Lord Joffe's new bill is based on the Oregon Death with Dignity Act.
This was a citizens' initiative first passed in 1994 by 51-49%. Implementation was delayed by a federal injunction, but in 1997 Oregon's voters reinstated it, this time by 60-40%. (Many people who were opposed to PAS nevertheless voted for it in 1997 to protest at having their autonomy overturned.) The law allows a 'capable' adult patient who is a resident of Oregon and has less than six months to live to request voluntarily a prescription for lethal drugs. By 2005 208 people had died under the law.
Information has to be collected and presented in an annual report. There were 42 reported PAS deaths in 2003 out of about 30,000 in the state, and 37 in 2004. It is most concerning that psychiatric evaluations are taking place in only 5% of patients on whom PAS is performed, that 22% of these report inadequate pain control, and that 35% of patients fear being a burden. 85% state fear of losing their autonomy as a main reason for requesting PAS. Palliative care in Oregon is graded E!
It is also dangerous to argue from silence, but we need to know that all this data is derived solely from those doctors who admit prescribing lethal drug doses. There are no penalties for nonreporting, and the Oregon Health Division (OHD) has no regulatory authority or resources to ensure compliance with reporting requirements. There are no checks and in any case reports can be anonymous. The OHD has said of doctors' reports, 'the entire account could have been a cock-and bull story. We assume, however, that physicians were their usual careful and accurate selves.' But we know from the Netherlands, where one of the reasons for finally legalising voluntary euthanasia was so that physicians would always report VE and PAS, that only 54% of cases are reported. Under-reporting in Oregon seems certain.
What is the Oregon experience? The experience is that there is no reliable experience and we should not be hoodwinked through ignorance into accepting bland assurances that Oregon proves PAS can be policed. It is not surprising that attempts to pass a similar law in over a dozen other states have been soundly defeated.
