The people of Oregon recently passed a referendum called the Death With Dignity Act. For the first time in America’s history, it allows a physician to prescribe a lethal dose of medication to be self-administered by a terminally ill patient. Shortly afterwards, the Task Force to Improve the Care of Terminally-Ill Oregonians was formed. This group of mostly medical professionals then wrote the “Guidebook for Health Care Providers”. According to its authors, the goal of this publication is “to offer guidance to health care providers whose patients may be interested in exploring their options under the provisions of the Death With Dignity Act.” In other words, its a how-to book for members of the medical community in Oregon who wish to help kill their patients.
Task Force is up front in stating their neutrality regarding physician-assisted suicide. The guidebook states that it was “designed to be a comprehensive reference book on all aspects of putting the Act into practice.” However, to the wary pro-life reader, its a thinly veiled attempt to mainstream physician-assisted suicide in Oregons medical community. Under the mission heading it reads, “we wish to facilitate understanding of diverse viewpoints.” Unfortunately, these are often code words for we have a contrary agenda.
The book raises many red flags regarding how the Task Force is approaching the execution of the Act (no pun intended). For example, they point out to the physician that the Act does not prohibit them from bringing up the idea of physician-assisted suicide, thus making it ethical to plant the idea with the patient. The guidebook also opens the door for possible assistance with self-administration of the lethal drug by explaining that the Act doesnt say how much, if any, aid someone may give the patient in dying. Having said that, they also point out that the Act is unclear whether the attending physician may prescribe an injectable drug for self-administration. It would seem that a subtle plan is unfolding.
Confidentiality for the patient and health care providers participating in physician-assisted suicide is a major concern of the Task Force. The physician is advised to make prior arrangements with a sympathetic pharmacist to help ensure this confidentiality. Pharmacies are also urged to “develop procedures to ensure confidentiality for patients, physicians and pharmacists” (emphasis added). This concern for confidentiality is a permeating theme throughout the guidebook. They acknowledge that providers such as pharmacists and hospice nurses have a right to not be unknowing participants in a morally objectionable action. “Nevertheless, attending physicians must respect the confidentiality of the patients request unless otherwise waived.”
It is the opinion of the Task Force that if a pharmacist has any question regarding the intent of a particular prescription, regardless of their willingness to participate in assisted suicide, it is his or her responsibility to contact the doctor and ask questions instead of being told up front. Further, physicians and pharmacists who refuse to participate in the intentional death of a patient are expected to refer them to someone who will. Perhaps this is what they mean in their mission statement by facilitating “understanding of diverse viewpoints.”
The Task Force has much to say about the actual administration of lethal prescriptions. Because of “liability concerns” and as a token olive branch to those who may object to assisted-suicide, they dont offer “specific formulas”. Formulas or not, a plethora of how-to information is shared.
Based on their experience with oral medications, death is likely to occur within 5 hours for most patients after ingestion. Perhaps the most chilling caution to health care providers by the guidebook is that the bodies of young people eliminate barbiturates more rapidly than elderly patients do, so higher doses are recommended to get the lethal effect. This indicates that they see more than just elderly terminal patients “benefiting” from the Act.
Serving tips for administering lethal medications are given with the nonchalance of a cookbook recipe. The barbiturates notoriously bitter taste can be overcome by “mixing the powder with pureed fruit, fruit juice, pudding or beverage.” Artificial sweeteners are also recommended.
To the Task Forces credit, they point out some of the pitfalls of dispensing lethal medication, such as how to prevent small children or others from having access to these medications or what should be done with the medication if the patient dies without taking it. The guidebook also points out that none of the drugs or drug combinations have been part of a scientific, controlled study for their intended lethal outcome.
Oregon’s Death With Dignity Act, by its vagueness, at times presents a danger to the rights of those its supposedly designed to protect. For instance, there are currently no mental competency standards. How will they decide who is mentally competent to choose to end his or her own life? What guarantees are there that the well-being and true wishes of the patient will be the motivation for decisions?
The Act states that health care providers are immune from civil and criminal charges if they conduct themselves in “good faith compliance”. This may be little comfort, as both the guidebook and critics of the Act agree that the meaning of “good faith” is unclear.
According to the Act, it is a Class A felony for a health care provider to use “undue influence” on patients to request assisted-suicide. However, this term is not defined in the Act. The guidebook cautions providers that in other areas of the law “undue influence” is also not precisely defined.
In addition, at the time of the guidebooks publication, the residency requirement had not been defined by the Act or by administrative rule. This has the potential to result in a one-way tourism industry.
If read carefully, the “Guidebook for Health Care Providers” sends an ominous underlying message. It demonstrates the potentially dangerous loopholes that may result in people being killed against their wishes. Oregons slippery slope may be steeper and much quicker than first imagined. History has taught us that, like in the
Netherlands, no amount of safeguards will prevent the taking of innocent human lives.