Oregon Voters Legalize Physician-Assisted Suicide

Date November 8, 1994

Oregon’s Death with Dignity Act was the first law passed by a U.S. state to legalize the practice of physician-assisted suicide.

Also known as Death with Dignity Act

Locale Oregon

Key Figures

• Thomas A. Constantine (b. 1938), administrator of the U.S. Drug Enforcement Administration, 1994-1999
• Robert E. Jones (1912-1997), U.S. district court judge
• Janet Reno (b. 1938), U.S. attorney general, 1993-2001
• John Ashcroft (b. 1942), U.S. attorney general, 2001-2005

Summary of Event

On November 8, 1994, Oregon voters narrowly (51 percent) approved a carefully written initiative petition that made physician-assisted suicide legal for terminally ill persons in the state. Implementation of the new law, called the Death with Dignity Act, was delayed by various injunctions, and in 1997, a legislative bill that would have repealed the act was put to the Oregon voters, who turned it down by a large margin (60 percent voted against the measure). Despite repeated efforts by a U.S. attorney general, the U.S. Supreme Court upheld the Death with Dignity Act, and it took effect on October 27, 1997. From 1998 through 2006, a total of 292 Oregon residents took advantage of the provisions of the act and sought physician assistance with their deaths.

The Death with Dignity Act allowed Oregon residents who met certain criteria to request prescriptions for lethal medication from their physicians. To qualify, an individual had to be eighteen years of age or older, had to be found capable of making and communicating health care decisions, and had to have been diagnosed with a terminal illness that would lead to death within six months. The patient had to make two requests for the medication at least fifteen days apart, and the requests had to be confirmed in writing in the presence of two witnesses. The law required a consulting physician to confirm all conditions. In the case of a patient who was found to be incapable of making health care decisions (because of depression or other disorder), the law required that the patient be referred for counseling. The law also required physicians to inform any patient seeking suicide assistance of alternatives such as comfort or hospice care and pain control measures.

No physician or health care system was required to participate in assisting patient suicide, and the law protected those who did from criminal prosecution. Physicians who refused to participate were required to provide their patients who requested assistance with referrals to doctors who would assist them. In addition, the law stipulated that the choice of physician-assisted suicide could not affect the status of a patient’s health or life insurance policies, including Medicare and Medicaid. Physicians had to report all prescriptions for intentionally lethal medications, as well as resulting death certificates, to the Oregon Department of Human Services, which, under the law, was required to issue an annual report on the usage of the act.

Some minor amendments were made to the act in 1999. A requirement was added that physicians must inform pharmacists of any lethal prescription’s intended use, and pharmacists were added to the list of those health care-related workers who could refuse to participate. In addition, the law was amended to stipulate that action in accordance with the act does not constitute mercy killing or homicide.

After the 1994 vote, opponents of the new law successfully requested an injunction to prevent its implementation. Following proceedings that included a petition denied by the U.S. Supreme Court, the Ninth Circuit Court of Appeals lifted its injunction just weeks before the voters turned down the 1997 referendum that would have invalidated the act. Immediately thereafter, the U.S. Drug Enforcement Administration (DEA) warned Oregon doctors that they could be arrested or have their licenses revoked for prescribing lethal doses of drugs that DEA administrator Thomas A. Constantine characterized as falling under the restrictions imposed by the Controlled Substances Act. Attorney General Janet Reno overruled Constantine, however.

The U.S. Congress then unsuccessfully considered a law that would have prevented the use of federally controlled drugs for assisted suicide and euthanasia. In 2001, Attorney General John Ashcroft overturned Reno’s ruling, and the state of Oregon, supported by the Oregon and Washington State medical associations, filed suit, claiming that Ashcroft was acting unconstitutionally. The following year, U.S. district court judge Robert E. Jones ruled in favor of the Oregon act. Ashcroft then appealed to the U.S. Court of Appeals. When a three-judge panel denied his appeal in 2004, he requested a review by the full eleven-judge panel, which was declined. In 2006, the U.S. Supreme Court affirmed the lower court’s decision.

Aware of, although neutral in, the continued controversy concerning the Death with Dignity Act, the Oregon Department of Human Services from the beginning used control groups of both patients and physicians to compare with those patients and doctors involved in physician-assisted suicide under the act. In its initial report in 1999, the department, acknowledging the small sample with which it had to work, found that there were no appreciable differences in age, race, sex, education, economic status, insurance coverage, or access to hospice care between patients who chose physician-assisted suicide and others who died of similar underlying illnesses. The department did find that divorced or never-married patients were slightly more likely to seek physician assistance with suicide.

The initial report also included the following findings. Of twenty-three persons who received lethal prescriptions, only fifteen used them. All fifteen were white, half were male, and four had psychiatric or psychological consultations but were found capable of making decisions for themselves. Of the fifteen who took lethal prescriptions, none was bedridden at the time. Six had to ask more than one physician before they found one who was willing to prescribe.

Later reports from the Department of Human Services noted some changes in the statistics: Persons who had higher levels of education, those under age eighty-five, and those with amyotrophic lateral sclerosis (Lou Gehrig’s disease), acquired immunodeficiency syndrome (AIDS), or cancer were more likely to use physician-assisted suicide than were people in other education and age groups and those with other diseases and conditions. Over the years, the reasons patients have noted for requesting physician assistance with suicide have remained essentially the same: Most have stated that they made their decision not out of a fear of pain, but because they feared a decreasing ability to participate in activities that make life enjoyable, loss of dignity, and loss of autonomy. The Oregon Department of Human Services has concluded that the Death with Dignity Act created an incentive for medical care providers to explore with patients their fears and wishes around end-of-life care and to make patients aware of other options.

Significance

Passage of Oregon’s Death with Dignity Act stimulated interest across the United States concerning the long-debated issue of an individual’s “right to die,” and the controversy continued into the twenty-first century. On one side are arguments that each person should have the right to “death with dignity” and that individuals should have the liberty to choose physician-assisted suicide to protect that right. On the other side are arguments regarding the dangers of allowing the establishment of any government-sanctioned right to choose to end a life. Critics of laws allowing physician-assisted suicide assert that such legislation will inevitably lead to abuses and may encourage individuals to seek suicide who might otherwise not consider such a step.

The U.S. Supreme Court has ruled in at least two cases that the right to physician-assisted suicide is not a liberty included in the U.S. Constitution and therefore is not available to persons in states that do not have, as Oregon does, laws expressly permitting it. The Court’s upholding of Oregon’s Death with Dignity Act thus set an important legal precedent.

Bibliography

Emanuel, Linda L., ed. Regulating How We Die: The Ethical, Medical, and Legal Issues Surrounding Physician-Assisted Suicide. Cambridge, Mass.: Harvard University Press, 1998. Collection of essays provides comprehensive discussion of the topic of physician-assisted suicide. Does not directly address the Oregon law, but deals with a number of well-known specific cases.

Harrison, Maureen, and Steve Gilbert, eds. Life, Death, and The Law: Landmark Right-to-Die Decisions. San Diego, Calif.: Excellent Books, 1997. Presents clearly written legal analysis of important court decisions concerning the issue of the right to die.

McKhann, Charles F. A Time to Die: The Place for Physician Assistance. New Haven, Conn.: Yale University Press, 1999. Presents a reasoned and dispassionate consideration of physician, patient, legal, and advocacy issues concerning the right to die, expressed in a historical context. Advocates the establishment of state laws that, like Oregon’s, allow physician-assisted suicide under controlled conditions.

Smith, Wesley J. Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder. New York: Times Books, 1997. Argues frankly against assisted suicide. Despite emotional tone and clear bias, nonetheless includes some interesting examples from the campaign for the Oregon act as well as actions in other states.

Weir, Robert F., ed. Physician-Assisted Suicide. Bloomington: Indiana University Press, 1997. Collection of essays provides thoughtful discussion of the historical, ethical, and public policy ramifications of physician-assisted suicide.

Wexler, Barbara. Death and Dying: Who Decides? Farmington Hills, Mich.: Thomson Gale, 2003. Presents a brief but comprehensive overview of the history, definitions, ethical and medical considerations, legal status, and opinions on death and dying. Includes two chapters detailing the Oregon experience.