Federal Court Upholds Oregon's Assisted Suicide Law

[zimv20]

link (http://www.nytimes.com/2004/05/26/national/26CND-SUIC.html?hp)


A federal appeals court today rejected an effort by the Justice Department to block the only law in the nation authorizing doctors to help their patients commit suicide.

The decision, by a divided three-judge panel of the United States Court of Appeals for the Ninth Circuit, in San Francisco, upheld Oregon's Death with Dignity Act.

The majority used unusually pointed and personal language to rebuke Attorney General John Ashcroft for overstepping his authority.

"The Attorney General's unilateral attempt to regulate general medical practices historically entrusted to state lawmakers," Judge Richard Tallman wrote for the majority, "interferes with the democratic debate about physician-assisted suicide and far exceeds the scope of his authority under federal law."

The Oregon law, the product of a 1994 voter initiative, allows adults with incurable diseases who are likely to die in six months to obtain lethal drugs from their doctors. The doctors may prescribe but not administer the drugs, and they are granted immunity from liability. About 30 people a year have used the law to end their lives since the law became effective in 1997. That represents about one in every thousand deaths in Oregon.

In 1997, Mr. Ashcroft, then a United States Senator, asked Attorney General Janet Reno to declare that assisted suicide involving doctors violated federal law. She declined, saying that individual states should be allowed to regulate their own doctors. When Mr. Ashcroft became attorney general in 2001, he reversed Ms. Reno's position and issued a directive saying that doctors who prescribe lethal drugs to patients could face prosecution.

[...]

Judge J. Clifford Wallace, in a dissenting opinion, said the attorney general had the necessary authority to issue his directive.

[mactastic]

Ah those communists on the 9th Circuit are at it again... Legislating from the bench and all that.

We'll see if the feds can keep their hands off this one, or if the right's 'state's rights' battlecry is just a joke.

[Ugg]

I am convinced that assisted suicide will trump abortion in the next few decades. The baby boomers who have reshaped society like few other generations is going to demand that their final years be as healthy as possible but when their health no longer allows them to live in dignity, I'm sure they will demand assisted suicide.

I've long stated that anyone with a terminal illness has the right to a dignified exit. That prolonging suffering is one of the most inhumane acts that we as a society can commit, much less the phenomenal financial burden this will place on society as technology increases our ability to keep vegetating humans alive.

I applaud these judges who've refused to allow religious extremists to trump state law. Maybe now other states will come forth and express their innate compassion by passing similar laws for their own citizens.

[blackfox]

Yay for Oregon (where I live)...before the recession/budget crunch up here, Oregon was a model for progressive initiatives in social services, education, as well as the assisted-suicide and medicinal marijuana laws...and Oregon is a pretty conservative state, but a reasonable one. Hopefully in time, the state will recover enough cash to re-fund most of these remarkable initiatives, but I will settle for this good news...

[Neserk]

As someone who has been close to a person who has suffered from depression for years I'm strongly against suicide. It's one of those personal experience things.

[pooky]

<rant>
I am just amazed that a political party can, in the same breath, claim to be for individual rights and then attempt to remove one of the most fundamental rights we have, the right to do with your life what you please as long as it harms no one. I guess something's only a "right" when it conforms to their highly restrictive millennia-old system of values. How can any party that is so fundamentally contradictory of itself have any members, or even be taken seriously?
</rant>

[Krizoitz]

As someone who has been close to a person who has suffered from depression for years I'm strongly against suicide. It's one of those personal experience things.

I find myself in the odd situation of agreeing with Neserk. In addition to his point about suicide, I'd like to add that I'm against the idea of physicians being involved even if it is legal. A doctor should not be involved in killing.

[blackfox]

I find myself in the odd situation of agreeing with Neserk. In addition to his point about suicide, I'd like to add that I'm against the idea of physicians being involved even if it is legal. A doctor should not be involved in killing.
Although admittedly not a comprehensive rebuttal to you and Neserk (who is a "she" BTW), I think in many cases, if a person is terminally ill (and in many cases, in great pain), it is ethical for a physician to end their suffering. If I was to come across a mortally-wounded animal, I may be inclined to put it out of its' misery, although normally I do not advocate killing animals (another poor analogy).

[numediaman]

I see this as another "government powers" issue. While you may be morally against assisted suicide, and suicide in general, do you want to give the government the power to interfere with a person's ability (and their doctor) to make this choice?

This is why I am "pro-choice" but personally against abortion.

It's the same reason I am against the death penalty. You can argue all you want about justice, revenge, victims rights, etc. I simply don't want the government to have that power. (I always thought I was very conservative about these things until the big government Republicans began to appear. Now I guess I'm liberal because I'm for limited government. I'll take me a while to adjust to this idea.)

Legalizing assisted suicide neither condones nor encourages suicide -- it simply means its not a crime. Before we prohibit something (that is, create a new "Prohibition") we should be sure we all agree that we are doing this for good legal and Constitutional reasons.

Finally, I actually think that a legal form of assisted suicide might prevent many suicides. A doctor would be able to evaluate the patient to see if this is a case of depression, a rash decision, etc. Anything that gets someone contemplating suicide into a doctors office would be good. My father committed suicide, so I personally know the pain that can accompany suicide. Had he seen a doctor about his desire to die, I'm sure his impulsive act could have been prevented.

[Krizoitz]

(who is a "she" BTW)

Man, I must be out of it today, i knew that. Sorry Neserk.

[Neserk]

I see this as another "government powers" issue. While you may be morally against assisted suicide, and suicide in general, do you want to give the government the power to interfere with a person's ability (and their doctor) to make this choice?


The problem is that when a person is suicidal they are making a choice based on false assumptions -- when one is depressed their outlook on the world is skewed and when the depression lifts they often realize that things are not as bad as they previously thought. It is not doctors (MDs) who are in the positon to undestand this. It is psychiatrists and psychologists who are trained for dealing with it.

[zimv20]

The problem is that when a person is suicidal they are making a choice based on false assumptions -- when one is depressed their outlook on the world is skewed and when the depression lifts they often realize that things are not as bad as they previously thought. It is not doctors (MDs) who are in the positon to undestand this. It is psychiatrists and psychologists who are trained for dealing with it.
and if that person, after therapy and meds, still wants to end their life, what then?

[Neserk]

and if that person, after therapy and meds, still wants to end their life, what then?

Their view on reality is still skewed. There is no "after therapy." Therapy for someone who is chornically depressed is an on going process.

[zimv20]

Their view on reality is still skewed. There is no "after therapy." Therapy for someone who is chornically depressed is an on going process.
granted. after how many years of meds and therapy can the patient get his/her wish? or is it never?

[numediaman]

Remember we are not talking about suicide for suicide's sake. We are talking about doctor assisted suicide when the patient already has a terminal illness and wants end their life on their own terms.

Depression would not be an acceptable reason for an assisted suicide. The "patient" would have to have a terminal illness in order to request help from a doctor to end their life.

A patient suffering from depression would not be eligible for suicide assistance from a doctor. Because of this, I feel that a number of patients who requested doctor assisted suicide and were suffering from depression, and were treated first for their depression, might in the end reject doctor assisted suicide. Getting these people to talk to a psychiatrist could be very beneficial.

In any case, doctor assisted suicide must have plenty of checks and balances to make sure that the patient is truly suffering, is truly ill, and is sure they are making the right decision.

[Neserk]

granted. after how many years of meds and therapy can the patient get his/her wish? or is it never?

Never.

[Neserk]

Remember we are not talking about suicide for suicide's sake. We are talking about doctor assisted suicide when the patient already has a terminal illness and wants end their life on their own terms.


I disagree with the interpretation of it being "on their own terms." Make the person as comfortable as possible (presuming they are in pain). Then their body will decide when it is time to go. Do a DNR. Refuse medications. But to actually allow assist the person in ending their own life through action (versus inaction) is not right.


Depression would not be an acceptable reason for an assisted suicide. The "patient" would have to have a terminal illness in order to request help from a doctor to end their life.


For some depression is terminal. And a person who is choosing to end their own life is depressed. Granted there may be an accompanying organic illness with it by the desire to end their life before their body has "given up" is a sign of clinical depression.

[zimv20]

For some depression is terminal.
exactly. and health insurance companies agree.

[Neserk]

exactly. and health insurance companies agree.

It is still treatable. Think of it as being similar to diabetes. You will always need insulin but that doesn't mean you just give in and end it all.

[zimv20]

It is still treatable.
oh yeah, i completely understand that. and i'm really just playing devil's advocate here.

i also understand that, where the OR law is concerned, it's not meant for depression. but i still think it's an interesting topic. and i'll submit that, after a period of time of unsuccessful treatment, doctors should be able to assist w/ suicide.

[Neserk]

oh yeah, i completely understand that. and i'm really just playing devil's advocate here.

i also understand that, where the OR law is concerned, it's not meant for depression. but i still think it's an interesting topic. and i'll submit that, after a period of time of unsuccessful treatment, doctors should be able to assist w/ suicide.

It is important that the law against suicide remain in tact. People who suffer from various mental illnesses which include depression and suicidal ideation need to be able to be treated against their will with temporary hospitalizations (usually up to 72 hours). Without the law there is no reason to do it. Health Insurance companies are even required to pay for the hospitalizations because of the law. The state of being suicidal is temporary. It is important that people who are in that state be protected from their own will during that time when their view on reality is skewed.

[zimv20]

It is important that the law against suicide remain in tact. People who suffer from various mental illnesses which include depression and suicidal ideation need to be able to be treated against their will with temporary hospitalizations (usually up to 72 hours). Without the law there is no reason to do it. Health Insurance companies are even required to pay for the hospitalizations because of the law. The state of being suicidal is temporary. It is important that people who are in that state be protected from their own will during that time when their view on reality is skewed.
i get where you're coming from, i just think that if some poor soul has been miserable for 20 years, or more, and have tried every treatment under the sun, let's let 'em sign the insurance waivers and decide to end their life humanely, painlessly and finally.

[Neserk]

i get where you're coming from, i just think that if some poor soul has been miserable for 20 years, or more, and have tried every treatment under the sun, let's let 'em sign the insurance waivers and decide to end their life humanely, painlessly and finally.

That person has family and friends and an actual life to lead. Being miserable is no reason to end it. It is simply something the person learns to live with, literally.

[Stelliform]

I don't understand why suicide is illegal in the first place. What will be next, being illegal for refusing medical treatment. It is your life.

BTW, I am against abortion because it is taking a life that isn't yours.

I know people who have committed suicide, and I can attest to the despair and confusion that it causes the family, but it really should be the person's choice. Maybe there should be babysteps to make everyone happy, like one year of counseling required before you do the deed.

Now what we are talking about is very different. Suicide with a terminal illness makes sense. You are relieving your family of thousands and thousands of dollars in medical expenses, you are stopping your suffering, and you are leaving when you have some measure of quality of life. It should be your choice.

BTW, are people in other countries so adverse to suicide?

[mactastic]

We're not talking about people who are depressed with their lives here. We're talking about people with terminal illnesses that will either spend some amount of time in extreme pain and then die, or will be allowed to leave on their terms. The family is going to face that persons death anyway, the question is whether they will go through the agony of certain terminal illnesses or not. This is only to be used in cases where the outcome is not in doubt. Put any safeguards you want on it (I certainly don't want to see anyone pressured into offing themselves by family or an insurance company) but don't take the right to choose away.

[skunk]

We're not talking about people who are depressed with their lives here. We're talking about people with terminal illnesses that will either spend some amount of time in extreme pain and then die, or will be allowed to leave on their terms. The family is going to face that persons death anyway, the question is whether they will go through the agony of certain terminal illnesses or not. This is only to be used in cases where the outcome is not in doubt. Put any safeguards you want on it (I certainly don't want to see anyone pressured into offing themselves by family or an insurance company) but don't take the right to choose away.
Agreed on all points.

[Neserk]

but don't take the right to choose away.


The right to choose is always there. But I will not see it advocated or assisted by a doctor! If someone truly wants to die they will not tell anyone (to prevent intervention) and will do it on their own.

Anything other than that is truly dangerous.

[skunk]

The right to choose is always there. But I will not see it advocated or assisted by a doctor! If someone truly wants to die they will not tell anyone (to prevent intervention) and will do it on their own.

Anything other than that is truly dangerous.
Some people CAN'T do it on their own...

[Neserk]

Some people CAN'T do it on their own...

IF someone is terminally ill their body will end their life when it is good and ready.

For someone who is suffering from depression w/o an accompanying illness they can always do it on their own.

[skunk]

IF someone is terminally ill their body will end their life when it is good and ready.
I'm not including depression as a pretext for assisted suicide. Nor, as far as I am aware, is anybody else. that WOULD be dangerous, and without any benefit.

Many terminally ill people are maintained in their near-death condition by medical intervention, or by a body that simply refuses to die even though they are in daily agony and their quality of life is zero. These people need help sometimes to end it.

[Neserk]

I'm not including depression as a pretext for assisted suicide. Nor, as far as I am aware, is anybody else. that WOULD be dangerous, and without any benefit.


Unless I misunderstood the Devil's advocate was, in his roll anyhow.


Many terminally ill people are maintained in their near-death condition by medical intervention, or by a body that simply refuses to die even though they are in daily agony and their quality of life is zero. These people need help sometimes to end it.

Then you stop the medical intervention.

I am against assisted suicide and suicide in general and if you can justify it for someone who is terminally ill you can certainly justify it for someone who is chronically depressed. Anyone who has been there on a repeated basis can tell you that their lives from a very young age is in daily agony with reprieves and that the quality of their life is zero.

[zimv20]

I'm not including depression as a pretext for assisted suicide. Nor, as far as I am aware, is anybody else.
i'm advocating it, though i'm trying to be careful to specify that i know it's outside the context of the larger discussion

[skunk]

Then you stop the medical intervention.

I am against assisted suicide and suicide in general and if you can justify it for someone who is terminally ill you can certainly justify it for someone who is chronically depressed. Anyone who has been there on a repeated basis can tell you that their lives from a very young age is in daily agony with reprieves and that the quality of their life is zero.
The two states are completely different. The depressive is to all intents and purposes physically healthy. The terminally ill can sometimes dwindle on unwillingly for years without any medical intervention.

[Neserk]

The two states are completely different. The depressive is to all intents and purposes physically healthy. The terminally ill can sometimes dwindle on unwillingly for years without any medical intervention.

The terminally ill person who wants to commit suicide *is* depressed. I've known a few people who either were terminally ill or had a very small liklihood of survival and those who were terminally ill fought to the end to live. The difference is in perception. That difference is caused by the depression.

[zimv20]

The two states are completely different. The depressive is to all intents and purposes physically healthy.
no no no and no. depression is a disease as real as diabetes and cancer. telling someone to get over their depression is as useless as telling someone to get over their cancer.

only the person living their life can make the determination if that life is worth living. where it gets tricky is that depression, by its nature, tends to make one say that life is _not_ worth living.

[skunk]

no no no and no. depression is a disease as real as diabetes and cancer. telling someone to get over their depression is as useless as telling someone to get over their cancer.
It is real, but not physical. Only in extreme cases does a person literally "die of depression".

only the person living their life can make the determination if that life is worth living. where it gets tricky is that depression, by its nature, tends to make one say that life is _not_ worth living.
Absolutely. The difference is that only in the case of some terminally ill people is any assistance required to commit suicide. In all other cases, it's up to the person "living their life", as you say.

[zimv20]

It is real, but not physical. Only in extreme cases does a person literally "die of depression".
it is physical in the sense of a chemical imbalance. and as i'd alluded before, insurance companies reckon mortality rates are (much) higher for the depressed, so though one may not die directly from the chemical imbalance, it somehow results in a higher death rate.


Absolutely. The difference is that only in the case of some terminally ill people is any assistance required to commit suicide. In all other cases, it's up to the person "living their life", as you say.
the difference, imo, is the directness of the cause of death. i don't believe for a second that someone who is diagnosed w/ major depression to have a higher quality of life than someone w/ cancer, AIDS, etc.

[Neserk]

where it gets tricky is that depression, by its nature, tends to make one say that life is _not_ worth living.

Yup. But that feeling is fleeting, eventually the person will snap out of the depression, realize that things aren't as bad as they thought they were and that they can get through what ever it is they have to face. For those who are chronic the depression will return. But it will also go away again. The trick in therapy is for the person to learn that while emotions are very real and valid they are also temporary. No matter how a person feels, that feeling will change.

[Ugg]

IF someone is terminally ill their body will end their life when it is good and ready.

For someone who is suffering from depression w/o an accompanying illness they can always do it on their own.

I understand your argument but it isn't valid in this day and age of feeding tubes, life support systems and so on. IF people were allowed to die when their bodies were good and ready, then there would be a greatly lessened need for assisted suicide. The problem is that doctors are duty bound to keep a body alive with little or no consideration given to quality of life or the patient's wishes. I've heard of too many elderly couples who choose to die together and then their attempt goes awry and one or both is alive and disfigured or incapacitated.

Have you been to a nursing home lately? I've no idea how many of those who have lost their ability to care for themselves would choose death over life but I'll bet it is a lot higher than one would think. Compassion and humane treatment of our fellow man have taken second place to keeping people alive at all costs. Not because it is the best thing to do but simply because we can.

[Neserk]

I understand your argument but it isn't valid in this day and age of feeding tubes, life support systems and so on. IF people were allowed to die when their bodies were good and ready, then there would be a greatly lessened need for assisted suicide. The problem is that doctors are duty bound to keep a body alive with little or no consideration given to quality of life or the patient's wishes.

Actually, all people have the right to refuse medical treatment. Even someone who is suicidal from depression can only be held for 72 hours.

And I'm strongly against life support systems and feeding tubes in most cases. I personally would not have one. When a person gets to the point of needing life support they aren't usually the one calling the shots. And they aren't ususally aware enough of their own suffering to desire their life to end. Same goes for feeding tubes, often.

The case of the elderly who wish to die together is more likely a problem (again) with depression. I'm sure each case is different but they probably feel that they can't live without each other. What they would find out is that they can indeed survive the death of their spouse. People have done so since the beginning of time. It isn't that I'm not sympathetic to their plight, I've seen 3 grandparents waste away, one physically and two mentally before they eventually died. But I don't see the solution being assisted suicide.

[zimv20]

But I don't see the solution being assisted suicide.
but if asked, what would they have said?

[Ugg]

Actually, all people have the right to refuse medical treatment. Even someone who is suicidal from depression can only be held for 72 hours.

And I'm strongly against life support systems and feeding tubes in most cases. I personally would not have one. When a person gets to the point of needing life support they aren't usually the one calling the shots. And they aren't ususally aware enough of their own suffering to desire their life to end. Same goes for feeding tubes, often.

The case of the elderly who wish to die together is more likely a problem (again) with depression. I'm sure each case is different but they probably feel that they can't live without each other. What they would find out is that they can indeed survive the death of their spouse. People have done so since the beginning of time. It isn't that I'm not sympathetic to their plight, I've seen 3 grandparents waste away, one physically and two mentally before they eventually died. But I don't see the solution being assisted suicide.

I disagree with you assertion that people on life support don't feel what is happening to them pain is one of the most elemental of feelings and why would you want to let them suffer if it is not necessary? The aspect that I can't understand is why people allow their loved ones to suffer yet put their pets aslepp?

Depression isn't the only reason for wanting to end one's life. Why do continue to state it so emphatically?


The majority of a person's medical expenses are incurred at the end of their life. Much of it in nursing home care and extreme medical procedures. As we get better at keeping bodies alive, doesn't it make sense to allow people to choose beforehand to what extent they want to be kept alive? Who is going to pay for this? There are too many infants and children in this country who go without basic medical care. Shouldn't they be given a fair chance instead of throwing money at a body that is no longer a person? All discussions on assisted suicide should include the cost of caring for the terminally ill. It is a very real and very valid reason.

[Neserk]

but if asked, what would they have said?

Don't put them on life support in the first place.

The people seeking help in Doctor assisted suicide are not on life support. If they were they could simply turn it off or have it turned off.

[Neserk]

I disagree with you assertion that people on life support don't feel what is happening to them pain is one of the most elemental of feelings and why would you want to let them suffer if it is not necessary? The aspect that I can't understand is why people allow their loved ones to suffer yet put their pets aslepp?


Most people recognize the difference between an animals life and a humans life for one. People on life support are not the same as those who are seeking helping in committing suicide. We are talking about to completely differen issues.


Depression isn't the only reason for wanting to end one's life. Why do continue to state it so emphatically?


Because it is the only reason for wanting to end one's life. Not everyone who is terminally ill or in chronic physical pain wants to end their life before their time. The difference between those who do and those who don't is depression.


The majority of a person's medical expenses are incurred at the end of their life. Much of it in nursing home care and extreme medical procedures. As we get better at keeping bodies alive, doesn't it make sense to allow people to choose beforehand to what extent they want to be kept alive? Who is going to pay for this? There are too many infants and children in this country who go without basic medical care. Shouldn't they be given a fair chance instead of throwing money at a body that is no longer a person? All discussions on assisted suicide should include the cost of caring for the terminally ill. It is a very real and very valid reason.

Sorry, but money is not a valid reason. In fact it is the worst reason imaginable. A person who wishes to die naturally who is terminally ill can refuse medical treatment. That is not the same as being given drugs which will kill them.

[skunk]

Because it is the only reason for wanting to end one's life. Not everyone who is terminally ill or in chronic physical pain wants to end their life before their time. The difference between those who do and those who don't is depression.
This is arguable. What about a ninety-year-old who in moments of lucidity recognizes the indignity of his or her incontinence and senility? Is this "depression"?

[Neserk]

This is arguable. What about a ninety-year-old who in moments of lucidity recognizes the indignity of his or her incontinence and senility? Is this "depression"?

in those moments is she going to be able to seek the advice and support of a doctor to help her commit suicide? The situation really wouldn't apply to the cases we have been talking about.

And yes, if she did feel in that moment that she wanted to end her life she would be depressed.

[pseudobrit]

I think anyone who's opposed to assisted suicide has not experienced a truly hopeless amount of physical suffering.

I have and didn't really care if I continued to live so long as the suffering stopped. It wasn't something inherently terminal, so suicide never became an issue, but had it been, I'd wish to have an option to be put out of my misery without further suffering, such as a morphine overdose.

[Neserk]

I think anyone who's opposed to assisted suicide has not experienced a truly hopeless amount of physical suffering.
.

I wouldn't be so sure about that.

[mactastic]

Is there much of a difference between respecting someone's wishes to pull the plug on them and respecting their wishes to bring them a large quantity of sleeping pills and a plastic bag? And remember, we're not necessarily talking about people who will live on and on in a vegetative state, or those who suffer from depression. I'm specifically talking about people for whom the choice is between a peaceful death now, or 3 to 6 months of hell before death.

Now, as far as chemical wackiness in the brain goes there unfortunately is a limit to how far you can go to prevent someone who want's to die from doing something about it. Ultimately you can't force someone to want to help themselves. You can do everything in your power to try to convince them to help themselves, but that's it mostly.