, CID personnel were present when 18 of the patients took the lethal medication, but the prescribing doctor was present at the time the lethal medication was taken for only 8 patients.

 

            It is noteworthy that this initial information came from the leadership of CID, and not from the Oregon Department of Human Services that has responsibility to inform the public on such matters.   And how does CID know that there were 6 deaths of non-CID patients?  How do they know there were 210,000 Oregonians dying in the past seven years (1998-2004)? 

 

George Eighmey, executive director of CID Oregon, told a New York Times reporter in April 2004 that he had been personally present at 25 assisted suicide deaths in Oregon.[2]  That is about one in every 7 physician-assisted suicide deaths in Oregon up to that time.

 

CID leaders are also working to legalize assisted-suicide in other states, including Hawaii.

 

AUTONOMY AND THE CONTROLLING ELITE

 

            The great majority of those dying of assisted suicide in Oregon have been upper-middle class Caucasians.  Oregon assisted-suicide patients have been described by their doctors as being fiercely independent and controlling.  Society should always fear laws that are established by and for the controlling elite.  History has taught us that once such laws are established, the poor and vulnerable are discriminated against.

 

            It is not surprising that the black community is much less likely to favor assisted suicide compared to the white community.  Families of Oregonians dying between June 2000 and March 2002 were interviewed regarding assisted suicide.  Whereas 18% of the dying whites personally considered assisted suicide (none of these people used assisted suicide), there was not one of 62 blacks that considered it.[3]  There have been no black deaths among the 171 deaths in Oregon between 1998 and 2003.[4]

 

PAIN, DEPRESSION AND DISABILITIES

 

There is not one instance in Oregon of assisted suicide being used because of actual untreatable pain.  It has been used for psychological and social concerns.  Depression is the leading cause of suicide, and depressed people have received lethal medication in Oregon.

 

            Assisted suicide proponents demean and demonize those with disabilities by suggesting to seriously ill people that there are conditions "worse than death".  Those with disabilities fear they may be the next targets of assisted suicide.  They have formed organizations such as "Not Dead Yet!".

 

 

 

THE PROBLEMS WITH "SAFEGUARDS"

 

            Assisted suicide proponents talk about the "safeguards" with Oregon's assisted suicide law.  The fact that the word "safeguard" is used is an indication that assisted suicide is dangerous and unsafe for the general public.  We have realized that the "safeguards" are really boundaries or restrictions around assisted suicide.  They may be considered as a means of protection against abuse, but they also act as a barrier or restriction to those who find themselves outside those boundaries.  

 

            When a person desiring assisted suicide finds themselves outside the boundaries that are written in the law's safeguards, they want to bypass or stretch the boundaries.  This is especially true of people who have been described by their doctors as being extreme in their desire for control of their lives and death.

 

The "safeguards" or boundaries in the Oregon law are:

            Diagnosis of a terminal illness; less than 6 months to live.

            Mentally capable.

            >18 years of age.

            Lethal drugs self-administered and taken by mouth.

            Lethal injection not permitted.

 

OREGON'S ASSISTED SUICIDE "SAFEGUARDS" ARE NOT BEING FOLLOWED      

 

                With virtually every case that has come to public light, the closer one looks at individual cases, the uglier is the reality.

 

            The assisted suicide law provides no protection for the depressed or mentally ill.  Only 5% of those dying from assisted suicide in 2003 had a mental health consultation. [4]

 

            In Oregon, patients with mental disorders can receive lethal drugs to kill themselves.  Nationally, the majority of forensic psychiatrists believe that the presence of major depressive disorder should result in an automatic finding of incompetence. [5]

 

            Kate Cheney was a woman in her 80s with cancer who requested assisted suicide.  After a psychiatric evaluation determined that she had dementia and was not mentally capable, she and her family sought a psychologist's evaluation that felt that she was capable.  This is an example of "doctor-shopping" to get a desired opinion.  She finally received the prescription for lethal drugs from a Kaiser HMO doctor. [6]

 

            Michael Freeland was a 62-year old man newly diagnosed with lung cancer, and with a history of depression and prior suicide attempt.  He received lethal drugs from a CID doctor without a mental health consultation.  He was later admitted to a psychiatric ward.  When he was discharged from the psychiatric ward, the doctors and court judged him incompetent.  Yet this man had a bottle of lethal drugs in his house. [7] Was this safe?  Where were the safeguards?

 

            Jake Harris was a man with multiple tumors in his brain, whose thinking was slipping and parts of his brain were blinking off.  And in that condition he received the lethal medication. [8]

 

            Patrick Matheny [9] and Barbara Houck [10] were patients with  ALS (Amyotropic Lateral Sclerosis), who had problems swallowing and being able to self-administer the medication.  Mr. Matheny had to be "helped" by his brother-in-law because of his trouble swallowing.  Mrs. Houck had the lethal medication spoon-fed into her mouth.  Where was the self-administration in these cases?

 

            Some Oregonians who have received the lethal medication have lived far longer than 6 months, some for more than 2 years.

 

            In 1996, a doctor in Corvallis, Oregon had a patient die form lethal injection.  He was not criminally prosecuted and his medical license was suspended for only two months. [11]

 

            In 2003, a patient drank only one-half of the lethal medication, and then vomited one-third of what he had taken, and he lived 48 hours before finally dying. [4] What was the true cause of death, since he had received a less-than-lethal-dose of short-acting barbiturate?

 

            We are dependent on self-reporting by doctors, and in over 70% of assisted-suicide deaths in 2003, the prescribing doctors were not there when the patients took their lethal medications. [4]    So how do they know what happened at the time of death?  The Oregon state Dept. of Human Services has commented that what they receive from doctors might be a "cock and bull story". [12]

We really do not know what is going on in Oregon.

 

DOCTORS DO NOT TELL THE TRUTH ON THE DEATH CERTIFICATE

 

When a patient dies from assisted suicide, Oregon doctors do not indicate on the death certificate that the patient died from a drug overdose.  They record the underlying disease (cancer, heart disease, etc.) as the cause of death.  There is nothing on the death certificate that identifies the death as an assisted suicide death, this is because of concern regarding confidentiality.

 

FINANCIAL CONCERNS

 

            In Oregon, I and other doctors, regularly receive notices that many important medical services and medications for our patients won't be coved by Medicaid (Oregon Health Plan).  Yet assisted suicide is fully covered and sanctioned by the state of Oregon and by Oregon Medicaid.  In 2003, Oregon Medicaid stopped paying for medicines for 10,000 Oregonians who had been on Medicaid.  This included patients with AIDS, bone marrow transplants, mentally ill and those with seizure-disorders.

 

            A physician member of Physicians for Compassionate Care received a phone call in the spring of 2003, from a man requesting assisted suicide.  The man said, "The state of Oregon has stopped paying for the pain meds I take for my chronic back pain.  If they won't pay for my pain meds, they might as well pay for my suicide."

 

            In December 2004, the Oregonian newspaper reported that 50.000 Oregonians had been cut from the Oregon Health Plan, and that the state plans to cut another 25,000 Oregonians from the plan by June 2005, to keep the state budget balanced. [13]

 

            These cutbacks in medical-care financial support are killing Oregonians.  It was reported in The Oregonian newspaper in December 2002 that there had been 94 mental health-related deaths because of the state cutback in mental health services. [14]

 

            The vulnerable poor of Oregon have very limited access to health care.  Sixty percent of Oregon doctors limit or do not see Medicaid patients.  More than 40% of Oregon physicians limit or do not see Medicare patients. [15]

 

            With all of these problems with reduction in health care to the vulnerably poor in Oregon, the Oregon Health Plan (Medicaid) continues to pay for physician-assisted suicide.

 

END-OF-LIFE CARE IS MIXED IN OREGON

 

            Oregon ranked high in per capita use of morphine before assisted suicide became legal.  Many other states have enacted or strengthened laws to ban assisted suicide, and per capita use of morphine in those states has increased in every case. [16]

 

            A national organization, "Last Acts", issued a "report card" in November 2002 to states regarding their end-of-life care.  Oregon was given a "D" grade for hospice (less than 1/3rd of dying Oregonians used hospice), and an "E" grade for palliative care programs. [17]

 

            In a 2003 Oregonian newspaper interview, Ann Jackson, Executive Director of he Oregon Hospice Association, said, regarding assisted-suicide patients, "In effect, they've said no to hospice, either because they don't believe we in hospice can meet their needs, or we're not meeting their needs." [18]

 

            After four years of assisted suicide in Oregon, there were twice as many dying patients in moderate or severe pain or distress, as there had been prior to Oregon's assisted suicide law being used. [19]

 

 

COMPARISON OF ASSISTED SUICIDE RATES BETWEEN STATES

 

            There has been a false report that Oregon has a lower assisted suicide rate than that of other states. [20]   There is no truth to that report.  Dr. William Toffler and I have published a report that shows that we do not know what the assisted suicide rate is in  states other than Oregon. [21]

 

TRUST BETWEEN PATIENT AND DOCTOR

 

            Physician-assisted suicide represents a reversal of the proper role of physician as "healer, comforter, consoler", to an improper role of helping patients commit suicide.

 

            The false message of assisted suicide proponents is that doctors can do a better job of killing patients than they can of caring for their medical needs.

 

CONCLUSION

 

            The citizens of Hawaii should learn from the problems with physician-assisted suicide in Oregon.

            The citizens of Hawaii should continue to improve your end-of-life care and palliative-care programs.

            Assisted suicide is not needed, and it puts vulnerable people at risk.

 

 

A SNAKE

 

            When I came on the plane to Hawaii yesterday, I signed a Hawaii state government form that certified that I was not bringing a snake into Hawaii.  Assisted-suicide is like a snake, you do not want it here in Hawaii.

 



[1]   Eighmey G. Fewer Oregon assisted suicides, Self-Deliverance Right-to-Die Euthanasia Weblog, January 31, 2005. http://self-deliverance.blogspot.com .

[2]   Estrin J. A woman ends her life among her friends. New York Times, June 1, 2004.

[3]   Tolle SW, Tilden VP, Drach LL, Fromme EK, Perrin NA, Hedberg K. Characteristics and proportion of dying Oregonians who personally consider physician-assisted suicide.    J Clin Ethics 2004;15:111-118.

[4]   Sixth Annual Report on Oregon's Death with Dignity Act, Oregon Department of Human Services, March 10, 2004, www.ohd.state.or.us/chs/pas/ar-index.cfm.

[5]   Ganzini L, Leong GB, Fenn DS, Silva JA, Weinstock. Evaluation of competence to consent to assisted suicide: Views of forensic psychiatrists. Am J Psychiatry. 2000; 157:595-600.

[6]   Barnett EH. Is Mom capable of choosing to die? The Oregonian. October 17, 1999.

[7]   Hamilton NG, Hamilton C. Competing paradigms of responding to assisted suicide requests in Oregon: Case report. American Psychiatric Association Annual Meeting Symposium on Ethics and End-of-Life Care: New Insights and Challenges, New York City, May 6, 2004.  To be published in Am J Psychiatry, April, 2005. (available at www.pccef.org, May 6, 2004)

[8]   Klare S. Jake Harris, in Compassion in Dying, edited by BC Lee (Troutdale, Oregon, NewSage Press), 2003, p 102.

[9]    Barnett EH. Man with ALS makes up his mind to die. The Oregonian, March 11, 1999.

[10]   Frey J. A death in Oregon: One doctor's story. Washington Post, November 3, 1999.

[11]   American Medical News. Board sanctions physician for 'active euthanasia'. August 11, 1997.

[12]  CD Summary, A year of dignified death, Oregon Health Division, March 16, 1999, Vol 48, No. 6.

[13]   Beggs CE. Governor proposes small school aid boost, new lottery games. The Oregonian. The Associated Press. December 1, 2004.

[14]   Roberts M. Did they have to die? The Oregonian. December 29, 2002.

[15]    Survey shows patient access problem grows. The Scribe. Published by the Medical Society of Metropolitan Portland. November 19, 2004.

[16]   Americans for Integrity in Palliative Care: Written testimony presented to the American Medical Association Annual Meeting, June 10, 2003.

[17]   Last Acts, Press Release, November 18, 2002.

[18]   Colburn D. Suicide: Study is based on interviews. The Oregonian. June 12, 2003.

[19]   Fromme EK, Tilden VP, Drach LL, Tolle, SW. Increased family reports of pain or distress in dying Oregonians: 1996 to 2002. J Palliative Med 2004;7:431-442.

[20]   Ganzini L, Dobscha SK. Clarifying distinctions between contemplating and completing physician-assisted suicide. J Clinical Ethics 2004;15:119-122.

[21]   Stevens KR, Toffler WL. Comparing Oregon's physician-assisted suicide rate with that of other states. J Clinical Ethics 2004; vol. 15, no. 4 (accepted for publication).

 


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