Assisted suicide is conflict of interest for doctors

Oregon law has little scrutiny, erodes doctor-patient trust

BY JEAN PARIETTI

After Oregon voters legalized physician-assisted suicide in 1994, doctors there created a foundation to spread the word about why assisted suicide is wrong, and publicize problems the law has created.

Assisted suicide supporters talk about giving the terminally ill the right to choose when they die, but “what they’re doing is expanding the power of doctors and health-care providers,” said Dr. William Toffler, national director of Oregon-based Physicians for Compassionate Care Education Foundation. “The real agenda is to essentially institutionalize assisted suicide within the medical profession,” added Toffler, a family medicine professor at Oregon Health and Science University in Portland.

But helping patients die, he said, is “an inherent conflict of interest for doctors.”
“We should not kill them, we should reverence their lives, because humans have an inherent worth,” Toffler said.

Toffler happens to be Catholic, but Physicians for Compassionate Care members have included doctors of many faiths – Catholic, Jewish, Muslim, Mormon, Quaker – those of no particular faith, agnostics and atheists.

“You don’t have to be a specific religion to oppose this,” Toffler said. “You have to be sensible. Whether you’re of faith or no faith, the conflict of interest issues are still there.”

Lack of scrutiny
Assisted-suicide supporters say everything is going well under the law: According to the required annual state reports, fewer than 300 people in nine years ended their lives after requesting a lethal prescription (the 2007 report is due out in February).

But therein lies one of the big problems, Toffler said: The law relies on the doctors who write the prescriptions to file reports.

“The records are all hidden under a shroud of secrecy. They’re never looked at,” Toffler said. The law prevents public access to the actual records; reporting is voluntary, with no penalties for doctors who fail to report, Toffler said. That makes it difficult to know if more assisted deaths are occurring than are reported: a study done in the Netherlands showed there were nearly 10 times as many assisted deaths occurring as were reported there, Toffler said.

It’s also unknown if patients are experiencing serious problems that aren’t reported. Death by an oral overdose isn’t always as swift and sure as proponents would like people to believe, he said.

Oregon reports that 6 percent of assisted-suicide patients regurgitated the medication they took, while another 2 percent had “unknown” complications. Death has taken as long as 38 hours, but 25 minutes was the midpoint. Doctors who wrote the prescriptions were present in only 29 percent of the deaths.

Because of the limited information available in Oregon, “there are just very few cases that make it to the light of day,” Toffler said. “Those that do are flawed.”

Three years ago, David E. Prueitt, a 42-year-old suffering from lung cancer, took what was supposed to be a lethal dose of drugs. But he woke up nearly three days later, living 13 more days before dying of natural causes. The case came to the public’s attention only after the family talked about it.

“Thankfully, David Prueitt woke up 67 hours later and didn’t have a stroke,” Toffler said.
Toffler finds the lack of scrutiny in Oregon troubling.

“It’s unique in medicine to have so little thoughtful study of what’s going on. Here you only have promoters of it reporting data,” he pointed out, likening it to the tobacco industry being the sole entity reporting on the effects of smoking.

A bad choice
Other problems with the law are subtler: The Oregon Health Plan, for those with limited incomes, covers the cost of assisted suicide with taxpayer dollars, but won’t cover certain treatments for cancer patients who have a less than 5 percent chance of living five years, according to Physicians for Compassionate Care.

And the legalization of assisted suicide has changed some patients’ trust in doctors, Toffler said.

“People call me and want to know the motive of the doctors, because they don’t know if they’re one of the ‘death doctors,’ ” he said. “They’re actually asking me my opinion – who can they ask who has a consistent ethic?”

He cautions that assisted suicide promoters in Washington will say they’re for choice.

“That’s like mom and apple pie in America,” Toffler said. “But some choices are bad, like beating your wife. It seems like we’ve been brainwashed not to say ‘bad choice’ – that’s judgmental,” he notes.

But for society, Toffler said, assisted suicide is a bad choice. And he believes that’s why no other state has followed Oregon’s path for more than a decade.

“The closer you get to it, the uglier it becomes,” Toffler said.