OREGON is the most progressive health state in America. Only 10.5 percent of its population is uninsured. That's slightly more than Hawaii, but Oregon spends its money more effectively. A point-priority plan directs low-income support dollars to where they will be most effective. Private dollars can be spent for anything but tax dollars are focused on cost-effective cure efforts. Oregon and physician-
assisted deathFirst of two articles (Dec. 8)
Patients for whom there is little hope are encouraged to accept comfort care. Thirty-one percent of Oregon's deaths are under hospice care versus only 18 percent in Hawaii.
A very small number of Oregon's 28,000 annual deaths -- only 10 approved in the first nine months after it became legal -- have been under the Death With Dignity Act that Oregon voters re-ratified by a 60-40 ratio in 1997 after years of bitter legal fighting (still in progress) and a narrow 51-49 original ratification in 1994.
In 1997-98 I served on Governor Cayetano's Blue Ribbon Panel on Living With Dignity. I joined an 11-7 majority recommending that assisted death be permitted in Hawaii when requested by a mentally alert person and approved by two physicians, a psychologist and a social worker over a two-week waiting period.
Oregon can help only terminal patients. We would broaden this to include patients with intractable or unbearable illness that can be neither cured nor successfully palliated and permit euthanasia.
Governor Cayetano said he will submit our proposal to the 1999 Legislature along with our six unanimous recommendations for more spiritual counseling when death approaches, more use of advance directives (living wills), a tripling of hospice usage, near universal pain control, greater public education, and a strict ban on involuntary euthanasia.
These deserve full legislative hearings. Right to Life will intensely fight our assisted death recommendation but join in endorsing our six other broad recommendations.
Since there are about 8,000 deaths a year in Hawaii and perhaps only 200 or 250 (a high guess in view of Oregon's early experience) would want physician-assisted death, we are in broad agreement on how to treat more than 96 percent of all deaths. I find this happily remarkable.
An assisted-death initiative was voted down by nearly 3 to 1 in Michigan this year -- but even that had a silver lining. As in Oregon, it seems to have awakened the medical community to the inadequacy of its comfort care for the dying.
Persisting pain today is a good reason to seek a new physician. Pain no longer has to be, say experienced medical personnel, including the American Cancer Society.
Year's end may bring a second tally on deaths under Oregon's Death With Dignity law. The report issued Aug. 18 on the first 10 approvals said two of the 10 patients approved lived an average 10.5 more days without self-administering the fatal potion provided them. The eight others averaged two days before they took their potion, but one waited 16. All deaths were within seven hours of taking the medication. The average time was 40 minutes.
THE 10 persons approved were five males, five females, average age 71, nine with cancer, one with heart disease. Personal details are not released for privacy reasons but the Oregon Health Division will release regular statistical reports, like the above. The very first death was publicized by the participants, not the Oregon Health Division. It was peaceful, with friends attending.
Holland and Switzerland are the only two nations where governments condone assisted deaths. A nationally syndicated Boston Globe columnist, Ellen Goodman, visited Holland for a week last spring. At the conclusion of three articles, she wrote: "Time and again, crossing this small country, I was told the same thing: 'Euthanasia should remain a possibility, but a last resort.'"
Goodman will lecture at the East-West Center at 10 a.m. Monday, Dec. 21, but will focus on broader journalistic issues.
A.A. Smyser is the contributing editor
and former editor of the the Star-Bulletin
His column runs Tuesday and Thursday.