Oregon takes stock of 'right to die' law

Ten years after Oregonians passed a controversial ballot measure allowing physicians to help some patients take their own lives, the records show that what critics feared has apparently not happened. No rush to end one's life, no people flocking here from other states, no pressure from family, doctors, and insurance companies to commit suicide.

Relatively few people opt to end their own lives by taking a doctor-prescribed drug, according to recently-released figures for 2006: 46 deaths last year, 292 overall since the law went into effect – about one-tenth of 1 percent of those diagnosed with terminal illnesses in Oregon.

Instead, palliative and hospice care have increased markedly here because the law helped raise awareness about caring for terminally ill patients. As a result, Oregon ranks among the best in the nation in end-of-life care. This means more people are looked after at home with the emotional and spiritual support of their families rather than spending their last days in a hospital.

"The practice has settled into a nice, safe, responsible, conservative record of aid-in-dying practice in the state," says Barbara Combs Lee, president of Compassion & Choices, a Denver-based advocacy group that supports physician-assisted suicide. "Once again, very, very few Oregonians have exercised their option under the law."

Although Oregon remains the only state to allow physician-assisted suicide, California is also moving in that direction, and the topic is being debated in Arizona, Vermont, and Washington. A bill sponsored by California Assembly Speaker Fabian Nunez (D) and other lawmakers patterns Oregon's "Death With Dignity Act."

The Oregon law specifically prohibits "lethal injection, mercy killing, or active euthanasia." But it does allow mentally competent adults who declare their intentions in writing, and have been diagnosed as terminally ill, to take a doctor- prescribed lethal drug themselves, orally, after a waiting period. The California proposal includes what supporters say are additional safeguards: requiring doctors to give patients a written summary of alternatives, and directing that those not under hospice care receive a psychological evaluation.

According to the Field Poll, 70 percent of all adults in California (including 59 percent of Republicans) believe that mentally competent patients diagnosed as incurably ill should have the right to ask for and get life-ending medication. Gallup and other national polls show that a majority of Americans favor the procedure, although it depends how the question is asked – particularly whether the word "suicide" is used.

When asked if doctors should be allowed to help end the life of a patient who is suffering from what's been diagnosed as an incurable disease and wants to die, 75 percent of Americans say "yes," reports Gallup. But when asked if doctors should be allowed to help a patient commit suicide under the same circumstances, the approval rate drops to 58 percent.

The 2006 Field Poll in California found that most Protestants (65 percent), Roman Catholics (64 percent), and even those identifying themselves as born-again Christians (54 percent) favor a choice in ending one's life.

Like abortion, stem-cell research, and the Terri Schiavo case, physician-assisted suicide is a hot-button issue for many religious people. Last August, Sen. Sam Brownback (R) of Kansas introduced the "Assisted Suicide Prevention Act," which would prohibit doctors from prescribing federally controlled substances to help people take their own lives.

"When the law permits killing as a medical treatment, society's moral guidelines are blurred, and killing could gain acceptance as a solution for the chronically ill or vulnerable," Senator Brownback said at the time."Doctor-assisted suicide could actually create a financial incentive for insurance companies to encourage prematurely ending the lives of those in need of long-term care."

The United States Supreme Court has moved carefully on the issue. It upheld state bans on the procedure, ruling that assisted suicide is not a constitutionally protected right. But the high court also ruled that the Bush administration exceeded its authority trying to overturn the Oregon law by arguing that prescribing a lethal drug violates the federal Controlled Substances Act.

Under carefully proscribed laws, such as Oregon's, most doctors say it is ethical to help people diagnosed as terminally ill take their own lives, according to a 2005 national survey of 1,088 physicians.

But in an amicus brief filed in one of the Supreme Court cases, the American Medical Association, the American Nurses Association, and the American Psychiatric Association warned that "physician-assisted suicide would create profound danger for many ill persons with undiagnosed depression and inadequately treated pain, for whom physician-assisted suicide rather than good palliative care could become the norm."

Past attempts to follow Oregon's lead in California and other states have failed.

California Gov. Arnold Schwarzenegger (R) wants the issue to go to the voters rather than through lawmakers. Vermont Gov. Jim Douglas (R) says the proposal there violates the Hippocratic oath, which says "I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect."

"There's no question that this topic stirs a lot emotion and a lot of debate," California Assembly Speaker Nunez said during a news conference announcing the proposed "California Compassionate Choices Act" last month. "I think when you pare it down to its essence, however, this is about how people are going to live the last days of their life."