X-Message-Number: 8728
Date: Thu, 06 Nov 1997 11:10:40 -0700
From: David Brandt-Erichsen <>
Subject: More on Oregon

Note:  Still unresolved is what constitutes a "resident" of Oregon.  Only
Oregon residents may seek physician-assisted death under the new law.

A copy of the Oregon Death With Dignity Act can be found at
http://www.oregondwd.org/dwdm16.htm

From the PORTLAND OREGONIAN
(Thurs Nov 6/97)

PATIENTS, DOCTORS SEEK ANSWERS

The suicide law leaves health field scrambling to
provide guidance

Erin Hoover, Patrick O'Neill and Steve Woodward of The
Oregonian staff

----------

As one of the biggest ethical shifts in
health care history became reality Wednesday,
one point became clear: Patients and doctors,
for the time being, are on their own to
decide how to proceed with physician-assisted
suicide.

The message from hospitals and health plans
to patients wanting to pursue
physician-assisted suicide: Talk to your
doctor.

The message, for now, to doctors: It's up to
you to figure out how to follow the law if a
patient requests aid in dying.

And the recognition dawning for many in
health care, as voiced by Dr. William
Toffler, who supported repeal of the Oregon
Death With Dignity Act, known to voters as
Measure 16:

"It's a different world today, November 5,
1997."

Despite a legal dispute about whether the law
is in effect and politicians weighing in on
whether to have a special legislative
session, the medical field proceeded as
though physician-assisted suicide is an
option.

Health care leaders scrambled to offer
guidance to doctors. But they acknowledged
the process would take time to evolve. In the
meantime, doctors will have to consult
whatever resources are available and handle
their legal responsibilities as best as they
can.

"For everybody -- doctors, this organization
-- this is all new ground," said James
Kronenberg, spokesman for the Oregon Medical
Association. Legal assisted suicide "has
never been done before. It's kind of a scary
time."

The Task Force to Improve the Care of
Terminally Ill Oregonians, a group of 25
hospitals and medical professional
organizations that formed after voters
approved Measure 16 in 1994, is writing a
guidebook to help caretakers navigate the
ethical maze of assisted suicide.

But it won't be ready for months.

EXPECTING MORE LEGAL ACTION

Dr. Susan Tolle, a medical ethicist and task
force leader, said the group expects another
court injunction to block the law from taking
effect. Court challenges had held up the law
since its approval, but the 9th U.S. Circuit
Court of Appeals lifted an injunction against
it Oct. 27.

"We've counted on that throughout this
process, that we'd have more time," Tolle
said.

Tolle said in the meantime it is critical
that Oregon continue to improve care for the
dying, an area in which the state has become
a national leader, particularly since Measure
16 passed.

She raised some of the immediate issues not
addressed in the law, such as what to do with
patients who take a lethal dose but do not
die right away, and how to deal with patients
who might choose suicide because they can't
afford medical or hospice care.

Tolle said the task force will push for
legislation creating universal access to
hospice and health care.

The Oregon Medical Association is considering
writing a pamphlet outlining physicians'
legal responsibilities.

Many doctors "don't know specifically what
their responsibilities are in terms of the
waiting time, signed consent, obtaining a
second opinion and a psychological evaluation
and so forth," Kronenberg said. If the
association writes recommendations, they
could be ready within a week or two.

SOME WON'T GET INVOLVED

Some health insurance plans and hospitals are
taking a hands-off approach.

The state's largest insurer, Regence
BlueCross BlueShield of Oregon, has no
special procedures for assisted suicide and
will process claims for lethal prescriptions
no differently than for any other
prescription it covers.

"This issue is still a doctor-patient issue,"
said Ken Strobeck, public affairs director.
He said the insurer's role is to pay claims
that are submitted.

Providence Health System, a Roman Catholic
organization whose operations include six
hospitals and a hospice program, is staunchly
opposed to assisted suicide, said Denece
Boyer, Providence Portland Medical Center
spokeswoman.

"We will not be participating in
physician-assisted suicide, but we will be
looking at other other things: supportive
care teams, hospice care, pain management,"
she said.

Patients who see doctors employed by
Providence Health Systems would have to seek
outside medical advice if they want to pursue
physician-assisted suicide.

Kaiser Permanente, with about 300,000 members
in Oregon, is waiting for guidance from the
Oregon Health Division before deciding what
to do, said Jim Gersbach, a spokesman.

But the division views its role under the law
as tracking the number of physician-assisted
suicides, not setting rules for
implementation.

The division filed rules Wednesday setting
regulations for reporting physician-assisted
suicides, a tally of which the agency will
publish annually with confidentiality of
patients strictly enforced, said Dr. Katrina
Hedburg, deputy state epidemiologist.

"We see our role as providing information,"
she said.

The state Board of Medical Examiners, which
regulates doctors, will oversee doctors'
compliance with the law. Family members or
patients concerned about a doctor's actions
can contact the board, said Kathleen Haley,
the board's executive director.

Licensing boards for other health care
providers also will define their regulatory
roles.

Pharmacists, who would be called upon to
dispense life-ending drugs, are unhappy that
the law does not require them to be told the
purpose of prescriptions.

The state Board of Pharmacy will hold a
telephone conference call today to discuss
formulating a temporary rule requiring such
notification.

SOME INFORMATION AVAILABLE

The six-page Oregon Death With Dignity Act,
which was printed in the state's 1997 Voters'
Pamphlet, provides some instruction to
doctors on how to handle requests for
suicide. It includes telling the patient
about options for adequate pain medication
and hospice care, and requesting, but not
requiring, that the patient notify a
relative.

The Mid-Valley Physician Assisted Suicide
Interest Group, a group of 24 doctors, wrote
guidelines in August that doctors can refer
to. They make suggestions such as: A lethal
prescription should not be written until the
day a patient plans to take it, and if a
patient's suicide attempt fails the first
time, he or she should be allowed to recover
from the side effects and try again, if
desired.

Dr. Peter Goodwin, a Physicians for Death
With Dignity leader who fought for assisted
suicide, said having the law take effect
doesn't signal a paradigm shift for the
medical profession.

He said doctors have been helping terminally
ill patients die for decades by using extreme
amounts of pain medication with the intention
of relieving suffering and the additional
effect of hastening death. The only
difference now is that the process is out in
the open and the patient has more control, he
said.

"It's a small step. But it's a step in the
empowerment of patients," Goodwin said.

Health care leaders' overall message to
patients, including those in hospice care, is
to talk with their doctors. Patients also can
use an advance directive and a physician's
orders for life-sustaining treatment to
specify preferences in end-of-life treatment,
besides doctor-assisted suicide, said Dr.
Patrick Dunn, a member of the Task Force to
Improve the Care of Terminally Ill
Oregonians.

SOME PATIENTS CAUTIOUS

But patients are not waiting for the medical
field to sort out its process before coming
to grips with their feelings about Oregon's
new state of affairs.

Some people are taking steps to protect
themselves against the possibility of
assisted suicide. A Northeast Portland woman,
for example, called Providence Health
System's regional office Wednesday seeking a
recommendation for a physician.

Her criteria: "A primary care physician who
not only would not recommend
physician-assisted suicide to her as an
option, but in general would not even be
practicing physician-assisted suicide," said
Dianne Danowski-Smith, marketing director for
the Providence Medical Group.

Mickey O'Brien, 49, who lies dying at
Hopewell House in Southwest Portland from a
weakened heart, said she supports assisted
suicide as an option.

"I probably won't choose that, and most
people won't choose that, but the fear is so
great that to have the option is so
important," she said.

----------

Suicide law reporting rules filed

By CHARLES E. BEGGS
The Associated Press
11/06/97 3:39 AM Eastern

PORTLAND, Ore. (AP) -- The state Health Division has filed
rules on how doctors are to make confidential reports to the
agency in cases of physician-assisted suicides.

The rules, filed Wednesday, have been in the works since
voters first passed the measure in 1994, but were held up
because of court challenges.

Physicians' reports are required but confidential under the
assisted-suicide law, said spokeswoman Katrina Hedberg of
the Health Division.

The agency does not plan to divulge even when someone has
requested a lethal prescription, Hedberg said.

"We're not intending to release information on a
case-by-case basis," she said.

The rules require doctors to send notices to the division
when they write fatal prescriptions.

When a death certificate is filed in such cases, the doctor
will complete a second form regarding circumstances of the
patient's death.

The division filed temporary rules Wednesday and now has six
months to adopt permanent rules, which will require a public
hearing.

The law requires the agency to collect information on how it
is being administered. The law's only provision for
releasing data says the agency is to publish an annual
statistical report.

Aims of the reporting requirements include determining how
often assisted suicide is being used and whether safeguards
are being followed.

Hedberg discussed the rules at a news conference held by a
task force that has been working since 1994 on guidelines
for health care professionals in dealing the with the law.
The panel plans to publish a guidebook soon.

Dr. Susan Tolle, a task force member, said the next step is
gaining universal access to health coverage so people don't
feel pressured toward assisted suicide for financial
reasons.

Tolle, director of the Center for Ethics in Health Care at
Oregon Health Sciences University, said health care coverage
is universal in the Netherlands, where euthanasia is not
legal but is widely tolerated.

She said Oregonians also should remember that the state
leads their country in end-of-life comfort care and that "by
far the majority of people will not use this law."

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