Oregon Reports on the First Year of Legal Physician-Assisted Suicide

By S. Van McCrary, Health Law & Policy Institute

On February 17, 1999, Oregon officials reported that in the first year of legally permitted assisted suicide, 15 terminally ill persons ended their lives with lethal medications. The average age of the persons who died was 69 years. Thirteen of these persons had cancer and the other two suffered from heart or lung disease. Of those who chose to end their lives, eight were men and seven women. Eight other persons received prescriptions for lethal medication, but six died from their diseases before taking the drugs and two were still alive on January 1, 1999. Advocates of physician-aided dying praised the report by noting there was no evidence of abuses, botched suicides, or a rush among dying persons to move to Oregon to take advantage of the law.

The day the report was released critics were already in full cry, complaining that there were undoubtedly additional cases of physician-assisted suicide that were not accounted for through legal means and that, therefore, the law was a failure. I suspect that these persons are correct in one respect--there probably were physician-assisted deaths in Oregon that did not comply with the new law’s requirements. Nonetheless, 15 cases were documented that complied with all legal requirements, and there were no reported adverse events.

A social practice like physician-assisted suicide is unlikely to change overnight simply in response to a changed statute. Moving such activity from the shadows into the light will take time and acceptance by both the medical community and the public. Many physicians are acutely sensitive about the legal implications of any action they take, and it is unclear how they will respond to the legalization of a formerly prohibited activity. Doctors will have to become more comfortable with moving a formerly-illegal practice into the public eye. This will not happen quickly, and it should not. However, assisted suicide will inevitably continue at some level, regardless of whether it is legally sanctioned. Oregon has determined it is preferable that the practice be subjected to regulatory scrutiny in order to prevent possible abuses. In this sense, adopting the Oregon law was only a first step in a process of institutionalizing physician-assisted suicide as a social practice.

The U.S. Supreme Court has given states some flexibility to "experiment" with medically-assisted suicide. In its opinion in Washington v. Glucksberg (521 U.S. 702, 1997), the Court explicitly drew on precedent referring to the "laboratory of the states." By approving a carefully crafted law through public referendum, a majority of the people of Oregon have determined that they support physician assisted suicide as one possible alternative to continued suffering for a limited class of patients. If the people of Oregon are dissatisfied with the results, they have the option of repealing the law.

Assisted suicide should never be routine, but may be able to be handled in a way that preserves human dignity while maintaining safeguards that prevent abuses. The people of Oregon have chosen to determine this for themselves. Despite the objections of critics, it is too early to pass judgment on this law. Given the current absence of reported abuses, Oregon should at least provide this law a reasonable trial period to ascertain its implications. One year is not enough.