On Nov. 8, 1994, Oregon voters took the unprecedented step of approving the Death With Dignity Act, which grants terminally ill individuals the choice, under very limited circumstances, of ending their lives. This decision was reaffirmed by 60 percent of Oregonians in the 1997 general election. Since then, opponents have been battling from the courtroom to Congress to try to undo their decision.
In the process, opponents, especially in Congress, have proven themselves willing to conveniently ignore the rights of states and the wisdom of voters, and also to disregard the sanctity of the doctor-patient relationship. Most galling, however, is the fact that this Congress is more interested in taking away choices from the terminally ill than in helping provide health care to the more than 43 million uninsured Americans--many of whom will die preventable deaths.
During both the 1994 and 1997 campaigns, opponents of the Death With Dignity Act made outrageous claims about how it would be used. Those fears ranged from a flood of terminally ill people moving to Oregon to take advantage of the option to end their own lives, to families conspiring to end the lives of ill relatives who had become burdens.
These arguments had more to do with unreasoned fear than they did with facts. The facts of what the law does and how it has been used in its first year make clear that such nonsense cannot and has not occurred.
The physician "aid" involves writing a prescription for a fatal dose of barbiturates, which is self-administered by the terminally ill individual. To be eligible an individual must have a terminal illness and be within six months of death. This diagnosis and prognosis must be concurred in by two independent physicians. Either physician can refer the individual to a psychiatrist for a mental health evaluation if there is any question about whether the patient is mentally competent to make the decision. There are other safeguards such as a waiting period of 15 days between becoming eligible and actually receiving the prescription.
As a consequence, in the first year under the act, only 15 persons chose to end their own lives. To put this into perspective, in 1998 there were 29,314 deaths in Oregon from all causes. Thus, only five of every 10,000 deaths in the state occurred as a result of this new law. Not one of the horror stories predicted by opponents has occurred.
Yet, in spite of the facts, the House of Representatives last week substituted its judgment for that of the citizens of Oregon by passing HR 2260, which effectively blocks the implementation of Oregon's law without actually overturning it. For a conservative Congress that prides itself on limited government, on freedom from government intervention, and on privacy and individual liberty, this is a tremendously hypocritical act.
Even more hypocritical is the fact that HR 2260 does not directly address the issue of physician aid in dying. Rather, it seeks to prevent the use of controlled substances such as barbiturates in implementing the act. This is disingenuous at best and dishonest at worst. Whether physician aid in dying is an option that should be legal in this country is a legitimate question over which reasonable people can disagree. That is not the question that this Congress is debating.
In its zealous effort to block Oregon's law, Congress has passed a bill that would have a chilling effect on the use of controlled substances in palliative care for the terminally ill. It does this by making it illegal for physicians to knowingly prescribe drugs in order to aid in a death.
This creates a problem, because every day in the legitimate and accepted treatment of terminally ill patients, physicians prescribe controlled substances in dosages that will hasten death. This leaves thousands of cases each year in which the intent of the physician could be questioned under this law. Faced with the specter of investigation by the DEA, prison or loss of their practice, many doctors will treat pain less aggressively than is required for full relief, in order to defend themselves.
HR 2260 empowers nameless, unaccountable bureaucrats within the Drug Enforcement Administration to second-guess the intention--after the fact--of every physician in America. Thus, whenever physicians prescribed narcotics for palliative care, they would be at risk of losing their licenses under this bill. This so-called "Pain Relief Promotion Act" would, in reality, have exactly the opposite effect.
In an attempt to prevent a choice for Oregon's terminally ill--a choice thoroughly debated and approved by Oregon voters in two general elections--Congress is putting at risk the practice of medicine, the treatment of pain and care for the terminally ill.
How much easier it is to grandstand on this emotional issue than to come to grips with America's true health crisis: the millions who are uninsured. As a physician and as a governor, I urge Congress to focus on this real crisis. Leave Oregonians alone to exercise the individual choice between life and death that they have wisely granted to themselves.
The writer, a medical doctor, is governor of Oregon.