Assisted Suicide in Oregon – Updated Facts re Safeguards

The State of Oregon (population 3.93 million) law allowing doctors to prescribe lethal overdoses for some patients’ suicides took legal effect late in 1997. Supporters often point to its safeguards operating well and having prevented abuse. In fact the data suggest that the “safeguards” are largely meaningless. The numbers of deaths under the Oregon Death with Dignity Act has greatly increased over the years.

  • In Oregon, 1545 lethal prescriptions have been written and at least 991 patients have ingested the drugs up to the end of 2015.
  • In 2015 there were 132 deaths, a 26% increase over 2014 and almost eight times the deaths in the law’s first full year.
  • All reporting about doctor-assisted deaths is self-reporting by the doctors prescribing lethal drugs.
  • Doctors cannot report reliably on the situation when patients actually ingest the lethal overdose and die, as nothing in the law requires them to be present. No one else who may be present is required to report.
  • In Oregon, the prescribing physician was present at the time of death in only 11% of cases in 2013 and 2015 and 14% in 2014, compared to an average of 16.5% in previous years.
  • From 1998 to 2012, on average only 6.2% of patients who died under the Act in Oregon were referred for counselling to check for “impaired judgment.” In 2013-2015 this declined to less than 4%.
  • Once lethal drugs have been prescribed the Act has no requirements for assessing the patient’s consent, competency, or voluntariness. No witnesses are required at the time of death.
  • In 2015, a clear majority were women (58%, compared to an average of 47% in past years).
  • Those dying under the law increasingly have no or only governmental health insurance – 56% in 2013, 60% in 2014, and 63% in 2015 (compared to an average of 35% in past years).
  • Inadequate treatment for pain or concern about it, is not among the top reasons for taking lethal drugs; in 2015, over 90% cite “losing the ability to engage in activities making life enjoyable” and “losing autonomy,” and 48% cite being a “burden” on family, friends or caregivers (compared to an average of 40% in past years).

Sources:

Oregon Death with Dignity Act: Data summaries 2013, 2014 and 2015. https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/ar-index.aspx

Secretariat of Pro-Life Activities, United States Conference of Catholic Bishops
http://www.usccb.org/issues-and-action/human-life-and-dignity/assisted-suicide/to-live-each-day/upload/Oregon-and-Washing-euthanasia-2013.pdf

 

Further articles

Articles in this section are ordered according to topic.

Disability


Dying/End of Life Experience


Euthanasia 


International


Medical/Palliative


Official Reports & Statements


Public Opinion/Discourse, Law


Suffering/Care/Compassion


Suicide/Assisted Suicide

Euthanasia in New Zealand

Over the last few years, there have been several events that have generated an active public discussion on euthanasia and assisted suicide in New Zealand. In 2012, then Labour List MP Maryan Street prepared a Private Members Bill, the "End of Life Choice Bill". It was subsequently withdrawn from the ballot box prior to the 2014 election campaign as the Labour Leadership did not want it debated during an election year.

Then, in 2015, Wellington lawyer Lecretia Seales, who was suffering from terminal brain cancer, sought a ruling from the High Court that "assisted dying" was not unlawful under the Crimes Act, and that a ban on "assisted dying" contravened her human rights under the New Zealand Bill of Rights Act 1990. The Court ruled that any assistance, whether in the form of assisted suicide or euthanasia by her doctor, would be unlawful and that the relevant provisions of the Crimes Act 1961 were consistent with the rights and freedoms contained in the Bill of Rights Act. It further suggested that changes to the law sought by Ms Seales could only be made by Parliament. Justice Collins referred specifically to the complexity and broad nature of the issues that are implicated in changing the law, stating that: "The complex legal, philosophical, moral and clinical issues raised by Ms Seales' proceedings can only be addressed by Parliament passing legislation to amend the effect of the Crimes Act.".

Following this ruling, a petition organised by the Voluntary Euthanasia Society (VES) was presented to Parliament in June 2015 by former MP and VES President Maryan Street and Matt Vickers, the husband of Lecretia Seales. It asked that the House of Representatives investigate public attitudes towards the introduction of legislation permitting "medically-assisted dying". The Select Committee investigated 1) factors that contribute to the desire to end one's life, 2) the effectiveness of services and support available to those who desire to end their own lives, 3) the attitudes of New Zealanders towards the ending of one's life and the current legal situation, and 4) international experiences.

ACT Party Leader and MP David Seymour submitted his own "End of Life Choice Bill" in October 2015. The key difference from Street's Bill was that it did not include End of Life care directives. While this Select Committee inquiry was still in process, Seymour's Bill was drawn from the private members ballot box on 8 June 2017. The Bill seeks to legalise euthanasia and assisted suicide in New Zealand for people 18 years and over with either a terminal illness or "grievous and irremediable medical condition" (effectively people with disabilities, chronic, and mental health conditions).

Meanwhile, the Health Select Committee have released their report on the VES petition in August 2017. The submission process received over 21,000 unique submissions from around the country between 27 August 2015 and 1 February 2016, and heard 944 oral submissions (read the submissions here). 80% of the submissions were opposed to the legalisation of euthanasia and assisted suicide in New Zealand. The Report echoed Justice Collins' observation that the issue "is clearly very complicated, very divisive, and extremely contentious", but made no clear recommendations about legislation on euthanasia or assisted suicide in New Zealand, stating that it was a usually a matter of a conscience vote. Instead, the Report encouraged "everyone with an interest in the subject to read the report in full, and to draw their own conclusions based on the evidence presented in it".

 Seymour's Bill had its first reading just before Christmas on the 13 Decmeber 2017. You can read the transcript or watch the videos from the first debate here. It is currently before the Justice Select Committee, who are receiving submissions from New Zealanders. It is important that as many people as possible make a submission to state their opposition to the Bill. The submissions are a chance for you to tell the Committee what you think about the Bill and euthanasia. This will inform their report back to Parliament, and will influence MPs and how they vote in the second reading. For more information on making a submission, click here.

It is also important to understand that personal choices that people make are always contextually bound. The current New Zealand context, characterised as it is by 'functionalism', increasing ageism that is manifesting itself in growing elder abuse and an increase in the social isolation of the elderly, and a deficit understanding and fear of disability means, in our view, that there has never been a more dangerous time to make suicide and/or euthanasia more easily available.

The answer to the existential suffering that many people experience, and which drives requests for euthanasia and assisted suicide in overseas jurisdictions, is not to make it easier for people to end their lives but to continue to improve access to palliative care for all New Zealanders. It is our informed view that when all of the risks are objectively assessed and weighed up, any perceived benefits for a small minority of persons would be far outweighed by far larger numbers being exposed to the very real dangers of a premature death.

 

The current legal status quo remains the most responsible option for New Zealand at this time.

 

 

Download: Quick Facts: Euthanasia and Assisted Suicide.

 


 

Quote 20

The most accurate predictors of a persistent request for euthanasia are not related to physical pain but to depression accompanied by feelings of hopelessness and/or a sense of social isolation.

Quote 19

One in every 45 deaths in the Netherlands comes about through euthanasia. In New Zealand this would translate to 700 deaths per year.

Quote 18

Once you open the door to assisted suicide and euthanasia it always becomes wider and wider and wider, and before you know it what starts as an option for a few becomes what’s expected for the many. - Alex Schadenberg

Quote 17

“The disabled are typically ‘in the front line’ when it comes to euthanasia. It’s very clear to me that when people talk about the right to die, it’s very quick for others to start talking about the need to die.” Kevin Fitzpatrick, Not Dead Yet

Quote 16

I am firmly against euthanasia because it is not physical suffering that guides the desire to die but a moment of discouragement, feeling like a burden … All those who ask to die are mostly looking for love. - Maryannick Pavageau - suffers from locked-in syndrome for 30 years

Quote 15

 

Requests for euthanasia soon after a stroke or accident are not well-informed … many patients come to find happiness in ways that we simply cannot imagine. - Dr Steven Laureys

Quote 14

Legalising euthanasia will create new pathways of abuse for the elderly and disabled.

Quote 13

Expanding one freedom often limits another … Expanding personal freedom to include assisted suicide undermines another right – to remain alive without having to justify one’s existence. - Mark Blocher

Quote 12

 

Euthanasia: The right to die will all too quickly become a duty to die.

Quote 11

How people die remains in the memory of those who live on. - Dame Cecily Saunders

Quote 10

Euthanasia will inevitably be practised through the various prisms of social inequality and bias that characterise the delivery of social and health services in our country.

Quote 9

Euthanasia will ultimately decrease the choices people have for treatment at the end of life because it will blunt clinical practice.

One in 20 medical diagnoses are wrong.

Euthanasia must be distinguished from the administration of pain relief that may have the foreseen but unintended effect of shortening a person’s life.

Euthanasia must be distinguished from the withholding or withdrawing of medically futile or burdensome treatment.

A person in pain constitutes a medical crisis not a reason for euthanasia.

The Dutch experience has shown that the acceptance of death as a medical solution is suppressing the performance of doctors and nurses in critical situations when life is threatened but can still be saved. - Dr. Richard Fenigsen

Twenty to 40 percent of medical diagnoses prove wrong when confronted with the ultimate criterion of truth, the autopsy. This means that the license to cause deaths on the grounds of medical diagnoses can lead to tragic mistakes. - Dr. Richard Fenigsen

Legalisation of euthanasia results in normalisation.

If euthanasia is a ‘right’ then it must be universal … and if it is universal then we can’t deny it to anyone. Once we allow it for some circumstances then, over time, we will have to allow it for many.

NZ Catholic Bishops message

[27 September 2013] 

In 2012 Labour MP Maryan Street prepared a Private Members Bill, the “End of Life Choice Bill”. The NZ Catholic Bishops sent the following letter to NZ Catholics in response to the Bill. The Bill was subsequently withdrawn from the private members ballot box in 2013 in order to avoid a controversial debate during election year. 

Dear Fellow New Zealanders,

The present attempt to make euthanasia and assisted-suicide legal in New Zealand is a matter of extremely serious concern. We want to encourage you to take the time to become fully informed about this very important issue.

There are many reasons why people object to legalising euthanasia and/or assisted-suicide. While these can include religious and moral ones, our concern is to point out the social dangers of such a law change.

Many people from a variety of personal and professional backgrounds share our concern that a law change would introduce a new and dangerous dimension to our society.

The legalisation of euthanasia would:

  • send a message that the lives of some people are not worth living
  • mean the sick, elderly, disabled and dying would too easily see themselves as a financial and/or emotional burden on their families and communities
  • put further pressure on elderly people at a time when elder abuse is a growing problem
  • send a mixed message about suicide when youth suicide remains at critical levels in New Zealand, well above all other countries in the OECD
  • undermine trust in the medical profession and put pressure on doctors and nurses to act against their consciences.

Legalising euthanasia would place the lives of vulnerable people at risk, including those whom others might be tempted to think would be better off dead. For some people, it will undermine their choice to live. The mark of a good society is its ability and willingness to care for those who are most vulnerable. The current law offers people who are dying the best protection and provides the best motivation and conditions for quality palliative care.

We urge you to make your views known, especially to your local Member of Parliament.

 

 

Baroness the Professor Ilora Finlay being interviewed by Kim Hill

Ethics and Euthanasia - A Debate that Never Dies

Call to Action – What you can do

 

  • Find out as much as possible about the issue.
  • Talk about euthanasia with your family and friends.
  • Discuss the issue in the workplace and in other groups you are involved in.
  • Write a personalised letter to your local Member of Parliament using your own words and selecting 3 or 4 arguments. Avoid the use of form letters.
  • Visit your Member of Parliament to express your view – stick to the issue and do not mix it up with other issues.

 How to write to your MP:

  • Make sure you have the MP’s name and title correct and address him/her accordingly (Titles of MPs are available on the parliamentary website)
    (See:Members of Parliament)
  • Introduce your topic: Re: …………. so the recipient knows what you are writing about.
  • Introduce yourself and your interest in the topic.
  • Avoid religious or moralistic language. Be factual.
  • Make your points as succinctly as possible – keep to one page or less.
  • If you are quoting from documents or Bills etc., include references
  • Be polite – even if you feel very strongly on the issue. Abuse is not acceptable. 
  • Sign the letter.
  • You are able to write to any MP free of charge at:

Freepost Parliament
Parliament Buildings
Private Bag 18-888
Wellington 6140  

 

 

The Dangers of Euthanasia - key arguments



  • The key issue is not compassion or morality – people on both sides of the debate want to prevent intolerable suffering. The key issue is the long-term consequences of a law change for public safety. This is an issue of social justice – protecting the vulnerable.
  • Changing the law would send a message that the lives of some are not worth living – it will steer persons towards a premature death.
  • Allowing PAE/PAS opens the door for the disabled, sick and elderly to see themselves as an excessive financial and emotional burden. The 'right to die' could very quickly become a 'duty to die'. No legislation can protect against this.
  • Good clinical care aims to eliminate the pain, not kill the patient. The NZ Medical Association, the Society of Palliative Medical Physicians & Palliative Care Nurses New Zealand Society all oppose a law change.
  • The fact that PAE and PAS are illegal means maximum efforts are made to relieve pain and address all aspects of a person's suffering. Will this still occur if the law is changed?
  • We should not ask doctors, who have a duty of care, to be involved in killing their patients.
  • When seriously ill patients receive good palliative care they rarely want to end their lives.
  • It is neither possible nor rational to limit PAE or PAS to particular groups of people or specific conditions. There would be the same erosion of boundaries here in New Zealand as has occurred overseas.
  • Legalising voluntary PAE/PAS paves the way for euthanasia without request or consent.
  • The legalising of PAE and PAS, especially for irreversible and unbearable mental conditions, accepts that 'some suicides are okay'. This risks sending a 'mixed message' regarding the tragedy of youth suicide and creates a confusing double standard.
  • Suicidal thoughts are usually associated with depression. Research shows that when depression is properly treated, most people change their minds about wanting to die.
  • Many assume that changing the law will simply allow the very small number of high-profile cases to proceed without legal objection. In fact, 'legalisation leads to normalisation' and, as has happened overseas, will lead to greatly increased numbers dying that way.
  • Abuse of the disabled and elderly is a serious issue in our country. Legalising euthanasia puts the elderly at further risk, especially in a society where the numbers of elderly are growing and there is increasing pressure on the health budget.
  • New Zealand abolished the death penalty in large part because of the danger of executing even one innocent person. Legalising PAE/PAS will inevitably lead to some people being killed ‘when they don’t want to die’.
  • These days no-one need die in pain. Persistent requests for euthanasia are mostly related not to unrelieved pain but to a desire to be in control, a fear of being a burden or the experience of social isolation. Euthanasia is not the right or best response to these issues.
  • Changing the law would create a legal situation in which the state licenses death in advance and sanctions the death of certain of its citizens.
  • Legalising PAE/PAS undermines the long-standing convention against killing persons.
  • The law already has the ability to show compassion to people who, in a state of anguish find themselves involved in assisting a suicide.
  • Changing the law will not mean an end to such cases going to court as it could still be difficult to distinguish between an assisted suicide and a murder.
  • Granting a very small and vocal minority the choice to be killed will undermine the choice and/or will of many others to live. 

 

 

 

 

End of Life Choice Bill - Key Facts

 

In October 2015, ACT Party Leader and MP David Seymour submitted his "End of Life Choice Bill" to the private members ballot, five months after the Seales vs. Attorney General high court case and only weeks after the submission of a petition from the Voluntary Euthanasia Society calling for an investigation into euthanasia and assisted suicide. Seymour's Bill was drawn from the ballot box on 8 June 2017 and currently awaits its first reading, which will occur sometime in the 52nd Parliament after the 2017 election on 23 September. Some key features of the bill are that it.

  • provides for both physician-assisted euthanasia (PAE) and physician-assisted suicide (PAS)
  • places doctors at the centre of euthanasia and assisted suicide, contradicting the ethical stance of key medical groups such as the New Zealand Medical Association, Australia and New Zealand Society of Palliative Medicine, Palliative Care Nurses New Zealand, as well as the World Medical Association
  • includes any competent persons aged 18 years suffering from "a grievous and irremediable medical condition; and... is in an advanced state of irreversible decline in capability; and experiences unbearable suffering that cannot be relieved in a manner that he or she considers tolerable..."
  • allows for "unbearable suffering" to be self-defined
  • does not require the person receive, or even have access to, appropriate medical, psychiatric or palliative care
  • would make PAE or PAS available to a range of persons not actually dying
  • does not oblige persons to talk to anyone other than the facilitating doctor
  • would include intellectual and physical disability as well as mental illness and the increasing frailty of old age
  • places responsibility for PAE/PAS on the shoulders of doctors but does not require the administering doctor to have any prior knowledge of the applicant as a patient
  • allows for a lethal prescription for PAS to be provided 6 months or more before the person is likely to die, even though doctors cannot predict when death will occur with any degree of certainty even when it is imminent. Once a prescription for PAS is granted, all safeguards and monitoring cease. There is no way to monitor its use. It would be impossible to know if a person struggled or was coerced into taking the medication
  • asks doctors to record on the death certificate the underlying illness or condition as the cause of death when in fact this would not be the case at all.

 Read the bill (pdf)

 

Download "Quick Facts: Euthanasia and Assisted Suicide" (pdf)

 

 

 

 

Understanding the issue

 
What is euthanasia?

An act which of itself and by intention causes the death of another person in order to eliminate their suffering. Medically assisted euthanasia (or Physician Assisted Euthanasia, PAE) refers to an act undertaken by a physician or other health professional.

What is assisted suicide?

This happens when a person commits suicide with assistance from others, often by self-administering a lethal substance that has been obtained with the assistance of a third party.

What is physician-assisted suicide?

Physician-assisted suicide (PAS) refers to a situation where a doctor prescribes or provides a lethal substance to a person which they can then take themselves at some later time when they decide to end their life.

Withholding or withdrawing treatment is not euthanasia

When a treatment is judged to be medically futile, or when the benefits of a particular treatment are deemed to be outweighed by the burdens for a particular person, it is a question of accepting the inevitability of death and allowing the person to return to their dying.

The New Zealand Code of Health and Disability Services Consumers' Rights allows for any person to refuse services and to withdraw consent to services.

People have a right to be free of pain

When a health professional administers medication with the sole intention of relieving a patient's pain, that action is morally acceptable even if it foreseeably shortens the patient's life. This is not an act of (slow) euthanasia as some claim.

 

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