The witness of choice for the proponents of assisted suicide in Vermont seems to be George Eighmey, a lawyer, not a doctor. Below, in italics, is what Kenneth Stevens MD, who has practiced medicine in Oregon for 40 years, told the Human Services Committee about, among other things, Eighmey, his advocacy organization, Compassion and Choices, and its role in facilitating assisted suicide deaths in his state. It is so important for the people of VT to know that most Oregon doctors refuse to assist in suicides, but that their right to refuse is under threat from Compassion and Choices.
As for patients, Dr. Stevens has learned from experience what True Dignity has always believed: the mere presence of legal assisted suicide steers people to suicide. It is the worst kind of doublespeak to assert, as Attorney General Sorell did in his testimony this week, that assisted suicide is a human right. Dr. Stevens’ testimony exposes it as actually the worst kind of violation of human rights.
Telephone and Written Testimony to Vermont Legislature, April 11, 2013
by Dr. Kenneth R. Stevens, Jr. MD, Radiation Oncologist,
Oregon Health & Science University, Portland, Oregon
President, Physicians for Compassionate Care Education Foundation www.pccef.org
I have been following the experience with legalized physician-assisted suicide in Oregon since 1994. I am a cancer doctor with more than 40 years’ experience in Oregon, where physician-assisted suicide is legal. I am also a Professor Emeritus and former chair of the Department of Radiation Oncology at Oregon Health and Science University.
My Personal Story
I first became involved with assisted-suicide in 1982, shortly before my first wife died of cancer. We had just made what would be her last visit with her doctor. As we were leaving the office, he said that he could provide her with an extra-large dose of pain medication. She said she did not need it because her pain was under control. As I helped her to the car, she said “Ken, he wants me to kill myself.” It devastated her that her doctor, her trusted doctor would suggest that she kill herself. Two weeks later she peacefully died in our home without pain, and with dignity.
Physician’s Role
I did not go into medicine to kill people. I went into medicine to help and care for people. Physician assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.
Suicide
When a person expresses a desire to take their own life, society acts to protect that person from committing suicide. However, when assisted suicide is legalized, society then acts to assist that person in committing suicide. This is especially true for those who are seriously ill or have disabilities – they have lost society’s protection against suicide.
The legalization of assisted suicide does not give any new rights to patients. Its purpose is to legally protect doctors who write prescriptions for lethal drugs.
Euphemisms
The strategies and methods of pro assisted suicide organizations are to use euphemisms. In his 1993 book “Lawful Exit”, Derek Humphry, founder of the Hemlock Society, devoted a chapter title “Doublespeak” to the importance of language. But assisted suicide is suicide.
Pain is Not the Issue
Pain can be controlled. Uncontrolled pain in the terminally ill rarely occurs. In Oregon only a very small minority or patients dying of assisted suicide chose it because of fear of pain in the future. This was not because they were having current pain.
“Terminal” Patients Steered to Suicide
In Oregon, the assisted suicide law applies to patients predicted to have less than six months to live. This does not necessarily mean that they are dying. In 2000, I had a patient named Jeanette Hall who had cancer of the low rectal area. At our first meeting, Jeanette told me that she did not want to be treated, and that she was going to “do” our law, i.e., kill herself with lethal dose of barbiturates. She had previously voted in favor of the law, and that was what she had decided. I informed her that her cancer was treatable and her prospects were good. She was not interested in treatment; she had made up her mind for the assisted suicide. Her surgeon informed her that without cancer treatment that she had only six months to a year to live. I asked her to return for weekly visits. On the third or fourth visit, I asked her about her family and learned she had a son in police training. I asked her how he would feel about her plan. She decided to be treated. Five years later, I saw Jeanette Hall in a local restaurant. She came over and exclaimed, “Dr. Stevens you saved my life.” She is now alive almost thirteen years since her diagnosis and treatment. For Jeanette, the mere presence of legal assisted suicide had steered her to suicide. She has told me that if her doctor in 2000 had believed in assisted suicide, “I would not be alive”.
I have treated many cancer patients who were told they had only a few weeks to a few months to live, who have lived much longer; some patients as long as 20 years after a “terminal” brain tumor diagnosis.
Financial Incentive for Assisted Suicide
In Oregon, the combination of legal assisted suicide and prioritized medical care based on prognosis has created a danger for my patients on the Oregon Health Plan (Medicaid). First, there is a financial incentive for patients to commit suicide: the Plan will cover the cost of assisted suicide. Second, the Plan will not necessarily cover the cost of treatment. For example, patients with cancer are denied treatment to prolong life, if they are determined to have “less than 24 months median survival with treatment” and fit other criteria. Some of these patients, if treated, would however have many years to live; as much as five, ten or twenty years depending on the type of cancer. This is because there are always some people who beat the odds. The Plan will cover the cost of their suicides. The story of Barbara Wagner was publicized in Oregon in 2008. She was informed that the Oregon Health Plan Insurance would not approve and pay for her lung cancer medication, but they would pay for Comfort Care, which included assisted suicide. She told the TV reporters, “They will pay for me to die, but won’t pay for me to live.” See her story at: http://www.katu.com/home/video/26119539.html.
As medicine becomes more politicized, you will lose your choice. Insurance companies and government bureaucracies will decide what treatments you may receive. You may not quality for the treatment that you want and that may benefit you.
Depression
Depression is the leading cause of suicide. Depression needs to be diagnosed and properly treated with counseling and medications. Oregon researchers in 2008 reported that 25% of Oregonians requesting assisted suicide were depressed. Yet, in the past 6 years only 1% (5 of 381) of Oregonians dying of assisted suicide had a psychiatric evaluation.
Oregon’s High Suicide Rate
Oregon has a suicide rate that is 140% of the national average. Oregon’s suicide rate has been increasing since 2000. Assisted suicide started in 1998. How do you justify suicide prevention in a state that has legalized assisted suicide? What message does legalization of assisted suicide send to those who are considering suicide because of life’s problems?
Lack of Oversight by Oregon Health Department
There is a serious problem with the Oregon Department of Health’s oversight of assisted suicide. Following a failed assisted suicide attempt in 2005 (David Pruiett), the Department of Human Services (DHS) stated that they had “no authority to investigate individual Death with Dignity cases – the law neither requires nor authorizes investigations from DHS “Press Release from DHS on 3/4/2005”
The problems with the Oregon information is exemplified by the following: The 2011 year report (released in 2012) listed the underlying illness as “Unknown” for 3 patients. How can an “Unknown” diagnosis be terminal? Residence was “Unknown” for 3 patients. How can two doctors confirm that a patient is terminal when the diagnosis in “Unknown”. In the past 4 years (2009-2012) the prescribing doctor has been present for only 22 of the 272 assisted suicide deaths in Oregon. Yet, doctors are asked to describe what happened at that time. They have no knowledge. Doctors are not required to care for the patient once the prescription for lethal overdose has been written.
Coterie of Insiders Runs the Program
We have learned that the Compassion & Choices organization are associated with three-fourths of Oregon’s assisted suicide deaths. In Oregon in 2009, 57 of the 59 assisted suicide deaths were their clients. They know and control the information released to the public. The Oregonian newspaper editors correctly stated “A coterie of insiders runs the program with a handful of doctors & others deciding what the public may know.” The Oregonian newspaper editorial 9/20/2008.
In Oregon patients are not getting the lethal prescriptions from their own doctor. They usually obtain the doctor information from Compassion & Choices doctors. Most of the prescriptions are concentrated in a small number of doctors.
From 2001 to 2007, 109 doctors (1% of Oregon doctors) wrote 271 fatal prescriptions for assisted suicide. Three doctors wrote 62 of those prescriptions (23% of prescriptions). Seventeen doctors wrote 165 of the 271 prescriptions (61% of prescriptions).
Hedberg, J Clin Ethics 2009:20:123-132
George Eighmey, C&C Exec Director, reported in The Oregonian newspaper in 2007 that he had been present and involved in over three dozen assisted suicide deaths; he is an attorney, he is not a doctor.
Seconal and Pentobarbital used to cause death
The barbiturates, seconal capsules (100 capsules) and pentobarbital liquid (about 7 ounces) are foul bitter-tasting material. Lovelle Svart is recorded as say, “That is the most god-awful stuff.” It is a bitter death. On a radio-talk show in 1998, I had the reporter taste a minute amount of seconal powder. He could not get the foul bitter taste out of his mouth. He told me “I would rather die than put that in my mouth.” It is bitter and foul tasting. Pentobarbital liquid is only certified for Intramuscular or Intravenous use; it is not certified for Oral ingestion.
Lack of Choice for Doctors
What is ahead for assisted suicide? What do proponents want? One of the things they want is no safe harbor for patients. They believe that doctors should be required to participate, or to have a duty to refer a patient to a doctor who will write a lethal prescription. They want no choice for doctors. Sue Porter, a leader of Compassion & Choices, has written in support of this policy. When I asked her why that “duty to refer” requirement was not written into the Oregon or Washington assisted suicide laws, she told me that the voters would not have voted in favor of the assisted suicide law. They use language to get the law passed, then they campaign to have the language changed to require doctors to participate, or to require them to have a “duty to refer” to a doctor who will write a prescription for lethal drugs.
In Summary
Physicians who care for patients should not order and direct their death through assisted suicide.
- It is against medical ethics: “Give no deadly drug”.
- It is too dangerous to give the power to kill patients to the medical profession
- It is dangerous because of insurance company and government financial incentives.
- It destroys the inherent trust between patient and physician.
- It devalues the inherent value of human life.
- It desensitizes us towards any type of suicide.
Don’t make Oregon’s mistake. Keep assisted suicide out of Vermont.
Thank you for the opportunity to testify in opposition to the legalization of assisted suicide.
Dr. Kenneth R. Stevens, Jr., MD