Initiative 1000: Pro-Con

By Barbara Roberts

I was governor of Oregon when voters approved our state’s landmark Death with Dignity Act in 1994. I endorsed that ballot measure, and another one in 1997 in which voters reaffirmed their support after the federal government tried to take the voters’ original decision away. I’ve followed the law closely, and now, more than 10 years later, I still strongly support individual freedom in end-of-life decisions.

You will hear plenty of exaggerations from opponents of death with dignity. I know, because they used the same arguments in Oregon. But I can tell you that none of those worst-case scenarios ever came to pass.

When you think about supporting Initiative 1000, Washington’s death with dignity initiative, I hope you will look at the Oregon experience, and I hope that my experience can help clarify some of the facts.

My husband Frank, who died in 1993, was the longest-serving member of the Oregon Legislature. He was often referred to as the “conscience of the senate.” Even before cancer put him in a wheelchair, Frank knew that as the parent of a disabled son and with 40 years of work in the disability community, I would never support a law that could harm people with disabilities. Let me state emphatically, I would never support a law that was harmful to individuals with disabilities or any other vulnerable population. The proposed Death with Dignity law is not a slippery slope.

In fact, after over a decade of experience, we know that disability and economic class are irrelevant to the Death with Dignity law. The law only applies to people who are diagnosed with a terminal illness, and who meet the strict safeguards.

There are many, many safeguards that ensure that the terminally ill patient’s decision is informed and voluntary. And those are the exact same safeguards that have worked in Oregon for over 10 years.

Responsible, safe

The Death with Dignity Act is safe, compassionate and responsible. It has improved end-of-life care for all patients in Oregon. Patients, families and doctors are more educated about end-of-life options, and have higher expectations about end-of-life care. Oregon is rated as having the best pain management and palliative care in the nation. More people die at home than in hospitals, because doctors, families and patients can have a more informed and honest conversation about what they want.

Oregon’s law has been upheld through every state and federal court challenge, including the U.S. Supreme Court. It was approved twice by voters, and only 341 Oregonians chose to end their suffering under the law in the past 10 years. These are usually end-stage cancer patients, and the personal stories they and their loved ones have shared have been beautiful accounts of dignified and gentle exits, made possible by the autonomy and freedom the Death with Dignity Act provided.

An additional 546 patients chose to access the medication, but decided not to use it. The issue was choice and having an option — and simply having that option removed some of their fear, even though they decided not to use it.

I have spoken with audiences across the nation about death and grieving, and I learned that for the terminally ill, the biggest concern is not cost or pain, but loss of control and loss of choice. The Death with Dignity Act gives terminally ill patients some control over their end-of-life care, and the right to decide how and when to ease their own suffering.

Just like in Oregon, Washington’s death with dignity initiative raises the question of who should make these difficult end-of-life decisions. I hope Washingtonians will agree that terminally ill patients should have the freedom to make the decision for themselves.

Please, vote yes on I-1000.

Barbara Roberts resides in Portland, and was governor of Oregon from 1991-1995. She has held positions at the John F. Kennedy School of Government and Portland State University. She remains active in community service.

By Chris Carlson

Voters should reject Initiative 1000 because it is poor public policy. When you read the fine print, you will see there are safeguards lacking in I-1000:

There is no requirement a spouse or family be notified. It is reasonable to imagine an understandably depressed and confused patient opting for the “quick exit” approach without family support.

There is no requirement the death be witnessed. It is possible someone could force feed the lethal dose to the patient. An undetectable crime is committed and the initiative provides the perfect alibi for the perpetrator.

I-1000 contains no mandatory requirement the patient receive a psychological examination. Suicidal tendencies are a cry for help and unmistakable signs of depression. Most frequently, when depression is treated, suicidal thoughts disappear. Society should be providing safe harbors for people nearing the end of their lives, not “quick exits”.

With I-1000 the act of assisted suicide is shrouded in secrecy. No opportunity exists for third party review of circumstances surrounding the patient’s death. Patient records are sealed and all interested parties are prohibited from viewing the records. There’s neither accountability nor transparency.

The doctor signing the death certificate is required to lie on the death certificate, listing the underlying disease, not the suicide, as the cause of death. Doctors are held immune from prosecution regarding falsifying the legal document.

The initiative allows one of the two witnesses in the request for physician-assisted suicide to be an heir. This contravenes existing law dealing with wills and estates. It creates the distinct possibility of a relative with ulterior, self-benefitting motives coercing the patient to commit assisted suicide.

I-1000 isn’t about end-of-life options. I-1000 contains the distinct probability that the decision to commit assisted suicide will not be yours at all. Safeguards are all but nonexistent.

Advanced directives for health care will no longer be deemed legally sufficient. The doctor-patient relationship of trust and the collaborative process between doctor, patient and family are destroyed.

Insurance, health care and government bureaucrats will be complicit in who lives and who dies.

Coercion in many forms

Oregon has already rationed health care with the Oregon Health Plan. Under that plan, if you are diagnosed with any of the major cancers and a team of doctors feels you have less than a 5-percent chance of living less than five years, you don’t receive the costly drugs to manage your illness. All you receive is the palliative drugs to manage your pain. According to anecdotal evidence, the plan will pay for the lethal dose of pharmaceuticals that will kill you.

I-1000 is about the choices others will have over you. It is about shifting public perception and changing public policy. Why should the many who accept the fact that life runs a natural course of events risk putting the government into end-of-life issues just so the few can feel good about committing suicide via a lethal dose of barbiturates?

In our broken health care system, doctors are offered incentives for implementing measures that save profit-driven insurance companies money.

Coercion comes in many forms and is interpreted by patients in many ways. Patients view doctors as authority figures. Hearing the option of assisted suicide from their doctor, patients may very well interpret it as an obligation to commit assisted suicide.

This initiative is not about pain. Current and continuing advances in palliative medicine make almost all patient pain manageable.

Make no mistake, I-1000 is really about profit and power. Derek Humphrey, co-founder of the Hemlock Society, has said: “Euthanasia and physician assisted suicide will inevitably prevail in our society because they make economic sense!”

If you don’t want corporations, the government and others intruding into this most private and personal end-of-life affair, vote no on 1000.

Chris Carlson is chairman of the Coalition Against Assisted Suicide.