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[EDITOR'S NOTE -- Jan. 17, 2006: This column is an updated version of Al's Morning Meeting from Monday, Jan. 16, 2006. The changes are meant to reflect the U.S. Supreme Court's decision today to uphold Oregon's "Death with Dignity" law, and to be used as a resource for journalists covering this breaking story.]

The U.S. Supreme Court has upheld (on a 6-3 vote) Oregon's "Death with Dignity Act." This story goes well beyond Oregon, because "right-to-die" issues are such hot-button topics. Lots of people are  interested -- just look at this brand-new poll released Jan. 5 by the Pew Research Center for the People and the Press:

An overwhelming majority of the public supports laws that give patients the right to decide whether they want to be kept alive through medical treatment. And fully 70 percent say there are circumstances when patients should be allowed to die, while just 22 percent believe that doctors and nurses should always do everything possible to save a patient.

But on the matter of physician-assisted suicide, the Pew poll shows no solid majority. The report says:

Americans make a distinction between allowing a terminally ill person to die and taking action to end someone's life. The public is deeply divided over legalizing physician-assisted suicide; 46 percent approve of laws permitting doctors to help patients to end their lives, while about as many are opposed (45 percent).

The Death with Dignity Act allows Oregon physicians to prescribe life-ending drugs to terminally ill patients who have fewer than six months to live. Two doctors must agree on the patient's prognosis. The patient must be able to take the medication on his or her own, with no help from another person. The patient must be mentally competent and not clinically depressed. There is a waiting period between applying for a death-hastening prescription and when he or she actually gets it. State figures (below) show a third of those who have gotten the prescriptions did not take their life. 

The Oregonian has a very useful background collection.

The groups that support the Oregon law were ready for the decision. They set up Web sites with resources, which include talking points and strategies for responding to journalists' questions. Those who oppose physician-assisted suicide say the law places doctors in an improper position, at odds with the doctor's role as healer, comforter and consoler.

The specific legal question before the Court was this [PDF]:

"Whether the Attorney General has permissibly construed the Controlled Substances Act, 21 U.S.C. 801 et seq., and its implementing regulations to prohibit the distribution of federally controlled substances for the purposes of facilitating an individual's suicide, regardless of a state law purporting to authorize such distribution."

By way of background, former Attorney General John Ashcroft made the case that federally controlled drugs should not be prescribed for use in suicide -- that suicide is not a legitimate medical purpose for federally controlled drugs.

Now that the Court has allowed the Oregon law to stand, other states will have a more open path to consider similar legislation of their own.

Interested Parties -- and How Journalists Can Contact Them

Several groups filed "friend of the court" briefs. Click here for the names and contact information for all attorneys and others who have filed briefs in the case.

Details of the Oregon Law

How many people have made the choice to speed their death?

Here is a list, going back to 1998 [Excel document], provided by Oregon's Department of Human Services, and published on the Death With Dignity National Center's Web site. 

Three hundred twenty-five people have gotten prescriptions for the sedatives that could be used to cause death under the Oregon law. But 208 people have actually taken their lives. Some may have changed their minds, some may have died without taking the medication.

Remember: In Oregon, the patient must be close to death before he or she can qualify. The median age of these patients in Oregon is 69 years. Nearly all are white. Most have graduated from at least high school.  Eighty-five percent of those who took their lives said a reason for their decision included "losing autonomy" over their lives.

The state of Oregon provides answers to these questions:

• What is Oregon's Death with Dignity Act?
• Who can request physician-assisted suicide?
• Can someone who doesn't live in Oregon participate in physician-assisted suicide?
• How does a patient demonstrate residency?
• How long does someone have to be a resident of Oregon to participate in physician-assisted suicide?
• Can a non-resident move to Oregon in order to participate in physician-assisted suicide?
• Who can give a patient a prescription for physician-assisted suicide?
• If a patient's doctor does not participate in physician-assisted suicide, how can he or she get a prescription?
• If a patient's primary care doctor is located in another state, can that doctor write a prescription for the patient?
• How does a patient get a prescription from a participating physician?
• What kind of prescription will a patient receive?
• What will happen if a physician doesn't follow the prescribing or reporting requirements of the Act?
• Must a physician be present at the time the medications are taken?
• Can a patient rescind a request for physician-assisted suicide?
• How much does physician-assisted suicide cost?
• Will insurance cover the cost of physician-assisted suicide?
• Can a patient's family members request physician-assisted suicide on behalf of the patient (for example, in cases where the patient is comatose)?
• Are euthanasia and physician-assisted suicide the same thing?
• What information is available on Oregon's Death with Dignity Web site?
• What is the Department of Human Services' opinion of physician-assisted suicide? Does it encourage people to hasten their deaths? Should this law have been passed? What are the pros and cons of physician-assisted suicide?
• What was the issue in the federal lawsuit against Oregon's Death with Dignity law?
• Where can I find a copy of the statutes and administrative rules governing the Death with Dignity Act?
• Where can I find the forms used for Death with Dignity?

Keep in mind, this is NOT euthanasia. Euthanasia involves a physician actually administering or injecting a drug to a person. Again, under Oregon law, the dying person must administer his or her own lethal dose. Oregon is the only state in the Union that has legalized physician-assisted suicide.

Last spring, The Oregonian reported some details about exactly how the deaths occur. It is not like putting a pet to sleep at the vet's office. Sometimes death comes slowly and sometimes there are complications:

All but one patient died at home -- the exception dying in an assisted-living center. All used a quick-acting barbiturate, and none regained consciousness after taking the drug.

Three patients vomited part of the medication, but all three died within 31 hours.

Half the patients became unconscious within five minutes, and all within 30 minutes. Half died within 25 minutes, and all within 31 hours.

Physicians for Compassionate Care [Educational Foundation], a group opposed to assisted suicide, released a statement saying the new report reflects "inadequate and sloppy reporting" by doctors.

"Physician-assisted suicide is not medicine," the group said. "It is contrary to and is not compatible with the doctor's proper role in caring for patients."

Dr. Kenneth R. Stevens, the group's vice president, said he is particularly concerned that only two of the dying patients had been referred to a mental health professional. "People who think their continued living has no meaning deserve a psychological evaluation," he said.

The Law's Record

Oregon got this law because its citizens voted for it.

The state's Web site said:

The Death with Dignity Act was a citizens' initiative passed twice by Oregon voters. The first time was in a general election in November 1994 when it passed by a margin of 51 percent to 49 percent. An injunction delayed implementation of the Act until it was lifted on October 27, 1997. In November 1997, a measure was placed on the general election ballot to repeal the Death with Dignity Act. Voters chose to retain the Act by a margin of 60 percent to 40 percent.

Each year, Oregon issues a report on how the Act is being used. Here are those reports, on the Oregon Department of Human Services Web site:

• 2004 Report [PDF]
• 2003 Report [PDF]
• 2002 Report [PDF]
• 2001 Report [PDF]
• 2000 Report [PDF]
• 1999 Report [PDF]
• 1998 Report [PDF]

Requirements of the Law

The Death with Dignity Act includes requirements that the patient:

• must be an adult, 18 years or older.
• must be a resident of Oregon who possesses an Oregon drivers license, is a registered Oregon voter, owns or leases property in Oregon and has filed an Oregon tax return for the most recent tax year.
• must make two verbal requests -- separated by 15 days -- to the physician.
• must make a written request to the physician, and the request must be witnessed by two individuals who are not primary caregivers or family members.
• must be able to rescind the verbal and written requests at any time.
• must be able to self-administer the prescription.

The law further requires that:

• The attending physician must be Oregon-licensed.
• The physician's diagnosis of the patient must include terminal illness, with six months or less to live.
• The diagnosis must be certified by a consulting physician, who must also certify that the patient is mentally competent to make and communicate health-care decisions.
• If either physician determines that the patient's judgment is impaired, the patient must be referred for a psychological examination.
• The prescribing physician must inform the patient of alternatives, including palliative care, hospice and pain-management options.
• The prescribing physician must request that the patient notify [his or her] next-of-kin of the prescription request.

In-Depth Reporting from The Oregonian

Here is some of The Oregonian's in-depth reporting on this issue:

• Archives
• "Brian's Journey"
• "Dealing with Death"
• "Puzzle of Pain"

Editor's Note: Al's Morning Meeting is a compendium of ideas, edited story excerpts and other materials from a variety of Web sites, as well as original concepts and analysis. When the information comes directly from another source, it will be attributed and a link will be provided whenever possible.
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