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June 14, 2017

Death with Dignity? Oregon: A Closer Look

Patricia Price

In 2008, when 64-year old Barbara Wagner received her diagnosis she was frightened, but the rejection letter from her insurance company was shattering.


An Oregonian woman, whose lung cancer had been in remission, learned the disease had returned and would likely be lethal. Her doctor had prescribed a chemotherapy drug that would make her remaining days meaningful. It was her last hope, but the insurance company refused to pay.


The Oregon Health Plan did agree to cover – the drugs for a physician-assisted death. These drugs would cost about $50.


"It was horrible," Ms. Wagner told reporters. "I got a letter in the mail that basically said if you want to take the pills, we will help you get that from the doctor, and we will stand there and watch you die. But we won't give you the medication to live."


Critics and proponents of the Death With Dignity Act (DWDA) were outraged over the indignity of her rejection letter. Her case is not unique. Doctor prescribed suicide is now legal in five states and the District of Columbia. Do you trust insurance companies?


The DWDA, enacted in late 1997, allows doctors to prescribe lethal doses of self-administered medication to terminally ill adult Oregonians. This includes deaths due to benign and uncertain neoplasms, other respiratory diseases, diseases of the nervous system (including multiple sclerosis, Parkinson's disease and Huntington's disease), musculoskeletal and connective tissue diseases, viral hepatitis, diabetes mellitus, cerebrovascular disease, and alcoholic liver disease. [Oregon Public Health Division – 2013 DWDA Report]


A study conducted at Georgetown University in 1998 showed a strong like between cost cutting pressures and a doctor’s willingness to prescribe a lethal dose of drugs. The study emphasized "a sobering degree of caution in legalizing [assisted death] in a medical care environment that is characterized by increasing pressure on physicians to control the cost of care."


Phenobarbital, the drug used for executions, is the drug of choice for Oregon policymakers and the few doctors who support this effort. Manufacturers, located in Europe, refused to provide the drug; thus phenobarbital is not used. The barbiturate Secanol is used. A patient must swallow 100-200 pills of Secanol in order to die.


Secanol at this dosage may burn the esophagus and gastrointestinal tract, and take up to five days to work. Additional side effects include seizures, severe nausea, vomiting, headache, and coma from which some patients awaken. One does not gently slip off to sleep.


An Oregon newspaper – the Willamette Week – reported that assisted-suicide advocacy group, Compassion & Choices (C&C – formerly called the Hemlock Society), is taking control. The organization is calling for a compounding pharmacy in Oregon and permission to manufacture the execution drug: phenobarbital. If approved, the compounding pharmacy would buy the chemicals needed, while C&C would facilitate its distribution for doctor prescribed suicide.


C&C drafts the doctor-prescribed suicide law, promotes and finances its passage, hires individuals to promote its use, and plays a key role in the drug distribution for deaths under the law.


In 2008, President Barack Obama, when asked what he thought of Oregon’s DWDA responded: “I’m mindful of the legitimate interests of states to prevent a slide from palliative treatments into euthanasia. On the other hand, I think that the people of Oregon did a service for the country in recognizing that as the population gets older we’ve got to think about issues of end-of-life care.”


Doctor prescribed suicide is considered medical treatment: end of life care. It gets personal.


Whom do you trust?


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