X-Message-Number: 8767 Date: Wed, 12 Nov 1997 13:24:01 -0700 From: David Brandt-Erichsen <> Subject: Oregon update & FAQ From the PORTLAND OREGONIAN (Sunday Nov 9/97; page A01) ASSISTED SUICIDE TURNS FROM THEORY TO DETAILS PATRICK O'NEILL and STEVE WOODWARD of the Oregonian Staff Summary: As procedures are fine-tuned, patients probably will be looking for answers In the world of medicine, specialists are a dime a dozen. But the sudden reality of Oregon's Death With Dignity Act has left a huge gulf of expertise in the newest medical field: physician-assisted suicide. On Tuesday, Oregonians overwhelmingly affirmed the 1994 law, which allows terminally ill people to seek life-ending medications. Theory now will give way to practice. Doctors, pharmacists and legislators are huddling over the nitty-gritty details -- everything from what to write in the patient's medical record to the exact wording on the prescription itself. And the patients themselves are left wondering: What do I do now? Assisted suicide boasts no comforting voice of experience. There are no veteran suicide doctors, no stacks of scientific studies, no support groups for people contemplating the act. Moreover, the law is fraught with unknowns. Patients, for example, must give oral notification of their desire to die by lethal prescription. But what constitutes oral notification? Does a voice-mail message on the doctor's answering machine qualify? What, for another example, is the responsibility of paramedics who could be called by relatives to the scene of a patient dying by choice? The new Oregon pioneers must blaze a trail through a medical and ethical wilderness. For the patient, these are the steps you probably will take: 1. You make the decision. Do you really want to end your life? You discuss your feelings and thoughts with your doctor, and the two of you talk about all of your options. To qualify under the Oregon Death With Dignity Act, you must: * Be 18 or older. * Be an Oregon resident. * Have a terminal illness. Further: * Your doctor and one other physician must determine that you have fewer than six months to live. * You must be free of mental illness, particularly depression, that impairs your decision to commit suicide. 2. You tell your doctor you want the medication necessary to commit physician-assisted suicide. This oral notification is the official beginning of the physician-assisted suicide process. According to the law's timing provisions, the soonest you could receive a lethal dose of medication is 15 days from this beginning. 3. Your doctor can do one of three things: * If assisted suicide is against his principles, he or she can refuse your request. You either must find another doctor yourself, or your doctor might help you find a physician willing to participate. * Your physician can talk you out of your decision. The law requires the doctor to tell you about alternatives to suicide, such as pain management, comfort care and hospice care. This discussion might persuade you to change your mind. * The physician can grant your request by allowing you to proceed. 4. The law requires the doctor to enter your request into your medical records and tell you that you can drop your request at any time and in any manner. Your doctor must then refer you to the second physician, who will determine whether the diagnosis is correct, that you have less than six months to live, that you are making the request voluntarily and that you are mentally capable of making the request. 5. If either doctor thinks you have a mental illness that impairs your decision, you will be referred to a psychologist or a psychiatrist who will examine you. 6. If the doctors find that you are acting voluntarily, your next step is to present a written request for life-ending medicine. The law includes a sample form to be used. It has blanks for your name, the disease and whether you have informed family members of the decision. Your signature must be witnessed by two people. Neither can be a doctor who is attending you. One witness must not be related to you by blood, marriage or adoption, must not be entitled to any part of your estate and must not own, operate or be employed by a health care center where you are a patient or resident. The witnesses are asked to declare that they know you, that you signed the document in their presence and that you appear to be making the request voluntarily and are not mentally ill or under undue influence from someone else. The document is entered in your medical records. 7. You have to wait at least 48 hours after the written request and at least 15 days after the oral request before you can get the prescription. Once the 15-day waiting period has passed, you must make a second oral request, and then the doctor must offer you an opportunity to back out. If you don't rescind your request, the doctor will write a prescription. The doctor will note on the prescription that it is written in accordance with the Death With Dignity Act. 8. You ask your doctor to discuss your case with the pharmacist before taking the prescription to the pharmacy. The pharmacist has the option of filling the prescription or declining to participate. The pharmacist who fills your prescription will counsel you on use of the medication. 9. After you receive your medication, you're on your own. The law doesn't require that your doctor be with you when you take the lethal dose. Undoubtedly, as you travel through the vast wilderness of physician-assisted suicide, these and other questions could occur: Q: Do I have to go to a doctor who specializes in physician-assisted suicide? A: No. You should go to your own "attending physician." The law defines that physician as the doctor who has primary responsibility for your care and the treatment of your terminal disease. If you are dying of cancer, for example, your attending physician is likely to be your oncologist. Q: My doctor refuses to participate in assisted suicide. Who can I turn to? A: Ask your doctor to refer you to another who can assume primary responsibility for your care and who is willing to work with you. Doctors are deeply divided on the issue of physician-assisted suicide, so be prepared to interview several doctors before finding one appropriate for your situation. If you have difficulty finding one, you can contact the Oregon chapter of the Hemlock Society, 1-503-297-1722. Q: My primary doctor is a naturopath. Can he perform physician-assisted suicide? A: No. The law allows only doctors of medicine or osteopathy (M.D. or D.O.) to write lethal prescriptions. Q: If I don't like the second opinion, can I get another? A: There's nothing in the law that prohibits you from seeking as many second opinions as you want. The only requirement is that you must have a second opinion that matches your attending physician's opinion that you are an appropriate candidate for assisted suicide. Q: Can I change my mind after I make the initial request? A: Absolutely. The law requires the physician to tell you on at least two different occasions that you have the right to rescind your request for lethal medication. You can withdraw your request at any time in any manner for any reason. And even after you get the medicine, you don't have to take it if you don't want to. Q: What happens if my doctor says I need counseling before proceeding? A: To write a lethal prescription, your doctor and your consulting physician must be convinced that your judgment isn't impaired by depression or another psychiatric or psychological disorder. Why? Depression is a mental disorder that can give you suicidal tendencies. Your doctors want to ensure that you are making an informed decision, not acting on impulses induced by mental disorder. Q: How do I find the right counselor? A: Ask your doctor for a referral to a trusted psychiatrist (M.D. or D.O.) or a psychologist (Ph.D.). These counselors can confirm or rule out a diagnosis of mental illness. If a counselor finds that your judgment is impaired, your doctor will not be allowed to give you a lethal prescription. Q: What kind of medicine will my doctor prescribe? A: The medicine will vary among patients and doctors, depending on individual circumstances. Nevertheless, doctors have said that an overdose of barbiturates probably would be used along with a drug to reduce nausea. Barbiturates depress the central nervous system, depress breathing, affect heart rate and decrease blood pressure and temperature. Q: Is there such a thing as a suicide pill? A: No. All medications are developed to cure disease and relieve symptoms and pain. Only when used inappropriately or in excess do some become deadly. Q: I'm homebound. Can someone else pick up my prescription for me? A: With regard to prescriptions, the law goes only up to the point at which the doctor writes the prescription. The law does not address the pharmacists' or the patients' responsibilities after the prescription is written. But there is nothing in the law to keep someone else from picking up your prescription for you. Q: Will the medicine hurt? A: Under normal circumstances, you will simply become unconscious and expire. Barbiturates have a bitter taste that is difficult to conceal. And you might become nauseated. But your doctor can give anti-nausea medication to take before consuming the lethal drugs. Q: Can I die in my home? A: Of course. The effect of the law is to allow patients to choose the time and circumstances of their deaths. You can choose to die, for example, surrounded by friends and family, or you can die alone. Q: May I choose to take the medicine in a hospital just in case something goes wrong? A: You should check first with a hospital representative. Some hospitals, particularly those operated by the Catholic Church, oppose assisted suicide and forbid their staffs and employees from being involved in any way. In any event, there is little that medical personnel could legally do to end your life if the suicide doesn't go as planned. The law forbids anyone from giving you a lethal injection, for instance, in case the prescription doesn't work. Medical personnel could provide the therapy they normally give for drug overdoses, however. Q: What if I can't swallow pills? A: In most cases the medication won't come in the form of pills. Normally, the pharmacist will open a large number of capsules and remove the powdered barbiturate. You would be told to mix the drug with some food -- pudding or applesauce -- to cloak the bitter taste. Q: Can I request a lethal injection? A: No. The law specifically prohibits lethal injections, mercy killing or active euthanasia. Q: What if I change my mind right after taking the medicine? A: Call 9-1-1 immediately. Q: Should I tell my family what I'm planning to do? A: That's up to you. Your doctor is required by law to ask you to notify your next of kin. But you are not required to comply with the request. Q: My mother is terminally ill, but she is too sick and disoriented to speak for herself. Does the law allow me to request physician-assisted suicide on her behalf? A: No. The requests must be made by the patient herself. The law, however, does not specifically address situations in which patients have signed over power-of-attorney to another person who has the legal authority to make decisions on his or her behalf. Q: My 18-year-old, terminally ill son wants to commit suicide. How can I stop him? A: You can't. Under the law, any Oregon adult resident, including 18-year-olds, can request lethal medication. But there's nothing in the law to prevent you or anyone else from counseling your son against taking his life. Q: Will my assisted suicide be covered by my health insurance? A: From a private insurance standpoint, there's no difference between office visits and prescriptions for physician-assisted suicide and for other medical purposes. As long as legitimate office visits and prescriptions are covered by a patient's insurance plan, the insurer is obligated to process the claims in the usual manner. The federal Medicare and Medicaid programs, however, probably will not cover the procedure, because the U.S. government has banned federal spending on assisted suicide, mercy killing and euthanasia. Q: Will my beneficiaries have any trouble collecting on my life insurance policy? A: Framers of the law have said they did not want assisted suicide to stand in the way of life insurance benefits. But there is no assurance of that other than a provision of the law stating that "a qualified patient's act of ingesting medication to end his or her life" shall have no "effect upon a life, health, or accident insurance or annuity policy." Q: I feel as though my doctor is trying to push me into assisted suicide against my will. What should I do? A: Physician-assisted suicide is entirely a matter of patient choice. If your physician's actions or words make you uncomfortable, contact the Oregon Board of Medical Examiners, 1-503-229-5770. The state licensing board regulates physicians in Oregon and will oversee physician activity under the Death With Dignity Act. Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=8767