When and how to die

I am a cancer doctor in Oregon, where physician-assisted suicide is legal, and I wish to respond to the editorial by Flegel and Fletcher.1

In Oregon, the combination of the legalization of assisted suicide and prioritized medical care based on prognosis has created a danger for my patients on the government-run Oregon Health Plan (Medicaid).

The plan limits medical care and treatment for patients with a 5% or less likelihood of 5-year survival.2 Patients in that category, who may have a good chance of living another 3 years and who want to live, cannot receive surgery, chemotherapy or radiotherapy to obtain that goal.2 The plan guidelines state that the plan will not cover “chemotherapy or surgical interventions with the primary intent to prolong life or alter disease progression.”2 The plan will cover the cost of the patient’s suicide.2

Under Oregon law, a patient is not supposed to be eligible for voluntary suicide until he or she is deemed to have 6 months or less to live. In the well-publicized cases of Barbara Wagner3^,4 and Randy Stroup,5 neither of them had such diagnoses, nor had they asked for suicide.

The plan, nonetheless, offered them suicide. In Oregon, the mere presence of legal assisted suicide steers patients to suicide even when there is not an issue of coverage. One of my patients was adamant she would use the law. I convinced her to be treated. Now 12 years later she is thrilled to be alive.6 I hope that others can avoid making the same mistake Oregon has.