"They are young," she says of her doctors. "They don't understand the pains of the elderly." —LILLIAN SULLIVAN Retired Oregon bookkeeper with ALS
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The law has surprised Oregonians in other ways too. Contrary to what was expected, most patients who seek the drugs say they are not doing it primarily to avoid eventual pain--something they appear to be willing to face down on their own. The very existence of the law, however, has focused Oregon doctors' attention on end-of-life care, spurring them to take extra training in complex pain management and encouraging them to refer patients to hospice care earlier than before. And, while critics feared that HMOs, insurance companies or relatives might subtly encourage suicide because it is cheaper than treatment, only 3% of those who took the lethal prescriptions cited financial considerations as a reason, according to state surveys of their doctors. The reasons most gave: "losing autonomy" and "less able to engage in activities making life enjoyable."
Despite the comparative ease with which the suicide statute has become a part of mainstream medical care in Oregon, many patients seeking lethal drugs still have to shop for a doctor. Catholic hospitals and even some nondenominational ones forbid their physician employees from writing such prescriptions. While a general survey found that 51% of the state's physicians support the act, only 34% say they would be willing to be the one writing the prescription. Instead, many refer patients to Compassion in Dying, a local nonprofit that can recommend willing doctors. That is the group Lillian Sullivan, 77, turned to for help.
Two years ago, Sullivan, a retired bookkeeper, received a diagnosis of ALS--amyotrophic lateral sclerosis, better known as Lou Gehrig's disease--which paralyzes and eventually suffocates the patient. She asked her Portland doctors to prescribe lethal medicine, but even as her condition has deteriorated and her pain has increased, they have refused to discuss it. "They are young," she says. "They don't understand the pains of the elderly." She has a date with a new doctor this month but fears that by then her muscle constriction won't allow her to swallow--and self-administering the drugs is a strict requirement of the law. "I have no life," she says. "I watch commercials on TV."
Some opponents of assisted suicide answer such despair with an argument that is insightful or cunningly circular, depending on your view, insisting that patients like Sullivan are depressed, and as such, don't qualify for suicide medication under the law. "If they are demoralized, we should take care of them, not overdose them," says Portland psychiatrist Gregory Hamilton. But the line between clinical and situational depression often gets blurred. "One doctor told me to take two antidepressants so I could have a Pollyanna attitude," Sullivan scoffs.
The risk in such situations is that people who want to die will simply contrive their own ways--ways that aren't always easy. Last year, Joe Ramos, a retired Northern California computer executive, reluctantly supported his wife's wish to end her life when she became debilitated with ALS. As she deliberately began starving herself to death--a process that took a month--he could only stand by and watch. "People shouldn't have to go through that kind of suffering," he says.