Topic:
SUICIDE; DEATH; RIGHT TO DIE; EVICTION; PHYSICIANS;
Location:
SUICIDE - ASSISTED;
Scope:
Court Cases; Other States laws/regulations;

OLR Research Report


January 22, 2002

 

2002-R-0077

OREGON'S ASSISTED SUICIDE LAW

 

By: Sandra Norman-Eady, Chief Attorney

You asked for information on Oregon's assisted suicide law.

SUMMARY

Oregon's Death with Dignity Act allows terminally ill Oregon residents to obtain and use prescriptions from their physicians for self-administered, lethal medications. Physicians and patients who follow the act's requirements are protected from criminal prosecution, and the choice of legal physician-assisted suicide cannot affect the status of a patient's health or life insurance policy.

Oregonians first passed the act in a November 1994 referendum by a margin of 51% to 49%. However, a legal injunction delayed its immediate implementation. It was not until 1997 when the Ninth Circuit Court of Appeals lifted the injunction that physician-assisted suicide became a legal option for terminally ill patients in Oregon. Since that time, 70 people have ended their lives with the help of a doctor. But, people's ability to use the law is once again threatened.

The latest issue is whether assisted suicide is a “legitimate medical purpose” within the meaning of the 1970 Federal Controlled Substances Act. Under the act, physicians can prescribe federally regulated drugs for legitimate purposes only. In a November 2001 letter to the Drug Enforcement Administration (DEA), U.S. Attorney General John Ashcroft, citing United States v. Oakland Cannabis Buyers' Cooperative, 532 U.S. 483 (2001), stated that assisted suicide is inconsistent with the public interest. Oregon's attorney general was successful in obtaining a temporary restraining order on Ashcroft's directive. A hearing on the directive is expected in April.

In Oakland Cannabis Buyers', the U.S. Supreme Court held cooperatives that distributed marijuana for medical purposes violated the Controlled Substance Act because marijuana has no proven medical value, a necessity for distributing controlled substances. OLR Report 2001-R-0894 provides a more detailed analysis of this case.

As stated earlier, 70 patients have died from physician-assisted suicide since 1997. Most of these patients had some form of cancer and stated the fear of losing autonomy as their primary reason for wanting to end their lives. Oregon's health department does not keep statistics on the total number of physicians writing legal prescriptions, but it does report that physicians wrote a total of 96 lethal prescriptions between 1997 and 2001.

DEATH WITH DIGNITY—OREGON'S ASSISTED SUICIDE LAW

The Death with Dignity Act (ORS 127.800 to 127.897) allows terminally ill Oregon residents to obtain and use prescriptions from their physicians for self-administered, lethal medications. Under the Act, ending one's life in accordance with the law does not constitute suicide. However, the law is referred to as “physician-assisted suicide” because it allows people to end their lives through the voluntary self-administration of lethal medications prescribed by a physician for that purpose.

The Death with Dignity Act legalizes physician-assisted suicide, but specifically prohibits euthanasia, where a physician or other person directly administers a medication to end another's life.

To request a prescription for lethal medications, the Death with Dignity Act requires that a patient voluntarily express his wish to die and be:

1. an adult (age 18 or older),

2. an Oregon resident,

3. capable (able to make and communicate health care decisions), and

4. diagnosed with a terminal illness (incurable and irreversible) that will lead to death within six months.

Patients meeting these requirements are eligible to request a prescription for lethal medication from a licensed Oregon physician. To receive a prescription for lethal medication, the following steps must be fulfilled:

1. the patient must make two oral requests to his physician, separated by at least 15 days;

2. the patient must provide a written, witnessed request to his physician (two witnesses);

3. the prescribing physician and a consulting physician must confirm the diagnosis and prognosis;

4. the prescribing physician and a consulting physician must determine whether the patient is capable;

5. if either physician believes the patient's judgment is impaired by a psychiatric or psychological disorder, he must refer the patient for a psychological examination;

6. the prescribing physician must inform the patient of feasible alternatives to assisted suicide, including comfort care, hospice care, and pain control; and

7. the prescribing physician must request, but may not require, the patient to notify his next-of-kin of the prescription request.

To comply with the law, physicians must report to Oregon Health Services (OHS) all prescriptions for lethal medications. Reporting is not required if patients begin the request process but never receive a prescription. Physicians must inform pharmacists of the prescribed medication's ultimate use. Physicians and patients who adhere to the act's requirements are protected from criminal prosecution, and the choice of legal physician-assisted suicide cannot affect the status of a patient's health or life insurance policies. Physicians and health care systems are under no obligation to participate in the Death with Dignity Act.

CHRONOLOGY OF EVENTS

Table 1 shows a chronology of events, starting with the dates Oregon voters passed the Death with Dignity Act and ending with the date a trial is expected to begin on whether physicians can prescribe controlled substances for use in suicides.

TABLE 1: CHRONOLOGY OF ASSISTED SUICIDE IN OREGON

Dates

Events

November 8, 1994

Oregon voters passed Death with Dignity Act (Measure 16) by a margin of 51% to 49%.

December 27, 1994

A preliminary injunction issued against the measure.

August 3, 1995

A permanent injunction was issued.

February 27, 1997

A three-judge panel of the U.S. Circuit Court of Appeals lifted the injunction.

October 14, 1997

The U.S. Supreme Court declined to hear the case.

November 4, 1997

Oregon voters defeated Measure 51, which would have repealed the Death with Dignity Act, by a vote of 60% to 40%.

1998 (Specific date unknown)

DEA determined that narcotics and other dangerous substances controlled by federal law could not be used to assist suicide.

June 5, 1998

U.S. attorney general overruled DEA determination, leaving it to the states to decide whether controlled substances could be prescribed to assist suicide.

November 6, 2001

U.S. attorney general issued a letter reinstating the original DEA determination, citing the U.S. Supreme Court's decision in United States v. Oakland Cannabis Buyers' Cooperative, 532 U.S. 483 (2001).

November 7, 2001

Oregon's attorney general sought a restraining order on the U.S. attorney general's letter.

November 8, 2001

The court issued a temporary restraining order, effective until November 20, 2001.

November 20, 2001

The court extended the temporary order for four months. A trial is expected in April of 2002.

ASSISTED SUICIDE STATISTICS

In compliance with a mandate in the Death with Dignity Act to develop a reporting system for monitoring and collecting information on physician-assisted suicide, OHS requires physicians to make a report whenever they write a prescription for lethal medication. OHS uses these reports and information it obtains from physician interviews and reviews of death certificates to confirm patients' deaths and provide patient demographics. Table 2 shows statistical information OHS obtained and reported in its third annual report on the Death with Dignity Act. For additional statistical information on Oregon's assisted suicide program, visit www.ohd.hr.state.or.us/chs/pas or www.iaetf.org/orstats.htm.

TABLE 2: THREE YEARS UNDER OREGON'S ASSISTED SUICIDE LAW

Categories

2000

1999

1998

Total

Number of reported assisted suicide deaths

27

27

16

70

Number of reported lethal prescriptions written

39

33

24

96

First doctor asked wrote prescription

11

8

8

27

Doctor present when patient took lethal drugs

14

16

8

38

Median duration (weeks) of patient-doctor relationship before lethal prescription provided

8

22

11

14

Patient Information

       

Underlying illness:

Cancer

Amyotrophic Lateral Sclerosis

Chronic Obstructive Pulmonary Disease

Other*

21

2

0

4

17

4

4

2

14

0

1

1

52

6

5

7

Median age in years

69

71

70

70

Reasons for requesting assisted suicide:

Fear of being a burden

Fear of losing autonomy

Fear of losing control of bodily

function

Inadequate pain control

Fear of decreasing ability to do

enjoyable activities

Financial implications

Combined concerns of burden,

autonomy, activity, and bodily

functions

Other combinations of burden,

autonomy, activity, and bodily

functions

17

25

21

8

21

1

11

15

7

21

16

7

22

0

4

17

2

12

9

2

11

0

0

13

26

58

46

17

54

0

15

45

Source: Oregon Health Department's Annual Reports

*Includes Acquired Immune Deficiency Syndrome, Congestive Heart Failure, multiple-system organ failure, and scleroderma.

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