Is Measure 16 a boon to hospice?

Few assisted suicide cases reported

Oregon so far remains the only state to pass a law legalizing assisted suicide. As far as observers can determine, the law is now in effect, allowing terminally ill Oregonians to request a lethal prescription from their physicians to end their suffering and their lives. But it is not known whether the law has been widely utilized.

There have been a few reports of hospices confronting suicide requests under Measure 16, says Ann Jackson, executive director of the Oregon Hospice Association (OHA). Most hospices in the state would provide care for terminally ill patients seeking assisted suicide, but would not participate directly in administering the lethal medication.

Patient confidentiality issues may be keeping actual cases out of the public eye, and with good reason. Health providers fear that if a patient's pursuit of assisted suicide were disclosed, "the media - or worse, Right to Life - would be at the door literally making a [test] case of it," Jackson says.

Almost daily, new wrinkles are emerging in the implementation of Measure 16, she adds. "A lot of things are coming up that we didn't prepare for." However, one issue that failed to pan out was a threat late last year by the federal Drug Enforcement Administration (DEA) to prosecute physicians for writing lethal prescriptions under the law. Although U.S. Attorney General Janet Reno has not yet issued a final ruling on this issue, a task force within DEA concluded that the federal agency does not have the authority to pursue such cases.

Meanwhile, healthy Oregonians are reported to be looking for personal physicians who would be willing to honor their future requests for assisted suicide, while some physicians have demonstrated a surprising lack of understanding of how the law works, Jackson reports. "Are physicians going to be willing to ask for the information they need to carry out the request" from assisted-suicide advocacy organizations such as Compassion in Dying? For instance, she wants physicians to understand that morphine is a poor drug choice for assisted suicide, and not to let the choice of lethal medication obscure the legitimate use of morphine to treat pain.

Meanwhile, controversy within the hospice community over whether hospices should have mounted a more strident opposition to Measure 16 (or more vociferous support for the 1997 ballot initiative seeking to repeal it) also appears to be dying down. OHA recently held "our annual meeting and we didn't even talk about it," Jackson says. Most of the current end-of-life focus in Oregon is aimed at improving care for the terminally ill in order to prevent the problems that drive requests for assisted suicide. Health policy leaders are also exploring approaches to guarantee universal access to hospice care.

In fact, virtually every hospice in the state has seen at least a 20% increase in referrals in the past year, and Oregon may be surpassing Florida as the state with the highest hospice penetration, Jackson says. It may be too much to call Measure 16 a boon for the hospice community, "but there definitely was a silver lining. It made everyone take hospice more seriously. Hospice has developed a great deal of credibility, and is seen as the expert in care of the dying."

This credibility might not have been as great if hospice had been more extreme in its opposition to Measure 16, Jackson adds. "It is very difficult for the public to understand that we can actually accept democracy's rule" and the voice of the people in enacting Measure 16.