Friday, August 31, 2012

New England Journal of Medicine Article Misleading

Dear Editor:

I am a lawyer in Washington State, one of two states where assisted-suicide is legal.  The other state is Oregon, which has a similar law.  Lisa Lehmann's article, "Redefining Physicians' Role in Assisted Dying," is misleading regarding how these laws work.

First, the Oregon and Washington laws are not limited to people in their "final months" of life.[1,2]  Consider for example, Jeanette Hall, who in 2000 was persuaded by her doctor to be treated rather than use Oregon's law.  She is alive today, twelve years later.[3]

Second, these laws are not "safe" for patients.[4][5]  For example, neither law requires a witness at the death.  Without disinterested witnesses, the opportunity is created for the patient's heir, or someone else who will benefit from the patient's death, to administer the lethal dose to the patient without his consent.  Even if he struggled, who would know?  

Third, the fact that persons using Oregon's law are "more financially secure" than the general population is consistent with elder financial abuse, not patient safety.  Do not be deceived. 

* * *

[1]  Margaret K. Dore, "Aid in Dying: Not Legal in Idaho; Not About Choice," The Advocate, official publication of the Idaho State Bar, Vol. 52, No. 9, pages 18-20, September 2010, available at http://www.margaretdore.com/pdf/Not_Legal_in_Idaho.pdf.
[2]  Kenneth Stevens, MD, Letter to the Editor, "Oregon mistake costs lives," The Advocate, official publication of the Idaho State Bar, Vol. 52, No. 9, pages 16-17, September 2010, available athttp://www.margaretdore.com/info/September_Letters.pdf 
[3]  Ms. Hall corresponded with me on July 13, 2012.
[4]  See article at note 1.  See also Margaret Dore, "Death with Dignity": A Recipe for Elder Abuse and Homicide (Albeit Not by Name)," at 11 Marquette Elder's Advisor 387 (Spring 2010), original and updated version available at http://www.choiceillusion.org/p/the-oregon-washington-assisted-suicide.html 
[5]  Blum, B. and Eth, S.  "Forensic Issues: Geriatric Psychiatry." InKaplan and Sadock's Comprehensive Textbook of Psychiatry, Seventh Edition, B. Sadock and V. Sadock editors.  Baltimore, MD: Lippincott, Williams and Wilkins, pp. 3150-3158, 2000. 

Thursday, January 19, 2012

Ken Stevens MD: "legalizing assisted suicide can result in decreased patient choice"

Assisted Suicide
http://www.sltrib.com/sltrib/opinion/53280042-82/suicide-patients-assisted-oregon.html.csp

Updated Jan 19, 2012 01:01AM

Patty Henetz' "Do Utahns have the right to choose how they die?" (Tribune, Jan. 8) refers to the legalization of assisted suicide in Oregon. Utahns should understand that legalizing assisted suicide can result in decreased patient choice.

I have been a cancer doctor in Oregon for more than 40 years. The combination of assisted-suicide legalization and prioritized medical care based on prognosis has created a danger for my patients on the Oregon Health Plan (Medicaid).

The plan limits medical care and treatment for patients with a 5 percent or less likelihood of surviving five years. Patients in that category who have a good chance of living another three years and who want to live cannot receive surgery, chemotherapy or radiation therapy. However, the plan will cover the patient's suicide.

Oregon law says only patients with no more than six months to live are eligible for voluntary suicide, but the plan nonetheless offers suicide to patients in this category.

The mere presence of legal assisted suicide steers patients toward suicide. One patient was adamant to use the law. I convinced her to be treated. Eleven years later she is thrilled to be alive.

Kenneth Stevens, M.D.

Sherwood, Ore.

Saturday, January 14, 2012

What People Mean When They Say They Want to Die

(originally published as a Statement for the BBC)

For a print version, click here

by William Toffler, MD
______________________________________________

There has been a profound shift in attitude in my state since the voters of Oregon narrowly embraced assisted suicide 11 years ago.  A shift that, I believe, has been detrimental to our patients, degraded the quality of medical care, and compromised the integrity of my profession. 

Since assisted suicide has become an option, I have had at least a dozen patients discuss this option with me in my practice.  Most of the patients who have broached this issue weren't even terminal. 

One of my first encounters with this kind of request came from a patient with a progressive form of multiple sclerosis.  He was in a wheelchair yet lived a very active life. In fact, he was a general contractor and quite productive.  While I was seeing him, I asked him about how it affected his life.  He acknowledged that multiple sclerosis was a major challenge and told me that if he got too much worse, he might want to “just end it.” “ It sounds like you are telling me this because you might ultimately want assistance with your own assisted suicide- if things got a worse,” I said.  He nodded affirmatively, and seemed relieved that I seemed to really understand.

I told him that I could readily understand his fear and his frustration and even his belief that assisted suicide might be a good option for him. At the same time, I told him that should he become sicker or weaker, I would work to give him the best care and support available. I told him that no matter how debilitated he might become, that, at least to me, his life was, and would always be, inherently valuable. As such, I would not recommend, nor could I participate in his assisted-suicide.  He simply said, "Thank you."

The truth is that we are not islands.  How physicians respond to the patient’s request has a profound effect, not only on a patient's choices, but also on their view of themselves and their inherent worth.

When a patient says, "I want to die"; it may simply mean, "I feel useless."

When a patient says, "I don't want to be a burden"; it may really be a question, "Am I a burden?"

When a patient says, "I've lived a long life already"; they may really be saying, "I'm tired.  I'm afraid I can't keep going."

And, finally, when a patient says, "I might as well be dead"; they may really be saying, "No one cares about me."

Many studies show that assisted suicide requests are almost always for psychological or social reasons.  In Oregon there has never been any documented case of assisted suicide used because there was actual untreatable pain.[6]  As such, assisted suicide has been totally unnecessary in Oregon. 

Sadly, the legislation passed in Oregon does not require that the patient have unbearable suffering, or any suffering for that matter.  The actual Oregon experience has been a far cry from the televised images and advertisements that seduced the public to embrace assisted suicide.  In statewide television ads in 1994, a woman named Patty Rosen claimed to have killed her daughter with an overdose of barbiturates because of intractable cancer pain.  This claim was later challenged and shown to be false.  Yet, even if it had been true, it would be an indication of inadequate medical care- not an indication for assisted suicide.

Astonishingly, there is not even inquiry about the potential gain to family members of the so-called "suicide" of a "loved one." This could be in the form of an inheritance, a life insurance policy, or, perhaps even simple freedom from previous care responsibilities.

Most problematic for me has been the change in attitude within the healthcare system itself. People with serious illnesses are sometimes fearful of the motives of doctors or consultants.  Last year, a patient with bladder cancer contacted me.  She was concerned that an oncologist might be one of the "death doctors."  She questioned his motives—particularly when she obtained a second opinion from another oncologist which was more sanguine about her prognosis and treatment options.  Whether one or the other consultant is correct or not, such fears were never an issue before assisted suicide was legalized. 

In Oregon, I regularly receive notices that many important services and drugs for my patients-even some pain medications-won't be paid for by the State health plan.  At the same time, assisted suicide is fully covered and sanctioned by the State of Oregon and by our collective tax dollars.

I urge UK leaders to reject the seductive siren of assisted suicide.  Oregon has tasted the bitter pill of barbiturate overdoses and many now know that our legislation is hopelessly flawed.  I believe Great Britain, the birthplace of Dame Cicely Saunders, and the Hospice movement, and a model to the rest of the world, deserves better.

On May 12, 2006

"The mere presence of legal assisted-suicide steers patients to suicide"

November 27, 2011

To Massachusetts Medical Society 


Dear House of Delegates Officers and Other Interested Parties:

I understand that the Massachusetts Medical Association will be voting on changing its policy against physician-assisted suicide. I have been a cancer doctor in Oregon for more than 40 years.  The combination of assisted-suicide legalization and prioritized medical care based on prognosis has created a danger for my patients on the Oregon Health Plan (Medicaid).

The Plan limits medical care and treatment for patients with a likelihood of a 5% or less 5-year survival.  My patients in that category, who say, have a good chance of living another three years and who want to live, cannot receive surgery, chemotherapy or radiation therapy to obtain that goal.  The Plan guidelines state that the Plan will not cover “chemotherapy or surgical interventions with the primary intent to prolong life or alter disease progression.”  The Plan WILL cover the cost of the patient’s suicide.

Under our law, a patient is not supposed to be eligible for voluntary suicide until they are deemed to have six months or less to live.  In the well publicized cases of Barbara Wagner and Randy Stroup, neither of them had such diagnoses, nor had they asked for suicide.  The Plan, nonetheless, offered them suicide.

In Oregon, the mere presence of legal assisted-suicide  steers patients to suicide even when there is not an issue of coverage.  One of my patients was adamant she would use the law.  I convinced her to be treated.  Eleven years later she is thrilled to be alive.  Please, don’t let assisted suicide come to Massachusetts.

 [Support for this letter regarding Barbara Wagner and Randy Stroup can be found in these articles:  http://www.katu.com/news/26119539.html & http://abcnews.go.com/Health/story?id=5517492&page=1  My patient’s letter in the Boston Globe describing her being alive 11 years later can be read here:
http://articles.boston.com/2011-10-04/bostonglobe/30243525_1_suicide-doctor-ballot-initiative   ]

Kenneth R.Stevens, Jr., MD
Sherwood, OR 

Professor Emeritus and former Chair, Radiation Oncology Department, Oregon Health & Science University, Portland, Oregon

Don't Follow Oregon's Lead: Say No to Assisted Suicide

 http://www.margaretdore.com/info/Bentz_Letter.pdf

I am an internal medicine doctor, practicing in Oregon where assisted suicide is legal.  I write in support of Margaret Dore's article, "Aid in Dying: Not Legal in Idaho; Not About Choice."  I would also like to share a story about one of my patients.

I was caring for a 76 year-old man who came in with a sore on his arm. The sore was ultimately diagnosed as a malignant melanoma, and I referred him to two cancer specialists for evaluation and therapy. I had known this patient and his wife for over a decade. He was an avid hiker, a popular hobby here in Oregon. As he went through his therapy, he became less able to do this activity, becoming depressed, which was documented in his chart.

During this time, my patient expressed a wish for doctor-assisted suicide to one of the cancer specialists. Rather than taking the time and effort to address the question of depression, or ask me to talk with him as his primary care physician and as someone who knew him, the specialist called me and asked me to be the "second opinion" for his suicide. She told me that barbiturate overdoses "work very well" for patients like this, and that she had done this many times before.


I told her that assisted-suicide was not appropriate for this patient and that I did NOT concur. I was very concerned about my patient's mental state, and I told her that addressing his underlying issues would be better than simply giving him a lethal prescription. Unfortunately, my concerns were ignored, and approximately two weeks later my patient was dead from an overdose prescribed by this doctor. His death certificate, filled out by this doctor, listed the cause of death as melanoma.

The public record is not accurate. My patient did not die from his cancer, but at the hands of a once-trusted colleague. This experience has affected me, my practice, and my understanding of what it means to be a physician. What happened to this patient, who was weak and vulnerable, raises several important questions that I have had to answer, and that the citizens of Idaho should also consider:

        * If assisted suicide is made legal in Idaho, will you be able to trust your doctors, insurers and HMOs to give you and your family members the best care? I referred my patient to specialty care, to a doctor I trusted, and the outcome turned out to be fatal.
        
        * How will financial issues affect your choices? In Oregon, patients under the Oregon Health Plan have been denied coverage for treatment and offered coverage for suicide instead. See e.g. KATU TV story and video at
http://www.katu.com/home/video/26119539.html  (about Barbara Wagner). Do you want this to be your choice?

        * If your doctor and/or HMO favors assisted suicide, will they let you know about all possible options or will they simply encourage you to kill yourself?  The latter option will often involve often less actual work for the doctor and save the HMO money.

In most states, suicidal ideation is interpreted as a cry for help. In Oregon, the only help my patient received was a lethal prescription, intended to kill him.

Is this where you want to go? Please learn the real lesson from Oregon. Despite all of the so-called safeguards in our assisted suicide law, numerous instances of coercion, inappropriate selection, botched attempts, and active euthanasia have been documented in the public record.

Protect yourselves and your families. Don't let legalized assisted suicide come to Idaho.

Charles J. Bentz MD, FACP
Clinical Associate Professor of Medicine, Division of General Medicine and Geriatrics Oregon Health & Sciences University
Portland Oregon

Oregon Doctor Finds Fault with State's Law

http://www.boston.com/bostonglobe/editorial_opinion/letters/articles/2011/10/04/oregon_doctor_finds_fault_with_states_law/ 
  +
I am a doctor practicing medicine in Oregon and Washington, where physician-assisted suicide is legal. I disagree with Scot Lehigh that these suicides are not like other suicides in which “a healthy person [takes] his life for reasons of despair, depression, or hopelessness’’ (“Death with dignity in Mass.,’’ Op-ed, Sept. 23).

First, doctors can be wrong. So, what looks like a few months to live can be years. For a good article on this subject, see Nina Shapiro’s January 2009 "Terminal Uncertainty" in the Seattle Weekly.

Second, despair, depression, and hopelessness are a part of assisted suicide. A few years ago, a patient of mine who was undergoing cancer treatment with a specialist became depressed, and expressed a wish for assisted suicide.

In most jurisdictions, suicidal ideation is interpreted as a cry for help. In Oregon, the only help my patient got was a lethal prescription intended to kill him.  Don’t make our mistake. Keep assisted suicide out of Massachusetts.

Dr. Charles J. Bentz
Portland, Ore.
The writer is an associate professor of medicine in the division of general medicine and geriatrics at Oregon Health & Science University.