the truth about
Assisted Suicide
The Oregon Department of Human Services has recommended active screening for depression in the elderly as an important factor in reducing suicides.
Background on Physician-Assisted Suicide
In November 1994, Oregonians voted to pass an initiative allowing terminally ill patients to request a prescription of lethal drugs from a physician by which they could commit suicide. With the passage of Measure 16, Oregon became the first jurisdiction in the world to legalize physician-assisted suicide under the “Death With Dignity Act.”
The measure was quickly challenged in court. In August of 1995, it was declared unconstitutional based upon the equal protection clause of the 14th Amendment.
The judge’s opinion stated that Measure 16 created a classification of people (terminally ill, diagnosed with less than six months to live) who were treated differently by no longer qualifying for protection against suicidal impulses as do the rest of Oregon citizens.
In his decision, he asked, “Where in the Constitution do we find distinctions between the terminally ill with six months to live, the terminally ill with one year to live, paraplegics, the disabled, or any category of people who have their own reasons for not wanting to continue living?”
The district court’s decision was appealed to the 9th Circuit Court of Appeals, who dismissed the case in February 1997. The appellate court’s ruling was based not on the merits of the case, but on the decision that the plaintiffs lacked standing to challenge Measure 16. The case was then appealed to the U.S. Supreme Court.
The 1997 Oregon Legislature returned Measure 16 back to the November 1997 ballot for reconsideration and repeal as Measure 51. The repeal effort lost. The U.S. Supreme Court declined to hear the case. Assisted suicide became legal in Oregon in November of 1997.
Immediately following the repeal defeat, Congressman Henry Hyde released a letter from Thomas Constantine from the Drug Enforcement Agency (DEA). Constantine, in response to questions from Congressman Hyde, interpreted the DEA’s responsibility if controlled substances were to be used for something other than a “legitimate medical purpose.” The DEA’s assessment was that “delivering, dispensing or prescribing a controlled substance with the intent of assisting a suicide would not be under any current definition a ‘legitimate medical purpose.’ As a result, [assisted suicide] would be, in our opinion, a violation of the CSA (Controlled Substance Act).”
In June of 1998, Attorney General Janet Reno issued her opinion, which overturned the findings of Thomas Constantine. In August of 1998, Senator Don Nickles and Congressman Henry Hyde introduced the Lethal Drug Abuse Prevention Act which would have outlawed controlled substances being used for assisted suicide. The bill received a hearing in the House and the Senate, but was not voted on.
Assisted suicide has been legally allowed in Oregon since November 1997. In 2023, Oregon Democratic Governor Tina Kotek signed a law removing the residency requirement from theDeath With Dignity Act, allowing Oregon physicians to prescribe lethal drugs to people from other states. The Oregon Health Authority had already stopped enforcing the residency requirement in 2022.
4,881 people have been prescribed lethal drugs since Oregon’s DWDA took effect in 1997, and at least 3,243 people (66%) have died after consuming them, the Oregon Health Authority’s 2024 assisted suicide report states. 22 of the people who died in 2024 after ingesting lethal drugs were non-Oregon residents.
Description of Physicia Assisted Suicide
Under the law, a patient who wants to access physician-assisted suicide (PAS) must be diagnosed with a terminal illness and have six months or less to live. A second doctor must confirm this diagnosis. In practice, patients with chronic conditions who decide to opt out of continued treatment can qualify for assisted suicide.
After qualifying as a candidate for PAS, the patient must verbally request assisted suicide drugs twice. These requests must be separated by at least 15 days. The patient then signs a written request, witnessed by 2 people. The doctor can then write the prescription.
After getting the prescription filled, the patient may take the drugs at any time, immediately or at a later date. The doctor may not administer the drugs. The patient must take the drugs by himself with no help. The doctor is not required to be present when the drugs are taken. A report must then be filed with the state by the attending physician, but no oversight is permitted in the matter.
In 2019, the Oregon Legislature passed Senate Bill 579. This bill eliminated the waiting period for those diagnosed with two weeks or less to live.
Depression & Physician Assisted Suicide
An estimated 90% of suicides in the U.S. are associated with mental illness, most commonly depression, but Oregon’s Death With Dignity Act containsno requirement for a psychiatric examination. If the doctor thinks the patient is suffering from depression he can order a psychiatric exam.
Diagnosing depression can be challenging, even in patients with cancer and other serious illnesses. A 1998 survey of 1109 cancer patients and their physicians reported that the physicians accurately classified only 20 of the 159 moderately to severely depressed patients, and rated 78 of these patients as having essentially no depressive symptoms. In other words, the patients’ cancer physicians were accurate in diagnosing moderate or severe depression only 13% of the time.
Suicide is a leading cause of death in Oregon, particularly among the elderly. The suicide rate for Oregonians ages 65+ was 66 percent higher than the national avergage for that demographic, according to 2016 data from the National Violent Death Reporting System. . 83% of those who died from Oregon’s physician-assisted suicide drugs in 2024 were over the age of 65. The Oregon Department of Human Services has recommended active screening for depression in the elderly as an important factor in reducing suicides.
Dr. Satya Chandragiri, M.D., a Salem-based psychiatrist, told Oregon Right to Life that people facing end-of-life decisions are often very vulnerable, physically weak, and may be dealing with cognitive difficulties. In that condition, they often change their minds and “lack capacity to give consent,” even if they may seem to have made a choice. Moreover, he said, elderly people frequently feel and even express that they are “no use to anyone,” but that doesn’t mean they truly wish to die by assisted suicide.
Despite these concerns, providers in Oregon have been offering increasingly more exemptions to patients to reduce the 15-day waiting period. In 2020, 20% of patients received an exemption. In 2024, 29% of patients received an exemption.
A 25-year analysis published in 2024 found that between 2010 and 2022, the length of time between a patient meeting with a physician and getting prescribed lethal drugs decreased from 18 weeks to just 5 weeks. Meanwhile,the percentage of patients referred for psychiatric assessment during that time was reported to be 1%.
It is a tragedy that so few physician-assisted suicide patients ever received such an important evaluation. None of these patients, who were considered to be terminally-ill by their physicians, were granted the standard of health care that other patients are expected to receive. In that sense, they were discriminated against. This is another example of how physician-assisted suicide patients in Oregon are receiving inadequate and substandard care from their physicians.
Resources
- Passik, S. D., Dugan, W., McDonald, M. V., Rosenfeld, B., Theobald, D. E., & Edgerton, S. (1998). Oncologists’ recognition of depression in their patients with cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 16(4), 1594–1600. https://doi.org/10.1200/JCO.1998.16.4.1594
- https://eugeneweekly.com/2020/01/30/out-of-focus/
- Regnard C, Worthington A, Finlay I. Oregon Death with Dignity Act access: 25 year analysis. BMJ Support Palliat Care. 2024 Nov 20;14(4):455-461. doi: 10.1136/spcare-2023-004292. PMID: 37788941.