Oregon’s latest report raises concerns about the wisdom of such legislation here
The latest official report has appeared from Oregon on the operation of that State’s so-called Death with Dignity Act in 2014. The report shows a sharp upturn in the number of deaths from physician-assisted suicide – up by 44 per cent from 2013. On our calculations the 2014 death rate, if applied to England and Wales, would result in 1,547 such suicide deaths annually here if we we were to have a similar law. Yet that is just what is being proposed in certain quarters – that Parliament should license doctors to supply lethal drugs to terminally ill patients. Oregon’s law is held up to us as a model. It is fair therefore that we should look carefully at what is happening there and take note.
As in previous years the 2014 report reveals evidence of multiple prescribing – ie of some doctors writing a number of prescriptions for lethal drugs. According to the report, at least one doctor wrote as many of 12 such prescriptions during the year. The problem here is that of ‘doctor shopping’. Only 1 in 3 doctors in Oregon will have anything to do with assisting the suicides of patients, so those seeking it have to go to a minority of willing doctors for the purpose. But how well do such referral doctors know the people whom they are assessing – whether, for example, their wish to die represents a settled intent, whether they are subject to depression or mood swings, whether there are any family dynamics which might be influencing the request? The latest report tells us that those who died had known the prescribing doctors for between 1 and 1,312 weeks, with a median of 19 weeks. That suggests that many of those who died in this way had known the doctors who assessed them and supplied them with lethal drugs for only a short period of time.
Most doctors in Britain are opposed to legalisation of physician-assisted suicide – or, as it is being euphemistically called, ‘assisted dying’. Surveys of medical opinion suggest that only 1 in 5 doctors here would be willing to participate in such practices if they were to be legalised. It is fair to assume therefore that we could expect to see a similar situation to that seen in Oregon arise here – of prescriptions for lethal drugs being written by a small minority of doctors whose knowledge of the patients concerned was based largely on their case notes.
Introducing his ‘Assisted Dying’ bill in the House of Lords last July Lord Falconer stated in reference to Oregon’s law that “there has been no evidence of abuse since its inception”. He did not point out that Oregon’s law contains no investigative machinery to enable a light to be shone on how requests for physician-assisted suicide are being handled. Are requests being approved on the basis of just a consulting room discussion? What steps are taken to ensure that there is no coercion or undue influence at work? There is no way of knowing the answers to these and similar questions. And yet Oregon’s law is the model we are being asked to follow here.
The annual reports list the illnesses from which those who ended their lives had been suffering. There seems to be a growing number of ‘other illnesses’, including many – for example, Parkinsons, multiple sclerosis – which are normally regarded as chronic rather than terminal – ie incurable ilnesses which are of long duration and may well at some point result in death but are not terminal in the sense of indicating that death is imminent. Oregon’s law is supposed to be for people with a prognosis of life remaining of six months or less. So are these ‘other illnesses’ instances where a chronic illness was considered to be in its terminal phase? Or is the line between terminal and chronic illnes becoming blurred? It is clear from successive annual reports that a number of those who have been supplied with lethal drugs on the basis of a six-months-or-less prognosis lived for longer, sometimes much longer, before either taking those drugs or dying of natural causes. It would certainly be helpful if future reports could tell us more about this growing category of ‘other illnesses’.
This latest report from Oregon will offer no comfort to those who are campaigning for a similar change in the law here. There have been ups and downs in the death rate before, but the sharp rise between the last two reports serves to confirm that after 17 years Oregon’s law is far from reaching stability. It should give us serious pause for thought in considering whether a similar law should be enacted here.