Statement from the Oregon Hospice Association regarding the 2006 Supreme Court Ruling in Gonzales vs. Oregon
The Oregon Hospice Association was relieved when the Supreme Court ruled in favor of Oregon. Not because we support Oregon's Death With Dignity Act, but because the repercussions of a decision in favor of Gonzales were potentially devastating.
We would like to think that the Supreme Court's decision marks the end of threats directed at Oregon physicians, because every time there is a threat made against Oregon's Death With Dignity Act, it is Oregonians--and Americans--who pay.
Countless studies confirm that regulatory scrutiny has a chilling impact on pain management. Countless studies identify the undertreatment of pain as a crisis in our country. Adding another layer of regulatory scrutiny, by granting the Attorney General of the United States the authority to interpret the legitimate practice of medicine under the Controlled Substances Act, would have compounded the problem.
We would like to think that Congress will consider carefully the potential repercussions on pain management of any action it might take against Oregon. Even a proposed law can have an immediate effect of undermining physician willingness to prescribe controlled substances, as we saw in its previous attempts to compromise Oregon's law.
We would like to think that Congress will instead recognize the valuable contributions Oregon's health care community is making in our laboratory of the states. Oregon’s Death With Dignity Act has been responsibly implemented with none of the predicted dire consequences. During the past eight years, countless studies are closing the data void that existed because never before had assisted suicide been practiced in a legal environment. We are learning from that body of knowledge, applying it to improve end of life care in Oregon. It’s knowledge that has application well beyond our borders.
Research supports our observation that many more Oregonians take comfort in the Act, than the 208 individuals who ended their lives under its provisions. A study published in 2004, revealed that only 1 of 200 individuals who considers assisted suicide will ever use a prescription.1 Oregon's hospices often describe as typical an individual who asks for a prescription on day 1, becomes qualified on day 15, and, because he or she has a plan to alleviate his or her worst fears, is then able to get on with life. That the Oregon law is available at all offers great comfort.
It no longer matters in Oregon whether assisted suicide is right or wrong because it is a legal option here. Dying Oregonians are eligible for both hospice and physician assisted suicide. 210,000 Oregonians died in the first seven years. 208 individuals used a prescription to end their lives. That so few have may be attributed to the fact that Oregon hospices stepped up to the plate.
Should the Supreme Court ruling create an atmosphere where other states will more seriously consider similar legislation, we don’t doubt that the nation's hospices will do the same: Step up to the plate. When hospice professionals learn that their Oregon counterparts do not turn away a patient who intends to use a prescription, an initial response is sometimes an indignant, "Well, we would never admit them!"
Oregon's hospices recognized very early that hospice support, or the lack of it, would be a determining factor in whether a patient would, in fact, choose to hasten his or her death. Hospice addresses well the fears most often identified by the public as reasons for supporting the legalization of physician assisted suicide.
But autonomy and control—not uncontrolled symptoms—are the reasons people use a prescription.2,3,4,5
A question the nation’s hospices might address is how well they respond to the needs of individuals who value most autonomy and control—and how seriously they are willing to consider such needs.
1 Tolle S, Tilden V, Drach L, Fromme E, Perrin N,
Hedberg K. Characteristics and Proportion of dying Oregonians Who Personally
Consider Physician-Assisted Suicide. J Clin Ethics, Vol. 15, No. 2, Summer
2004
2 Ganzini, L., Harvath, T., Jackson, A., Goy, E.,
Miller, L., Delorit, M. Experiences of Oregon nurses and social workers with
hospice patients who requested assistance with suicide. NEJM, Vol. 347,
No.8, August 22, 2002
3
http://egov.oregon.gov/DHS/ph/pas/docs/year7.pdf
4
http://www.ohsu.edu/ethics/guidebook/toc.pdf
[this link has been moved since this posting]
5 Simopoulos N, Carlson B, Jackson A, Goy E, Ganzini
L. “Oregon Hospice Chaplains’ Experiences with Patients Requesting
Physician-Assisted Suicide”, Pall Med 2005
