Oregon health officials are allowing physician-assisted suicide for nonresidents.
Oregon’s Death with Dignity Act permits physicians to provide lethal medications to terminally ill patients. The law requires patients seeking physician-assisted suicide to show proof of residency, such as a driver’s license, property lease or title, or an Oregon tax return.
The Oregon Health Authority (OHA) will no longer “apply or otherwise enforce” the residency requirement, under an agreement to settle a lawsuit state Public Health Director Rachael Banks released on March 21.
‘No Legal Merit’
A lawsuit claiming the Oregon law’s residency requirement violates the U.S. Constitution’s Privileges and Immunities and Commerce clauses was filed in the U.S. District Court in Portland in October.
The plaintiffs were Oregon physician Nicholas Gideonse, M.D., who stated he wanted to prescribe lethal drugs to patients across the state line in Washington, and Compassion and Choices, a nonprofit group that supports assisted suicide. The defendants, various state officials, and Multnomah County District Attorney Mike Schmidt agreed in the settlement not to enforce the residency requirement or prosecute anyone for violating it.
In addition, the OHA agreed to recommend to the state legislature specific changes in statutory language eliminating the residency requirement from the law. Officials failed to defend the legislation Oregon voters approved, says William L. Toffler, M.D., a family practitioner in Portland.
“The state just went into negotiations,” said Toffler. “That’s going against what the people voted on in 1994 and 1997. The people of Oregon were voting on a law that would only apply to the state of Oregon. Constitutionally, the case had no legal merit and should not have reached a quick settlement.”
Violates Medical Ethics
Oregon could become the go-to spot for suicidal patients, says Twila Brase, R.N., Ph.N., president of the Citizens’ Council for Health Freedom and a policy advisor to The Heartland Institute, which co-publishes Health Care News.
“Oregon may become the place where sick Americans go to kill themselves, with the help of physicians who have forgotten the tenets of medicine,” said Brase.
Physician-assisted suicide violates medical ethics, says Brase.
“Hippocrates wrote that ‘life is sacred’ and as a physician treating a patient he would ‘never give him an herb to soothe his pain, even if he begs for it in anguish if it might take away his breath.’ Helping a patient kill himself is the antithesis of being a physician.”
‘Predatory Practices Going Unnoticed’
In 2019, Oregon amended the law by removing a 15-day waiting period and created alternatives for the administration of deadly drugs to patients who cannot swallow or “ingest” the drugs themselves.
“That is no longer assisted suicide, it is euthanasia, administered by a doctor,” said Toffler.
The law still requires 24 hours between a patient’s request and the physician’s provision of drugs. Allowing Oregon physicians to prescribe drugs to residents of other states increases the risk of abuse, said Lois Anderson, executive director of Oregon Right to Life in a statement published on March 29.
“We already have a problem with dangerously short physician-patient relationships and the push to eliminate any waiting period for life-ending drugs,” said Anderson. “We should not be expanding access to lethal prescriptions. The residency requirement at least protected some patients from predatory practices going unnoticed in the current execution of the law.”
‘Something Very Unnatural’
The OHA’s 2018 annual report describes two physicians who violated the Death with Dignity Act and the Oregon Medical Practice Act, one of whom was determined to have “dozens” of violations and was repeatedly negligent in prescribing controlled substances.
The physician was ordered by the Oregon Medical Board “not prescribe or manage the prescriptions for any medication for any patient enrolled in hospice care,” or “any patient requesting Death with Dignity,” according to the Euthanasia Prevention Coalition, an advocacy group.
The lawsuit settlement could lead to more abusive practices, says Brase.
“As we’ve seen in Europe, the countries that embrace indirect euthanasia move easily into explicit euthanasia, including for people who are simply unhappy with their life,” said Brase.
In Oregon, 2,217 lethal prescriptions have been written since the law was enacted in 1997; but the rate of physician-assisted death increased 60 percent from 2014 to 2018. Procedural changes have obscured the Oregon law’s effects, says Brase.
“I find it particularly disturbing that Oregon recommends the death certificates report the underlying diseases as cause of death and mark the manner of death as ‘natural.’ There is nothing natural about suicide and there is something very unnatural about a physician helping patients kill themselves.”
Prescribing Across State Borders
Allowing non-residents to receive lethal prescriptions in Oregon they could take back to their own state has national implications, says Toffler.
“It’s not a regional issue when you’re talking about people accessing assisted suicide even in states where it’s not legal,” said Toffler. “It is very much against the laws of other states.”
After the settlement, co-plaintiff Compassion and Choices placed guidelines on its website urging patients and doctors to be physically located in Oregon during drug administration.
Physician-assisted suicide by telemedicine or medical tourism would be dangerous, says Marilyn Singleton, M.D., J.D., former president of the Association of American Physicians and Surgeons.
“Matters of life and death should be handled by one’s own physician or health professionals who know the patient and their family and life situation,” said Singleton. “Death is irreversible and hastening it should not be taken lightly.”
Ashley Bateman (email@example.com) writes from Virginia.
“Settlement Agreement and Release of Claims,” March 18, 2022
“Medical Aid in Dying: best practices for physicians, other health care providers supporting of otherwise in contact with individuals requesting medical aid in dying who are not Oregon residents,” Compassion and Choices.
This article was updated on May 4 to include additional quotes.