1. Suicide is contagious. Public policy that encourages any form of suicide sends a dangerous message to society and promotes suicide in general.
The rate of assisted suicide in Oregon has increased four-fold since legalization.[i] The rate of non-assisted suicides in Oregon began increasing in 2000, three years after legalization of assisted suicides. In 2010, Oregon’s suicide rate was 35% higher than the national average.[ii]
2. Assisted suicide leads to elder abuse. Oregon, where assisted suicide is legal, had 20,000 reported cases of elder abuse in 2010 and estimates that only 1 in five cases is reported.[iii] 68.3% of people who died by means of legal assisted suicide in Oregon between 1998 and 2009 were elderly, defined as being 65 years old or older.[iv]
In an illustrative case, 85 year old Kate Cheney received the drugs and committed suicide despite a psychiatrist’s judgment that she was incompetent to make the decision. A consulting psychologist judged her competent despite noting that her daughter was being “coercive”. The daughter had accompanied her to a first physician, who dismissed the request for assisted suicide, and to a second who called for a psychiatric consultation as required by her insurance company. The daughter become “very angry” at the psychiatrist who said Ms. Cheney was not able to give informed consent to assisted suicide and continued the quest until she found cooperative doctors. At the very least, this case raises troubling questions about informed consent and the possibility of elder abuse.[v]
3. Patients with treatable depression may receive assistance in committing suicide. According to the article in the Journal of Medical Ethics, “only 8.4% of the 460 people who had ended their lives” by assisted suicide in Oregon had been evaluated by a psychiatrist, and that the numbers of referrals had dropped to near zero as the years since legalization had passed.”[vi] The Journal article also cites a study that evaluated 18 people who had been approved for assisted suicide but had not yet taken the pills. It found that three of them, or one in six, had treatable depression.
4. Assisted suicide is not a personal choice that only affects the person committing suicide. A person’s suicide deeply affects family and friends. A family history of suicide puts the surviving family members at an increased risk of suicide.[vii] Assisted suicide also affects an entire medical community, which is why we see major medical organizations opposing efforts to legalize it.
According to the American Medical Association’s Code of Medical Ethics Opinion 2.211, “…allowing physicians to participate in assisted suicide would cause more harm than good. Physician-assisted suicide is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.”[viii]
5. The chronically ill and disabled are at an increased risk for assisted suicide. There is no way to be sure a person’s illness is terminal, so people who might be chronically ill and disabled, rather than dying, may be assisted in suicide.
Diagnosing an illness as terminal is very difficult. A Nov. 11, 2010 article from Journal of Medical Ethics cites Oregon Health Department data that the longest time between a patient’s first request for lethal drugs and death was 1009 days, about 2 and ¾ years, despite the fact that the Oregon law only allows assisted suicide for people diagnosed with a life expectancy of six months or less. The journal article also points out that many illnesses that may eventually become terminal have a long chronic phase, during which the patient may or may not become disabled, and that other illnesses may take them before the underlying “terminal” illness causes death.[ix]
Recent letters to the editor of a newspaper in Montana from an Oregon woman tell how she was diagnosed with terminal cancer over ten years ago and how she requested medication under the Oregon assisted suicide law. Because the doctor refused and persuaded her to accept treatment, she is still alive and very glad to be.[x]
[i] G. Finley, R. George, “Legal physician-assisted suicide in Oregon and The Netherlands: evidence concerning the impact on patients in vulnerable groups__another perspective on Oregon’s data”, Journal of Medical Ethics online, November 11 2010, http://jme.bmj.com/content/early/2010/11/10/jme.2010.037044.
[ii] Shen X, Millet L, “Suicides in Oregon: Trends and risk factors”, Oregon Department of Human Services, Portland, Oregon, http://www.oregon.gov/DHS/ph/ipe/nvdrs/docs/Suicide_in_Oregon_5year_data_report_2010.pdf?ga=t.
[iii] Matthew Neal, “Elder Abuse: A Growing Problem in Oregon”, Dalles Morning Chronicle, Jan. 7, 2011, http://www.thedalleschronicle.com/news/2011/01/01-07-11-03.shtml.
[iv] G. Finley, R. George, “Legal physician-assisted suicide in Oregon”.
[v] Herbert Hendin, Karen Foley, “Physician-assisted Suicide in Oregon: a Medical Perspective”, Michigan Law Review, June 2008, pp. 1613-1640, http://www.spiorg.org/publications/HendinFoley_MichiganLawReview.pdf.
[vi] Oregon Department of Human Services, Death with Dignity Act Annual Reports, Years 1-11, 1999-2009, quoted in G. Finlay and R. George, “Legal Physician-Assisted Suicide in Oregon”.
[vii] Ping Qin, M.D., Ph.D., Esben Agerbo, M.Sc., and Preben Bo Mortensen, Dr.Med.Sc., “Suicide Risk in Relation to Socioeconomic, Demographic, Psychiatric, and Familial Factors: A National Register–Based Study of All Suicides in Denmark, 1981–1997”, Am J Psychiatry 160:765-772, April 2003, http://ajp.psychiatryonline.org/cgi/content/full/160/4/765.
[viii] American Medical Association, “Code of Medical Ethics: Current Opinions with Annotations, 2010-2011.” http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2211.shtml
[ix] G. Finlay, R. George, “Legal physician-assisted suicide in Oregon”.
[x] Jeanette Hall, letter to the editor, Missoula Independent, June 17-June 24, 2010, p, 4.