Human Exceptionalism

Oregon “Guidelines That Do Not Protect

We keep hearing that the Oregon law is working without a flaw. The media touts that party line in almost every story about the issue. Of course to do that, contrary information has to be ignored. For example, the Michael Freeland case (reported in the American Journal of Psychiatry) in which a man became psychotic after being prescribed a lethal brew–even though his cancer had probably not reached the terminal stage–but was allowed by his own psychiatrist to keep the prescription “safely at home.” Such as the recent study demonstrating that people without serious symptoms of their disease are given lethal prescriptions by doctors anyway.

And here’s another media-ignored study, published in the Michigan Law Review by two of the most notable physician experts on this issue in the country, palliative care expert Kathleen M. Foley and psychiatrist Herbert Hendin. “Physician-Assisted Suicide in Oregon: A Medical Perspective” is a long piece and can’t be completely reproduced here. (I can’t even summarize it adequately in a short post. Sorry.)

First, here is their summarized conclusion (my emphasis):

Drawing on case studies and information provided by doctors, families, and other care givers, it finds that seemingly reasonable safeguards for the care and protection of terminally ill patients written into the Oregon law are being circumvented. The problem lies primarily with the Oregon Public Health Division (“OPHD”), which is charged with monitoring the law. OPHD does not collect the information it would need to effectively monitor the law and in its actions and publications acts as the defender of the law rather than as the protector of the welfare of terminally ill patients.

That’s been clear for a very long time, and it is good that these two stellar professionals have now quantified it. They offer examples:

In Oregon, intolerable suffering that cannot be relieved is not a basic requirement of assisted suicide…The unintended consequence of this provision is that it enables physicians to assist in suicide without inquiring into the source of the medical, psychological, social, and existential concerns that usually underlie requests for assisted suicide, even though this type of inquiry produces the kind of discussion that often leads to relief for patients and makes assisted suicide seem unnecessary.

That’s the true hospice approach, but assisted suicide is subverting hospice. (I’ll have a piece out next week on that issue.) And call me cynical, but I think the absence of an intolerable suffering element in the law is quite intended. The concept of unrelievable suffering is only the selling point.

Several actual case studies are presented in the article. “Helen,” the first legal assisted suicide has been discussed before–including in my Forced Exit–and demonstrates abuse from the git go (to use the vernacular), including “doctor shopping” for a willing prescription writer after the patient’s own doctor said no, that has marked the Oregon experience from the beginning. Here is another case I knew less about–that of Joan–who had ALS. The reporting here demonstrates what happens when the law gives the state’s imprimatur to some suicides and how meaningless referrals for a “consultation” can be:

He [the prescribing death doctor] stated that after talking with attorneys from the Oregon Medical Association and agreeing to help aid Joan in death, he asked Joan to undergo a psychological examination. The doctor reported that…”I elected to get a psychological evaluation because I wanted to cover my ass.”

The doctor and the family found a cooperative psychologist who asked Joan to take the Minnesota Multiphasic Inventory, a standard psychological test. Because it was difficult for Joan to travel to the psychologist’s office, her children read the true-false questions to her at home. The family found the questions funny, and Joan’s daughter described the family as “cracking up”over them. Based on these test results, the psychologist concluded that whatever depression Joan had was directly related to her terminal illness, which he considered a completely normal response… [Me: Can we say “rubber stamp?]

The psychologist’s report in Joan’s case is particularly disturbing because without taking the trouble to see her, and on the basis of a single questionnaire administered by her family, he was willing to give an opinion that would facilitate ending Joan’s life. The physician’s attitude toward the consultation surely played a part in his receiving a report that did not meet professional standards.

Well, that and six bits will buy you a cup of coffee, I guess. Nobody cares. She had ALS, she wanted to die. What do professional standards have to do with it?

The entire article reads very much like the collapse of Dutch medical ethics that came along with its euthanasia laws. This is the bottom line: Assisted suicide is abandonment. The crucial question facing the culture of the West is: Do we care enough about each other any more to exercise true compassion, (the root meaning of which is to “suffer with”)?

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