Physician-Assisted Suicide in Oregon

On October 27, 1977, Oregon State became the first state to enact the first jurisdiction Act in the history of the United States of America that legalized physician-assisted suicide. The Oregon's Death with Dignity Act (DWDA) was enacted after voters' approval through a ballot initiative, after undergoing a series of injunctions and wide criticism from various organs of the health profession. The Court was also against the controversial Act, with the argument that the passing of the Act would be unconstitutional in the sense that it would fail to offer protection to terminally ill patients, the same way the law offers protections against suicide cases.

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According to the Act, mentally competent, terminally ill patients over the age of 18 who are residents of the state of Oregon has the choice of ending their life through the voluntary self-administration of lethal doses of medication (Linda, 2008). The DWDA Act requires that only the attending physician should prescribe a lethal dose of the medication as demanded by the terminally ill patient. There are a few requirements that such patients must undergo before they can be allowed to proceed with physician-assisted suicide. The patient must first make one written request and two oral requests within a specified period of 15 days. A second physician, different from the attending physician must confirm the patient's diagnosis as well as the patient's decision-making capacity, based on the conditions that surround them. Additionally, the physician must carefully examine the patient's decision, to ensure it is purely voluntary, and not from any coercion or influence from any second party. The physician is also expected to ask the patient to disclose their decision to the family, which they have the freedom to oblige or not (Melinda, 2015).

In addition to the above procedures and requirements, before a terminally ill patient can be allowed to end their life, they must be in the right state of mind, free of any mental disorder or depression that might influence them to make such a decision. In case there are any reasonable doubts regarding the patient's state of mind at the time of making the decision, the patient must be immediately referred to a mental health professional who must examine and acknowledge that the patient is, indeed, in his/her right state of mind to proceed with making the request. The prescribing physician is charged with the responsibility of informing the patient of the potential alternative available to physician-assisted suicide, which range from pain management, hospice care, to comfort care (Linda, 2008). The Act also requires that the involved physicians report their participation in the assisted suicide of terminally ill patients to the Oregon State health division. This is, however, in the understanding that the Act shields the physicians and the patients involved from any professional liability or prosecution. It's also important to note that the choice of the terminally ill patients to undertake assisted suicide does not affect, in any way, the patient's health or life insurance policy cover. The Oregon Death with Dignity Act takes care of the aforementioned incidences.

There are several scenarios or cases that the Oregon's Death with Dignity Act excludes. According to the law, there are several groups of patients that are not allowed to take on the lethal prescription. Active euthanasia that is where the involved physicians take upon themselves to administer the lethal drug to the patients is prohibited under the DWDA. With this understanding, physicians cannot provide assistance to patients who are too incapacitated to ingest the lethal medication prescribed to them by their own. Such patients are, therefore, not covered by the Act. The other class of patients that is not covered by the Act is patients who suffer from non-terminal illnesses and chronic conditions, including amyotrophic lateral sclerosis (Linda, 2008).

The DWDA requires the Oregon Public Health Division to collect and prepare the compliance information from all the cases of terminally ill patients. Additionally, they should issue an annual report detailing specific number of patients for whom prescriptions are written, and the number of deaths from that result from the intake of the prescribed DWADA lethal medications. According to the report analysis posted by the Oregon Public Health Division, as of February 2, 2015, there were a total of 155 for whom prescriptions were for lethal medication were written in the year 2014, a number that is slightly higher than 2013 where 121 patients received he prescriptions (OREGON.GOV, 2015). As a result of the prescriptions, the report indicates that 105 people died from taking the lethal medications prescribed by their attending physicians in 2014 under the DWDA. In total, since the law was passed back in 1997, 1,327 people have undertaken the DWDA prescriptions, and a total of 859 terminally ill patients has consequently died from ingesting the lethal medications prescribed by their physicians in accordance with the Oregon's Death with Dignity Act (OREGON.GOV, 2015).

Out of the 155 patients for whom prescriptions were written in 2014, 94 patients ingested the prescribed medication, and all the 94 patients died from ingesting the lethal medication. There were no cases of any terminally ill patient that took the prescribed dosage regaining consciousness. These results only indicate that the Act has been accepted and highly effective since its inception in 1997. In as much as there have been numerous criticism and perceptions from both the health sectors and the public in general, more patients continue to consider taking the option to end their own lives voluntarily, all for their own personal reasons, than wait for their eventual death.

Despite the fact that there is growing acceptance of assisted suicide from the public, several professional institutions and bodies still oppose the Act. Research by Linda (2008), however, indicates that practicing physicians are quite divided on whether to oppose or support the practice. Studies indicate that 54 percent of U.S physicians have expressed neutral and positive attitudes towards the endorsement enactment of the DWDA that competent, terminally ill patients should have the right to end their life through lethal medical subscriptions. However, a considerable number of physicians express their views that physician-assisted suicide is immoral and violates professional ethics. Other people argue that the legalization of the physician-assisted suicide among terminally ill patients violates personal religious beliefs, terming it as a sin that is punishable in the eyes of God.

Most people, however, are of the view that some patients would choose to undertake the physician-assisted suicide for the fear that they may be a burden to their family, friends, and the society in general. They believe that such patients may opt for the option, not out of their own will, but for the fear of causing financial pressure to their families, especially if they are of a lower class that are financially unstable (Melinda, 2015).

The response from physicians about the DWDA has been of varied nature, with different scenarios being unfolded. Some physicians have forwarded their concerns that with the legalization of the physical-assisted suicide for terminally ill patients, the involved physician could give overdoses to the patients without their consent.

Out of the reactions and views advanced by the different physicians about the enactment of the DWDA, there are several practical issues of concern that are worth noting. Firstly, physicians have raised concerns about the possible harm that may occur if an attempt of ingesting the drug failed, or a complication occurred. As such, physicians fear that the patient's family may sue, which would have serious legal and professional impacts. The second practical concern that practicing physicians have raised is the possibility of someone other than the intended patient taking the drugs prescription, a move that would jeopardize their practicing license, and the ability to practice in a different state, or worse off even lead to the creation of sanctions by hospitals. The third critical concern was that most physicians were not 100 percent confident that they could predict a specific time left for a patient to live, for instance 6 months, as is the case with the terminally ill patients that are legible for the physician-assisted suicide in Oregon (Melinda, 2015).

In addition, physicians and health practitioners acknowledge that they may not be confident to recognize whether the patient for whom a prescription is written suffers from depression, as is required under the Oregon's with Dignity Act (Melinda, 2015). Such are the concerns and issues that surround the practicability of the Act that must be addressed to ensure that any terminally ill patient who undertakes the option of physician-assisted suicide does so under his/her will, free from any form of depression. The prescribing physician must act in accordance to the highest degree of the code of conduct and career responsibility.

References

Linda, G. and Edgar, D. (2008). Physician-Assisted Suicide In Oregon. Springer International Publishing. Print.

Melinda et al., (2015). Journal of Medicine: Legalizing Assisted Suicide - Views of Physicians in Oregon. Retrieved From: http://www.nejm.org/doi/full/10.1056/NEJM199602013340507#t=articleDiscussionOREGON.GOV. (2015). Death with Dignity Act. Oregon Health Authority. Retrieved From: https://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/Deathwit hDignityAct/Documents/year17.pdf

Thomas, J. (2013). Physician-assisted suicide in the united states. Place of publication not identified: Grin Verlag Ohg.