Oregon: A person can be ‘terminal’ even if treatment is available
In December 2017 Fabian Stahle contacted the Oregon Health Authority with questions about how their assisted suicide law works in practice.
In Oregon a person is eligible to receive a prescription for lethal drugs if they are terminally ill with a life expectancy of six months or less. Since the proposed New Zealand End of Life Choice Bill includes a similar clause, Mr Stahle made a submission to Parliament’s Justice Committee.
Here is an excerpt:
On 4 December 2017 I sent an email to the Oregon Health Authority asking,
In the law, “terminal disease” is defined as an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment (in the opinion of the patient’s attending physician and consulting physician), produce death within six months. Is this rule interpreted as ‘without administration of life-sustaining treatment’?
Craig New, Research Analyst, Oregon Health Authority, Center for Public Health Practice, Public Health Division, answered my question on 4 December, 2017:
…your interpretation is correct. The question is: should the disease be allowed to take its course, absent further treatment, is the patient likely to die within six months? (emphasis added)
So under Oregon’s assisted death law, one can achieve the status of being “incurably” sick even if the disease can be treated! Thus, all diseases which, without treatment, are expected to lead to death within six months are considered to be incurable and therefore qualify for assisted death. This is in fact an alteration of the traditional meaning of the concept of “incurable,” which usually denotes an untreatable condition. Consequently, a far larger group of patients qualifies for medically assisted death than just the extreme cases for which the law was originally said to apply. A patient with a curable or chronic disease can make him/herself eligible for assisted death.
This interpretation of “incurable” has profound consequences. In New Zealand, as in most societies, it is indeed an accepted right for patients to refrain from medical treatment. Since assisted death laws claim to have the purpose of expanding, not limiting, the autonomy and self-determination of the patient, I sent the following questions to the Oregon Health Authority on 5 December 2017:
– If the doctor suggests, to an eligible patient, a treatment that possibly could a) prolong life, or b) transform a terminal illness to a chronic illness, or c) even cure the disease — and if the patient doesn’t give his/her consent to the proposed treatment is he/she still eligible to take use of the Act?
– If a patient with a chronic disease (for instance, diabetes) by some reason decides to opt out from the life-sustaining medication/treatment and by doing so is likely to die within 6 months, thereby transforming the chronic disease to a terminal disease — does he/she then become eligible to take use of the Act?
On 6 December 2017, Craig New gave the following answers to these questions:
Interesting questions. While this is not addressed specifically in the law, the answer in both cases is yes—those patients would qualify. The law is best seen as a permissive law, and states only that patients must have a terminal illness with six months or less to live. It does not compel patients to have
exhausted all treatment options first, or to continue current treatment. It is up to the patient and doctor to discuss disease and treatment options. But if the patient decides they don’t want treatment, that is their choice. (emphasis added)