Oregon USA: People can be ‘terminal’ even if treatment is available

 

 

The End of Life Choice Act and Oregon’s Law

 

At Referendum 2020, New Zealand will vote on whether the End of Life Choice Act 2019 should come into force.

The End of Life Choice Act is similar to the assisted dying law in Oregon USA, because both limit eligibility for assisted dying to terminally ill people who are expected to die within 6 months. 

Oregon set the precedent for how the 6-months prognosis eligibility clause is to be interpreted around the world. 

Therefore under the End of Life Choice Act, people could also be terminal and eligible for assisted dying even if treatment is available.

However, in Oregon, only assisted suicide is legal: A person has to take the lethal dose of medication themselves. The End of Life Choice Act allows euthanasia also: A New Zealand medical practitioner or nurse practitioner would be allowed to administer the lethal dose intravenously.

 

 

What ‘terminal’ means in Oregon USA

 

In December 2017 Fabian Stahle contacted the Oregon Health Authority with questions about how their assisted suicide law works in practice.

Mr Stahle made a submission to Parliament’s Justice Committee on the End of Life Choice Bill. Here is an excerpt (emphasis added):

 

“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?” 

Fabian Stahle continued in his submission:

“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.”

 

 

Conclusion

 

New Zealand voters can expect that under the End of Life Choice Act, eligibility criteria for assisted dying do not compel patients to exhaust all treatment options first either.

A person would not even need to try any treatment before receiving euthanasia or assisted suicide under the EOLC Act. A person would only need to say that they don’t consider the treatment options “tolerable”.