Slippery Slope and Assisted Suicide in Oregon

An opinion piece in yesterday’s National Post argues against the Canadian federal government's position against physician assisted suicide. The author makes many dubious claims, but there is one that clamours to be addressed. He says that 17 years of legal assisted suicide in Oregon disproves the slippery slope argument. He explains how there is no data showing abuse. His statements are not accurate.

No Proper Data

The Oregon system has not been designed to show problems. In an excellent in-depth analysis, the Disability Rights Education & Defense Fund (DREDF) shows that data collection is minimal and there is a “gross lack of oversight”. They point out that:

  1. There are no teeth to the reporting requirements - While in theory the law requires physicians to report prescription of lethal drugs, in practice, there is no penalty for those who do not.
  2. Non-Compliance isn’t monitored - While there is a legal requirement for annual statistical reports, there is no monitoring of under-reporting, noncompliance, or violations. The annual reports add a disclaimer to the effect that the numbers are based on “a reporting system for terminally-ill patients who legally receive prescriptions for lethal medication, and do not include patients and physicians who may act outside of the law”.
  3. Important questions aren’t asked - It is impossible to get a true picture of the situation in Oregon because there is a lot of missing information. We cannot know how many requests for assisted suicide are made and how many were turned down because the data isn’t there. As the data for the annual reports comes from questionnaires and phone interviews conducted with doctors who wrote lethal prescriptions, doctors who may have advised against assisted suicide, or psychiatrists who may have evaluated the individuals are not polled. Nurses, families and friends of the patients aren’t questioned either. What’s more, “the law does not require autopsies to determine if deceased patients were actually terminally ill”.
  4. Abuse is not investigated - While cases of abuse are reported in the media or documented by others the State does not investigate these cases. The public cannot report abuse as there is no reporting system. Further, the State says it has neither the resources nor the authority to investigate cases of abuse.
  5. The data is destroyed annually - State officials admit that the reports’ underlying data is destroyed every year, making it impossible for anyone to go back and verify accuracy or to conduct long-term analysis.

Theory vs Practice of Physician Assisted Suicide in Oregon

In another document, DREDF contrasts the theory against the practice of physician assisted suicide in Oregon (PDF)

6 Months to Live

  • Over one quarter of physicians willing to write a lethal prescriptions admit that they can’t be confident the patient only has 6 months to live.
  • The number of days between the initial request and death ranges from 15 to 466 days.
  • 13% of patients admitted to hospice are discharged alive. Hospice admission in Oregon requires a prognosis of less than 6 months’ survival.

Mental Competence

  • In at least one case, the patient was found to “lack capacity” by a psychiatrist and to have “cognitive deficits” by a psychologist, but the doctor wrote a lethal prescription regardless.

Unbearable Pain

  • None of the first 208 cases of assisted suicide in Oregon were due to pain. About 20% of patients reported fearing future pain.
  • In 2013, the 3 main reasons cited for requesting assisted suicide were: Loss of autonomy, decreased ability to participate in life’s activities, and loss of dignity.

The Slippery Slope Is Indeed an Issue

We cannot rely on the official reports on assisted suicide in Oregon to paint a true and accurate picture of what has been happening there in the last 17 years. We cannot ignore the cases reported in the media. We simply cannot blithely pretend that there is no risk.