Published Case Studies

 

Oregon Case Studies

These case studies, from Oregon, show the many circumstances in which a two-doctor approach and other safeguards in the law fail patients, because they are inadequate, can be easily circumvented, are just simply ignored, or are superceded by other state laws.  The tragic result is lives that are shortened, lives that are taken unnecessarily, and cures that did not have a chance to happen.

The cases are followed by links to the Oregon Department of Health Annual Reports for more patient statistics and information.

Dr. Charles Bentz,

an internist in Portland, Oregon, diagnosed a malignant melanoma in a 76-year-old man who had been under his care for over ten years. Unfortunately, the cancer had already spread to his shoulder at the time of diagnosis, so it was not curable. Dr. Bentz referred this active man to both radiation oncology and medical oncology, using two methods to slow the cancer and prolong the man’s life.

When the patient finished the radiation therapy, the radiation oncologist informed Dr. Bentz that the patient was depressed due to his diminished physical stamina. At almost the same time, he finished his chemotherapy and asked his medical oncologist for a prescription so he could take his own life by suicide. The medical oncologist called Dr. Bentz, asking him to act as the required second physician to confirm the diagnosis and prognosis before he wrote the prescription, saying secobarbital “works very well” and indicating he had used it many times. Dr. Bentz responded that he could not do this; the man had a documented depression and needed therapy for this. The oncologist then found another physician to render the required “second opinion” and did not refer the man back to his primary physician. Two weeks later the patient was dead from a lethal prescription.

Dr. Bentz obtained permission from the man’s family and obtained a copy of the death certificate which falsely said death was from malignant melanoma.

[Note:  How safeguards failed the patient of Dr. Bentz: * The patient’s well-documented depression was not evaluated by a mental health specialist, nor was it treated. * The patient’s primary physician was excluded from helping him with his end-of-life concerns. * The patient’s oncologist falsified a public document by lying about the cause of death.]

Kate Cheney

Her daughter went doctor shopping, among doctors aligned with promoters of assisted suicide, to find a doctor to give Kate a lethal perscription http://www.wrtl.org/assistedsuicide/personalstories.aspx Kate Cheney, 85, had terminal cancer and told her doctor she wanted assisted suicide. However, he was concerned that she didn’t meet the required criteria for mental competence because of dementia. So he declined to write the requested prescription and instead referred her to a psychiatrist as required by law. She was accompanied to the psychiatric consultation by her daughter. The psychiatrist found that Kate had a loss of short-term memory. It also appeared that her daughter had more interest in Cheney’s assisted suicide than did the patient herself. The psychiatrist wrote in his report that while the assisted suicide seemed consistent with Kate’s values, ‘she does not seem to be explicitly pushing for this.” He also determined that Kate did not have the “very high capacity required to weigh options about assisted suicide,” and he declined to authorize the lethal prescription.

Kate seemed to accept the psychiatrist’s verdict, but her daughter did not. Her daughter viewed the guidelines protecting her mother’s life as obstacles, and in a press interview called the guidelines a “roadblock” to Kate’s right to die and demanded that Kate’s HMO, Kaiser Permanente, provide a second opinion. This was provided by a clinical psychologist (rather than an MD-psychiatrist) who also found Kate had memory problems. The psychologist also worried about familial pressure, writing that Kate’s decision to die “may be influenced by her family’s wishes.” Still, despite these reservations, the psychologist determined that Kate was competent to choose death.

Sometime later, Kate went into a nursing home for a week so that her family could have some respite from care giving. After she returned home, she declared her desire to take the pills herself and approved the writing of the lethal prescription.

[Note: How safeguards failed Kate Cheney:

  • It is possible to circumvent safeguards by “shopping” for an agreeable professional if the patient or family disagrees with professional opinions. 
  • By giving the interview, the patient’s daughter unintentionally revealed that the law does not adequately protect patients with diminished capacity from family coercion. 
  • Financial considerations may have influenced the HMO director to write the prescription.]

Helen X

Soon after the Oregon law allowing a physician to write a lethal prescription for a patient went into effect, Helen asked her physician for one. She had a history of breast cancer and was enrolled in hospice. She had been using a wheelchair for two weeks and had some shortness of breath for which she used oxygen. However, she had no pain and she was still doing aerobic exercises regularly. Her physician declined. Helen saw a second physician, and he too declined because he felt she was depressed. Her husband called Compassion in Dying (a group that supports assisted suicide) and they found a willing physician who wrote the prescription, though he admitted he was shaken by Helen’s eagerness to die.

[Note: How safeguards failed Helen X:  Physician refusal to write a lethal prescription because the requesting patient does not meet the legal criteria need not deter a patient who is eager to die. All Helen had to do was keep asking until she found someone willing.]

David Pruitt

David Pruitt, a man from Oregon with lung cancer, obtained from a physician the standard lethal prescription.  When he felt it was time, he took the entire amount. He went to sleep for 65 hours and woke up saying “What the hell happened? Why am I not dead?” He was so unnerved by the experience that he didn’t want to go through it again. He died naturally about two weeks later.

[Facts learned from David Pruitt:

  • While Mr. Pruitt’s case is the first to come to public attention, repeated data from the Netherlands shows that 18-25% of Dutch people who take the same dose of the same drug as is used in Oregon do not die. They are then given a lethal injection by their doctor which is legal in the Netherlands.
  • The Oregon law does not allow lethal injection, and it is not known what happens to those who do not die. Deaths from physician-assisted suicide are not investigated in Oregon, and the state government says they have no way of knowing how often assisted suicide happens outside the framework of the law.

Maryanne Clayton 

Lived many years after prognosis she was terminal with only 6 months to live http://www.seattleweekly.com/2009-01-14/news/terminal-uncertainty/ In Oregon, two doctors must say a patient has six months or less to live before suicide medication can be prescribed. Maryanne was  diagnosed with Stage IV lung cancer and given two to four months to live.  The tumor  metastasized up her spine.  Prodded by a son who lives in Seattle, Clayton sought treatment from Dr. Renato Martins, a lung cancer specialist at Fred Hutchinson Cancer Research Center, started with radiation, and then participated in the clinical trial of a new drug called pemetrexate.

Her response was remarkable. The tumors shrunk, and although they eventually grew back, they shrunk again when she enrolled in a second clinical trial. (Pemetrexate has since been approved by the FDA for initial treatment in lung cancer cases.)…She now comes to the Hutch every three weeks to see Martins, get CT scans, and undergo her drug regimen. The prognosis she was given has proved to be “quite wrong.”

Since the day she was told two to four months, Clayton has gone with her children on a series of vacations, including a cruise to the Caribbean, a trip to Hawaii, and a tour of the Southwest that culminated in a visit to the Grand Canyon. There she rode a hot-air balloon that hit a snag as it descended and tipped over, sending everybody crawling out.  “We almost lost her because she was having too much fun, not from cancer,” Martins chuckles.

Dr. Stuart Farber, head of palliative care at the University of Washington Medical Center, with regard to their ability to predict end of life, “Even when applying the rigid criteria for hospice eligibility, doctors often get it wrong.  Dr. Nicholas Christakis, a professor of medicine and sociology at Harvard University and a pioneer in research on this subject, agrees. He says,  in his 2000 book, Death Foretold: Prophecy and Prognosis in Medical Care. “As a child, his mother was diagnosed with Hodgkin’s disease. When I was six, she was given a 10 percent chance of living beyond three weeks….She lived for nineteen remarkable years…I spent my boyhood always fearing that her lifelong chemotherapy would stop working, constantly wondering whether my mother would live or die, and both craving and detesting prognostic precision.”

Barbara Wagner 

She was refused treatment to prolong life or cure, instead given option to end life

http://www.lifesitenews.com/news/archive//ldn/2008/jun/08060402

The Oregon Health Plan did not support the required treatment to prolong life.  It did support PAS.  Barbara appealed the verdict twice, and lost twice.

“Treatment of advanced cancer that is meant to prolong life, or change the course of this disease, is not a covered benefit of the Oregon Health Plan,” read the letter notifying Wagner of the health plan’s decision….

Barbara had hope when, “A representative from the company that manufactures the treatment called the cancer patient to say they would give her the medication for free. “I am just so thrilled,” she said. “I am so relieved and so happy.”

Dr. Walter Shaffer, medical director of the state Division of Medical Assistance Programs, which administers the Oregon Health Plan, attempted to defend the health plan’s decision…According to an AP story on Wagner’s case, local oncologists in Oregon have said that, despite the Health Services Commission’s assertion that they were just clarifying policies already in place, healthcare practitioners have observed a sizable shift in policy in the way recurrent cancer is treated in the state. Increasingly, say local oncologists, sufferers of recurrent cancer are not receiving coverage for chemotherapy. They are always, however, eligible for state-funded assisted suicide.

Wesley J. Smith, a prominent conservative bioethicist, says that he was not surprised by the events. “We have been warning for years that this was a possibility in Oregon. Medicaid is rationed, meaning that some treatments are not covered. But assisted suicide is always covered. And now, Barbara Wagner was faced with that very scenario.”

Smith also mentioned a similar circumstance that had occurred in the past: “This isn’t the first time this has happened either. A few years ago a patient who needed a double organ transplant was denied the treatment but would have been eligible for state-financed assisted suicide.”

See video at  http://www.mofopolitics.com/2009/08/03/video-oregon-says-no-to-chemotherapy-offers-doctor-assisted-suicide/

Randy Stroup

He was refused treatment to prolong life or cure, instead given option to end life

Randy Stroup who had prostate cancer was also offered doctor-prescribed suicide by the Oregon Health Plan.

“Oregon Offers Terminal Patients Doctor-Assisted Suicide Instead of Medical Care” Some terminally ill patients in Oregon who turned to their state for health care were denied treatment and offered doctor-assisted suicide instead, a proposal some experts have called a “chilling” corruption of medical ethics.

Jeannett

Lived years after her decision for suicide

http://www.ravallirepublic.com/news/opinion/mailbag/article_34acbde8-3686-11e2-b260-0019bb2963f4.html

I am a doctor in Oregon, one of two states where assisted-suicide is legal. This letter responds to your article about the controversy over this practice in Montana. (AP article, Medical Examiners Board, Nov. 16, 2012). I write to clarify that legalizing assisted suicide would allow non-dying persons to be steered to suicide.

Oregon’s assisted-suicide law applies to patients predicted to have less than six months to live. In 2000, I had a cancer patient named Jeanette Hall. Another doctor had given her a terminal diagnosis of six months to a year to live. This was based on her not being treated for cancer. At our first meeting, Jeanette told me that she did not want to be treated, and that she wanted to opt for what our law allowed – to kill herself with a lethal dose of barbiturates. I did not and do not believe in assisted suicide. I informed her that her cancer was treatable and that her prospects were good. But she wanted “the pills.” She had made up her mind, but she continued to see me. On the third or fourth visit, I asked her about her family and learned that she had a son. I asked her how he would feel if she went through with her plan. Shortly after that, she agreed to be treated, and her cancer was cured.

Five years later she saw me in a restaurant and said, “Dr. Stevens, you saved my life!”

For her, the mere presence of legal assisted suicide had steered her to suicide. I understand that assisted suicide will be an issue in your upcoming legislative session. I urge you to encourage your legislators to clarify your law to keep assisted suicide out of Montana.

Kenneth Stevens, MD, Sherwood, Ore.

Edward Kennedy – by Victoria Reggie Kennedy —

When diagnosed with cancer, his prognosis was that he only had 2-4 months to live.  The prognosis was wrong. He lived 15 more productive months. …..see

http://bostoncatholicinsider.wordpress.com/2012/10/31/kennedy-widow-says-no-on-assisted-suicide/

Mrs. Kennedy adds:  “My husband used to paraphrase H.L. Mencken:  for every complex problem there is always an easy answer.  And it’s wrong.  That’s how I feel about this case…

 

For All Oregon Annual Reports  (law enacted in 1997) see:

http://public.health.oregon.gov/ProviderPartnerResources/Evaluationresearch/deathwithdignityact/Pages/index.aspx

[Note: The Dept of Health Annual Reports, Oregon, 2008 – 2011, are worth a read.  They show that those who have asked for PAS do so for quality of life issues and because they feel they are a burden on family care givers.]