Oregon's 'death with dignity' law enters healthcare debate

Supporters say end-of-life care, including counseling and hospice, have made the state a model. Opponents look at Oregon and see "medical rationing" and "death panels."

It was inevitable that the debate over end-of-life issues and healthcare reform would turn to Oregon -- the only state that allows doctors to help people take their own lives.

It’s a profound and politically-charged issue. Depending on one’s point of view, it’s either “death with dignity,” to use the phrase describing the law Oregonians approved in two ballot measures in the 1990s. Or it conjures up images of involuntary euthanasia.

The Oregon law strictly prohibits "lethal injection, mercy killing, or active euthanasia." But it allows mentally competent adults who declare their intentions in writing, and have been diagnosed as terminally ill, to take a doctor-prescribed lethal drug themselves, orally, after a waiting period.

Since the law went into effect in 1998, about 40 people a year have taken their own life this way. Last year, 60 individuals did so (out of 88 who received the prescriptions).

Over the years, there have been no reported violations under the law -- no evidence that individuals have been pressured by doctors or family members. And Oregon has become noted for the quality of end-of-life care, especially the use of hospices.

But the law has always had its strong critics.

The Bush administration tried unsuccessfully to stop the practice using the federal Controlled Substances Act, a move the US Supreme Court rejected. Some medical professionals say helping a patient take his or her own life violates the Hippocratic Oath. Efforts to enact similar laws in California, Washington, and other states have failed. Conservative religious groups have fought it just as hard as they do abortion.

These days, Oregon’s law has become part of the rancorous debate over whether healthcare reform should include a provision that Medicare pay for voluntary counseling sessions to plan for end-of-life medical care. Opponents say some Oregonians have been denied medical care that could have successfully treated their illness.

The Family Research Council, known for its opposition to abortion, has been particularly vocal on the subject, insisting that “there is no such thing as a life not worth living.”

Supporters of Oregon’s law are pushing back.

Rep. Earl Blumenauer (D) of Oregon says claims that legislative proposals for advance care planning consultations include euthanasia and are mandatory every five years “are blatantly false.” He’s set up a “myths vs. facts” page on his website.

Other supporters of end-of-life counseling point to a new study in the Journal of the American Medical Association (JAMA) which found that patients and their families benefit from having such counseling.

“This study confirms the benefits of end-of-life counseling, as have other studies. It’s shameful that opponents suggest that such counseling is harmful,” says Barbara Coombs Lee, president of Compassion & Choices, a Denver-based advocacy organization that provides patient counseling.

“Recently, an idea took hold that it’s highly dangerous and tyrannical to encourage doctors to talk with patients about what kind of treatments they would want if they were terminally ill and unable to speak for themselves,” says Coombs Lee. “This notion is false. Talking about death won’t kill you, but not talking about it may increase unnecessary suffering.”
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