Oregon assisted-suicide law doesn’t affect ICUs
Pulling the plug isn’t addressed by the law
Oregon’s controversial assisted-suicide law has had no effect on one segment of the state’s critical care workers or their patients. The law was intended to deal primarily with individuals who have been diagnosed as suffering from terminal conditions, hospital officials say. And most of those patients are currently under palliative care or in a hospice program.
"The law is really aimed at patients who have exhausted every effort at palliative care and there is no alternative remaining for them," explains Barbara Glidewell, RN, MBS, a health care ombudsman and director of patient relations with Oregon Health Sciences University in Portland.
Most critically ill patients have not yet reached a stage in which they wish to die, Glidewell says. That’s the main distinction raised by Oregon’s Death with Dignity Act, which lawmakers passed November 1997. The law allows terminally ill patients to seek to end their lives with a physician’s assistance.
Death doesn’t come easy
The statute became controversial because most states make physician-assisted suicide illegal. Oregon is the first state in the nation to legalize the procedure. Since its passage, some 10 patients have died from a lethal prescription drug that is administered after the individual has passed a series of state-required approvals, including a psychiatric evaluation.
Glidewell makes clear that the statute does not authorize withdrawing or withholding life-support equipment by medical personnel in a hospital setting. "That is an entirely different issue not addressed by this statute or related to physician-assisted suicide," she points out.
Critically ill patients are permitted to end their lives, but in those cases, the patient’s family makes a collective decision and only when medical care is no longer a viable option in the patient’s survival or recovery.
However, the assisted-suicide law has opened a dialogue among the families of the critically ill regarding end-of-life alternatives. It also has raised important issues for health care workers. Some state officials are concerned that physicians who regularly administer pain medication to severely ill patients now may have wider latitude to make life-and-death decisions.
It would be quite easy to end a patient’s life by regulating the dosage if the individual were to ask the physician. Under the new law, some physicians may be afraid to use drugs such as barbiturates on extremely frail patients out of concern for the way it may be portrayed legally if the patient dies from a low tolerance to the drug, Glidewell concludes. The question of intent may become a legal issue, she adds.
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