In assisted death, model is Oregon law

Backers of a proposal to allow terminally ill Californians to hasten their deaths with lethal drugs pointed Thursday to legalized assisted suicide in Oregon, where a new report shows it is used sparingly.

Forty-six Oregon residents, most of them cancer patients, used the law to end their lives in 2006, according to the Oregon Department of Human Services’ ninth annual report on the so-called Death with Dignity Act that voters there passed in 1994.

That law is unique in the country. Two Democratic lawmakers in California are making their third attempt in three years to enact a similar law here.

Since the Oregon law took effect in 1998, only 292 of about 86,000 likely eligible residents have used the lethal prescription to end their lives. To be eligible, people must be Oregon residents, diagnosed with less than six months to live and deemed mentally capable of making medical decisions.

“I think the experience in Oregon should reassure Californians that end-of-life choice greatly benefits patients and their families,” said Keith Graham, a doctor in rural eastern Oregon who helped one patient use the prescription last year.

His patient, an 80-year-old with cancer, wanted to die at home rather than in a nursing home, he said.

“She was able to choose the time and place,” said Graham. “She died in the bedroom that she and her husband had shared in the house they had built, surrounded by her five children and many, many grandchildren. The house was just full. It was a very smooth transition. It was very peaceful. The family was very grateful.”

The California bill, AB 374 by Assembly members Patty Berg (D-Eureka) and Lloyd Levine (D-Van Nuys), is opposed by the Catholic Church, which considers life, from conception to natural death, sacred.

The bill is also opposed by some activists for the disabled, who say they fear that people with chronic medical troubles will be pressured by a cost-conscious medical system into ending their lives under such a law.

Tim Rosales, spokesman for AB 374 opponents, said the limited use of the Oregon law calls its value into question.

“You don’t make public policy in this way just to affect a narrow swath of Californians,” he said, “especially when you have issues related to health insurance, the uninsured, the poor, completely different demographics in California than you have in Oregon.

“We’re in the middle of a health insurance crisis,” he continued. “When you have a profit-driven health management system ... there are significant dangers.”

Similar bills by Berg and Levine have failed before. AB 374 has stronger support from Assembly Speaker Fabian Nunez (D-Los Angeles). Last month Nunez said he was willing to “buck my church” on the issue.

As in previous years, the latest report from Oregon shows that those who choose to hasten their deaths are as likely to be men as women, tend to be better educated than the rest of the population and list their top concerns as loss of autonomy, decreasing ability to engage in activities that make life enjoyable and loss of dignity.

The median age of those who used the lethal drugs in 2006 was 74, and 87% had cancer. Nearly all died at home, and all but one patient had health insurance. Most became unconscious within several minutes of taking the drugs, typically barbiturates.

It takes several weeks and multiple requests to obtain a prescription. Not everyone who seeks one uses it.

“I ... am not even sure I will use the medication,” said Glenn Elfman, a Southern California native who lives in Pistol River, Ore. He has been told he is dying of prostate cancer and has obtained a prescription.

“All I know is that ... it has been an enormous comfort knowing that I could spare my family and myself the indignity of an end I would not want,” he said.

The latest report included one semantic change hailed by proponents as significant: The Oregon Department of Human Services stopped referring to the act as “physician-assisted suicide.”

“The state has used that term and it has been much to the dismay of dying patients, who have felt it has insulted their exhaustive battles with cancer and other terminal illnesses,” said Barbara Coombs Lee, president of Compassion & Choices, a nonprofit group that helps people get and use the life-ending prescriptions.

The Oregon law “clearly stated that the practice it sets out is not suicide, not assisted suicide,” Lee said. She uses the term “aid in dying.”

Oregon state epidemiologist Mel Kohn said he “had to agree” with Lee. The death certificates of people who take the lethal prescription list the underlying terminal illness, he said.

“It’s very difficult to come up with any kind of terminology that is really neutral,” Kohn said.

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nancy.vogel@latimes.com