Do insurance companies push euthenasia?

Steve Mason is ready for death. Since last December, the 65-year-old writer has kept four small bottles of clear liquid Nembutal-- a lethal dose of barbiturates--in his Ashland, Ore., condominium. And at some point in the next few months, when terminal lung cancer has spread to his liver or brain, when his breath is short and he feels too sick to eat or sleep, he will pick a day to gather close friends and family about him. He will give away his belongings and say his goodbyes. "It will be a celebration of life," Mason predicts. "I'd like to hear Satchmo singing What a Wonderful World." When he actually swallows the potion, he expects to slip into unconsciousness and die within minutes. "I've lived my life with dignity," he says. "I want to go out the same way."A continent away from the political battle that has surrounded Terri Schiavo, a radical experiment in end-of--life policy has unfolded much more quietly over the past seven years. Oregon's Death with Dignity Act, twice approved in statewide voter referendums, is the only statute in the U.S. allowing doctors to write lethal prescriptions for terminally ill patients who want to control the time and place of their death. The law would not affect a case like Schiavo's: patients qualify only if they are fully conscious and able to administer their own overdose. But Oregon represents a new frontier in the right-to-die movement by legalizing--and stringently regulating--a practice deemed a crime in most other states.Now, in the aftermath of the Schiavo furor, physician-assisted suicide is likely to erupt as the next big conflagration over end-of-life issues. Indeed, things have already begun to heat up. The U.S. Supreme Court agreed last month to take up a Bush Administration challenge to the Oregon law. The White House wants to revoke the license of any doctor who writes a lethal prescription, arguing that federal drug laws trump states' rights to regulate medical practice. Meanwhile, legislative committees in Vermont and California will vote this month on whether to adopt Oregon-style statutes. Other states have considered similar laws. If the polls are to be believed, the public is ready to give such measures a close look.In a TIME poll conducted last week, 52% of Americans surveyed said they agree with the Oregon law, vs. 41% who did not. In California, where opponents defeated assisted-suicide legislation just six years ago, a Field poll this month showed 70% of residents agreeing that "incurably ill patients have the right to ask for and get life-ending medication." More than two-thirds said they would want their doctor to help them die if they were expected to live less than six months. "People's worst nightmare is that powerful politicians will rob them of a peaceful death," says Barbara Coombs Lee, head of the national advocacy group Compassion and Choices.Oregon Governor Ted Kulongoski, a backer of his state's pioneering law, does not want to be one of those pols. "Oregon should be a model for every state," he says. "We live longer through medical technology. But there is more to life than breathing." A Roman Catholic, Kulongoski is knowingly taking a position in defiance of his church, which opposes his state's law. The church, in turn, is joining hands with disability-rights activists, who see assisted suicide as a first step to euthanasia. Even many doctors, who understand better than most what a horror a slow death can be, have trouble with the idea of speeding up the process. The American Medical Association remains opposed to any aid-in-dying laws, and the group speaks for a lot of its members. "When a doctor writes a prescription for lethal drugs," says Portland, Ore., radiologist Kenneth Stevens, "the message to the patient is, 'I don't value you or your life.'"Patients such as Steve Mason don't view it that way. A retired Army captain who served in Vietnam and has published three books of poetry, he was diagnosed with terminal cancer last April. Eventually, his longtime internist agreed to write his Nembutal prescription, but only after Mason cleared all the law's hurdles: submitting oral and written requests in the presence of two witnesses, waiting a mandatory 15 days and getting the concurrence of a second doctor that he had less than six months to live. "This isn't suicide," Mason insists. "Suicide means a needless taking of life. When five doctors tell you nothing can be done, you are merely insuring that your life ends at the proper time. I don't want my daughters to see me wither away to 80 lbs. and have some night nurse shave my beard to get some tubing into my mouth."What's perhaps most remarkable about the Oregon law, despite its opponents' fears, is how few people have used it. In seven years, according to the Oregon Department of Human Services, 208 people took legal, lethal overdose prescriptions--out of 64,706 Oregonians who died of the same diseases. Last year 40 doctors wrote 60 lethal prescriptions, but only 37 were used. For many patients, the drugs are a form of insurance. They can take the medicine if the pain gets too bad or if they deteriorate to the point that they feel ready to go, but otherwise not.Dick Farris, a Portland photographer, saw his father and brother felled by incurable pancreatic cancer. When he came down with the same condition, "he asked his friends for a gun," says his widow Gloria. "He could smell the decay inside himself." But after getting the prescription from his family doctor, she recalls, "he was able to relax, knowing he had control over his death." He chose to die on a Sunday morning, surrounded by his wife's three daughters and 9-year-old granddaughter. Says Gloria: "He told us, 'If I had any more love in this room, I'd have to keep it in Fort Knox.' Then he drank the Nembutal, and in five minutes, he was gone."The law has surprised Oregonians in other ways too. Contrary to what was expected, most patients who seek the drugs say they are not doing it primarily to avoid eventual pain--something they appear to be willing to face down on their own. The very existence of the law, however, has focused Oregon doctors' attention on end-of-life care, spurring them to take extra training in complex pain management and encouraging them to refer patients to hospice care earlier than before. And, while critics feared that HMOs, insurance companies or relatives might subtly encourage suicide because it is cheaper than treatment, only 3% of those who took the lethal prescriptions cited financial considerations as a reason, according to state surveys of their doctors. The reasons most gave: "losing autonomy" and "less able to engage in activities making life enjoyable."Despite the comparative ease with which the suicide statute has become a part of mainstream medical care in Oregon, many patients seeking lethal drugs still have to shop for a doctor. Catholic hospitals and even some nondenominational ones forbid their physician employees from writing such prescriptions. While a general survey found that 51% of the state's physicians support the act, only 34% say they would be willing to be the one writing the prescription. Instead, many refer patients to Compassion in Dying, a local nonprofit that can recommend willing doctors. That is the group Lillian Sullivan, 77, turned to for help.Two years ago, Sullivan, a retired bookkeeper, received a diagnosis of ALS--amyotrophic lateral sclerosis, better known as Lou Gehrig's disease--which paralyzes and eventually suffocates the patient. She asked her Portland doctors to prescribe lethal medicine, but even as her condition has deteriorated and her pain has increased, they have refused to discuss it. "They are young," she says. "They don't understand the pains of the elderly." She has a date with a new doctor this month but fears that by then her muscle constriction won't allow her to swallow--and self-administering the drugs is a strict requirement of the law. "I have no life," she says. "I watch commercials on TV."Some opponents of assisted suicide answer such despair with an argument that is insightful or cunningly circular, depending on your view, insisting that patients like Sullivan are depressed, and as such, don't qualify for suicide medication under the law. "If they are demoralized, we should take care of them, not overdose them," says Portland psychiatrist Gregory Hamilton. But the line between clinical and situational depression often gets blurred. "One doctor told me to take two antidepressants so I could have a Pollyanna attitude," Sullivan scoffs.The risk in such situations is that people who want to die will simply contrive their own ways--ways that aren't always easy. Last year, Joe Ramos, a retired Northern California computer executive, reluctantly supported his wife's wish to end her life when she became debilitated with ALS. As she deliberately began starving herself to death--a process that took a month--he could only stand by and watch. "People shouldn't have to go through that kind of suffering," he says.It's for that reason that a growing number of doctors seem willing to lend a hand in bringing lives to a close--and not all of those physicians are in Oregon. Many doctors admit to being willing to administer so-called terminal sedation, raising drug levels high enough to induce a fatal coma. Others simply increase morphine doses until the patient stops breathing. In 1998 the New England Journal of Medicine published a physician survey showing that when patients asked for lethal prescriptions, 16% of doctors complied, albeit quietly. "Aid in dying happens in every state," says assemblywoman Patty Berg, co-sponsor of the California bill. "We need to bring it out of the closet, impose legal safeguards and careful oversight."Advocates of assisted suicide in Vermont and California are optimistic. But the legislative history of aid-in-dying measures also gives them cause to be wary. An Oregon-type voter initiative failed by only 2 percentage points in Maine in 2001, and a similar statute was narrowly defeated in Hawaii in 2002. Recent legislation was tabled in Wisconsin, Wyoming and Arizona. But with two Academy Award--winning movies this year featuring themes of assisted suicide--Million Dollar Baby and The Sea Inside--momentum, or at least public awareness, is clearly on the rise."In 10 years, the whole country will have laws that value the civil right to die," predicts Steve Mason. That may be wishful thinking, and in any event, Mason won't be around to see it happen. Soon, as is his wish, his ashes will be scattered among Oregon's giant redwoods. "I feel liberated," he says. "Because, when my time is up, I get to choose." And that, it seems, adds a small consolation to the goodbye.

OregonContrary to the rest of the United States, Oregon has legalized physician assisted suicide (but not euthanasia in the sense of a physician or anyone else causing death): residents have voted for it at the Oregon Ballot Measure 16 (1994), and voted against repealing it at the Oregon Ballot Measure 51 (1997). Oregon's law has been attacked by various organizations, and federal government parties that support those organizations, ever since it was first enacted.Legal Times reports that former Attorney General "John Ashcroft, a longtime opponent of assisted suicide, stated that Oregon's practice violated the Controlled Substances Act because it lacked a 'legitimate medical purpose.'," and physicians who prescribe controlled substances to assist with suicided will have their medical licenses taken away. [2] (Law.com) The issue of whether the Federal Government or the State of Oregon has jurisdiction over this issue is now before the United States Supreme Court. INSERT: Oregon has passed the Death With Dignity Act ( State of Oregon: Oregon Department of Human Services - Page not found Page not found ).
[edit]Statistics and methodsIn 2003, in Oregon 42 cases of physician assisted suicide were reported (0.14 % of all deaths), all by drinking a strong barbiturate potion. The doctor is not required to be present, in 12 cases he/she was.Since 1998, 171 Oregonians have relied on the assisted suicide law.There were three cases of regurgitation. In each case at least one third of the potion was retained, which caused death anyway, though in one case only after 48 hours.The time from ingestion to unconsciousness was 1 to 20 minutes (median 4 minutes), the time from ingestion to death 5 minutes to 48 hours (median 20 minutes).By far, most reported cases concerned cancer patients. Also, in most cases the procedure was applied at home.