X-Message-Number: 7868
Date: Sun, 16 Mar 1997 14:25:41 -0700
From: David Brandt-Erichsen <>
Subject: More on Measure 16

        From the PORTLAND OREGONIAN, March 15


        MARK O'KEEFE and TOM BATES - of the Oregonian Staff

        Summary - In practical terms, a pharmacist testifies that taking
        your own life with medication can be unpredictable and awkward.

        Ending your life with medication isn't as simple as voters may
        have thought when they approved Oregon's doctor- assisted suicide
        law in 1994.

        Three days of legislative hearings at the Capitol this week
        revealed conflicting interpretations and one new suggestion about
        the most effective yet legal way to end the lives of terminally
        ill patients under Measure 16.

        Voters approved the initiative in 1994 making Oregon the first
        state in the country legalizing doctor- assisted suicide . Though
        still under appeal, a February federal court ruling strongly
        backing its implemenation caught legislators and physicans by

        By Friday, pharmacists, activists and lawmakers appeared more
        confused than when the hearings began. Whether clarity emerges
        could determine how or if the Legislature tinkers with Measure 16.
        It can be tabled for further study, sent back to voters or allowed
        to take effect as written.

        One point of discussion this week was the manner of death, and how
        to avoid a botched suicide.

        Drafters of Measure 16 recommend using pills. But pharmacists say
        the number needed to kill people can vary between 20 and 100
        barbiturates. Some vomit from such a large dose, especially when
        already nauseous from illness.

        "There is a perception that this is easy and it happens quickly,"
        said Gary Schnabel, compliance director for the Oregon Board of
        Pharmacy. "It's often not quick and easy."

        In testimony, Schnabel offered a state Judiciary Subcommittee on
        Family Law a better way. He held aloft an "infusion" device,
        controlled by the patient and designed to allow a flow of
        medication directly into the bloodstream through an intravenous

        The device would ensure better absorption of the drug with little
        chance of vomiting because it avoids the stomach altogether.
        Schnabel said people on daily doses of antibiotics often receive
        medication this way.

        "As a pharmacist, I have experience with patients using these
        devices," Schnabel explained Friday. "I'm comfortable that
        patients can perform this without problems. I've trained patients
        from ground zero, showing them the equipment, training them how to
        do it, then monitoring it over the weeks and months they use it."

        Does Measure 16 allow such a device? Much depends on the legal
        definition of "medication."

        Measure 16 states: "Nothing in this Act shall be construed to
        authorize a physician or any other person to end a patient's life
        by lethal injection, mercy killing or active euthanasia."

        A section on insurance refers to the patient's "act of ingesting
        medication." A sample request form includes the line, "I expect to
        die when I take the medication to be prescribed."

        Dr. Peter Goodwin of Portland, a co-author of Measure 16, said,
        "My own belief is that medication would cover intravenous
        medication." But Eli Stutsman, another co-author and an attorney,
        said an intravenous device "would not be permitted" by Measure 16.

        "When we drafted the statute," said Stutsman, "we carefully chose
        the word medication. Had we said the physician could prescribe
        drugs, appliances or devices, then the medical device the
        pharmacist said would come within Measure 16."

        During the campaign, opponents alleged Measure 16 would lead to
        the use of "suicide machines" similar to the ones used by Dr. Jack
        Kevorkian of Michigan.

        Schnabel of the Oregon Board of Pharmacy objects to portraying his
        device that way.

        "It's not a machine," Schnabel said. "It contains liquid under
        pressure. When the patient wants to start an infusion they release
        the flow clamp that's blocking the tubing."

        But a problem even Schnabel sees is "you need a doctor or nurse to
        get started" to "pierce the skin . . . where the patient inserts
        the needle when they start a dose or infusion."

        In a 1996 article published by Pharmaceutical Products Press,
        right-to-die advocate Stephen Jamison wrote " . . . drugs often
        fail, and partners and family, who may be unprepared emotionally
        and practically, may hesitantly come to use whatever means are
        left at their disposal to ensure a dying person's last request."

        A much-quoted study from the Netherlands, where assisted-suicides
        have gone on for years, shows one in four patients taking lethal
        medicine endured lingering deaths of three hours or more. Dutch
        doctors finish the job with a lethal injection.

        Measure 16 was written so skittish doctors can take a hands-off
        approach by merely writing a lethal prescription and letting the
        patient take over from there. The infusion device requires more
        involvement by a physician or nurse, something Derek Humphry, head
        of the Euthanasia Research & Guidance Organization has been
        advocating all along.

        "I'm going to go to a pharmacy and see if I can buy one," said
        Humphry of the infusion device. "I find it encouraging because the
        weakness of Measure 16 is that there are some people who cannot
        take drugs by mouth and they shouldn't be left out. It would be
        inhumane. This may be the answer."

        To clarify the situation, the Legislature could amend Measure 16
        to allow for the use of devices and more physician involvement.
        But the chairman of the subcommittee where such legislation
        originates says that won't happen.

        The committee plans to finish Measure 16 hearings Thursday before
        making a decision.

        "The Family Law subcommittee is not going to give authority to
        doctors to kill people," Rep. Ron Sunseri, R-Gresham, said. "We
        will not cross that line. That's what you are suggesting if we go
        beyond the oral ingestion of pills."

        At stake are future lives, and deaths. Will they be peaceful final
        exits or botched suicides?

        "We know this could happen soon," said Schnabel of Measure 16.
        "These aren't new questions; but two or three years ago we had the
        luxury of time, and we could stop talking about this. Now we

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