Death with Dignity?

It's not an issue on too many Oklahomans' radars, but outside the Sooner State, there is a gradually unfolding philosophical shift where euthanasia and physician-assisted suicide are concerned.

On the larger world stage, Ozzy and Sharon Osborne, of Black Sabbath and reality TV-fame, recently brought certain European countries' more liberal approaches to end-of-life decisions to light with a visit to Switzerland.

They traveled there in October to scout out and show their support for Dignitas, a so-called "death apartment" where physician-assisted suicide and euthanasia were performed.

It's not exactly clear how they would notice, but the couple said they planned to make an appointment with the clinic if Ozzy ever came down with Alzheimer's disease.

(Their visit was cut short, incidentally, upon discovering that Dignitas had just been evicted from the building after repeated complaints by other tenants of the large number of coffins cluttering the side of the street outside).

Closer to home, Oregon is recognizing its 10-year anniversary this year as the only state in the nation in which physician-assisted suicide is legal.

This is largely due to the efforts of Compassion and Choices, an Oregon-based nonprofit group that provides end-of-life counseling and advocates, through litigation and legislative lobbying, patients' rights to choose their own manner of dying.

The word "suicide" was intentionally left out of the group's description because it takes particular offense to the use of the word to describe what it supports, regardless of the "physician-assisted"-prefix.

"Suicide is when somebody, usually irrationally, takes their life, but these people want to live. They love life, but they're already dying," said Mike Beard, media relations director for Compassion and Choices.

"Physician-assisted dying" more accurately described the practice established in the Death with Dignity Act, the law passed in Oregon in 1997, he said.

In the decade since the act took effect, the law "has worked extremely well," Beard said.

It's his group's goal that the rest of the nation's laws concerning to end-of-life rights would someday mirror Oregon's.

"There are, at any moment in time, tens of thousands of people who are in extraordinary amounts of pain and they have no options for how they can exit this life with peace and with grace, and we think we ought to afford people at the end of this life with a certain amount of dignity," said Beard.

He said the Death with Dignity Act was now so much a part of the fabric of Oregon's law and medical culture that he sees no possibility of it ever being repealed.

So, their attention is focused outward, to other states. Compassion and Choices has 45,000 members and 52 different local chapters across the nation.

But none in Oklahoma, Beard said.

That might be because, like Oregon, Oklahoma is unique in the nation, but for the opposite reason: because an opposing ethic is already woven into the fabric of the state's laws and medical culture.

"We're unique in the U.S. There's a statute on the books that makes a presumption that, if a patient can't speak, physicians are to provide them with therapy," Dr. Curtis E. Harris told UTW.

While that statutory presumption wouldn't technically conflict with Oregon's Death with Dignity Act (more on that later), the philosophies behind the two laws do represent the two opposing sides of the debate, as the doctor explains.

Fighting Death

Harris is Chief of Endocrinology at the Chickasaw Nation Carl Albert Diabetes Care Center in Ada.

He wears several other hats as well, including Adjunct Professor of Law, specializing in medical law, at the Oklahoma City University School of Law.

He also serves on the state Medical Licensure Board, and has been a regular commentator on medical ethics on National Public Radio.

Harris is also a member of the little-known Nightingale Alliance, the mission of which is "to promote compassionate, medical, emotional and social care at the end of life, allowing each individual to be treated with respect until natural death occurs, and to oppose the life-ending acts of physician-assisted suicide and euthanasia," according to www.nightingalealliance.org.

The Nightingale Alliance has existed for six years.

Barbara Lions, director of the Nightingale Alliance, said the organization came about as a response to a series of meetings from people across the country to legalize assisted suicide.

"It's mostly an information source. It doesn't lobby in the Legislature," she said.

Harris said he was asked to join the Nightingale Alliance because he had become so recognized for having started another group with similar goals.

"I founded the American Academy of Medical Ethics, which is about 8,000 physicians scattered throughout the southwest who wanted to return to the original Hippocratic tradition, to counter some of the principals advanced by Jack Kevorkian," he told UTW.

Of course, "Jack Kevorkian," a.k.a. "Dr. Death," is a household name across the country and beyond for having become the public face of physician-assisted suicide.

Hippocrates, though, might not be so familiar a name, save for doctors and "Jeopardy" buffs.

The ancient Greek is regarded as the Father of Medicine and formulated what is known as the Hippocratic Oath, variations of which are taken by doctors before embarking upon their careers.

The classical version, and others, contains a pledge to "neither give a deadly drug to anybody who asked for it, nor make a suggestion to this effect."

Harris explained that, not only was there a need to counter Kevorkian's influence, but another advocacy group--The Hemlock Society--was strenuously at work to change the pertinent laws in several other states, making them friendlier to principles Harris sees as consistent with Kevorkian's.

The Hemlock Society eventually changed its name to End-of-Life Choices and then merged with the similarly-purposed Compassion in Dying in 2004, becoming Compassion and Choices.

Harris said the Oklahoma Feeding and Hydration Act, which was passed in the early 1980s, sprang from a deep-seated medical ethic in the state that opposes anything but naturally occurring death, which would make any efforts at changing the state's laws an unwinnable, uphill struggle, which might explain why groups like Compassion and Choices have no significant presence in Oklahoma.

The law upholds the notion that a physician's role is to preserve life, never to end it, by creating the presumption that if a patient can't speak and hasn't previously indicated wishes to the contrary, they are to be kept alive by providing them with continued nourishment.

While Oregon's Death with Dignity Act lays out what Beard calls "really rigid standards and a fairly complicated process" by which terminally ill patients can receive a physician's assistance in dying, and does not create a statutory presumption in opposition to Oklahoma's Feeding and Hydration Act, Harris said it undermines that long-held notion established by Hippocrates in the 4th Century B.C.

"Prior to Hippocrates, the shamans, who were responsible for providing a type of medical care, would also administer poisons to end someone's life. Hippocrates changes all that, but we seem to be going back to that after 2,400 years," said Harris.

Accordingly, Lions said legalized assisted suicide or euthanasia would dramatically alter the medical profession.

That alteration, she said, would transform physicians' current roles as healers to the dual roles of healers and death-dealers.

That diversification of roles would inevitably lead to physicians bowing to "pressure to encourage people to choose death for financial reasons," said Lions.

The main victims, she said, would be women and minorities.

Minorities would be victimized because, well... dying is a lot cheaper than life-saving health care.

Lions said women would likely be victims because that was the case with Dr. Jack Kevorkian's "patients" or "victims," depending on how one views the issue.

"I have no idea why they were all women, but that's what happened," she said.

Harris said that "slippery slope" could be seen in the Netherlands, where euthanasia and assisted suicide were legalized decades ago after a highly publicized case in which a physician euthanized her mother at her own request because she was dying and expected to pass within a month or two.

The woman was convicted of murder, but due to an overwhelming amount of public sympathy, she was only sentenced to one day in prison, which she didn't serve, Harris recounted.

The incident swayed public opinion in favor of laws allowing euthanasia and assisted suicide in the Netherlands, which came about shortly thereafter, taking effect in 2002.

One Pill Makes You Stronger...

According to data collected two or three years ago by the Dutch government, Harris said 37 percent of all euthanasia operations in the nation were performed on competent, non-consenting adults.

If they're non-consenting, how is that not "murder?" he was asked.

"Because their law says it's not," answered Harris.

"Tolerance has become so great that this is acceptable in the Netherlands," he added.

Harris didn't recall the name of the study off the top of his head, however, and UTW wasn't able to locate it.

Regardless, that "slippery slope" might be apparent in a study conducted by the Royal Dutch Medical Association in 2005.

The study underscored the Dutch euthanasia law's lack of a specific definition of what physical or mental conditions must exist in a patient for euthanasia to be legally acceptable--only that a patient "must be suffering hopelessly and unbearably."

Jos Diikhuis, the emeritus professor of clinical psychology who led the study, said many doctors were approached by patients seeking euthanasia who did not have a classifiable disease.

"It is an illusion to suggest a patient's suffering can be unambiguously measured according to his illness," the report read.

Diikhuis and crew argued that the legal threshold for euthanasia should be "suffering through living" that could be judged "unbearable and hopeless."

Another subject of debate among the Dutch in the past several years has been euthanization of terminally ill children.

"There is no logical end," said Harris.

He said the worldwide movement toward euthanasia indicated a philosophical shift in people's definitions of life and the self.

"Personal autonomy has been the mantra in the past half century; social obligation and 'no man is an island' isn't the way people think any more. Now, 'My freedom ends at your nose' is the way they think," said Harris.

"In 1750, if I killed myself, I'd be buried in a paupers' field with no marker, and any inheritance I left would go to the state," said the medical/legal guru.

"Since the late 1800s and early 1900s, though, with the development of psychology as a field of science, suicide was no longer regarded as a crime but as a disease--a symptom of depression," Harris continued.

"So, if someone commits suicide, it's a failure of medicine. But now, we have this odd swing--it's no longer an emotional disease, it's a choice," he added.

Harris said the conditions described by Beard of the tens of thousands of people in extraordinary amounts of pain with no hope of recovering to health, did not exist.

"If I ran across that person, you might be pushing my ethics, but I've never seen that person," he said.

"We can control pain. We can sedate them," he added.

Harris said it was fine for physicians to relieve suffering through anesthesia, though.

Beard, though, said that's essentially what Compassion and Choices advocates for patients who are dying anyway.

He said Oregon's law only allowed assisted suicide under the strictest of conditions.

They must be terminally ill and dying within six months, they must initiate written requests for medication for the purpose of ending their life, and they must be able to administer it to themselves, among numerous other conditions.

Since the law took effect in Oregon, Beard said the state's suicide rate had declined.

"When someone has the option of the Death with Dignity Act, they don't need to use a weapon or drive their car in to a bridge abutment--they don't have to use violence on themselves," he said.

"Most people who are dying in Oregon die peacefully in their own homes," Beard added.

Also, he said many people who obtain medication to end their lives don't wind up taking it.

"Psychologists say it's because it gives them some measure of control over their own lives," he said.

He also said that, like the Nightingale Alliance, Compassion and Choices did not support "Kevorkian-esque techniques," and they opposed euthanasia.

While his organization is largely occupied in lobbying to change laws to allow assisted dying, Beard said his group opposed both euthanasia and Kevorkian's practices "because they're both against the law."

When pressed for an explanation, he simply answered, "They're against the law, and there's no need."

Regarding the "slippery slope" argument, Beard said it has been "absolutely disproven" by the recently completed Battin Assisted Suicide Study, led by University of Utah bioethicist Margaret Battin, published in October's Journal of Medical Ethics.

The report studied data collected for the past 10 years in Oregon and the past 20 years in the Netherlands, and concluded that legalized assisted suicide does not result in more deaths among certain terminally ill patients.

The report came under immediate fire when it was released, though, because she didn't disclose that she was a member of the advisory board of the Death with Dignity National Center in Portland.

Alex Schadenberg, head of the Euthanasia Prevention Coalition, published an article on " www.lifenews.com in which he wrote that the study "at best, can be referred to as propaganda."

He also dismissed its conclusions about the non-existence of the "slippery slope" because the data analyzed--the annual reports from the Oregon Department of Human Services--did not include information pertaining to the decision-making process of the person seeking assisted dying.

Also, the report did not address the issues raised by Harris about the increased tolerance for euthanasia seen in the Netherlands.

To that, Beard said, "This isn't the Netherlands. I can't imagine that happening here."

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