End-of-Life Choice, Palliative Care and Counseling

Posts TaggedOregon Death with Dignity Act

Assisted Dying: Experts Debate Doctor’s Role

By Katie Moisse
ABC News
July 13, 2012

Peggy Sutherland was ready to die. The morphine oozing from a pump in her spine was no match for the pain of lung cancer, which had evaded treatment and invaded her ribs.

“She needed so much morphine it would have rendered her basically unconscious,” said Sutherland’s daughter, Julie McMurchie, who lives in Portland, Ore. “She was just kind of done.”

Sutherland, 68, decided to use Oregon’s “Death With Dignity Act,” which allows terminally-ill residents to end their lives after a 15-day requisite waiting period by self-administering a lethal prescription drug.

“Her doctor wrote the prescription and met my husband and me at the pharmacy on the 15th day,” said McMurchie, recalling how her mother “didn’t want to wait,” she said. “Then he came back to the house, and he stayed with us until her heart stopped beating.”

But not all doctors are on board with the law. In the 15 years since Oregon legalized physician-assisted dying, only Washington and Montana have followed suit, a resistance some experts blame on the medical community.

“I think it has to do with the role of physicians in the process,” said Dr. Lisa Lehmann, director of the Center for Bioethics at Brigham and Women’s Hospital in Boston and assistant professor of medicine at Harvard Medical School. “Prescribing a lethal medication with the explicit intent of ending life is really at odds with the role of a physician as a healer.”

More than two-thirds of American doctors object to physician-assisted suicide, according to a 2008 study published in the American Journal of Hospice and Palliative Care. And in an editorial published Wednesday in the New England Journal of Medicine, Lehmann argues that removing doctors from assisted dying could make it more available to patients.

“I believe patients should have control over the timing of death if they desire. And I suggest rethinking the role of physicians in the process so we can respect patient choices without doing something at odds with the integrity of physicians,” she said.

Instead of prescribing the life-ending medication, physicians should only be responsible for diagnosing patients as terminally ill, Lehmann said. Terminally ill patients should then be able to pick up the medication from a state-approved center, similar to medical marijuana dispensaries.

But assisted dying advocates say doctors should be involved in the dying.

“Patients deserve to have their physician accompany them there and not walk away,” said Barbara Coombs Lee, president of the Denver nonprofit Compassion and Choices.

Coombs Lee, a nurse-turned-lawyer and chief petitioner for the Oregon Death with Dignity Act, said decisions about death should be no different than other treatment decisions.

“Physicians don’t walk away from patients who make other intentional decisions to advance death, such as refusing a ventilator or a pacemaker,” she said. “Why walk away from a terminally ill patient requesting life-ending medication?”

McMurchie agrees.

“Anything that improves access to assisted dying is a step forward,” she said. “But I think shepherding patients through their final days is a huge part of a physician’s responsibility.”

Oregon Medical Board, Death with Dignity Safeguards Protect Patients

Compassion & Choices today responded to the Oregon Medical Board’s suspension of Dr. Stuart G. Weisberg’s medical license. Dr. Weisberg had proposed to open a private, for-profit facility to offer physician aid in dying.

Patient safety, ensured by precautions in the Death with Dignity Act (DWDA) would have prevented Dr. Weisberg, a psychiatrist, from serving as an attending (prescribing) physician, “the physician who has primary responsibility for the care of the patient and treatment of the patient’s terminal disease.” Neither could he have been a consulting physician, “qualified by specialty or experience to make a professional diagnosis and prognosis regarding the patient’s disease.” ORS 127.800 s.1.01. A psychiatrist does not have the expertise necessary to treat or diagnose a terminal illness.

“Law enforcement and professional oversight are in place to ensure no individual tries to practice outside the law or established standard of practice,” said Barbara Coombs Lee, President of Compassion & Choices. “The Oregon Medical Board made the right move suspending Dr. Weisberg’s license for past violations improperly prescribing drugs. Additional safeguards would have prevented him from prescribing under the DWDA.”

 ”We understand a proposal like this attracts attention,” said Coombs Lee, “but aid in dying is legal in Oregon. It is part of the standard of practice along with other end-of-life care options. After twelve years, the DWDA is working as the voters of Oregon intended. Individuals can take control of their dying if suffering becomes intolerable. They usually choose to do so among the people they love in their own homes. Oregonians don’t need and don’t seem to much want the kind of setting Dr. Weisberg proposed. The rest of what he proposed to offer is illegal.”

Read the press release here>>

Study Finds Patients Use Oregon DWD Act to Die at Home, Stay Independent

A new study published today in the Archives of Internal Medicine, in which clients of Compassion & Choices of Oregon participated, found that terminally ill individuals using the Oregon Death with Dignity Act did so because they wanted to die at home, remain independent and control pain at the end of a terminal illness.

“The study’s findings continue to confirm the safety and benefits of Oregon’s Death with Dignity Act,” said Barbara Coombs Lee, president of Compassion & Choices, the nonprofit organization that serves as the steward of the law and serves terminal patients and their families throughout the U.S.

Read the press release here

Eleven Years of Death with Dignity

Today the Oregon Department of Human Services released 2008 results of the eleventh year report for the Oregon Death with Dignity Act. The report reveals terminally ill patients and their families continue to benefit from the law.

The Oregon Department of Human Services reported that during 2008, as in all 10 prior years, many more terminal patients received prescriptions (88), than used those prescriptions (54), with 6 using prescriptions received in 2007. As in prior years, the report showed increased peace of mind for terminally ill patients. Sixty terminally ill patients used the Oregon law in 2008 to help ease their imminent deaths.

Read the press release here
View a summary of the report here
View a table of the characteristics of DWD users here

Don’t Confuse FEN Death and Investigation with Aid in Dying

The media has recently reported the arrest of individuals associated with a group known as Final Exit Network (FEN) on charges of assisting a suicide in Arizona, and attempting to engage in similar activity in Georgia. The cases reported in the media this week involving FEN ought not be confused with the choice of aid in dying.

Media accounts of the facts suggest that the Arizona decedent was not terminally ill and may have suffered from impaired judgment and/or mental illness.

It is important to recognize the difference between the choice of a mentally competent, terminally ill patient for a peaceful death via self-administering medications prescribed for this purpose, and the act of a distraught individual who is not dying, who may be suffering from impaired judgment or mental illness, to precipitate death.

Read the press release here