I recently received an article from a nursing colleague that briefly compared some parts of Oregon's physician assisted suicide law with California's proposal to enact assisted suicide defined as compassionate choices. The comparison was in a Bay area newspaper compiled by Steve Geissinger.

Steve listed areas of physician requirements, mental exam requirements, medication regulations, administration of the drugs, and coercion. But if we take a closer look at the actual problems in Oregon's law, California's law will face the same problems. Any manner of interpretations could be interjected into why the law is good or bad in Oregon, and why the law would be good or bad in California.

If Oregon has such a good law, why was data erased; why are certain statistics not available to the public as in Freedom of Information Act; what changes did the medical field incur due to this law; what changes did society incur; what problems were identified and were they ever corrected?

Oregon has no regulated reporting method, no regulation, no oversight, data is questionable and in some cases unknown, and so the statistics are far from accurate which leaves many unanswered questions and a faulty process when dealing with life and death. Compassion, dignity and other terms used by proponents simply cannot justify and alleviate the flaws in the Oregon law.

Under physician requirements:
Oregon: The patient's doctor must orally inform the patient of the feasible alternatives, including comfort and hospice care, as well as pain control.
California: The patient's attending physician would have to provide the patient, in writing, with alternatives. Admission into a hospice setting can be initiated or achieved by a patient, their family, or recommendation from a physician. Patients include the terminally ill who are dying, mentally incompetent such as Terri Schiavo, those with Alzheimer's, drug addicts who are not a candidate for liver transplants, and even the elderly who are transferred from nursing home status to hospice status.

How can a California law be monitored with such a range of patient problems? Oregon's current law is unmonitored, so why would California be any different or any better? There is simply no way to ascertain whether alternatives are offered to patients or not. A physician can say they did offer, but there is no way to prove it; no documentation and no oversight.

Oregon physicians are at liberty to report what they want, when they want, how they want, and without any regulations. The patient will always be victimized with a set up of this type. Just because a physician hands you a piece of paper or pamphlet does not indicate you willingly accept, can understand, or even agree with the state treatment options and alternatives. Why are some options, such as pain control, forced on patients, even if they do not ask for a pain reliever?

Currently in Oregon, the physician requirements are not followed, and cannot be tracked, and there is no way to verify the slim amount of data reported. California will be no different. HIPPA regulations made sure of that.
http://www.pccef.org/articles/art44.htm
View Table 1 for missing data.

Under mental exam requirements:
Oregon: If the patient's physician believes the patient's judgment is impaired by a psychiatric or psychological disorder, the patient must be referred for a psychological exam.
California: If a patient is not enrolled in a hospice, the patient would have to be referred to a psychiatrist or psychologist for an exam. The process would proceed only if the patient has been determined mentally capable.

Oregon does not refer all patients with impaired judgment to a psychological consult, including the mentally incompetent. http://www.pccef.org/pressreleases/press18.htm

Where are the guarantees that hospice patients in California with mental health issues would receive a psychological evaluation? The law is not followed in Oregon. Why would California be any different?

According to the study, "Many Diagnoses of Depression May Be Misguided" in the NY Times, one in four people who appear depressed are really struggling with an emotional crisis like a broken marriage, job loss, or financial problems. Will patients in these crises have proper mental health treatment or will they receive help to kill themselves during a state of despair?
NY Times - Health - Depression Articles
http://archpsyc.ama-assn.org/cgi/content/abstract/64/4/433

A family recently experienced a need for a psychological evaluation for competency of an elder relative. The particular physician could not decide whether the patient was competent or not. Even after consulting a psychiatrist, some family members had doubts as to the accuracy of the diagnosis, as the psychiatrist spent a grand total of 2 minutes with the patient.

If you have spent time with an Alzheimer's patient or another form of dementia, you know the capabilities of the patient at their specific stage in the disease process, whereas someone exposed to the patient for a limited amount of time cannot adequately assess and realize the exact limitations of such patients.

When physicians are unable to accurately diagnose competency, how can a law say they can? How can a law guarantee mental health consults will be performed when data is kept from the public and data is missing, unknown, and untraceable?

If a patient is depressed or suicidal, what guarantees are in place to help patients, instead of assisting their suicide, without oversight, without accountability, and without statistical data available to analyze?

According to the Center for Disease Control (CDC) statistics between 1999 and 2004, suicide ranked as a higher cause of death in Oregon than in California. The number could even be higher considering that assisted suicides in Oregon are not recorded as suicides. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5415a1.htm

Under medical regulations:
Oregon: The written request for medication must be witnessed by at least two people, one of whom cannot be a relative.
California: The written request would have to be witnessed by two people, neither of whom are relatives.

In Oregon, a relative can witness a narcotic or sedative order which often sets up an immediate conflict of interest. Again, there is no oversight and no data to track problem issues. How can problems be rectified, if they cannot be identified and go unaddressed? Just because the health department in Oregon says it is so does not mean I believe it and neither should you.

Patty Berg (D), the sponsor of the California bill, said, "We should be allowed to live or die according to our own moral code. The opposition comes from a very small segment of society that believes it has a ... better morality than the rest of us."

Berg, like some in America today, believes their moral code supercedes everyone else's and is the only one that matters. They believe medicine ought to be used as the long arm of the law in assisting suicide in patients. No matter if medicine agrees with assisted suicide or not. We can kill easily and they can pass a law that legalizes the practice as a medical procedure. Their moral principles are not compromised; ours are. The integrity of the medical field is forever changed from healer to killer. There are no assurances here.

Under administering the drugs:
Oregon: The law's intent is that the patient self-administers the prescription but does not specifically use those words.
California: AB374 would specifically require the patient to self-administer the drugs.

We know patients have been unable to administer their own medications in Oregon to cause their death. Therefore, the law cannot always be followed when assisting suicide.

The medication dosage is pertinent, as doses are generally higher than regular strength doses with the order to increase the dose as needed in many hospice facilities. As a result, these patients are literally sedated to death and are not just asking for pain relief. These narcotics that depress the central nervous system are ordered on a regular schedule and in high doses, often putting the patient in a semi-comatose and comatose state.

In Oregon the physician is responsible to help the patient kill themselves. Physicians practice healing then must change their attitude and demeanor to practice assisted suicide. At the very least, they intentionally help kill the patient with consent, and sometimes without consent.

Under coercion:
Oregon: The state considers coercion a serious "Class A" felony.
California: The state also would list it as a serious "Class A" felony. Further, coercion by the patient's next of kin or any third party would bar the availability of the procedure for that patient.

We do not know what occurs without oversight. With inaccurate data, amended data, unknown data, felonies are sure to occur. The problem is that you cannot prove it and are unable to access information for assurances. As Rita Marker states, physicians in Oregon police themselves. They surely would not report themselves if they violated the law.
http://www.pccef.org/pressreleases/press16.htm
http://www.pccef.org/pressreleases/press22.htm
http://www.pccef.org/pressreleases/press23.htm

Under terminology: (My addendum)
Oregon: Physician Assisted Suicide law was recently changed to Physician Aid in Dying.
California: Compassionate Choices is used.

An article by Rita Marker discusses verbal engineering which also applies to the name change Oregon has recently put in place using aid in dying, instead of assisted suicide. The article states Compassionate Choices is an example of the "verbal engineering", while the Oregon "Death with Dignity" law, which the California bill mirrors, is an example of the "social engineering." Regardless, we are taught by word games that assisted suicide is acceptable. We can expect the verbal engineering phase to surface in the middle school curriculum in our children's schools. http://www.calcatholic.com/news/newsArticle.aspx?id=a729181d-aa75-4327-a70d-d5e6bc9255ef

The greatest injustice to society would be to allow the laws to progress. Lawmakers may not believe they are affected by their own laws, but we are all victims of their laws. Assisted suicide as a medical treatment option will become medical policy used on all patients, and not just those dying, terminally ill, or in a hospice. 4-25-07