Briefing papers Oregon - The Blanket of Secrecy ALERT 2004 Introduction The doctor-assisted suicide law in the US state of Oregon was implemented in 1998. Earlier this state had pioneered a rationing system to abolish free health care for certain conditions. "Advocates promised Oregon voters that legalisation of assisted suicide would bring this previously rare and clandestine practice out into the open", writes Dr Gregory Hamilton, an Oregon doctor, in a recent book. The Case Against Assisted Suicide: For the Right to End-of-life Care  edited by Kathleen Foley MD and Herbert Hendin MD, pub John Hopkins University Press. ISBN 0-8018-6792-4. "Some advocates emphasise that physician-assisted suicide should be an experiment conducted in the 'laboratory' of the states. Yet the culture of silence that has developed around assisted suicide in Oregon has led to the result of this practice largely being kept secret." As mandated by the law, the Oregon Dept of Human Services must "'annually review a sample  of the records' and 'the information collected shall not be a public record and may not be made available for inspection by the public,'" reports the International Task Force on Euthanasia and Assisted Suicide. UPDATE, year 2000, Vol 16, No 1 "The only information the public is to receive is an `annual statistical report' with limited data." (Oregon Death with Dignity Act, 127.865 3.11. Emphasis added.) "The ODHS obtains all its information on assisted-suicide deaths after the patient is dead, from physician interviews, and periodic reviews of death certificates. The actual patients, their families and care givers, are not interviewed. The law does not penalise doctors who fail to report assisted suicide deaths, and ODHS has no authority to enforce the reporting requirement.. The actual statistics for physician non-compliance or any other abuse of the assisted-suicide law will never be known." Economic Pressure Not Admitted Dr Sherwin B Nuland, a doctor who supports the principle of ending patients' lives, strongly criticises the practice of it in Oregon, (Ibid). He writes: "Following AHD's lead, a year later, a survey that did list general types of insurance failed to divulge crucial specifics about capitated care arrangements, profit-sharing incentives restricting care, and known severe limits on palliative care benefits..." Dr Nuland quotes from "Freedom to Die," a book co-authored by Derek Humphry, founder of "Hemlock": "As technology advances, as medical costs sky rocket out of control, as the projected rate of the 85-and-older population accelerates, as managed care seeks to cut costs, and as Medicare is predicted to go bankrupt by 2007, the pressures of cost containment provide impetus, whether acknowledged or not, for the practicalities of assisted death... " Dr Nuland comments "This is terrifying stuff. Where is the vaunted freedom of which Humphry and his sympathisers boast? And where... is self-determination? Presumably in the same hell-hole that they occupied in Germany in the 1930's, where such philosophies led to their natural culmination in murder." Physicians for Compassionate Care Before the law was implemented in Oregon, its supporters claimed that in most cases the doctor supplying lethal drugs would be the patient's own practitioner. Opponents doubted this. Dr Gregory Hamilton writes: (Ibid) "Because of this controversy, it made sense that OHD would ask how many patients got assisted suicide from their own doctor versus how many obtained the fatal overdose after referral from an assisted suicide group, such as Compassion in Dying or the Hemlock Society. Yet OHD left the answer to this question, and this question alone, out of the report. "However, Compassion in Dying, an out-of-state suicide group that moved to Oregon just weeks after the law was implemented, claimed that eleven of the fourteen doctors involved were theirs."  The Oregonian reported that another doctor belonged to the Hemlock Society. Secrecy in the Classroom Dr Hamilton reports further: "On December 3rd 1999 Cathy Hamilton, a licensed mental health counsellor, took a continuing education class on how to counsel patients about assisted suicide, at Portland Community College, She was surprised to find that all the teachers in the day-long seminar were widely-known, politically active assisted suicide proponents, only one of whom was actually a practising clinician. No faculty member was there to discuss how to help patients overcome suicidal despair. "When, despite careful editing of cases, several disquieting facts about actual assisted suicide attempts were revealed, one of the instructors went so far as to demand that students not talk to anyone about anything that was said during the class. The counsellor was dismayed when George Eighmey, the executive director of Compassion in Dying in Oregon, followed her down the hall insisting that she not reveal important clinical problems raised in the class." "OREGON'S DEATH WITH DIGNITY ACT: HEALTH PROFESSIONALS SPEAK OUT ON ITS IMPACT' was the title of a national conference for central agency administrators, investigators and some legislators. Yet when Dr Hamilton, the only health care professional on the panel, spoke about a previously published case, George Eighmey told him it was "unfortunate" that he should have referred to it. The patient, who had motor neurone disease, had twice failed to swallow enough of the suicide pills for them to be effective. After this his brother-in-law "helped" him die. This case had been chosen for publication. (Examination of an earlier case of which details became known showed that a patient awarded the right to die had been suffering from dementia as well as cancer, and her death was most wanted by her daughter.) Abridgement of Free Speech Dr Hamilton again:  "Not only is the giving of lethal overdoses to patients taken out from under the purview of the medical organisations, which clearly define it as unethical the law actually forbids medical organisations to censure physicians for unethical conduct in this area... This abridgement of free speech is at the very heart of Oregon's assisted suicide law. "The... law states 'No professional organisation or association, or health provider may subject a person to censure, discipline, suspension, loss of licence, loss of privileges, loss of membership or other penalty for participating or refusing to participate in good faith compliance with ORS 127.800 to 127.897..." In contrast to this severity, there is no penalty in the law for doctors who fail to report their assisted suicide cases. US Department of Justice On November 8th 2001 Physicians for Compassionate Care filed a Friend of the Court brief supporting the United States Dept of Justice ruling that federally controlled substances may not be used for assisted suicide, and protecting aggressive pain management. One of their conclusions was: "As observed in the Code of Medical Ethics, Sec 2.211, over-throwing laws protecting the public against doctor-assisted suicide is destructive to the doctor-patient relationship, proves impossible to control, and poses serious societal risks. It creates an economic environment with institutional incentives favouring suicide over medical care. It is impossible to adequately monitor."