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 HEARINGS REVEAL CONFUSION ABOUT COMMITTING SUICIDE 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 suprise. 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 line. 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 can't. Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=7868