Source: Oregon Health Authority
Source: Oregon Health Authority
During the 2019 Oregon Legislature, lawmakers nixed the 15-day waiting period for terminally ill patients who ask for legal overdoses under the state’s assisted suicide law. Now, patients can get drugs immediately, provided a doctor says they will not live past 15 days.

According to Dr. William Toffler, the removal of safeguards is just getting warmed up.

“They will keep coming back to the Legislature until they make it essentially suicide by demand for anyone,” said Toffler, a longtime medical school teacher who now leads Holy Family Clinic in West Linn. “This is what has happened in every country that started down the path.”

Safeguards or barriers?

In the 1990s, proponents of assisted suicide in Oregon touted the waiting period and other safeguards as they were trying to pass the nation’s first law permitting doctors to give lethal prescriptions.

Now, some assisted suicide activists say the measures are impediments to those who want to hasten death.

“The time has certainly come to reevaluate and refine the law, and to remove those unnecessary regulatory requirements that create barriers,” Dr. David Grube, national medical director of Compassion & Choices, told a committee of the Oregon Senate in May 2019.

“We support eliminating barriers like waiting periods for medical aid in dying because many terminally people die with needless suffering during the waiting period,” said Sean Crowley, media relations director for Compassion & Choices.

“The idea was that you are not going to do this on a whim,” Toffler countered. “Removing the waiting period shows a profound disregard for a person who is in the most critical time of need and devalues their inherent worth. When a patient says, ‘I want to die,’ it may simply mean, ‘I feel useless.’ When a patient says, ‘I don't want to be a burden,’ it may really be a question, ‘Am I a burden?’”

Diane Coleman of the disability rights group Not Dead Yet said that ending the waiting period endangers older, ill and disabled people. In her 2019 testimony at the Legislature, she said the change just increases the pressure to get out of the way.

“There is always the potential that coercion is taking place,” Coleman told lawmakers.

But the waiting period repeal passed in the House 35-22 and in the Senate 16-11. Leading the Senate opposition was Sen. Cliff Bentz, an Ontario Republican who now is running for the U.S. House.

“This decision is one that should never ever be made in haste,” said Bentz, a member of Blessed Sacrament Parish in Ontario. “The idea behind the so-called reflection period was that it be commensurate with the seriousness of the decision.”

Bentz said that many people at the end of life have difficulty being clear on any decision. In addition, he said, men especially are prone to abrupt choices, as is evident from suicide involving guns.

“You don’t want them to do it by impulse,” Bentz said. “Have them slow down and think about it. We are trying to avoid euthanasia and shortening that period is getting close.”

Slippery slope?

In 2016, Canada legalized assisted suicide, which means self-administering the lethal drugs, and euthanasia, which means someone else can administer the drugs, perhaps by injection.

Last year in British Columbia, a depressed man was euthanized. In the Netherlands and Belgium, many doctors have performed euthanasia on patients who were physically healthy but depressed.

A bill proposing lethal injections and inhalation of deadly compounds passed the Oregon House in 2019 but was stuck in a Senate committee at the time of adjournment.

The specter of doctors killing patients by injection thwarted the euthanasia movement for years. The notion of self-administered drugs is what helped the Oregon law pass in 1994 and become a model for seven states, including Washington and California.

“Opponents of assisted suicide, including myself, have been warning all along that assisted suicide laws lead to euthanasia,” Dr. Kenneth Stevens told a committee of the Oregon Senate in May 2019.

A member of the Oregon Health and Science University radiation oncology faculty since 1972, Stevens said that the mechanisms imagined in the expansion bill would make it possible for patients to be killed without ever knowing what is going on.

“Oregonians have reason to oppose the expansion of an already harmful assisted suicide public policy,” Stevens said. “Assisted suicide and its inevitable next step, euthanasia, exacerbate the existing problem of rationing health care — especially for those at an economic disadvantage. That’s because one sure way to control health care costs is to eliminate the patient.”

In his May 2019 testimony, Toffler warned that proponents of expansion were distorting the term “ingest.” Toffler said it clearly means that something is to be taken by mouth, but activists want to include injections and inhaled gases.

“Obviously, this will open the door even wider for abuse,” Toffler told lawmakers.

There is disagreement among assisted suicide advocates on expanding to injection and inhalation. Proponents say the provisions help patients who are unable to swallow.

But Geoff Sugerman, campaign manager for the original Death with Dignity Act in 1994, told lawmakers the proposals could lead to botched attempts and leave patients too open to death without consent — otherwise known as homicide.

Deaths increasing steadily

Since Oregon’s assisted suicide law went into effect in 1997, more than 1,600 Oregonians have used it to take their lives. In order to qualify, patients must ask on their own and must have six months or less to live, according to a physician. In 2019, 188 people used the law to die, the most in a year. The number has climbed every year since the start.

Suicide was never illegal under state code; the law actually was meant to protect doctors who help their patients kill themselves.

According to 22 years of state data, which come not from an independent source but from the physicians who dispense the lethal drugs, most patients were 65 or older and had cancer. Patients tend to be highly educated, residing in the Portland area and 96.4% white. Only 1.2% of those who used the law to die were Hispanic.

On average, the doctor who prescribed the lethal drugs had known the patient for only three months. Complications were reported in 47 cases, but there is no independent source of information, just doctors reporting on their own work.

In 2019, one doctor was referred by the state to the Oregon Medical Board for failure to comply with requirements. Only one patient was referred for psychological evaluation.

According to state data, year after year the top reason people request assisted suicide is loss of autonomy (95%), followed by “less able to engage in activities” (95%), “loss of dignity” (87%), “losing control of bodily functions” (56%), and feelings of being “burden on others” (52%).

Medicine corrupted?

Physicians for Compassionate Care, a Portland-based association, argues that assisted suicide endangers the value society places on life, especially for those who are most vulnerable and who are near the end of life. The group also holds that the Oregon law undermines trust in the patient-physician relationship and corrupts physicians’ role as healers.

Toffler criticizes doctors who push or condone assisted suicide.

“They are dispassionate,” he said. “They don’t want to suffer with you.

These doctors become vending machines.”

Toffler said that about 50 patients have broached the idea of assisted suicide with him since it became legal. Most were not terminally ill. “Many studies show that assisted suicide requests are almost always for psychological or social reasons,” he said in testimony at the Oregon Capitol in April 2019.

He said a person asking for death should always get a psychological evaluation. But that is rare among Oregon’s assisted suicide patients.

Toffler’s wife died recently. He said both cherished the last weeks and days “and every nanosecond” they could spend together.

He is irked that the assisted suicide movement has coopted and, in his view, distorted a lot of language — “dignity” first of all. Death, he said, can be awful but still dignified, with the Passion and crucifixion of Jesus being the prime example.