|RIGHT TO DIE?|
November 24, 1998
LEE HOCHBERG: Since assisted suicide was approved last fall in Oregon, advocates for the right to die say 18 terminally ill patients have died from ingesting lethal prescriptions. Their average age was 71. Seventy-five-year-old Meg Green is glad the option exists.
MEG GREEN, Cancer Patient: When you can't function, what's the use of living? Or if the pain gets too great, what's the use of living? And I think you have a right to have the final say.
LEE HOCHBERG: Like most of those who've sought an end to their lives, Green has cancer. Hers has moved from her bladder into her bones and lungs. She's undergoing chemotherapy but says the day may be soon ahead when she seeks her doctor's aid in dying.
MEG GREEN: We put our dogs to sleep when they can't function anymore to put them out of pain. What's the difference?
LEE HOCHBERG: Oregon right-to-die advocate Barbara Coombs Lee says assisted death has been difficult but liberating for patients and their families.
BARBARA COOMBS LEE, Compassion in Dying: It's the patient who's saying now's the time to do this, now's the time to do that, I'll prepare the medication this certain way; I want these people here; good-byes are said. And the patient takes the medication.
LEE HOCHBERG: Coombs Lee's group, Compassion in Dying, has counseled 58 terminal patients this year; 11 of them later ingested a lethal dose of a fast-acting barbiturate to end their lives. Average time from dosage to death is 40 minutes.
BARBARA COOMBS LEE, Compassion in Dying: And these patients are asleep in a very deep sleep in an extraordinarily short period of time, and then they are unconscious, appear to be sleeping or in a coma, and then very gradually respirations cease.
LEE HOCHBERG: Few who've observed the deaths have spoken publicly, but hospice nurse Steve Sehm, a supporter of assisted suicide, met with his as and his partner packed for a move to Minnesota. He told of a suicide he observed in the bedroom of an 85-year-old Portland man. The man was seated in a bathrobe on a rose-colored recliner, white hair combed neatly, a blanket atop him.
STEVE SEHM, Hospice Nurse: He never wavered, never once, with all the people with whom he interacted. He was always very clear. You know, he was always clear.
LEE HOCHBERG: He remembers the man smiled as he drank from a coffee cup a bitter prescription flavored with cherry. In 30 seconds, the man was asleep. Sehm recalls seeing the life literally drain from him.
STEVE SEHM: So it was very difficult emotionally and personally to see that happen, versus it being just natural. It was uncomfortable for me.
LEE HOCHBERG: Sehm says he may work for legalization of assisted suicide in his new state, but he's unsure he'd participate in an aided-death again. Aside from these rare anecdotes, details about the deaths are sketchy. Voluntary reports from physicians suggest none of the deaths has been uncomfortable, but to protect patient privacy, little clinical data has been recorded.
LEE HOCHBERG: So we don't know a great deal about the first cases, it sounds like.
DR. KATRINA HEDBERG, Oregon Health Division: That's right. This was a citizen's initiative, which I think, you know, is highly unusual.
LEE HOCHBERG: State epidemiologist Katrina Hedberg says assisted suicide arose from a political rather than a medical movement, so it hasn't been carried out like traditional medicine.
DR. KATRINA HEDBERG: A lot of the things that are done in standard medicine like enrolling people in a clinical trial are comparing procedures, or keeping track of data, just our - to the extent the medical aspects of the data are just something that are not there with us.
LEE HOCHBERG: The state soon will release physicians' surveys on medications being used and any side effects, but Hedberg says clinical monitoring is inappropriate.
DR. KATRINA HEDBERG: When people die, they're dying. It doesn't make any sense to be taking blood samples to find out what's happening. It doesn't make any sense to be monitoring their blood pressure, because when people die, their blood pressure drops and falls. I mean, that's going to happen with everybody. Their heart stops beating; they stop breathing.
LEE HOCHBERG: But the departure from scientific method alarms opponents of the right to die.
DR. GREG HAMILTON, Right-To-Die Opponent: It doesn't follow any of the standards of medical procedures. It's unresearched. LEE HOCHBERG: Portland Psychiatrist Greg Hamilton says doctor-aided death has been carried out in an almost paranoid secrecy that threatens the terminally ill.
DR. GREG HAMILTON: We can tell nothing which would protect the vulnerable individual to this day. There is secrecy about every aspect of this. There's no organized study done. There's no availability of impartial data here.
LEE HOCHBERG: Dr. Peter Goodwin of Oregon's Right-To-Die Group says Hamilton misses what voters had in mind when they approved aid in dying.
DR. PETER GOODWIN, Right-To-Die Advocate: This is not a medical procedure. The whole scenario to be determined by some researcher - this is a holy process of dying. How can you - how can you pervert it in that way? It's a perversion to my way of thinking. What's the pulse rate from minute to minute? Does it matter?
DR. GREG HAMILTON: Killing people is not holy. To say that it's holy is an abomination.
LEE HOCHBERG: Hamilton says there's another problem: people receiving aid in dying who shouldn't be. He says one woman was clinically depressed and might have reconsidered with proper therapy. He cites this tape recording the elderly woman left behind that was aired on local television.
ELDERLY WOMAN: I am looking forward to it because being I was always active. I will be relieved of all the stress I have.
DR. GREG HAMILTON: That woman was diagnosed as having depression, and yet, within three weeks, she was given a lethal overdose, instead of being given hope and treatment like anybody else.
DR. PETER GOODWIN: That is totally absolutely a fabrication.
LEE HOCHBERG: But right-to-die supporters and the patient's family say opponents have mis-told the story to ignite political opposition to assisted suicide.
DR. PETER GOODWIN: It's a total mis-statement of what really happened with this lady.
LEE HOCHBERG: Goodwin says the patient contacted him early this year, distraught that her physician had diagnosed her as depressed and had refused her request for aid in dying. Oregon law says if two doctors find a patient rational, she can receive such aid. Goodwin found five physicians, including a psychiatrist, who said she was of sound mind.
DR. PETER GOODWIN: There are six physicians who interacted with that patient. Five believed that the patient was acting totally rationally. Enemies of the law, I believe that they are using this case totally unjustly.
LEE HOCHBERG: The right to die is also mired in politics in Washington, DC. Arguing assisted suicide is an illegal use of drugs, Illinois Congressman Henry Hyde proposed a law to revoke physicians' rights to prescribe medicine if they aided death. Hyde chided Oregon for fomenting a culture of death, where the sick are lined up to relieve their loved ones of their burdensome existence by plunging off this cliff. Oregon Governor John Kitzhaber, a physician, called the proposed law an unprecedented intrusion of the federal government into medicine.
GOVERNOR JOHN KITZHABER, (D) Oregon: The hypocrisy here is the individuals who are sponsoring this amendment are the same people who pride themselves about keeping the government out of the private lives of American citizens. But they're intruding into probably the most personal decision that any of us will ever make.
LEE HOCHBERG: Congress never voted on the proposed law. Its sponsors are likely to reintroduce it in the upcoming session. Physicians fear its passage would not only end aid in dying but restrict their ability to manage pain for terminal patients. Oregon oncologist Peter Rasmussen has presided over at least one suicide. He says he'd pause before prescribing powerful painkillers for fear the government would accuse him of hastening a patient's death.
DR. PETER RASMUSSEN, Oncologist: People who are seriously ill toward the end of their life, who are having trouble controlling their pain, probably will find it harder to get doctors who are willing to give them the type of treatment they need to be made comfortable. I'm not talking about assisted suicide. I'm just talking about enough drugs - usually narcotics - to make them comfortable so that the remaining days of their lives can have a certain degree of dignity. I think it will turn into a disaster.
LEE HOCHBERG: Better end-of-life pain control has been a noted byproduct of Oregon's trial with assisted suicide. Morphine is used more commonly in Oregon today than in any other state. Shortly before dying of cancer, 72-year-old Faye Jackson said the drug was a godsend.
FAYE JACKSON, Cancer Patient: (September 10) If I ever got off Morphine completely, I'd be in so much pain that I wouldn't live more than 72 hours. I'm not about to get off and just see how bad I can hurt.
LEE HOCHBERG: In Oregon hospices and nursing homes 170,000 patients have attached these new pink forms to their medical charts. They order doctors to provide maximum comfort care but no CPR or ICU care. But right-to-die advocates say even if some Oregonians benefit from better comfort care at the end of life, the option must be retained for others to choose death.