Sledding in Oregon

On 8 November, voters in Oregon made their state the first in the nation to legalize physicians' directly helping patients to die. By a 32,000 vote margin (51 to 49 percent) they approved Measure No. 16, which removes criminal penalties for physicians who prescribe drugs to enable people to take their own lives. Eight days later, a jury in Saskatchewan found Robert Latimer guilty of second degree murder for killing his severely handicapped daughter Tracy.[1] Though the circumstances in that case seem a world away from the new Oregon law, the changes in community and professional norms inherent in the Oregon act may well push the law beyond its enacted confines with profound consequences for future Latimer-type cases. Ballot Measure 16 Oregon was the third state to have a Death with Dignity Act on its election ballot in this decade. Initiative measures with the same names were defeated in Washington State in 1991 and California in 1992, both by 54 to 46 percent, despite repeated polls that show strong public support for physician assistance to bring a speedy and pain-free death. Analyzing those prior votes, proponents concluded that die electorate wanted stronger safeguards and more limited power for physicians. Giving doctors a lesser role than had the neighboring states' proposals (which allowed active euthanasia), the Oregon act legalizes physician-assisted suicide but leaves patients to perform the final act. The law applies only to residents of Oregon eighteen years of age or older who have "the ability to make and communicate health care decisions," including "communication through persons familiar with [their] manner of communicating if those persons are available" [section] 1.01 (6)]. To be "qualified" to receive a lethal prescription, the person must also be suffering from a terminal disease, which is defined as "an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six (6) months" [section] 1.01(12)]. Beyond these requirements, the statute contains four principal "safeguards." First, the attending physician must convey information not only about the diagnosis and prognosis and the risks and results of taking the prescribed medication, but also "the feasible alternatives, including, but not limited to, comfort care, hospice, and pain control" [section] 3.01 (2)]. The physician must ask the patient to notify next of kin of his or her plans but may not deny the request for medication because a patient "declines or is unable" to do so [section] 3.05]. Second, a consulting physician must confirm that the patient has a terminal illness, is capable, and has made a voluntary and informed decision [section] 3.02]. Third, if either the attending or consulting physician thinks the patient suffers from a psychiatric disorder, including "depression causing impaired judgment," the patient must be referred for "counseling." Lethal medication may then not be prescribed until a licensed consultant rules out such a disorder or depression [section] 3.03]. Finally, a person wishing to commit suicide must make a series of oral and written requests to that effect. At least fifteen days must elapse between the initial oral request and the one that immediately precedes the writing of the prescription, and sometime between the two oral requests - and no less than forty-eight hours before the prescription - the patient must execute a written request for medication, witnessed by at least two people who can attest to the patient's apparent decisionmaking capacity and voluntary, uncoerced decision. Mirroring advance directive statutes, the Oregon law proscribes the attending physician's being a witness, and at least one of the witnesses must be disinterested, in the sense of not being a relative, someone entitled to a portion of the estate, or an owner or employee of a health care facility where the patient resides or receives care [section] 2. …