Oregon Measure 16 closer to enactment
State hospices resigned to reality of assisted suicide
Oregon’s unprecedented attempt to become the first state to legalize physician-assisted suicide recently took another halting step out of legal limbo and toward reality. After more than two years of legal challenges by opponents of legalization, most observers now say that Measure 16, narrowly approved by voters in 1994, is likely to be implemented some time this year.
When that happens, the state’s hospices will face new ethical, legal, and practical dilemmas as they try to reconcile the hospice philosophy of not hastening death with their commitment to supporting their patients’ autonomy. However, hospices in the state appear resigned to the imminent right of terminally ill Oregonians to request a physician’s assistance in ending their lives. Most have developed policies specifying how they will deal with the new reality, says Ann Jackson, executive director of the Oregon Hospice Association (OHA) in Portland.
The latest development in Measure 16’s unfolding drama is a Feb. 27 decision by a federal appeals court in San Francisco to dismiss a suit attempting to overturn the initiative. Plaintiffs were expected to appeal that ruling and seek a stay of execution until after the U.S. Supreme Court rules in two other assisted-suicide cases sometime this summer, although that may just be postponing the inevitable.
The Appeals Court overturned a ruling by U.S. District Court Judge Michael R. Hogan in Eugene that Measure 16 violated terminally ill patients’ rights to due process protection against being pressured into committing suicide, finding instead that plaintiffs had not demonstrated immediate threat of harm from the measure.
Two other cases involving legal challenges to Washington and New York laws banning physician-assisted suicide were heard before the U.S. Supreme Court earlier this year. Legal experts predict that the court will find no constitutional right to assisted suicide and will turn the controversial issue back to the states to set their own policies. That would return the ethical spotlight to Oregon’s law, as well as to current bills introduced in at least six other states’ legislatures, also proposing to permit assisted suicide.
In response to the San Francisco Appeals Court’s ruling, the House Commerce Committee quickly scheduled a March hearing on a bill sponsored by Rep. Michael Bilirakis (R-FL) to deny federal funds for physician-assisted suicide in Oregon.
Although OHA and the National Hospice Organization opposed Measure 16, the mood of the state’s hospices has mellowed in recent years and appears reconciled to the measure’s enactment sometime in 1997, Jackson says. While OHA is still on record opposing legalizing assisted suicide, its board recently decided not to take a position on another bill, sponsored by the state’s Catholic Conference, to overturn Measure 16.
"Our position is that we will provide information to anyone, regardless of their position on assisted suicide. We’re no longer fighting it, but trying to facilitate care of the terminally ill whatever their views on assisted suicide. We don’t want to discourage anyone from seeking hospice care because of those views," Jackson reported. "And we will respect the opinions of our members, which are all across the board" in how they propose to respond to the reality of Measure 16. It now appears that no hospice in the state would refuse to admit a patient who is also considering physician-assisted suicide, Jackson adds.
Legislature seeks to clarify guidelines
Meanwhile, the Oregon legislature is considering at least seven bills to help clarify guidelines for implementing Measure 16 or to rectify perceived ambiguities in the original measure. Analysis suggests potential problems in areas such as confidentiality protection, state residency requirements, and whether the oral termination medications permitted under the measure would be effective in every case. However, these bills appear unlikely to go forward because public opinion favors allowing the successful vote to stand, Jackson says.
A new proposal has surfaced to allow legislators to make a symbolic statement on the issue by mandating universal access to hospice throughout the state by appropriating funds for those patients who lack other sources of coverage for hospice care.
Hearings were planned for mid-March, and it appears that the bill would not be costly, since most state residents already have access to hospice coverage through Medicare, HMOs, or the state health plan, Jackson says.
In 1995 the state’s hospices served 7,200 patients, a higher number than the total number of cancer deaths in the state, and significantly above national utilization rates for hospices.
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