Dr. Kenneth Stevens, Jr. is the Professor Emeritus and former Chair of Radiation Oncology, Oregon Health & Science University, Portland, Oregon and President, Physicians for Compassionate Care Education Foundation, www.pccef.org
Pictured above is Lauren Hill, who has been diagnosed with an inoperable brain tumor and has been given only a few months to live. She has just played in the opening basketball game at Mt. St. Joseph University.
Physician-assisted suicide has recently been in the media because of Brittany Maynard, diagnosed with a brain tumor earlier this year, who came to Oregon and died of suicide from an overdose of barbiturates on November 1, 2014. The assisted suicide proponent organization, Compassion & Choices (former Hemlock Society), has orchestrated and centered a skillful media campaign about her story to promote further legalization of physician-assisted suicide.
She was attractive, young, recently married, and diagnosed with a malignant brain tumor. Even though she was very functional and able to travel to the Grand Canyon in recent weeks, she felt without hope. She ended her life prematurely a few days ago with the drug overdose.
My 47-year experience caring for patients with cancer in Oregon has been rich with experiences with patients. Since Oregon’s assisted suicide law was passed by voters in 1994, I have studied the law and its effects and led efforts to fight it.
Brittany Maynard’s story is currently in the news, but there are other stories regarding assisted suicide in Oregon.
I first became involved with assisted-suicide in 1982, shortly before my 39-year old wife died of cancer in the brain. We had just made what would be her last visit with her doctor. As we were leaving the office, he said that he could provide her with an extra-large dose of pain medication. She said she did not need it because her pain was under control. As I helped her to the car, she said “Ken, he wants me to kill myself.” She had suffered a lot over the prior 18 months, but her doctor’s statement caused the most suffering to her. It devastated her that her doctor, her trusted doctor, would suggest that she kill herself. Two weeks later she peacefully died in our home without pain, and with dignity. We treasured all of our time together, even to the natural end of her life on earth.
In the year 2000, 55-year old Jeanette Hall was referred to me by her surgeon with a diagnosis of inoperable low rectal anal cancer. When I first met Ms. Hall, I informed her that I felt she had a tumor which, although it was inoperable, could be treated with radiation and chemotherapy with a good likelihood of cure. When she came to me with the inoperable diagnosis, she felt hopeless and was despairing. Following the cancer diagnosis, as she was leaving the hospital, she was asked by the hospital personnel, “Are your affairs in order, do you have a funeral plot?” They didn’t have much hope for her future.
She informed me that she did not want cancer treatment, she wanted assisted suicide. “I voted for the law, and that is what I want. I don’t want to go through all the problems with treatment,’ she said.
She was very set in her determination to die from assisted suicide. She agreed to return and visit with me in a week. During that week she saw her surgeon again, and he informed her that without treatment she had 6 months to 12 months to live. In Oregon, people are eligible for assisted suicide if they have a 6 months or less life expectancy, so she qualified for the law.
When I saw her the following week, she said, “Dr. Stevens, I’m here for the pills, why aren’t you giving me the pills?” I again encouraged her to receive the cancer treatments, but she continued to have a hopeless feeling regarding her diagnosis. She refused the cancer treatments, and was very determined to die from assisted suicide. She did agree to return on a weekly basis. After the 3rd or 4th visit I asked more about her family. She had a son who was attending the police academy in Oregon. I said, “Ms. Hall, wouldn’t you like to see him graduate, wouldn’t you like to see him get married?” She then realized that she did have something to live for, her feeling of hopelessness and despair was replaced with hope.
She agreed to and received radiation and chemotherapy which were successful and the cancer melted away. Five years later, I saw her in a restaurant where she was with a friend, and she came over and said, “Dr. Stevens, you saved my life. If I had gone to a doctor who believed in assisted suicide, and agreed with my decision to have assisted \suicide instead of the treatments, I would not be here, I would be dead.” That was 14 years ago, she continues to be very functional and joyful in her life, and frequently exclaims, “It’s great to be alive!” She has been interviewed by the media many times. Because of the Brittany Maynard story, in the last two weeks, she and I were interviewed in her apartment by TV crews from Nippon TV and Fuji TV of Japan. Even a correspondent from Al Jazeera English video interviewed me this past week.
There can be a financial incentive for assisted suicide. In Oregon, the combination of legal assisted suicide and prioritized medical care based on prognosis has created a danger for patients on the Oregon Health Plan (Medicaid). First, there is a financial incentive for patients to commit suicide: the Plan will cover the cost of assisted suicide. Second, the Plan will not necessarily cover the cost of treatment.
For example, patients with cancer are denied treatment to prolong life, if they are determined to have “less than 24 months median survival with treatment” and fit other criteria. Some of these patients, if treated, would have many years to live; as much as five, ten or twenty years depending on the type of cancer. This is because there are always some people who beat the odds. Yet the Plan will only cover the cost of their suicides.
The story of Barbara Wagner was publicized in Oregon in 2008. She was informed that the Oregon Health Plan Insurance would not approve and pay for her lung cancer medication, but they would pay for Comfort Care, which included assisted suicide. She told the TV reporters, “They will pay for me to die, but won’t pay for me to live.” See her story at: https://www.katu.com/home/video/26119539.html.
Medical ethicist Dr. Ezekiel Emanuel has proposed that scarce medical resources should be directed to those between the ages of 15 and 55 years; and he sees no reason for himself to live more than 75 years. Legalizing assisted suicide has economic consequences.
When a person expresses a desire to take their own life, society acts to protect that person from committing suicide. However, when assisted suicide is legalized, society then acts to assist that person in committing suicide. This is especially true for those who are seriously ill or have disabilities – they have lost society’s protection against suicide. How ironic this is.
Another group against physician-assisted suicide are those with disabilities. When people say there are things worse than death, they often seem to be describing those who have disabilities. Some of the disabled have formed a group called Not Dead Yet to assert that they choose to live. There is also a problem with people suffering from depression not receiving the psychological evaluation and treatment that they deserve, who are instead given the option to choose physician-assisted suicide.
They say that when people say there are things worse than death, that they seem to be describing people who have disabilities. They have formed an organization called Not Dead Yet. There is also a problem with people with depression not receiving the psychological evaluation and treatment that they deserve.
Oregon has a high rate of suicides (excluding assisted suicides) that is 140% of the US national rate and it has not diminished with the legalization of assisted suicide.
I am concerned that the media’s reporting regarding Ms. Maynard may result in additional suicides. There is a serious problem of suicide contagion where media reporting of suicide encourages other suicides. There are media guidelines which have not been followed in the reporting of Ms. Maynard. The risk of suicide contagion is real and can include children. See https://www.margaretdore.org/2014/10/the-brittany-maynard-case-illustrates.html
The legalization of assisted suicide does not give any new rights to patients. Its purpose is to legally protect doctors who write prescriptions for lethal drugs. The strategies and methods of pro-assisted suicide organizations are to use euphemisms. In his 1993 book “Lawful Exit”, Derek Humphry, founder of the Hemlock Society, devoted a chapter title “Doublespeak” to the importance of language. You can call it “compassion” or “caring”, but assisted suicide is suicide.
People who are given a terminal diagnosis are not necessarily terminal, and are not necessarily dying. A friend of mine learned in 2004 that he had 13 tumors in his liver, over 70 tumors in his lungs, and his doctors told him that he would be dead in one and a half months. Within 2 weeks of receiving the terminal diagnosis, he and his wife sold at garage sales or gave away an estimated $20,000 of his tools and belongings in order that his wife would be unburdened of his stuff and to help prepare her for a life without him. They sold his things for ten cents on the dollar and made arrangements for a burial plot in another state. They even contacted a realtor and almost sold their house.
Then he realized that in spite of all those tumors in his liver and lungs, he did not feel ill, and he questioned his terminal diagnosis. His doctors reviewed his medical information, and found that his tumors were not malignant. He continues to live and work 10 years later, never having received any specific cancer treatment. After the original diagnosis of terminal tumor, he and his wife made very hasty decisions that financially cost them dearly. Since he lives in Oregon, he would have qualified for assisted suicide. Had he chosen assisted suicide before receiving the correct non-terminal diagnosis, he could have ended his life very prematurely early.
There are many reported instances of patients outliving the terminal diagnosis and prognosis of their doctors. Legalization of assisted suicide cheapens and shortens lives of vulnerable people.
It is sad that Ms. Maynard developed a brain tumor. It is tragic that she ended her life prematurely and that family and friends were not able to spend more memorable time with her. Don’t we value time with our loved ones? Why shorten that time? Medicine does have the means of taking care of patient’s symptoms and helping them be comfortable.
Contrast Ms. Maynard’s story with that of 19-year old Lauren Hill, a college basketball player with an inoperable brain tumor. In spite of that diagnosis and with only months to live she is living her life to the fullest and is raising public awareness about pediatric cancer. She is not seeking to shorten her life with assisted suicide. She is a true hero in playing for her college basketball team in Indiana on November 2, 2014. .
We as a society should focus on hope and faith, and not on hopelessness and despair. Physician-assisted suicide is wrong and dangerous.