A change in the upward trend? Or just a pause?
The Public Health Division of the Oregon Health Authority has published its statistical analysis of deaths in 2016 from legalised physician-assisted suicide. This reports broadly the same number of deaths as in the year before – 133 (equivalent to just under 2,000 in England and Wales). The 2015 figure followed sharp rises in numbers of deaths in the previous two years. So is this apparent levelling-off in numbers significant or just a momentary pause? It’s hard to say at this stage: there have been similar ups and downs before. Time will tell.
However, the report discloses that there were 54 people who had received lethal drugs from doctors in 2016 and whose “ingestion status is unknown” – in other words, the Authority has no idea whether or not they have swallowed the drugs. This is a higher number of unknowns than in previous years and it would be surprising if the figure of 133 told the whole story.
The report also reveals that in only 14 cases was the prescribing physician present when the lethal drugs were ingested. There is nothing new about this. In the years during which Oregon’s Death with Dignity Act (as it is called) has been in force the prescribing doctor’s presence has been the exception rather than the rule. And yet the doctor’s presence is, many would argue, essential – not just to be on hand in case medical complications occur (these are rare but they do occur – three times in 2016 according to the latest report) but, more important, to ensure that the terms of the law are being complied with. For example, without a responsible witness present what reliable evidence exists that there is no pressure being applied on the person to take the drugs?
There seems to have been some recognition of this problem. The latest report notes that a revised procedure was introduced in 2010 under which information about the time and circumstances of death is accepted “only when the physician or another health care provider is present at the time of death”. It adds that “this resulted in larger numbers of unknowns beginning in 2010”. In 2016, says the report, out of 133 deaths only 33 were witnessed – 14 by prescribing doctors, 14 by another health care provider and 5 by “no provider” (whatever that means). It is details like these that undermine statements by lobbyists for legalisation of ‘assisted dying’ in Britain that there has been no abuse of Oregon’s physician-assisted suicide law. The plain fact is that, with few of these deaths being witnessed by those responsible for supplying the lethal drugs, there is no way of knowing.
According to the report, the number of prescriptions for lethal drugs written per doctor ranged from 1 to 25. Here we encounter one of the fundamental issues with what is being called ‘assisted dying’ – that the majority of doctors are unwilling to participate in such practices, with the result that many of those requesting lethal drugs end up being assessed by a minority of doctors to whom they have been introduced specifically for the purpose. Even our regular doctors often know little of us beyond our medical conditions. The question has to be asked: just how well-placed to make such life-or-death decisions is a doctor previously unknown to the patient, especially when those decisions involve considerations which go beyond the field of clinical expertise?