Thursday, March 10, 2005
DAVID REINHARD
Oregon's dirty little secret is getting out -- finally and just in time for the
Supreme Court to contemplate the regulatory and pharmacological netherworld our
assisted-suicide law has created. Our dirty little secret: The pills used in
Oregon's assisted-suicide experiment don't always kill.
If that has a familiar ring it's because critics of the state's approach to assisted suicide had warned that the drugs wouldn't always lead to the swift, sweet or sure death that assisted suicide's promoters promised. For their pains, critics were called liars, but last week Oregonians learned that one terminally ill man awoke nearly three days after he took his kill-pill potion. "What the hell happened?" Estacada's David E. Prueitt asked his wife upon waking up. "Why am I not dead?"
Excellent questions. Critics provided answers years ago, and last week assisted-suicide fans finally had to admit a truth they once deemed a lie. Said Barbara Coombs Lee, co-president of Compassion & Choices: "He just didn't die."
Assisted-suicide supporters, and even some non-supporters, hasten to note that this is the first problem in 171 cases. But this betrays a "hear-no-evil, speak-no-evil, see-no-evil" approach to our experiment. In fact, the problems with the assisted-suicide law -- its reliance on drugs, its sham safeguards and feckless reporting regime -- were apparent before last week's news.
The veil lifted in 1999. Patrick Matheny's brother-in-law, Joe Hayes, told The Oregonian he felt compelled to "help" Matheny end his life when the drugs presented a problem. "It doesn't go smoothly for everyone . . .," he said. Was Matheny reduced to the vomiting that assisted-suicide foes warned of? Did Hayes resort to a plastic bag or pillow over the head to help him die? Hayes wouldn't say what prompted his intervention or how he helped.
Was this case a fluke? No, in early 2000, a Barbara Coombs Lee friend and assisted-suicide backer told an audience about another less-than-perfect case. After one man took the pills, Cynthia Barrett said, "he began to have some physical symptoms. The symptoms were hard for his wife to handle. Well, she called 9-1-1. The guy ended up being taken by 9-1-1 to a local Portland hospital. Revived. In the middle of it. And taken to a local nursing facility. . . ."
Like Prueitt, this man later died of natural causes. Barrett refused to describe those complications, and Compassion in Dying's George Eighmey, who was there, even denied that Barrett had said any such thing when Brainstorm magazine reported her comments. Except that the article's author, Cathy Hamilton, had taped Barrett's remarks. This is the same George Eighmey who told The Oregonian last week that the recent Prueitt case is the first failed case. Oh, really?
What's even more disturbing than assisted-suicide advocates' conveniently flushing this 1999 case down the memory hole is this: The case wasn't even reflected in the state's 2000 report on 1999 assisted suicides.
In fact, an assisted-suicide supporter at Yale University School of Medicine found that the Oregon report wasn't credible because it included no complications and this didn't jibe with the Dutch experience. In 21 of 114 Dutch cases where the original intent was to provide assisted suicide, doctors stepped in to give a lethal injection when things went badly.
Viewing Oregon's report, Sherwin Nuland wrote in the New England Journal of Medicine, "Is it really possible that debilitated, terminally ill people . . . will unfailingly succeed in attempts to end their lives without medical help? Can any experienced witness to dying believe such a thing?"
This hinted at the state's feeble monitoring of its new assisted-suicide law. Under the act that advocates themselves drafted, state health officials only compile data on each case and summarize the data in an annual report. They don't have authority to probe individual cases or ensure the data is factual. And, of course, state health officials can't provide an accounting of what's never reported to them in the first place. Finally, those reporting the data have an interest in prettying up the results of Oregon's experiment.
Yes, Oregon is conducting an assisted-suicide experiment, but its architects have created an experimental and regulatory environment only a Dr. Frankenstein -- or Kevorkian -- could love.
David Reinhard, associate editor: 503-221-8152 or
davidreinhard@news.oregonian.com
http://www.oregonlive.com/
http://www.registerguard.com/news/2005/03/07/b1.cr.healthfiles.0307.html
March 7, 2005
The Health Files / Tim Christie: Oregon
ranks near top in suicides among elderly
By Tim Christie
The Register-Guard
Much ink has been spilled over the suicide last month of gonzo
journalist Hunter Thompson. At age 67, in the kitchen of his Colorado
compound, he stuck a .45-caliber gun in his mouth and pulled the trigger.
Those who knew the hard-living, gun-loving Thompson, including his family,
have said his violent, self-inflicted death came as no surprise, nor was it
the result of chronic pain or depression.
"This is a triumph of his, not a desperate, tragic failure," his wife, Anita
Thompson, told the Rocky Mountain News.
While Thompson was a true American iconoclast, his means of death
exemplifies what public health and mental health officials say is a
troubling, preventable trend in Oregon and across the country: Elder
suicide.
The elderly - particularly older white men - have the highest suicide rates
of any age group, by far. And Oregon has some of the highest elder suicide
rates in the country.
Between 1999 and 2002, the rate of suicide among Oregonians 65 and older was
24 per 100,000 population, ranking sixth in the nation and 56 percent higher
than the national average of 15.4 per 100,000.
In 2003, the suicide rate among Oregon men 65 and older was 38 per 100,000.
By age 85, the rate jumped to 109 per 100,000.
Dr. Cliff Singer, a geriatric psychiatrist at Oregon Health & Science
University, said it's not clear why older white men are more likely to
succumb to suicide.
But the chronic illnesses that come with age often impair their ability to
function in life, and that can lead to depression, he said.
"They become demoralized because they can't be as active and independent as
they'd like to be," he said. "Demoralization can lead to depression and
depression is a major risk factor for suicide."
Disability may hit older white males harder than other demographics, he
said.
"This is a group that is more used to feeling like they had leadership roles
in society and within their families," he said. "Now they feel emasculated
and highly shamed by their physical frailty and functional decline. They
cope with it less well than others."
Most of these men who kill themselves had recently visited a physician,
Singer said.
"That tells you they are asking questions about their health and their
prognosis," he said. "When they're told they have a chronic disabling
condition for which perhaps only palliative care is available, they decide
to end it."
Older white men are also more likely to succeed at suicide, Singer said. One
of four attempts result in death, compared with one in 20 attempts among the
general population.
"They tend to be nonambivalent and choose highly lethal means," he said.
Guns, in particular, are the means of choice. Among elderly Oregonians, guns
are used in 80 percent of suicide deaths, according to state statistics.
State public health officials are developing a plan to prevent elder
suicides, said Lisa Millet, who manages the injury and violence prevention
program for the Department of Human Services.
Doctors, she said, should screen their patients for depression, and not view
depression as a normal reaction to declining health and diminishing
independence.
One strategy is training lay persons in intervention skills, just as many
people get CPR training, Millet said. To date, nearly 3,000 Oregonians have
been taught how to intervene when a friend or family member is facing a
mental or emotional crisis.
Singer said it's important for doctors and family members to get seniors to
talk about their feelings of hopelessness or demoralization. Talking about
it can lead to treatments, such as better pain control or antidepressants.
"Just the psychological relief of the unburdening that comes through talking
about a person's hopelessness, that sometimes relieves tension and buys
time," he said.
At PeaceHealth Medical Group's Senior Health and Wellness Center, doctors
routinely screen new patients for depression, said Sandy Sanders, a licensed
clinical social worker.
Sanders counsels seniors who are feeling depressed, anxious or struggling to
adjust to a major life change, such as the death of a spouse or the
inability to live independently.
"It's pretty much all about loss," she said.
Singer said he sees no connection between Oregon's high elder suicide rates
and the fact that it's the only state that permits doctor-assisted suicide.
"I think they're independent aspects of the same social psychology of
Oregon," he said. "We are a state of independent-minded people who want to
control their own destiny."
The fact that Oregon is a very secular state - our churchgoing rates are
among the lowest in the country - may play a role in higher suicide rates,
he said.
"Religious beliefs and spiritual practices ... have some measure of reducing
suicide risk," he said.
As for Thompson, a notorious hell-raiser with a prodigious appetite for
drugs and alcohol, family members insist that his suicide was the result of
his desire to go out on his terms - not because of depression or chronic
pain resulting from a hip replacement, broken leg and back surgery.
"Hunter did not do this in a moment of fear, desperation or despair," his
son, Juan Thompson, told the Rocky Mountain News.
"I don't know why he chose this moment. But he was quite clear about what he
was doing and he was going to go out on his own terms on his own time."
Tim Christie can be reached at 338-2572 or
tchristie@guardnet.com.
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