Hospice Patients Alliance: Consumer Advocates


Oregon Hospice Association President
Denies Problems with Physician-Assisted Suicide in Oregon

by Ron Panzer, HPA President


During a phone interview conducted February 16, 2001, Oregon Hospice Association President Anne Jackson responded to charges from opponents of legalized physician-assisted suicide about limitations on the hospice benefit in Oregon and the practice of euthanasia in that state. Anne Jackson specifically stated that the HMOs in Oregon are not setting caps or limitations on the hospice benefit. She stated that Pacc Health Plans (HMO) does not have a specific hospice benefit, but allows its patients to receive hospice care under other health plan benefits and that patients are not denied access to hospice services. According to her account, Kaiser HMO also does not set caps on the hospice benefit.

During the conversation, Ms. Jackson stated that the state of Oregon has begun scientific research studies to evaluate the practice of physician-assisted suicide in Oregon, since it is one of the few sites in the world where physician-assisted suicide has been legalized. She also stated that there were relatively few actual cases of physician-assisted suicide performed in 1998-99 with a total of 63 cases reported. She did say that, in her opinion, the hospices and physicians involved closely evaluated each case and provided independent physician and psychiatric evaluation to assure the appropriateness of the physician-assisted suicides/euthanasias.

When requested to send a copy of the Kaiser HMO and Pacc Health Plans benefit description, Ms. Jackson changed the subject and stated that there were many plans within the HMOs and individual situations might vary. She did not offer to send a copy of the Kaiser or Pacc Health Plans actual benefit description even though directly requested to do so.

According to Ms. Jackson, the Oregon Hospice Association (and others) clearly support increased funding for hospice services, and amendment to the laws governing the administration of narcotic medications, so that physicians and nurses would not have to fear prosecution when they are sincerely attempting to relieve pain.

  • Ms. Jackson stated that Dr. Herbert Hendin, MD was incorrect in pointing out numerous problems with euthanasia in the Netherlands and Oregon. Dr. Hendin is a psychiatrist, President of the American Foundation for the Prevention of Suicide, Professor at New York Medical College and author of Seduced by Death - Doctors, Patients and the Dutch Cure.

  • Ms. Jackson stated that Dr. Carlos Gomez, MD was incorrect in pointing out numerous problems with euthanasia in the Netherlands. Dr. Gomez is the author of Regulating Death, Euthanasia and the Case of the Netherlands.

  • Ms. Jackson disagreed with the official conclusions of the Dutch government's research published in the Remmelink report in 1991 which exposed many problems in the Netherlands' practice of euthanasia. [The Dutch government had given full immunity from prosecution to all physicians, so that the physicians could freely report what was truly occurring in the Netherlands. These Dutch physicians revealed that many patients were euthanized without their knowledge, permission and that many physicians don't even report the euthanasias that they perform.]

  • Ms. Jackson stated that the research [noted below] from the JAMA and Archives of Internal Medicine about euthanasia in the Netherlands and Oregon was incorrect in concluding that there may be problems with physicians adhering to the safeguards regulating euthanasia.

  • Ms. Jackson stated that if there were problems with achieving pain control for the terminally ill, that frequently the cause was an impaired nurse who was diverting the narcotic pain medications for her own drug habit. Ms. Jackson did not admit any possibility of wrongdoing by a hospice that might not intervene if a patient's attending physician had not prescribed adequate pain medications.

  • Ms. Jackson stated that families were often incorrect in viewing a patient's death as even being a euthanasia case. She asserted that the families often had it wrong ... that the patients often simply are dying due to the terminal illness and that the families misinterpret the giving of a narcotic for pain medication as being the cause of death, rather than medication for pain

  • When questioned about COPD cases where the families report their loved one had no pain and morphine was given, resulting in an involuntary euthanasia, Ms. Jackson stated that the families probably had it wrong (even though Ms. Jackson was not there to know) and that the COPD patients were in pain and that the morphine being given was the reason the patients were not in pain, even though the reports stated the patients denied pain before being given morphine, and that the patient's respiratory rate had been depressed to a point where the breathing simply stopped.

  • When discussing the Code of Federal Regulations governing hospice, I mentioned that Hospice Patients Alliance gets complaints from all over the USA from families reporting violations of the Code. When I stated that probably just about every regulation in the Code had been violated by one hospice or another, Ms. Jackson stated that she thought the regulations needed revising and that hospices didn't "have the time to provide all those services!"

    I found that disappointing, especially since I personally know hospice nurse managers who state that they actually do provide all the required services described in the Code of Federal Regulations, and that, "yes, it may be difficult, but we do it since it's what the patients need."






[Note: The Hospice Patients Alliance agrees that government should increase funding for hospice services (which has been shown to save money compared to caring for the terminally ill in the acute care hospital setting) and that laws governing the administration of narcotics for pain relief should be amended to assure physicians that they will not be prosecuted for sincere attempts to relieve the sometimes severe pain of certain end-stage disease processes.

Hospice Patients Alliance has not yet been able to obtain actual copies of the Kaiser and Pacc HMO hospice benefit plan descriptions. Whether all euthanasias in Oregon are performed within the standards of care is yet to be scientifically established. Research described in the JAMA and Archives of Internal Medicine suggests that there are problems with euthanasias: see
  1. JAMA at http://jama.ama-assn.org 1998 and search from the JAMA site for the following article: Aug 12;280(6):507-13 entitled "The practice of euthanasia and physician-assisted suicide in the United States: adherence to proposed safeguards and effects on physicians." written by Emanuel EJ, Daniels ER, Fairclough DL, Clarridge BR done at the Center for Outcomes and Policy Research, Division of Cancer Epidemiology and Control, Dana-Farber Cancer Institute, Boston, Mass 02115, USA.]

  2. Archives of Internal Medicine - AMA at http://archinte.ama-assn.org/cgi/content/full/160/1/63?maxtoshow=&hits=10&RESULTFORMAT=1&author1=Willems&title=Attitudes+and+Practices+Concerning+the+End+of+Life&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=160&fdate=1/1/2000&tdate=4/30/2001&resourcetype=HWCIT Vol. 160 No. 1, January 10, 2000, "Attitudes and Practices Concerning the End of Life - A Comparison Between Physicians From the United States and From the Netherlands" (by Dick L. Willems, MD, PhD; Elisabeth R. Daniels; Gerrit van der Wal, PhD; Paul J. van der Maas, PhD; Ezekiel J. Emanuel, PhD)


Comment: When considering Ms. Jackson's comments, I am reminded of the chemical companies and government enthusiastic promotion of DDT back in the World War II era 1940s: DDT was hailed as a wonder of science.

"DDT was promoted as a potent nerve poison on insects to combat yellow fever, typhus, elephantiasis, and other insect-vectored diseases. In India, DDT reduced malaria from 75 million cases to fewer than 5 million cases in a decade. Crops and livestock sprayed with DDT sometimes as much as doubled their yields. With the publication of the American marine biologist Rachel Carson's Silent Spring in 1962, suspicion grew that DDT, by entering the food chain and eventually concentrating in higher animals, caused reproductive dysfunctions, ... In 1973 DDT was banned in the U.S. except for use in extreme health emergencies." [from Encarta 99 encyclopedia].

What does that have to do with the practice of physician-assisted-suicide and/or euthanasia? Well, we all now know that DDT was initially viewed as a benign insecticide helpful to mankind, but was later discovered to be devastatingly poisonous and something which may take years for its deadly chemicals to take effect. Just like DDT, euthanasia might, for some, be viewed in its ideal practice as having some desirable consequences (relief of suffering), but when fully evaluated, will be recognized as a horribly misguided and dangerous practice which will definitely result in human rights violations, patient rights violations and totally involuntary euthanasias.

Research shows that there are euthanasia cases that are not even terminal: some patients are depressed, some are disabled or chronically ill. Ms. Jackson's belief that "all" cases of euthanasia in Oregon were done in accordance with the regulations is very well contradicted by the research which clearly shows that many US physicians don't even report the cases of euthanasia that they participated in, that the physicians admit not following the sageguards and may not even inform the patient or get permission.

Linda Ganzini, MD, director of geriatric psychiatry at the Veteran’s Affairs Medical Center in Portland, Oregon has written: "Studies of dying cancer patients reveal that between 59-100% of patients wanting hastened death have major depressive disorder." Yet, during the first two years under Oregon’s physician assisted-suicide law, less than 35% (15 out of 43) of the patients who received lethal prescriptions were referred for a psychiatric or psychological consultation. [See: L. Ganzini, "Commentary: Assessment of Clinical Depression in Patients Who Request Physician-Assisted Death," Journal of Pain & Symptom Management, June 2000 and, the State of Oregon Health Division, "Oregon’s Death with Dignity Act: The Second Year’s Experience, Table 2, 2/23/00]. 59-100% of patients seeking physician assisted suicide are depressed, but less than 35% are referred for psychiatric consultation before being assisted to their death! What a contradiction, and what a direct challenge to anyone who says the safeguards are being followed!

The JAMA article noted above shows that only one third of physician assisted suicide cases are performed consistently with proposed safeguards. What is the obvious conclusion? Two thirds of cases are performed in violation of the safeguards (that's the politically incorrect, but accurate way of putting it.)

Should we expect a State Hospice Association President to admit to problems in the hospice industry? Well, California Supervising Deputy Atty. Gen. Nancy Stoner (speaking about hospitals reporting violations of the standards of care) has said "It is not in the hospital's best interest to let people know what went wrong inside their facility." [See LA Times article, dated Feb 18, 2001 about involuntary euthanasias] The article goes on to say: "Underreporting of professional misconduct by hospitals is a broader problem, consumer advocates say." Just as hospitals may feel it's not in their best interest to admit to problems with violations of the standards of care, hospices and their lobbying/Public Relations groups: the state hospice associations, would naturally believe that they need to suppress information about the violations of standards of care within hospice agencies.
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