Oregon Death with Dignity Act

Measure 16 of 1994 established the U.S. state of Oregon's Death with Dignity Act (ORS 127.800-995^[1]), which legalizes physician-assisted dying with certain restrictions. Passage of this initiative made Oregon the first U.S. state and one of the first jurisdictions in the world to permit some terminally ill patients to determine the time of their own death.

The measure was approved in the November 8, 1994 general election. 627,980 votes (51.3%) were cast in favor, 596,018 votes (48.7%) against.^[2] Measure 51, referred in the wake of Washington v. Glucksberg by the state legislature in November, 1997, sought to repeal the Death with Dignity act, but was rejected by 60% of voters.^[3] The act was challenged by the George W. Bush administration, but was upheld by the Supreme Court of the United States in Gonzales v. Oregon in 2006.

The law

Under the law, a capable adult Oregon resident who has been diagnosed, by a physician, with a terminal illness that will kill the patient within six months may request in writing, from his or her physician, a prescription for a lethal dose of medication for the purpose of ending the patient's life. Exercise of the option under this law is voluntary and the patient must initiate the request. Any physician, pharmacist or healthcare provider who has moral objections may refuse to participate.

The request must be confirmed by two witnesses, at least one of whom is not related to the patient, is not entitled to any portion of the patient's estate, is not the patient's physician, and is not employed by a health care facility caring for the patient. After the request is made, another physician must examine the patient's medical records and confirm the diagnosis. The patient must be determined to be free of a mental condition impairing judgment. If the request is authorized, the patient must wait at least fifteen days and make a second oral request before the prescription may be written. The patient has a right to rescind the request at any time. Should either physician have concerns about the patient's ability to make an informed decision, or feel the patient's request may be motivated by depression or coercion, the patient must be referred for a psychological evaluation.

The law protects doctors from liability for providing a lethal prescription for a terminally ill, competent adult in compliance with the statute's restrictions. Participation by physicians, pharmacists, and health care providers is voluntary. The law also specifies a patient's decision to end his or her life shall not "have an effect upon a life, health, or accident insurance or annuity policy."

Analysis of impact

From the act's passage to 2008, 401 patients used the act, representing an estimated 19.4 deaths per 10,000 total deaths in the same time period.^[4] The average patient age was 70, with 81.8 percent of patients suffering from malignant neoplasms (cancer).^[5] All but five of the 401 deaths involved a lethal medication of either secobarbital or pentobarbital; of those patients ingesting medicine received under the act, 95.1% experienced no complications.

An independent study published in the October 2007 issue of the Journal of Medical Ethics reports there was "no evidence of heightened risk for the elderly, women, the uninsured, people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations."^[6]

Attempts to repeal

In addition to the standard arguments against physician-assisted dying, opponents feared that terminally ill people throughout the nation would flock to Oregon to take advantage of the law. This fear has not been realized, largely because drafters of the law limited its use to Oregon residents.^[7] Despite the measure's passage, implementation was tied up in the courts for several years.

In 1997, the Oregon Legislative Assembly referred Measure 51, which would have repealed the act, to the ballot.

Proponents of Measure 51 argued that the Death with Dignity Act lacked a mandatory counseling provision, a family notification provision, strong reporting requirements, or a strong residency requirement.^[8] Measure 51 opponents argued that sending the measure back to voters was disrespectful considering they had already passed Measure 16 via the initiative process. They also felt that the safeguards in the Death with Dignity Act were adequate.

Measure 51 was defeated in the November 4, 1997 special election with 445,830 votes in favor, and 666,275 votes against.^[9]

Some members of the United States Congress, notably Senator Don Nickles of Oklahoma, tried to block implementation of Measure 16, but failed.^[10][11]

In 2002, federal judge Robert E. Jones blocked a move by United States Attorney General John Ashcroft to suspend the license for prescribing drugs covered in the Controlled Substances Act of doctors who prescribed life-ending medications under the Oregon law.^[12] The Ninth Circuit Court of Appeals affirmed the block, stating that the "Attorney General lacked Congress' requisite authorization".^[13]

In October 2005, the U.S. Supreme Court heard arguments in the case of Gonzales v. Oregon to determine the fate of the Death with Dignity law. Arguing on behalf of the state was Oregon Senior Assistant Attorney General Robert Atkinson. Oregon's five Democratic members of Congress also filed a brief in support of the State's position.^[14] United States Solicitor General Paul Clement argued on behalf of the Bush administration, which challenged Oregon's right to regulate the practice of medicine when that practice entails prescribing federally controlled substances. On January 17, 2006, the court ruled 6–3 in favor of Oregon, upholding the law.^[15]

Documentary film

How to Die in Oregon is a 2011 documentary film about the Oregon Death with Dignity Act, directed by Peter Richardson. It won the Grand Jury prize for documentary film at the 27th Sundance Film Festival.

See also

• List of Oregon ballot measures
• Washington Death with Dignity Act, a similar measure passed in November 2008 in the state of Washington
• Compassion & Choices of Oregon, providing medical consultation and direct service for persons eligible for the Oregon Death with Dignity law.
• Baxter v. Montana, a court decision legalizing aid in dying in Montana
• Death with Dignity National Center, an organization founded to pass and support the law.
• Gonzales v. Oregon
• Washington v. Glucksberg

References

1. ^ "Chapter 127.800-995 The Oregon Death with Dignity Act". Oregon State Legislature. http://www.leg.state.or.us/ors/127.html. 
2. ^ "Initiative, Referendum and Recall: 1988-1995". Oregon Blue Book. http://bluebook.state.or.us/state/elections/elections21.htm. 
3. ^ "Initiative, Referendum and Recall: 1996-1999". Oregon Blue Book. http://bluebook.state.or.us/state/elections/elections22.htm. 
4. ^ "2008 Summary of Oregon’s Death with Dignity Act". Oregon.gov. March 2009. http://egov.oregon.gov/DHS/ph/pas/docs/year11.pdf. Retrieved 2009-03-05. 
5. ^ "Table 1. Characteristics and end-of-life care of 401 DWDA patients who died after ingesting a lethal dose of medication, by year, Oregon, 1998-2008". Oregon.gov. March 2009. http://egov.oregon.gov/DHS/ph/pas/docs/yr11-tbl-1.pdf. Retrieved 2009-03-05. 
6. ^ Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in "vulnerable" groups. Battin, P. et al. Journal of Medical Ethics 2007;33:591–597
7. ^ Howell, Joseph (2006). "Death With Dignity Act 2006 Annual Report". State of Oregon. http://egov.oregon.gov/DHS/ph/pas/. Retrieved 2007-04-11. 
8. ^ Measure 51 Legislative Argument in Support
9. ^ Measure 51 election results from Oregon Secretary of State
10. ^ Wentz, Patty. "Dignified suicide". Willamette Week. http://www.wweek.com/html/25-1994.html#suicide. Retrieved 2010-07-07. 
11. ^ "Senate Bill To Nullify Death With Dignity Act Also Threatens Pain Care Nationwide". Compassion in Dying. Body Health Resources Corporation. Spring 2000. http://www.thebody.com/content/art16692.html. Retrieved 2007-04-17. 
12. ^ Johnson, Kevin (2002-04-18). "Federal judge backs Oregon suicide law". USA Today. http://www.usatoday.com/news/nation/2002/04/17/court-suicide.htm. Retrieved 2007-03-18. 
13. ^ "Oregon V Ashcroft May 26, 2004". http://openjurist.org/368/f3d/1118/oregon-v-ashcroft-asa-w. 
14. ^ Daly, Matthew (2005-07-21). "Assisted suicide defended". Associated Press (The Columbian). http://0-docs.newsbank.com.catalog.multcolib.org/openurl?ctx_ver=z39.88-2004&rft_id=info:sid/iw.newsbank.com:NewsBank:VCBB&rft_val_format=info:ofi/fmt:kev:mtx:ctx&rft_dat=10B80E28D006C0B0&svc_dat=InfoWeb:aggregated4&req_dat=0D10F2CADB4B24C0. 
15. ^ Christie, Tim (2006-01-18). "Assisted suicide upheld". The Register-Guard. http://docs.newsbank.com/openurl?ctx_ver=z39.88-2004&rft_id=info:sid/iw.newsbank.com:NewsBank:ERGB&rft_val_format=info:ofi/fmt:kev:mtx:ctx&rft_dat=10F469EFD3418CD8&svc_dat=InfoWeb:aggregated4&req_dat=8CE642B8CA5C4083BE84A2539D6E1A73. 

External links

• Text of the law
• State government website about law
• Web site in favor of law
• Briefs filed by the state of Oregon in the Oregon v. Gonzales case
• Is the Oregon Death with Dignity Act a good law? Website with pros and cons
• Oregon Voter's Guide page on Measure 51--includes the full text of the measure, and arguments for and against
• The New Atlantis: Ten Years of "Death with Dignity"