Seven Days; An hour-long special edition on assisted suicide/ Measure 51 in the '97 Nov. election;

[Loud tone] [Loud tone] [Loud tone] [Loud tone] [Loud tone] [Silence] [Silence, intermittent beeping, music fades in] [Music]

[Music] Hi, I'm Stephanie Fowler, and this is a special edition of Seven Days. For the next hour, we'll focus on ballot Measure 51. That's the proposal on the November ballot that would repeal Oregon's doctor-assisted suicide law. In our first half hour, supporters and opponents of Measure 51 will discuss the key issues in the campaign. Later in the program, some of our regular Seven Days panelists will join us to talk more about the measure. Let's meet our guest for the first discussion. Dr. Bennet ?Husted? is the founder of a nonprofit Portland physician service that cares for homebound patients. Dr. Rick Beyer represents Physicians for Death with Dignity. He's a board-certified adult medicine specialist. Trish Conrad is the campaign manager for Yes on 51, and Barbara ?Coombslee? is representing the No on 51 campaign. In 1994, she was a chief petitioner for Measure 16, which became the law that is now the subject of the repeal effort. To start off, we'd like one representative from each campaign to briefly explain why you feel voters should agree with your position on the measure. Bennet ?Husted?

representing the Yes on 51 campaign, you have two minutes. And just to clarify for viewers Yes on 51 means repeal doctor-assisted suicide, no means keep it. Bennet? [Bennet] Thank you. I'm in favor of Measure 51, which would repeal Measure 16, doctor-assisted suicide, because Ido not believe that Measure 16 has adequate safeguards. The Dutch have been doing this for 24 years and they know something that we don't. They know there's no guarantee that a lethal dose of pills will lead to death with dignity. Yes, there is a study. It says that 20% of people who took the recommended lethal dose of pills required an intravenous injection to end their lives. In the beginning, the Dutch used pills. Now, more than 97% use lethal injections. But Measure 16 specifically prohibits lethal injections. Measure 16 is a justice issue. Look at who Measure 16 protects, and who it doesn't it. It protects doctors from liability and botched assisted suicides,

yet it fails to require doctors to provide good end-of-life care. It fails to require doctors to report assisted suicides, and it fails to require managed care plans to offer other options for those who are terminally ill. Measure 16 lacks necessary safeguards to protect patients from doctors' misdiagnosis of terminal illness. To protect patients from doctors' failure to diagnose depression. To protect poor people from financial pressure to die. To protect the 40,000 Oregonians with no health insurance, and to protect senior citizens and severely disabled persons from feeling they should die. In 1994, Measure 16 barely passed. Doctors know now things they didn't know then, which is why the Oregon Medical Association House of Delegates voted 99-1 to endorse the repeal of Measure 16. Now the voters have the same opportunity. A yes vote on 51 will repeal 16. [Host] Now we hear from the No on 51

campaign. Barbara ?Combslee?, you have two minutes. [?Combslee?] Well, Oregon voters passed the Death with Dignity Act in 1994 because they judged that the government shouldn't force people to endure miserable and prolonged deaths against their will. The option of a peaceful and humane death should be available. People like Emerson ?Hugstradt? shouldn't have to submit to coma and slow starvation to avoid intolerable pain. People like Alvin ?Sonard? shouldn't have to leave his wife's side when she dies to avoid criminal prosecution. Most physicians and Oregonians of every persuasion and faith support the right of an adult to a choice to hasten death in the face of intolerable suffering. Measure 16 safeguards are exhaustive, so it provides that choice safely and effectively. Three-quarters of Oregon doctors support a patient's rights under Measure 16, and would comply with the new law. Most psychiatrists favor Measure 16. Three-quarters want the option for themselves, and a whopping 96% say that with time they can certify whether the patient is competent. Measure

16 gives them that time. So why are we voting again? Opponents of choice made up a scary story to get 51 through the legislature. Lobbyists from the Right to Life and Oregon Catholic Conference worked with OCA-backed legislators for an outright repeal, but they couldn't overcome the governor's veto. So for the first time in history, they're making us vote again on a measure we've already passed. They launched a five million dollar campaign to scare us into changing our vote. They hired an aggressive political operative from California, and brought money in from archdiocese, and moralist extremists from all over the country. TV stations won't even run their ads, they're so misleading. Scientific data simply doesn't support them. 52 politicians are trying to overturn the will of over 600,000 Oregon voters, and that's wrong. These legislators don't want to implement the will of the people. Only a repeal will satisfy them. Oregonians should keep the careful, compassionate judgment they made in 1994, and allow dying people to make their

own choice at the end of life. [Host] Okay, thank you. I'd like to start out with a question that there seems to be some agreement on, and that is that the presence of the assisted suicide law has enhanced end-of-life care and motivated the medical community to improve pain management, comfort care, and if the law's repealed, what incentive will there be to continue to devote resources, and money, and time to comfort care. I'll pass that question on to Dr. ?Husted? since she's our medical expert here today. [Husted] Well, I think it's true that Measure 16 was a real wakeup call to doctors, to the medical profession, and a lot has been done in the last three years to educate physicians about better end-of-life care, about using adequate pain control. I just attended a conference here a couple weeks ago that was sponsored by a group called Physicians for Compassionate Care that has over a thousand members, physician members, in the state of Oregon, and that is exactly what their purpose is, is to teach other doctors how to take care of people at the end of life.

[Man] I think we need to recognize that we can't just say "doctors" and generalize. I think there has been excellent end-of-life care by certain doctors for a long, long time, and there've been lots of efforts by medical oncologists and other physicians who are interested in this to try to teach that. I appreciate that more attention has been given to this recently, and I certainly think there's plenty of need for helping people at the end of life, but I think that the literature shows that end-of-life care efforts have been written about for a long time. Medical oncologists have been doing this. Hospice nurses have been doing this, and been doing a fine job. So I think that we need to continue our efforts for end-of-life care, but what we need is more physicians onboard, because not every physician is learning this. [Host] Okay, in terms of the campaign, you can- both sides, you can say the election is about whatever you wanna say it's about, and what you say it's about is what your polling tells you, you know, will most frighten or damage the voters, or damage the other people's side,

but regardless of what you're trying to tell voters, the election is about- isn't it really about whether mentally competent dying people should have some control or choice over the end of their life? [Woman] Well, we think that's exactly what's about, because implementation issues are some details that can and should be handled by the legislature. If there are concerns about this or that, this is a statute, this is code, this is not a constitutional amendment, and legislatures it should have implemented, not repealed it. It's about that and it's also about what is the purpose of a legislature, what is the proper role? When the people vote, when the people let their will be known, isn't that the role of the legislature to implement that will, and not second-guess it and turn it back to people? [Woman] Well, I would tell people to look at their voter pamphlet, which is something that everyone should already have in their mailbox, if not already in their house, and look what the actual ballot says. And I have said repeatedly that if the ballot asked, "Do you religiously, morally, conceptually, or philosophically support the concept of assisted suicide, we would be debating it on this basis, but it doesn't. The ballot is aboout this specific law, and that is why our campaign has focused on this specific law. When talking about the legislature, I know that it was not OCA-backed legislators, and unfortunately our opponents have made that claim, although they've never been able to produce one piece of paper or anything else to actually support it. But actually Democrats and Republicans, including Senator David Gordley, a Democrat from Portland, and Representative Brian Johnson, a Democrat from Salem who voted to refer this legislation, pardon me, initiative, and they did so, they admit that there are some parts of this law they could

have fixed, but they've also said there's no piece of legislation, no amendment, no revision, that could've made this method, those 60-100 pills more effective, more dignified, could not have made doctors more able to predict when someone would die, could not have made psychiatrists more able to detect if depression was an impact on a request for assisted suicide. So with all of that new information, not just from 1994, but 1996 and '97 as well, they felt it better to give this option to the voters again, and frankly I'm very thankful that they did, because I voted yes on Measure 16, and it's not very often we get to correct a mistake like that. [Woman] So what I heard you just say is, it isn't about the law, it's about assisted suicide, and that there's no way, in your opinion, the campaign's opinion, that you can make it okay. [Woman] No, actually that's opposite of what I said. I said it's about this specific law, and within the specific law, there is no amendment that they could've made that would have corrected some of those problems, but there are other problems as well. But it is about the specific law, and that's what our campaign has focused on from day one, and will through election day, and focus on those fatal flaws. [Woman] But your answer pretty

much revealed that there was no amendment that was going to be suitable. I mean, recall that in the legislature, we had a minority report, Stephanie. We had a minority report in the Senate and in the House, with 19 or 17 suggested amendments. These legislators were not the least bit interested in addressing any of their concerns. They wanted it repealed, they're morally opposed to individuals in Oregon having the choice. These are legislators who are backed by the OCA. Perhaps not every single one, but the point - people in both the House and the Senate are supported by the OCA. Charles Star in the House, and Eileen ?Pughtab? in the Senate. These are the people who did our dirty work in- not ours, but the campaign's dirty work, in the legislature, and sent his back to the people. [Woman] It sounds like you're conceding that there are problems with the legislation. What Iunderstand is that some people have certain concerns. They don't

think that the intent of the law is sufficiently clear. For instance, there was a question about whether the residency requirement should be made more specific. Now, I think that everyone understands that it's the clear intent that Measure 16 is by and for Oregonians. No one who is not an Oregon resident, who isn't domiciled here, who doesn't vote here, seek their medical care here, bank here, et cetera, et cetera, is eligible for it, and that's pretty clear on its face, but if a legislator feels better putting more and more of those things in the law that's ok, and we certainly agree that they should do that if that makes them feel better. That doesn't mean the original law is flawed, that just means you can clarify it if you'd like. [Woman] I guess I would like to point out that, still no evidence has ever been presented to support any OCA support of anyone, and certainly two individual legislators cannot put anything back on about, it takes a lot more than that, and if that's all she's talking about certainly not any major political machinery. And I think the question that people need to look within themselves and ask is, do we keep a law that we know is bad because maybe we're mad at the

legislature, even though I don't think there's a reason for that, or do we get rid of this law because we know it's bad, and I think that's the question that it comes down to in terms of the legislature. [Woman] Well, I mean, there's no particular evidence, scientific evidence that says the law is bad. I mean, you don't like it. [Woman] Actually, there's over 300 pages of medical documentation that shows some of the problems with some of the provisions of this law, not specifically about Measure 16, quote unquote, within the documents, but do show some of the problems, particularly with the method, with doctors been unable to detect when someone will die, to detect the impact of depression on a request for assisted suicide, and the Yes on 51 campaign is working right now on making those over 300 pages of medical documentation available to every voter in Oregon. [Woman] What about the difficulty with diagnosing the time of death? [Man] Well, I want to emphasize that under normal circumstances, patients have a primary care doctor that they see, and most of the patients who have this tend to have cancer, or AIDs. Cancer is usually diagnosed by the primary care doctor with consultation.

Most cancer diagnoses required biopsies, require surgeons to get involved, require pathology laboratories, microscopy, and various tests, and so forth, and this goes on for a long, long time. It's between difficult and possible to make a diagnosis of cancer the very first time. If a woman comes in with a breast lump, you really don't know whether it's cancerous or not till she's gone through the consultation, the biopsy, the microscopic examination, and so forth. So I think that the diagnosis of cancer is usually a diagnosis based on microscopic studies, and the diagnosis is fairly firm, and certainly there are tumor boards and dozens of physicians can be involved. So I have no problems with the diagnosis of cancer. I think if you're trying to diagnose something from an image or a shadow on an x-ray, that's more difficult, but when you got them under the microscope, you can make the diagnosis of cancer. [Host] What [Woman] Can an oncologist say- what degree of certainty - and I know this is kind of a hard question - can an oncologist who deals with cancer predict that a patient will die

within six months? [Man] Well, when a person has a particular diagnosis, then what you can tell that person is, "Other people like you will live an average of..." I think it would be rather foolish for a physician to think that they can predict the future with extreme accuracy, but you can tell a person that if you have this condition, your chances of living beyond two months, three months, and so forth, are very, very unlikely, and that's called the prognosis. [Woman] Well, I would agree with that, totally, it's just a statistical statement when you say, most people with your disease live this length of time, but we really can't predict- you know, I'm sure you have seen many people in your practice who you thought couldn't live another month, and they might live six months, or they might live a year, and this kind of thing does happen frequently enough that I think it's a risk. [Woman] But seeing that that is a flaw, if you think that that's a major problem, I think

puts much too much emphasis on the physician in this process, and the wonderful thing about Measure 16 is it really does make the decision reside with the patient from beginning to end. It's not the physician who decides whether or not the patient should make a request, and certainly not the position who decides whether or not the patient will actually take any lethal dose of medication. Marcia ?Angell?, the executive editor of the New England General Medicine, wrote a very wonderful editorial which she called "No One Trusts the Dying". Why don't we trust the dying? People know when they're in the last throes of their disease. They know when they're in a situation where death is imminent and there is nothing the intolerable agony. If we trust the dying to have the power and the control to eliminate their suffering, to end their suffering in the only way that they can at that point, then that is the mission, that's the promise of Measure 16 - not a decision being made by a physician. [Woman] So doctor-assisted suicide shifts the balance of power at the end of life from the doctor to the patient. What's wrong with that? [Woman] I would disagree with that

that completely, because what I see that happens - and maybe in an ideal world this person, this hypothetical patient, has received all of the best end-of- life care, all of the best pain control, and still they're in trouble, but you know as a physician we're used to making recommendations to patients we offer them alternatives and I think if Measure 16 goes into effect physicians, some of them at least, will begin to offer that as an option to people. And how often have you heard a patient say to you, "Well, whatever you think is best, Doc. You know, what do you think I should do?" It really does put a lot of power in the hands of the physicians. [Woman] I would like to add something to go back to the law, that's of course this ballot, and unfortunately within this law there is a sort of- I call it that superficial threshold of a terminally ill person with six months left to live, and the determination of that, of course, is in the hands of the physician. So to insinuate or conclude that it's the patient who knows how long they have left to live, or they're the ones that make the decision in that regard is both untrue and certainly not within the intent or the

letter of the law. So that the portion does exist within the law. [Woman] But, under the law as well, not only one physician, but two physicians, not only have a sort of a casual guess, but they must actually certify, they must make a positive finding that this patient has entered that window of time which has been used for years and years. You know, this is a very common determination, within reasonable medical judgment, someone will in all likelihood not live beyond six months. That's the criteria we use right now for hospice. Not only the original physician must make that determination, but a consulting physician must also make that determination. There's safeguard after safeguard after safeguard in the act. [Woman] What about the argument that these people are really depressed and they just be treated for depression and and then they won't want to die? [Man]Well, I would like to emphasize that when you're treating chronic pain in these individuals, that antidepressants are standard therapy in treating chronic pain, so by the time that somebody is reaching a terminal state, whether it's breast cancer with bone metastases that aren't responding, prostate cancer, and so forth, that these patients are generally

already on antidepressants, and I hope- I don't think that physicians are going to wait until the last minute to address that. They've also seeing multiple physicians many times, and at any hint of depression, a physician can diagnose that and treat that, or they can refer that person. So it's a longstanding relationship, it's not a quick visit. The primary care doctor, the patients I've known- we've known patients for ten, fifteen years, and you initiate depression anytime they have it, whether it's associated with terminal illness or not. [Woman] He is talking about an ideal case. You are. I think that in an ideal world maybe what you're describing would be true, but there's no- this is not written into law in any way, and I think depression is something that physicians commonly miss on diagnosis. There was an article that was in the Oregonian recently, it was just last month by Dr.- there was a quote from Dr. Cliff Singer who is a geriatric psychiatrist at OHSU, where he says that, of elderly people who commit suicide, 60%

of them have seen their primary care physician within a month. 40% of them have seen them within a week, and 20% of them have seen them within one day. Now, I think that's a case of missing the diagnosis of depression. [Woman] If I could just bring us back to the law, because i know it's a long law, and there are lots of things in it, but oftentimes we don't read the law thoroughly, or don't remember all of its provisions. It's wrong that it's voluntary, that counseling is voluntary. Counseling is mandatory under this law. If either the attending physician or the consulting physician believes that there is a sign of depression, and there may be impaired judgment, counseling is mandatory. The patient must go to a psychiatrist or a psychologist, and they stay in counseling until that psychiatrist can certify, they must certify, on a form to the health division, that the depression has cleared and the judgment is not impaired. That is not voluntary. That is required under the act. [Woman] It has to be diagnosed. [Woman] I'm actually pretty familiar with the law myself, and she's right. If they detect it, they should

refer the person, which is an if, and an if, and certainly not anything that's mandatory which would be required in every case, and if you look at the New England Journal of Medicine on February 1st of '96, then June 19th of '97, Doctors ?Ganzini? and Lee and others did a survey of Oregon physicians, and then a follow-up clarification editorial. And they said a couple of interesting things. They said that it's true that 60% of our physicians do support physician assisted suicide in some circumstances, was not specific to Measure 16's provisions, but they also said that over half of Oregon's doctors felt they could not accurately predict when someone would die, and that 94% percent of our psychiatrists, those people who specialize in the detection and treatment of depression, did not feel very confident that they could detect that, as an impact on a request for assisted suicide. So even if a terminal diagnosis is correct, and if they detect the depression, and if they get to a psychiatrist, the chances are still very, very high that a lot of those things would be missed, and I think those are way too many ifs for this situation. [Woman] Now this is a perfect example of taking medical research and distorting it, and using only half of

it, using only the half on that supports your side of the argument. The truth is that, of those psychiatrists who were interviewed by Linda ?Ganzini?, 96% percent said that they were confident that they could discern whether depression or anything else was impairing judgment if they had more than one visit to do it. 96%. Well, there's nothing in Measure 16 that says that they can't take as many visits as they require. [Woman] There's nothing that says that they have to either though. [Woman] But they have to certify it. And if they have a doubt, then they can't certify it. Measure 16 applies only when the physicians feel certain enough that they can sign the form, sign their name to it, and certify to the health division that they're sure. If there's a doubt, then it can't go forward. [Woman] I've got a question about the potential for abuse. That seems to imply that we're doing something really new here, and currently, I mean, even without Measure 16, terminal sedation, which means giving patients enough pain medication to kill the pain, and if it kills the patient, well,

that wasn't intended, so it's ok to do that, and family members- and the doctor can do that, without any written consent, without, you know, any patient consent. Families can cut off life support from a patient, cut them off their respirator. Why does that situation, which is currently accepted now, and approved- at least, some of the terminal sedation is approved by the Catholic Church- why does that not invite more abuse than a system under Measure 16, and the assisted suicide law, which does have safeguards, and under which only the patient can act? Death does not occur unless the patient acts affirmatively to end it. [Woman] Sure. If I could, I'd like to [inaudible] this one part of the law, and then turn the medical issue over to Dr. Husted. A very important point about this law is, people think about doctor-assisted suicide, and really there is no "doctor" in "doctor-assisted suicide", and actually no requirement that the physician be there to give you the pills, hold your hand, and supposedly slip away peacefully. In fact, Dr. Peter Admiral, who I think is a recognized expert on both sides, was quoted in the American Medical News, which is the

American Medical Association's publication on September 15th of this year, as having sharp criticism for the lethal prescription method, and cited an instance in the Netherlands where a doctor prescribed drugs, the terminally ill patient got it, gave it to a neighbor, the neighbor took it, it was a botched suicide, the doctor got sued. So there really is no doctor in the house once these pills have been dispensed. They're in the hands of that person, and we have no idea whose hands they may end up in. As to the other question about the morphine and whatnot, I believe Dr. Husted could probably address that better than I can. [Husted] I think what you're talking about is the double effect, this is the term that's been used for this, and it's long been a practice, I think, for physicians to- physicians who are not afraid to prescribe an adequate amount of pain medication to do so, to try and keep the patient comfortable, and if the patient has reached a point in their disease process where that requires enough pain medication to sedate them, that that is done, and one of the side effects of morphine, which is commonly used for pain control, is that it does depress the respiration,

so the person loses some of their drive. [Woman] Right. I need to give that we're running out of time, and I need to give this side a chance to respond to that. [Woman] I think a good way to respond to that is to say that yes, medical people draw that distinction- to some people it's a very, very important distinction. For people of goodwill, it's not. Look at James ?Michener?. He stopped his dialysis, and he died, we presume, of uremia. No one questions his ability to stop his dialysis. James Michener was also a right-to-die activist, and he could have, in the process of dying from his uremic poisoning, taken a lethal dose of medication to speed the process. People don't see a moral distinction between those two things. Most people don't. [Woman] Okay, I think we're out of time and ready for our concluding statements. To conclude, each side will have one minute to summarize your argument. Bennet, I think you go first. Oh Trish, you go, it's your turn, I'm sorry. Bennet start it, you go. [Bennet] There's a couple things I would like to say that are not so much medical in nature, but about some of the campaigns, and being a native Oregonian, I understand the standards that people expect in this state, and I would hope that we would hold them in this campaign. Before I get to that I'd like

to talk just a second about the Supreme Court, and I'm sure it was heard about that by now, but if not, basically what it was was a ruling on a technical procedural issue and not any way an endorsement of Oregon's assisted suicide law. There've been some questions about moral issues, and while people may make a decision based upon their own moral feelings, our campaign's focus has been this law because that is what is on this ballot. To say that there's no new information is just completely untrue. Again, I say there are about 300 pages of medical documentation we will be providing to the voters of Oregon. We're working on that project. It should be done by the first of next week. To say that there is no study is also untrue. It's right here. I'm showing it to everyone, because I've been asked to show you the study. And that will be available also. To say there's a conspiracy of lies is untrue. If that is true, then the American Medical Association, Oregon hospitals, and many, many others are part of that conspiracy including the Oregonian. Look at the documents, look at the facts, and make a decision. [Woman] Okay, thanks Trish. Rick, you have one minute. [Rick] Personal choice,

patient autonomy, the right of mentally competent, terminally ill adults to hasten their inevitable death. Oregon voters made this choice in 1994 when we passed Measure 16. For the first time in Oregon history, our cowardly legislature has sent back an unchanged law to be voted on again, saying, "We don't like it. Vote again." We need to send our legislature a message that we were right in 1994. Our opponents are distorting medical science, they're using fear tactics, and are spending millions of dollars, most of it from out of state, to try to force their political agenda onto us. We need to send a message that Oregon voters are not for sale. The Oregon Death with Dignity law is a moderate law with extensive safeguards. If a mentally competent, terminally ill adult chooses to hasten their inevitable death, it should be their choice, and not the politicians in Salem. Please vote no on Measure 51. Thank you. [Fowler] You're all great at watching the clock. Trish Conrad, Benneth Husted, Barbara Combs Lee,

and Rick Beyer, thanks for joining us on this special edition of Seven Days. Our program on Measure 51 will continue in a moment with a panel of reporters and editors. [Music] [Music] [Music] [Music] [Music] [Music] [Host] Let's meet our second panel. Dianne ?Dietz? is a reporter at the Eugene Register Guard. Colin Fogarty is a reporter for OPB radio. Bill Lanch is OPB radio's political analyst, and David Reinhart is an associate editor at the

Oregonian. All four of you watched the Measure 51 debate as it occurred. Let's begin with some analysis of the key arguments that each side makes in the campaign. Bill, what do you see as the key points on either side? [Bill] Well, for the opponents of Measure 16, who have brought Measure 51 to the ballot, and we'll get to the double negative aspects of this for the voters in a minute, their argument is that Measure 16, which was passed in '94, is a flawed law, and this leads them to their campaign slogan: "It's fatally flawed". On the other side, the opponents of Measure 51 who are supporting existing law say, in defense, that it's a carefully crafted lot with lots of safeguards, which provides for higher level of individual autonomy, that they then have a sort of "offense is the best defense" argument, which is that the legislature was arrogant in sending this back to the voters without trying to make changes, and without trying to make it work. And so part of what they're trying to tap into is unhappiness with the legislature and with the process that got us to the point

where we're voting on this here in October and November of 1997. [Man] Yeah, Bill, and it's interesting how different the debate is this year than it was in 1994. In 1994, the discussion was about patient autonomy, it was about the right to die, it was about the health care system, it was about the concept of assisted suicide, and whether patients should be able to do this. This time, the opponents of assisted suicide have really shifted the debate to clinical issues. Does- do barbituates work? Will you vomit? Will you linger for more than five hours? Do you need a lethal injection? [Woman] And completely missing from the debate this time is the sort of thoughtful, moral arguments that we heard in 1994. It seems like they've decided it was politically- not politically advantageous to have the church and god involved, so they sort of put them aside, and let's focus on the practical aspects. [Woman] And it's been kind of ironic that they'll say, "Well this is such an important issue, this is why we had to vote on it

again", and it's so important because it goes to the fiber of each person's moral belief and being, and yet they don't want to argue those points. [Man] I think those points are implicit when you point out some of the flaws in Measure 16. You look at the absence of real safeguards, you look at the problems with the pills, you look at what this will do to the doctor-patient relationship, particularly in the time of managed care, and there are great moral issues at work there. I mean we're talking about really creating problems for the weak and vulnerable in our in our society. There are more- those are, there are moral questions raised in that, and- [Woman] Right, but there's an inconsistency in position, it seems to me, on the side of the anti- assisted suicide people, because if their chief feeling is that it's morally wrong to use such a law, you would rejoice if there was a 25% percent failure rate. You would say, "Good, 25% percent of the people

would be saved." To be logically consistent. [Man] What? No, I don't think so at all. Why would anyone, anyone want to rejoice when a a suicide, an assisted suicide, is botched, and a person lingers on- [voices overlapping] Excuse me, let me just finish, okay- lingers on, and experiences awful consequences, or can experience awful consequences and there is no remedy? That's not something anybody should take delight in, [inaudible] assisted suicide. [Woman] And that's what's more likely to happen now when people don't have the protection of law to do a legal assisted suicide. It's not that this will create a desire to die all of the sudden. People do it now, and they don't have any- they don't have any instruction, they don't have access, the doctor's not protected. So you're much more likely to have a botched suicide now, if that's truly the concern, than under the law. [Man] It's interesting how this discussion is happening, and it seems to me this is an interesting study of how ballot measures work, and how ballot measure campaigns work, because what's happening in the discussion we just heard

there are all sorts of statistics and studies thrown about, and this doctor says this, and this case says this, and the problem with this debate is that there's very little study about this. You can say you have 300 pages of documents, but the bottom line is that there's very little study about what happens when someone commits suicide under a law like this. [Woman] We give in to this little teeny, tiny argument when there's these huge moral issues we could be talking about. [Man] These are not implementation details though. When you are sending Oregonians out with pills that may not work as planned, when you're sending them out without the care of a doctor, you are asking for some real problems. [Man] Dave, the problem with that is the study- and Colin can speak to this because he's been to the Netherlands and has spoken to the people who are involved in this there, but the study which the opponents of assisted suicide- so the proponents of Measure 51- cite, or claim to cite, has been contravened

by the people they are claiming to cite. The doctors involved say the patients do die, it may take them a little longer than five hours, but they do die. [Man] Excuse me, how do they die? In 20% of the cases- this is from the person who's done this study- in 20% of the cases, they die because they are given an injection of muscle relaxant, which is really a muscle paralyzer. That is not- that relaxant is not allowed under Measure 16, so don't tell me that they all die. They all die because there is an injection. That can't happen here. [Woman] But the doctors- haven't the doctors also said, I mean quite recently, because they're annoyed by the misuse, that the Yes on 51 people [inaudible] their study, and they said they would have died anyway, giving them, the 20% who had the injection, died more quickly with the injection. [Woman] Also, look at the reality at the bedside. This is sort of gruesome, but let me just say it anyway because what we're talking about here is death. In late stage ovarian cancer, for instance, there could be a blockage of the digestive

tract, and the person or the uh yeah the digestive tract and the person at some point will start vomiting their feces, and there's very little at the end stage that can be done about this. So, here's this person that's in this horrendous condition. Before they get to that condition, they tried many therapies, and many of the therapies with a very small chance of success, so they're used to taking a chance on something that may not work. The assisted suicide would seem to offer a 75% chance of a sweet- I don't know if it's a sweet death, but a death. So- [Man] That 25%, though, does not include the 10-20% of terminally ill patients that this euthanasia expert that the No on 51 people cite claim cannot swallow. They can't swallow. [Man] Well, this assisted suicide- or this euthanasia expert is Dr. Peter Admiral, and he's sort of infiltrating every

aspect of this debate in a sense, and it's important- let's go over that debate, or that study, that happens- there's a survey of doctors who had helped their patients die through various means between 1990 and 1994- [Woman] In the Netherlands. [Man] There were 87 of those patients that took oral medication. It was not pills. In each case, it was nine grams of barbiturates, which is three times the lethal dose. It was put into an elixir. In some cases there was an anti-bittering agent that was put in so it tasted a little better. In most cases it was still a bitter thing. What happened for 75% percent of the cases, within three to five hours, the patients died. They went into a coma, they didn't wake up, and they died. For 20% of the cases, the doctors and families, for whatever reason, we don't know, decided that it was appropriate to give a lethal injection, and in the Netherlands they don't think there's much of a difference between handing a patient some lethal drugs to swallow, and giving them a lethal injection. That's a different discussion about whether there's a difference there. In 4% of those cases- so, that was at five hours, and we can assume that

those patients would have lingered in a coma for a while there. In 4% of those cases, the patients linger for up to 24 hours. In none of those cases, and this is where the real problem comes in, in none of those cases did any of those patients vomit, or have permanent psychosis, or have any of the symptoms that the anti- assisted suicide people talk about. On the other hand, the same doctor that did that study, Peter Admiral, say there's a widespread feeling in the Netherlands about oral medication, is that they do not think oral medication is the best way to help the patient die, because they don't trust it as much as lethal injection. With a lethal injection, it happens very quickly, and it's very peaceful. [Woman] So why don't we have lethal injection here, and in this law? [Man] That's the politics of this, and I'm glad you got to that because the politics of this are fascinating. For one thing, for voters who want to overturn assisted suicide, they have to vote Yes on Measure 51. Those who wish to retain the law, keep the law, enforced, they have to vote no. So in order to get a negative result, you have to vote yes, to get a positive result you have

to vote no. We know from prior work that's been done in surveys of initiative situations like this that 25%, maybe more than that, of the voters who vote on this will mistake their own preference. And the way we do this is you go to a survey after elections and say to folks, "How did you vote on Measure 51?" And the person says, "I voted yes." You then say, "That had the effect of overturning or eliminating the assisted suicide law," and they say, "Ah, that's the reverse of what I wanted to do." And this is a fairly consistent finding, so we can expect that a fairly large chunk of the voters in Oregon who vote on this are going to vote contrary to their own wishes, unless they pay a great deal of care to this. [Woman] So which side does voter confusion benefit? Seems to me it would benefit the side that's behind, in this case. [Man] It probably, on balance- what I'm describing, mistake their own preference, will wash out. But the folks who are opposed to 51, who support the existing law, this week started running radio, and I think TV ads, in which they use the "It's fatally flawed" slogan

to refer to Measure 51, not Measure 16, which was the original reference, and that will confuse folks. And what we also know that when voters get confused, they tend to vote no. [Woman] So why is there no lethal injection in the Oregon law? [Man] Well, it was a political issue- [Man] You know, what had happened is that there were there were ballot measures in California, and a ballot measure Washington, and those included lethal injections, and voters voted against it. And this was the only law, the only proposal that did not have lethal injection. People sort of felt like it wasn't as extreme. [Woman] I think people are more comfortable because theoretically it puts the means in the patients' hands. [Woman] But is there any evidence in terms of oral self-administration of barbiturates, either in an applesauce, or elixir, if they can't swallow the pills, that there is indeed a failure to die, I mean, within, you know, 24 hours, or 48 hours, or- [Man] We don't know, because- [Man] Dr. Admiral says that the patients die.

[Man] Well, what is a failure? I mean, that's the real question. I mean, what anti- assisted suicide people say is that if you linger there for longer than five hours, and your family becomes alarmed at that, then that's a failure. Other people say, look, I'd rather have a coma for five hours than having whatever symptoms I'm having to begin with- the reason why I wanted assisted suicide. So I mean it's important to decide what is a failure. [Man] In the Netherlands, you have a doctor that's around, can provide the lethal injection if the person dozes off. These people in the Netherlands went to lethal injection because these folks were breathing in a labored way, or they dozed off before they got the massive amounts of drugs that are required make this happen, [Man] And when you when you ingest it orally, it's not as- you know this already- is that, when you take a pill, or you take a liquid, it doesn't absorb into your body as quickly as it does when you do it with an injection, and so that's why it works slower. [Man] But to go back to the politics of it, why lethal

injection was not included in the Oregon law, it not only has to do with autonomy, as you said, Dianne, and that's quite right, but in addition there was a more sort of elementally political aspect to this, which was the opponents of the assisted suicide laws on the ballot in California and Washington that Colin mentioned ran TV ads featuring hypodermic needles, which people are afraid of, and they're offended or at least put off by them, and so in basically the market research, if you want to call it that, what the proponents of assisted suicide did, they figured out that if they included lethal injection in the law, even though it might be medically desirable, it would put people off in such a way that the measure would have a much more difficult time and might not pass. [Man] Well, it's politically difficult, but you would also have information, and it's pretty consistent information coming in from the Netherlands, that when you have the needles and syringes used, and lethal injections, you have about a thousand people a year who are dying without their-

who are being basically killed without their consent, and a good chunk of them are mentally competent adults, so it brings its own horrors with it. [Man] And this actually was, a lot of Dutch doctors and patients were very disturbed by this- there was a statistic- I'm not sure if it was a thousand a year, I'm not sure exactly what percentage it was- but there were a significant number of patients who were being euthanized by their doctors without having asked for it, without having expressed an opinion, and usually in those cases- it's very important to remember that the Netherlands has a very different health care system than the United States does. The doctors know the patient for a long time, there's not so much of an emphasis on individuality as in this country, and so I think that if you're going to say, whether you agree with assisted suicide or not, I think that having a law that does not include lethal injection, but only has an oral medication, which you are more certain that the patient is acting autonomy, seems to fit Oregon better. [Woman] But this law does not permit euthanasia, and it's kind of confusing. [Man] Right.

[Man] That's true. [Woman] This idea of autonomy seems to resonate here, and that's why I'm a little puzzled by some of the arguments against assisted suicide that we hear. For instance in our mainstream political thinking and social thinking, if you're in poverty, you gotta pull yourself up by the bootstraps. If you're in ill health, you better get out there and jog, go on a diet, take charge of your healthcare, or you know, you're in charge of getting the right doctor and making sure you get the right medicine. But when it comes to death, the argument that the anti- assisted suicide people are saying, you've got to allow the people around you to improve their moral development by taking care of you until you die, and it just seems inconsistent to me. [Man] I don't think it is, though. When you consider that one one comes down with a terminal illness, you are in a position of utmost vulnerability. You're often depressed, depressed before you even- sometimes before you even know you are terminally ill because of the

nature of the disease. A lot of AIDS patients- this happens to a lot of AIDS patients. You are in a weakened, vulnerable state, and the doctor-patient relationship, as people as far back as Hippocrates have known, is not an equal relationship. You are- he or she has great power over the patient. Powers to suggest, powers to deny care, and it's not an equal relationship. [Woman] I'm suggesting that that paradigm is changing with healthcare. [Man] It's getting- to my mind, it is getting more problematic because of managed care. You've got doctors that are going to be paid more for providing less care. [Woman] David, isn't that- I mean, aren't you playing both sides of the fence in that sense, because you're saying, god, you can't trust these doctors, they're powerful. You can't trust them not to kill you. And then you say, don't vote for this thing, 'cause these compassionate doctors will give you the care that you need, and that may be very expensive at the end of life. [Man] Well, I think if they if they are given the choice to-

obviously, most doctors are good human beings. They're going to do the right thing. But there are others who, as we know, don't act admirably all the time. If they have the chance to get rid of a costly patient by suggesting that, you know, your life's painful, this is going to be very painful and expensive, you're going to bankrupt your estate, and also the fact that they may cut their own costs in a managed care environment, they are going to be tempted to do that. And bad ones are going to be tempted to do that very much, and we've got to guard against them. [Man] The argument of the proponents of assisted suicide of maintaining the existing law contend that the law as passed by Measure 16 increases the autonomy of the patient, and improves the circumstances of the patient in this end-of-life situation to make that choice. They don't have to do it, but it gives them the option. [Man] That's what they maintain. I would suggest that's a falsehood.

[Man] That's the argument, it was an argument which made sense adequately, though barely adequately, with the electorate in '94. The polling since then, which admittedly is now five, six weeks old, and so people may have changed their minds, but the polling on these questions that Tim Hibitz and Adam Davis did about six weeks ago, published in your- [David] We're the Oregonian. [Man] -in your newspaper, David, that's right- shows that that argument, that the law provides for increased autonomy on the part of patients who are at the end of life makes sense to a majority, and not a small majority of Oregonians. [Woman] Yes, that's what I was speaking to earlier, that that autonomy, that self determination, in this society makes sense, and that's why it seems like the Yes on 51 people are arguing against the grain. [Man] And it's important to remember, I mean, this is something, whether you think assisted suicide should be legal or not, something that they've found in the Netherlands is that only about a third of the patients who actually bring up the idea of assisted suicide or euthanasia

to their patients actually end up committing suicide. Most of the patients, and this happens in America now, who say that their doctor, "Doc, I'm really afraid I'm gonna be in pain, you know, my life is pretty horrible right now, and I want the option to be out." That's when the doctor, who may or may not have been paying attention before that, says, "Okay, let's do something about this. Let's treat your symptoms. Let's get you better comfort care. Maybe we need to get you into hospice, maybe we need to do this." And in most of the cases in the Netherlands where that happens, the patient decides, "Okay, well I don't to commit suicide." [Woman] I've heard patients here say, "I don't necessarily want the pills but I want them there as assurance. That makes me feel like I have control, if the pain is going to get too bad." [Man] And the question we face is, if we're going to give that option, how can we make it- is it possible to make it a public policy where there is no abuse, where, in every single case, it happens appropriately. Where, in every single case, it happens medically correct. [Man] The potential for abuse in just

that scenario is amazing. Somebody gets that dosage of Seconal that he's going to have for the end of his life, he may not, in three months, either A) be able to take it, or B) want to take it, and yet it is out there, it is in the home, and the potential for a relative who may have a financial interest in this, or someone else, to rob that person of real autonomy when they are weaker- [Woman] So I guess you have to weigh, are you more afraid of your relatives, or are you more afraid of what end might be? [Woman] Doesn't that potential for abuse exist now with the ability of the family to cut someone off of life support- [Woman] And we're sure there's lots of morphine in the home of any of these hospice patients. [voices overlapping] [Woman] And there is no reports, there probably is

a potential, but there are not reports of widespread abuse, and someone's made the decision that yes, the potential is there, but it's so small compared to the benefit that people get from that sense of control. [Man] There is that. Nobody's denying that some of this goes on. My view is that when you legalize anything, you're going to get more of it. We know that from the abortion experience. We've got a lot more abortions today than we ever would have. And in this instance- [Man] Well, we don't know that, David. Because we don't know how many abortions went on. [David] Well, we know that pretty well. [voices overlapping] [Woman] And the interesting thing is, they continued to be legal. You know, I think that- I suspect that might happen with this. It's like people don't want to talk about it, it's morally painful, they don't want to deal with it, they very quietly keep that right there. [Man] And by the safeguards, or alleged safeguards, of Measure 16, which aren't much when you really start looking at them, there can be more danger, more potential for abuse of these

patients, and since the law is basically tilted to protect the doctor and healthcare provider, they get a free pass on it. [Man] It's interesting, you know, bringing in the Supreme Court- not to change the subject too much, but the Supreme Court last week- or this week- basically said that the effect of their ruling was that once voters either vote on Measure 51, it's either going to go up and down. Really, I mean, if Measure 51 had failed before the Supreme Court did this, then it would still be on hold, but now it's pretty certain that it will go into effect, barring unexpected challenge to it. But it's also interesting that the Supreme Court last year said that there is no constitutional right to die, however, one of the things that Justice Rehnquist said is that they sort of kicked it back to state legislatures, and in this case kicked it back to the people in the form of an initiative campaign. One of the things he said is that the people of America are in an earnest and profound debate. And I actually came prepared to this discussion,

prepared to see a really, ugly awful debate. Previous to us, from the campaigns, I thought it was just going to be really ugly and really awful, and I do have to say that it was very civil, and it was an earnest and profound debate, and that is what we're engaged in. [Man] You wouldn't know that by the television ads. [laughter] [Woman] But I covered one in Salem recently, also, and it was between two doctors, and I was amazed at how seriously and civilly they treated each other and the subject, so. [Man] Well there are differing levels in the electorate. I think there's a level in the electorate of people who are taking this very seriously, who will try and inform themselves, who make considered choices and who will vote their preferences. They won't make the mistakes I was describing earlier. But the TV ads, the thirty second spots, are aimed at another segment of the electorate that doesn't pay very much attention, doesn't have a lot of information, but will nonetheless a vote. And for that, each side has various slogans which are not necessarily fully revelatory of their position,

to put it mildly, and so the proponents of Measure 51 talk about it being "fatally flawed" without explaining that necessarily terribly well in the thirty second ads, and the opponents of Measure 51 talk about the fact that the Oregon Citizens Alliance is responsible in part for bringing this back to the ballot even though the OCA is only connected to a certain fraction of the legislators who voted today to do that, though they all are. [Man] And both sides, it's pretty darn clear that both sides of this campaign have really stretched the truth pretty far, and one can judge which side is more guilty than the other, but each side has really been misleading in their ads, and has really done a disservice. [Woman] David, go ahead. [David] Yes, you can judge which one has done it more, and my judgment is the No on 51 people have trafficked in anti-Catholic bigotry, they have to have made outright false- stated outright falsehoods in many of their TV and radio ads.

The other side, I've gotta say, you ask for documentation from them, the Yes on 51 folks, they give it to you, and they give it to you, as you know, in great big bundles. [Man] Yes, I've been faxed all of their material, and let me tell you, there's a lot of it. [Host] Okay, we're out of time. Bill Lanch, David Reinhart, Colin Fogarty, and Dianne Dietz, thanks for joining us this week on Seven Days. Please join us next weekend at 8:30 for another Seven Days election program. We'll be discussing Measure 52, which would authorize lottery back bonds for Oregon schools. We'll also talk about local transportation tax measures in several counties around the state. That's next Friday at 8:30 on Seven Days. Thanks for watching. Goodnight. [Music] [Music] [Music]