What you don’t know can kill you

Vermont’s House of Representatives recently defeated an assisted-suicide bill very similar to AB 374, the bill before California legislators. They didn’t vote it down because they are religious conservatives.

Democrats and progressives from small parties outnumber Republicans in that Legislature by a large margin. The themes in their debate were the ones that always echo whenever thoughtful people dig beneath the surface of this issue: Assisted suicide is bad public policy. The safeguards are inadequate. There are too many unanswered questions.

“Too many unanswered questions” is a good way to describe AB 374 and Oregon’s law on which it is modeled. Let’s look at the supposed safeguards, using information in the annual Oregon Human Services Department reports on the law’s implementation.

Two doctors must agree that an individual meets the law’s criteria. But there’s considerable evidence that, in Oregon, if your doctor tells you no, you can find another one who will say yes. How many people who died under the Oregon law first asked their own doctor and were told “no?” This isn’t counted, so we don’t know.

An overwhelming number of suicides were facilitated by the pro-assisted suicide advocacy group Compassion and Choices. Its leaders claimed involvement in 75 percent of such deaths up to 2002 and 79 percent in 2003. Researchers at Oregon Health Sciences University put the figure at 90 percent since then. How often do these referred physicians say no? We don’t know. The official Oregon reports don’t tell us.

The person must be terminally ill with six months or less to live. Yet diagnosing death six-months out is a very inexact science. Are depressed persons who are misdiagnosed as terminal given lethal drugs? We don’t know. In Oregon last year, according to the report, only two people were sent for a psychological assessment. Yet depression is the most common cause of requests for death.

Under the law and AB 374, psychological assessments may be as brief as one visit. Is that enough time to assess whether depression is affecting a person? Not according to a substantial majority of psychiatrists. Have people whose depression could have been successfully treated died in Oregon? The official reports don’t say, so we don’t know.

The law has no controls over the lethal medication once it’s prescribed. The reports show that many people who get lethal drugs die before taking them. What happens to the deadly medication that remains? We don’t know.

There is evidence that sometimes the “safeguards” have been disregarded, such as too few witnesses, or prescribing the lethal drugs without waiting the 15 days the law requires. Yet no one has been disciplined or penalized. How often have the on-paper safeguards been violated in practice? We don’t know.

Do the annual statistical reports mandated by Oregon’s law and this bill really show us the full picture?

Oregon statistics are based solely on doctors’ self-reporting. Reporting is required on paper, but there are no penalties if doctors don’t. How many have failed to report? We don’t know. The law authorizes no investigations. Nor does this bill.

How accurate and comprehensive are Oregon’s statistics? We don’t know, because they depend on the self-reports by doctors and because once each annual report is published, the state destroys its data. That makes independent verification impossible.

How many doctors wrote lethal prescriptions for multiple individuals last year? We don’t know. The reports have stopped providing this number. Why? We don’t know.

How many people actually resorted to assisted suicide because of pain? Before last year, it was very low–fears about concerns in the future were far more often the reason. But we can no longer know, because starting last year, the report combines “inadequate pain control” with “fear of future inadequate pain control.”

The Oregon law requires only that doctors act in “good faith.” This weak standard renders all its safeguards unenforceable because no practitioner will be liable if they claim they acted in “good faith.” Have any doctors acted negligently? Because the law fails to authorize investigations, we don’t know.
Oregon’s law is not a model for California to adopt, because what you don’t know can kill you.

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