Oregon voters affirm legalized assisted suicide
Oregon voters affirm legalized assisted suicide
Referendum to overturn Measure 16 voted down
In a mail-in ballot wrapped up on Nov. 4, Oregon’s voters defeated by 60% to 40% Ballot Measure 51, aimed at repealing Measure 16, which was narrowly approved by voters in 1994 to make Oregon the first state to legalize physician-assisted suicide. Although Measure 16 has never been implemented because of legal challenges, the best information available at press time says it is now in effect.
Measure 51 was placed on this year’s ballot by the state legislature in an effort to repeal Measure 16 because of perceived structural problems in the original measure. However, voters soundly rejected the attempt, and the last apparent legal impediment was removed Oct. 27 when the 9th District Court of Appeals in San Francisco vacated a December 1994 ruling by U.S. District Judge Eugene Hogan, barring its implementation. A round of new legal challenges is predicted, and the parties to the original legal challenge to Measure 16 were scheduled to reconvene in Judge Hogan’s courtroom Nov. 25 for a status conference.
"At this point, we believe Measure 16 is in effect," with its 15-day waiting period intact, says a spokesperson for the state Attorney General’s Office. Terminally ill residents can now request from their physicians a lethal medication dose to end their suffering by ending their lives. It is also believed that implementing regulations from the state are not required, despite numerous outstanding questions about the measure.
The state’s medical and pharmacy boards are likely to issue their own guidelines for providers. An ad-hoc Task Force to Improve Care of the Terminally Ill Oregonians, representing 24 state health organizations, was convened by Oregon Health Sciences University in the wake of Measure 16’s passage to develop professional standards to guide its implementation. This task force is now finishing a comprehensive, 100-page guidebook of recommendations for providers.
Meanwhile, a potential new barrier has emerged. In response to questions raised immediately after the election by Sen. Orrin Hatch (R-UT) and Rep. Henry Hyde (R-IL), Thomas A. Constantine, administrator of the federal Drug Enforcement Administration (DEA), issued a warning that doctors participating in assisted suicide, even when permitted by state law, would be in violation of federal controlled substances law. They would thus risk losing their licenses to prescribe narcotics, on the grounds that there is no legitimate medical purpose or legal justification for using controlled substances in this way.
Later in November Attorney General Janet Reno said the DEA, which is part of the U.S. Justice Department, failed to notify her of its opinion. The department was reviewing the issue, with no projected date for completion, she said. Hyde has predicted that the controversy will need to be settled in court. Hospice Management Advisor’s calls to the DEA and the Department of Justice for confirmation were not returned.
Where does hospice fit?
"We’re concerned how [the DEA threat] will affect current medical practice. Will it make doctors even more reluctant to prescribe pain medications?" wonders Ann Jackson, executive director of the Oregon Hospice Association (OHA). In a Nov. 5 memo, OHA advised its members to make sure their relationships with physicians, pharmacists, and law enforcement officials in their communities are on a solid footing. OHA also recommended that hospices have their own policies on Measure 16 in place and have copies of relevant laws and regulations on hand.
Barring another last minute legal reversal, the state’s hospices will now find out what it is like to operate in an environment where assisted suicide is a legal option. It is not clear what that reality will mean to the progress the state’s hospice advocates have made in recent years. Oregon now has the country’s lowest rate of in-hospital deaths, the highest per capita use of morphine for pain management, the third highest rate of hospice utilization, almost universal access to hospice coverage for its citizens and an innovative new advance directive program called POLST (physician orders for life-sustaining treatment).
But providers now fear the public will blur the distinctions between hospice and assisted suicide, between palliative care and euthanasia, and between the use of narcotics for terminal pain management or for assisted suicide. Jackson says she expects most or all of the state’s hospices will admit terminally ill patients who have expressed an interest in obtaining lethal medications under Measure 16, but not participate in dispensing or administering such medications.
She also expresses frustration at the way the recent Measure 51 campaign played out with an emphasis on oversimplistic, negative messages rather than educating the public about real options in end-of-life care and with the lack of a hearing for hospice’s expertise, except in Portland’s Oregonian newspaper. On the other hand, both sides of the assisted suicide issue "strongly recommend that terminally ill patients be referred to hospice. Hospice census is up, and length of stay may even be affected because people are starting to discuss these issues," she says.
The day after Oregon’s vote, California Assemblywoman Carole Migden (D-San Francisco) held hearings to look into whether that state’s lawmakers should consider a similar measure to Oregon’s although she emphasized that these were only preliminary discussions. Under the auspices of the newly formed California Assembly Select Committee on Palliative Care, which Migden chairs, testimony was heard from a dozen physicians, nurses, lawyers, disabled advocates and religious leaders as well as Brad Stuart, MD, Santa Rosa-based medical director for Visiting Nurses and Hospice of Northern California in Emeryville, representing the California State Hospice Association.
According to information from the National Conference of State Legislatures, 24 states considered legislation this year regarding physician-assisted suicide, either to prohibit it, permit it, or clarify that providing terminally ill patients with pain medications which might hasten their death is not the same as assisted suicide. Of seven legislatures still in session in November, four still had active bills on the issue and three of these in Massachusetts, Michigan, and Wisconsin were proposals to legalize assisted suicide. Nine other states have bills that will carry over to 1998 sessions.
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