Since 1994, when Oregon voters considered physician-assisted suicide, much new information has come to light. Mark O'Keefe and Tom Bates' article (Oregonian, March 2, 1997) reports that our legislators are taking this information seriously. That's what we elected them to do. The voters would be ill-served were their representatives to ignore the many disturbing facts that have been revealed over more than two years.
For example, since 1994, it has come to light that even the pro-assisted suicide forces in Oregon believe it is often a prolonged, grotesque, and inhumane procedure. They now publicly declare that they are not satisfied with assisted suicide, unless it is backed up by active euthanasia, that is, the doctor finishing the job with a lethal injection.
Since 1994, studies from the Netherlands have revealed that once euthanasia is officially sanctioned (by rules, procedures, exceptions to other laws), suicide increases many fold. It does not decrease when brought out in the open. Studies published in the New England Journal of Medicine, November 28, 1996, reveal that a quarter of people euthanized by Dutch doctors have been killed without their consent! This is established fact, not speculation about what might happen in the future.
The desensitization of our culture to conditional killing is already expanding the practice of euthanasia. In San Francisco, between 1990 and 1995, AIDS doctors and their patients were subjected to intensive propaganda promoting suicide as dignified. In 1990, only 8% of the San Francisco AIDS doctors had participated in assisted-suicide or euthanasia. In 1995, that number had increased to over half the AIDS doctors (New England Journal of Medicine, February 6, 1997). One doctor had personally participated in more than a hundred of these deaths! Clearly, sanctioning and promoting suicide has had an effect -- on both doctors and patients.
Two weeks after this report, the Center for Disease Control happily announced that new treatments for AIDS have dramatically lowered mortality rates (16% lower in the West), even though the number of new cases continues to rise. Meanwhile, many AIDS patients, who could have benefited from these new treatments, were "assisted" to their deaths by doctors they trusted, when hope was just around the corner. What about these patients? Sadly, these individuals were judged to be hopeless. Would legalizing euthanasia have protected them? Absolutely not. In the Netherlands, 22% of AIDS patients who die, do so at the hands of their doctors.
Yet, proponents of assisted-suicide still claim that sanctioning it can control it. While the rules and regulations have not worked in the Netherlands, safe-guards are weaker, indeed, almost non-existent in Oregon. For example, proponents continue to tout the protection of mental health consultation for those who request the hastening of their death. Yet euthanasia's backers know psychiatric consultation is not required at all and that only about one third of depression is recognized by the average doctor. In fact, since 1994, a study documented that 94% of Oregon psychiatrists are not confident they can determine when depression is affecting judgment about assisted-suicide requests (American Journal of Psychiatry, November, 1996).
The safe guards are so weak that some proponents *ving to create new angles to reassure nervous voters and legislators. Dr. Peter Goodwin, one of Measure 16's sponsors, claimed that "the risk of lawsuits would be far too great for doctors and health care organizations to participate in anything unethical" (Oregonian, March 2, 1997), when in fact the Death with Dignity Act forbids lawsuits about assisted-suicide and even prohibits scrutiny of the practice by the public. Dr. Goodwin knows this. He helped write Measure 16.
Since 1994, the extent of managed and capitated care problems has only begun to come to light. Oregon is one of the leaders in the number of patients in managed and capitated care plans. In capitated care, doctors, and the organizations which increasingly control them, can increase profits by providing less service to enrollees. Money can be saved by withholding care or not providing it at all.
As an example, in January, 1996, Time magazine documented that a California woman with a life threatening illness was denied treatment, because she was a managed care patient. The company considered the available treatment futile. The patient had no choice. When she returned to the same institution claiming to be a fee for service patient, she was offered the very same treatment she had just been denied. Now, it was no longer futile, but reasonable. Now, she had a choice. While many managed care organizations strive to minimize potential abuses, won't organizations, currently denying treatments to enhance profits, also preferentially encourage assisted-suicide? They can do so merely by considering treatment futile. Assisted-suicide is clearly the cheapest option. Assisted-suicide and euthanasia give control to large health care bureaucracies and governmental agencies, not to the individual doctor and patient, as initially claimed.
The voters of Oregon know we have a combined representative and democratic process. They also know we have a judicial system, which is closely examining this issue. It is the duty of the judges to give it their consideration. It is also the duty of our representatives to give it theirs. They must examine the new and disturbing information which has come to light. The Oregon voters deserve nothing less.
Dr. Hamilton is a Portland psychiatrist and author of the nationally acclaimed book, Self and Others. Dr. Toffler is a family physician and President of Physicians for Compassionate Care.