Oregon Faces Wrenching Vote on Suicide Law

Barbara Oskamp still plays bridge down at the senior center, plays with the same three women she’s played with every week for years. The difference now is, she can’t remember their last names. The reason is, the tumor that sprouted up along her optic nerve made its way up against a cranial artery and started to grow.

To open up her head and take it out would be to remove the best part of her brain. Now Oskamp waits and hopes that the day the tumor finally kills her is far away. She addresses it each day by name: Tu. “It’s short for tumor,” she explained, “and it’s also a famous phrase from Shakespeare, that would be ‘Julius Caesar,’ I guess: ‘Et tu, Brute!’ ”

“I speak to it in a friendly way,” she said. “I don’t want to irritate it.”

In 1991, doctors said most patients live eight years with a tumor like hers. Against a narrowing window of time, Oskamp has laid plans to ease her departure if it becomes an unbearably painful one. She will swallow an anti-nausea drug, then open 50 caplets of barbiturates into a bowl of applesauce and take on the good night.

Oskamp is one of a small but significant number of the terminally ill in Oregon whose very lives and deaths depend on the outcome of balloting Tuesday, when state voters will decide whether to repeal the first law in the nation that would legalize physician-assisted suicide.

If the repeal effort fails, a court injunction will likely be lifted shortly thereafter and patients with less than six months to live and a clear will to die will be free to obtain a doctor’s prescription for a fatal dose of oral medication.

After years of legal debate on the issue of assisted suicide, capped by this year’s U.S. Supreme Court decision refusing to declare it a constitutional right, Oregon is poised to become the proving ground upon which a new social revolution unfolds.

“I’m expecting that relatively few patients will go through the various procedures that they need to make a formal request, and of those that do so, a much smaller number will actually go through with it,” said Barbara Coombs Lee, who is leading the campaign against repeal of the measure.

“The wide benefit is from the knowledge that it is there. Patients call it their parachute. They just derive a tremendous amount of courage and strength from knowing that if the going ever gets really tough, if they find themselves in their worst nightmare, there is a way out.”

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Those leading the repeal effort warn that Oregon is about to implement a badly flawed statute that will lead to botched suicides and large numbers of people ending their lives out of simple, treatable depression. They raise the prospect of managed-care health providers coolly guiding expensive terminal patients into abrupt end games.

“In an era of managed care, when increasingly decisions are being made to serve a health care bureaucracy to help shave costs, the idea of introducing the so-called option of assisted suicide is incredibly dangerous. Because the most cost-effective solution with patients who require expensive medication and intervention procedures is to consider eliminating the patient who has that need,” said William Toffler, a family physician and medical school professor who is leading an organization of 1,000 doctors seeking the repeal. They are joined by the Oregon Medical Assn., the American Medical Assn. and the state hospital association. Another group of 400 physicians has rallied in support of the assisted-suicide measure.

Gov. John Kitzhaber, himself a physician and former emergency-room doctor, has backed the statute. “As a physician,” he has said, “I can tell you that there’s a clear difference between prolonging someone’s life and prolonging their death.”

Oregon voters initially approved a ballot initiative authorizing doctor-assisted suicide in 1994 by a 51%-to-49% ratio. A court challenge blocked implementation of the measure and, as the Supreme Court allowed states to adopt laws banning assisted suicide, the Oregon Legislature fretted over supposed deficiencies in the state statute and put it back on the ballot.

The campaign has been an all-out battle in a state accustomed to dramatic debate over social issues. With the help of the Catholic and Mormon churches, proponents of repeal expect to spend up to $5 million and have unleashed an army of volunteers in one of the largest grass-roots campaigns the state has ever seen. More than 100,000 “Yes on 51” lawn signs have been planted; 600,000 brochures have been handed out; airwaves have been filled with radio and TV spots for weeks.

Proponents of assisted suicide say they will raise and spend barely a fifth of what the opposition has. “Over half their money’s come from the Catholic Church, from archdioceses all around the country,” Lee said. “It’s a very formidable force. It has to be one of the wealthiest and most powerful political machines in the world. Add to that the AMA, add to that the Christian Coalition, who are providing the grass-roots shock troops.”

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While early polls showed support for assisted suicide running at about a 2-to-1 level, that margin has narrowed in recent weeks as voters began posting their ballots in a mail-in election that concludes Tuesday. “I think it’s going to be very close,” said Portland pollster Tim Hibbits. “If you push me, my instincts are that it [the repeal] will fail narrowly, but I wouldn’t bet a plug nickel on the outcome.”

Except for the money, Hibbits downplays the likely impact of the Catholic Church in the outcome: It is the state’s largest denomination, claiming about 15% of Oregonians as members. But the state is one of the least church-affiliated in the nation, and up to half of all Oregon Catholics are likely to split with the church on issues such as abortion and assisted suicide, Hibbits said.

While the original 1994 debate on the measure ranged over broad spheres of morality and ethics, the 1997 battle has been fought in the trenches, with opponents attacking the details that they say amount to a statute that won’t work.

The statute permits a physician to prescribe a lethal oral dose of medication only to patients who have been determined by two doctors to have less than six months to live. The patient must make three witnessed requests, one of them in writing. Patients deemed to have impaired judgment from depression are to be counseled. Doctors and hospitals can elect not to participate.

Unlike failed assisted-suicide measures in California and Washington state, there is no provision for lethal injection, the quickest and surest way of medically ending a life. As a result, the campaign has focused in recent weeks on the horrific details of how an oral dose of barbiturates could go wrong.

Opponents point to studies in the Netherlands, where assisted suicide is legal, that showed many patients took several hours to die. Physicians there normally stand by with a lethal injection to administer a coup de grace in those cases.

With those studies in hand, a highly controversial television spot began airing a few weeks ago (although several stations refused to run it), showing a young man diagnosed with a fatal disease who is about to opt out of his life.

“He won’t die right away,” the ad warns. “He’ll choke on his own vomit, in painful convulsions, and linger for days.”

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Proponents of the assisted-suicide option were furious, pointing out that the law was never designed for teenagers. They claim that although a heavy oral barbiturate may not kill instantly, the patient slips quickly and quietly into a coma and will die within several hours at the most.

“The vomiting is a lie. They have not one case that they can show of medically assisted dying where the patient vomited,” said Lee, a former nurse, adding that anti-nausea drugs are available and that vomiting associated with barbiturate overdoses usually comes with suicide attempts that are not medically supervised.

“Think about this,” countered Toffler, the physician opponent. “Have you ever had surgery yourself? What did they ask you to do before you had surgery? If you ate a single bite of anything, your surgery would be canceled, flat out. Every anesthesiologist knows that as you slip into a coma, there’s a danger of vomiting and aspiration.

“There’s no such thing as a pill that doesn’t have side effects,” Toffler said. “And we’re not talking about drying up somebody’s runny nose. We’re talking about killing them 100% of the time and not having them vomit. These folks should sell snake oil.”

Opponents raise other complaints: Although the measure is restricted to Oregon residents, it doesn’t define residency; in a survey of Oregon doctors in 1996, half of them said they can’t predict accurately when someone will die; and a third of primary-care physicians said they couldn’t say for sure whether depression, a potentially reversible condition, was playing a role in a terminal patient’s attitude.

Yet a handful of terminal patients who have stepped forward to fight the repeal say all of those arguments are quite irrelevant against the reality of an imminent and painful death. Oskamp, 66, doesn’t know now how long she has left to live.

“But it made such a difference, passing that law,” she said. “I don’t know that I would be in bad pain at the end; obviously, I hope not. But it’s the choice of having the pills up there on the bedside table. I don’t know what I’d do. I don’t know what I’d choose, but just the fact of having the pills there gives me a little relief.”

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In the small central Oregon town of Pleasant Hill, 56-year-old Penny Schlueter, a retired college economics professor, has been fighting ovarian cancer since 1993. Despite years of therapy, it has spread further in her abdomen, and Schlueter is at a stalemate with the disease: It’s not spreading, it’s not retreating. But eventually treatment is likely to fail, and Schlueter’s original doctor told her she could expect six months of a slow, agonizing death.

“The doctors who are against assisted suicide have stated they can control pain. Other doctors disagree. After two surgeries, I challenge the pain-control specialists,” Schlueter said.

“The other part is the debility. There’s really nothing that can be done about the weakness, where you get so weak you can’t get out of bed by yourself. If the cancer metastasizes to the bones, then your bones break. One man I know ended up breaking his ribs just so he could turn over in bed and get comfortable. It’s very likely I will have severe intestinal problems . . . constant diarrhea or constipation. What about the debility that leaves a person a vegetable, unable to move, just watching your body deteriorate? Life is ended. It is not life, just to be stuck in bed, unable to do anything. It’s that time when life has ended, but death hasn’t come yet.”

When that time comes, Schlueter says, she wants to have the option of deciding her own fate. “The point is,” she said, “people who would like the option want that option because they value life.”