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Letters

When and how to die

Kenneth R. Stevens
CMAJ November 06, 2012 184 (16) 1814; DOI: https://doi.org/10.1503/cmaj.112-2076
Kenneth R. Stevens
Portland, Ore.
Roles: Radiation Oncologist
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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.

References

  1. ↵
    1. Flegel K,
    2. Fletcher J
    . Choosing when and how to die: Are we ready to perform therapeutic homicide? CMAJ 2012;184:1227.
    OpenUrlFREE Full Text
  2. ↵
    Prioritized list of health services. Salem (OR): Government of Oregon: Health Services Commission; 2009. Available: www.oregon.gov/oha/OHPR/HSC/pages/pp_0109.aspx (accessed 2012 July 18).
  3. ↵
    1. Harding S
    . Letter noting assisted suicide raises questions. Katu 2008 July 30. Available: www.katu.com/news/26119539.html (accessed 2012 July 18).
  4. ↵
    1. Donaldson James S
    . Death drugs cause uproar in Oregon. ABC News 2008 Aug. 6. Available: http://abcnews.go.com/Health/story?id=5517492&page=1 (accessed 2012 July 18).
  5. ↵
    1. Springer D
    . Oregon offers terminal patients doctor-assisted suicide instead of medical care. Fox News 2008 July 28. Available: www.foxnews.com/story/0,2933,392962,00.html (accessed 2012 July 18).
  6. ↵
    1. Hall J
    . She pushed for legal right to die, and — thankfully — was rebuffed [letter]. Boston Globe 2011 Oct. 4. Available: http://articles.boston.com/2011-10-04/bostonglobe/30243525_1_suicide-doctor-ballot-initiative (accessed 2012 July 18).
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Canadian Medical Association Journal: 184 (16)
CMAJ
Vol. 184, Issue 16
6 Nov 2012
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When and how to die
Kenneth R. Stevens
CMAJ Nov 2012, 184 (16) 1814; DOI: 10.1503/cmaj.112-2076

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When and how to die
Kenneth R. Stevens
CMAJ Nov 2012, 184 (16) 1814; DOI: 10.1503/cmaj.112-2076
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