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The Rev. Richard Chasse
Ms. Diane Kaczmarek
Dr. Olatunde Kuye
The Rev. George Kyle
The Rev. Rosemary Lillis
Ms. Jill McNish, Esq.
Ms. Peggy Moncrief
Ms. Carole Murphy
Dr. James Pruden
Dr. Stuart Ravnik
Mr. Stephen Shaw, Esq.
The Rev. Gordon Tremaine
The topic of this report is assisted suicide. Assisted suicide is a hotly debated issue within every institution of our society. The task force chose to focus on those issues relating to situations in which a person is contemplating the ending of her/his own life and the issues surrounding those choices. The discussion of involuntary and nonvoluntary euthanasia is of great importance, and requires further study but is beyond the scope of this report. For purposes of clarity the various forms of assisted suicide and euthanasia are defined as follows:
Euthanasia - Etymologically euthanasia meant in antiquity a "good death" or an "easy death" that is death free from severe pain. However, euthanasia no longer simply means an easy death. Today Euthanasia refers to any intervention which lessens the suffering of illness; an intervention that at times carries with it the danger of terminating life prematurely. Sometimes the word euthanasia may also be used to mean mercy killing, the purpose being to put a complete end to extreme suffering. For our purposes euthanasia means an action or omission that by its nature or by intention causes death with the purpose of putting an end to all suffering. Euthanasia is therefore a matter of intention and method.
There are several forms of Euthanasia and Assisted Suicide:
The intentional ending of one's life is an issue that raises the most serious pastoral, moral, and theological questions. The deliberations of the task force on assisted suicide proceed from the assumption that individuals have the ability to make moral choices. These choices can and should be made with the assistance of an enlightened conscience informed by scripture, tradition and reason. This report presents a number of factors that should be taken into consideration in informing the conscience and arriving at an informed moral choice.
Creation
We begin our consideration of the theological issues of assisted suicide with the doctrine of creation. As Christians we believe that God is the creator of the universe. As such, the whole of the created order including human life is a gift from God. An integral part of that gift is that humans have free will which needs to be exercised responsibly in obedience to God.
The statements of basic beliefs need to be elaborated in order to see the connection between freedom, creation, and assisted suicide. Reverence for God's creation requires that we refrain from any unnecessary and willful destruction of that creation. Yet, given the nature of creation, some destruction is inevitable and necessary. It is inherent in nature that life can be sustained only at the expense of other life. The willful taking of life, however, can be morally justified only if the good desired outweighs the potential evil and only if that good cannot be achieved in a less destructive manner. Therefore, with creation there is also destruction. This apparent paradox was clearly described by a report of the Church of England:
The creation of new value is as important as, if not more important than, the preservation of existing value. And it can be argued, paradoxically but not nonsensically, that the greater value could be achieved in a person's life, taken as a whole, if he knew that at a certain stage of his dying he would be painlessly put to death rather than be allowed to linger on, feeling himself a burden to others as well as to himself. In certain circumstances his death could be said to be a good rather than an evil. The act of physical destruction, it could be argued would be a morally creative act.
In the case of assisted suicide, one must balance the onerous consideration of taking a human life against the pain and suffering of that same individual. The idea of the sanctity of human life is a deep-seated principle in Christian theology. This principle however does not negate the role of human-kind in creation. It is our belief that creation is an ongoing activity of God and it is a high calling of humans to share in that activity.
If human-kind is part of and a contributor to creation then we must also address the nature of our dependence upon God. Some argue that suicide is never permissible because it indicates that the person does not comprehend the appropriate relationship between God and humans. According to this argument suicide indicates a lack of trust in God. We would suggest, however, that dependence upon God is in no way violated by the responsible exercise of our God-given freedom to choose, especially when it comes to our own death.
The progress of medical science is such that while a person's body can be kept alive much longer than was possible only decades ago, the quality of that life may be described by unremitting pain and loss of those very qualities which describe human life. The theology of creation allows us to contemplate the relationship between God and humans in this area but it does not give us ready answers to the questions regarding assisted suicide.
Exodus
Augmenting the theology of creation is the constitutive event at the foundation of the Judeo-Christian community, the story of the Exodus. Here God draws the chosen people out of bondage and suffering into the consecrated life of the covenant. As creation theology holds the notion of life itself, bios, at the center of the relationship between God and humanity, Exodus theology holds zoe, the abundance of life in and through the revelation of God to God's own people, as the primary expression of God's creative force. Zoe represents the sweetness and significance of life described by Jesus as the very center of the incarnation: "I have come that you might have life and have it more abundantly." In considering how to be faithful to God's intention for humanity in the present question, one must hold in creative tension the respective claims of both bios and zoe. The fact of life itself is clearly to be cherished, but God's saving action is also expressed in the relief of suffering, in the drawing of humanity from the bondage of suffering into the deeper, creative significance of life in God. It is the essence of the Christian hope to affirm that discovering that meaning is not a quest that ends in death, but is taken up by God as we are reclaimed in death for eternal life. Accordingly, the end of bios by no means results in the end of zoe. We must remain open to the possibility that this assertion is not negated by the choice for voluntary death in the kinds of extraordinary circumstances to be discussed later in this report.
Resurrection
A refusal to acknowledge any possibility of the ethical integrity of a prayerful decision to end ones life, or to assist someone else to do so is, in a sense, a failure to be mindful that "God's steadfast love endures forever" (Ps. 118:1), and that Christian faith looks forward to what lies ahead, notwithstanding "the terror of the night... [and] the destruction of the wastes at noonday" (Ps. 91:5-6). The light of Easter morning is disclosed only by the shadow of the cross.
The historic creeds of the Church openly acknowledge death in affirming resurrection from the dead. The Apostles' Creed professes belief in "the resurrection of the body and the life everlasting". The Nicene Creed declares that we "look for the resurrection of the dead, and the life of the world to come".
The Christian hope is that of being raised from every power of death by the same power of God's Spirit that raised Jesus Christ from the dead. Indeed, an explicit longing for death in order to achieve the highest spiritual condition has been, at times, a powerful part of Christian tradition. It was the motivation for joyful Christian martyrdom in the early Church. In his letter to the Philippians, St. Paul revealed his own desire for death in order to "be with Christ" (Philippians 1:23). We refer to these traditions simply as a reminder that neither the tradition, teaching, nor scripture of the Church have held up human life on earth as the ultimate good to be maintained at all costs. Ours is a resurrection faith.
Our baptismal covenant calls us to "respect the dignity of every human being". (BCP p. 305) Surely this cannot mean requiring all persons under all circumstances to continue in human life which has become unspeakably and unrelievably agonizing and undignified for them.
Suffering
No discussion of assisted suicide can proceed without a serious look at the issue of suffering associated with serious illness, and what Christian faith requires in response. If human suffering were completely manageable in the midst of illness, the issues of assisted suicide would be moot.
From the earliest days of the Christian faith, there has existed an integral connection between faith and suffering. The passion of our Lord and its redemptive effect stood at the center of our initial kerygma (proclamation of the Gospel). Early Christianity lived out its embryonic centuries in a hostile environment where faith, persecution, and suffering were inextricably bound together. From this context our formative theological reflection on suffering was born.
Saint Paul is eloquent on the suffering that rises out of the experience of faith, and on the virtue of that tribulation. Representative of his understanding are the words of the fifth chapter of Romans:
. . . we rejoice in our suffering, knowing that suffering produces endurance, and endurance produces character, and character produces hope, and hope does not disappoint us, because God's love has been poured into our hearts through the Holy Spirit which has been given to us. (Rom. 5:3-5)
This is a clear endorsement of the virtue of suffering and of the abundance of grace that flows through its process for the Christian. Similar attitudes toward suffering emerge in the words of Saint Paul in Rom: 8:17ff; 1 Cor. 12:26; 2 Cor. 1:6. What must be emphasized here is that such statements by Paul regarding suffering never glorify the virtue of suffering for its own sake. All of Paul's references refer to suffering for the sake of the Gospel and its proclamation into the often hostile world. The author of Hebrews offers us this reflection on suffering:
For it is fitting that he, for whom and by whom all things exist, in bringing many children to glory, should make the pioneer of their salvation perfect through suffering. For the one who sanctifies and those who are sanctified all have one origin. For this reason Jesus is not ashamed to call them brothers and sisters . . . (Heb. 2:10-11)
Here the reference is not to human suffering in general, but specifically to the redemptive quality of the suffering of Jesus. The label "pioneer" certainly indicates like followership, but it refers to salvation, not perfection through suffering. Jesus is the pioneer of our salvation, not of our descent into painful tribulation for its intrinsic redemptive value.
The circumstances of suffering, therefore, are critical to formulating a faithful response to its existence. Unless an individual somehow understands suffering due to serious illness as a direct consequence of ones' faithful response to the Gospel, endurance of such suffering cannot be seen as a mandate, either moral or theological, on the basis of the scriptural witness. It is not a moral failing to view such suffering as devoid of purpose, and thus without redemptive value. This, coupled with the clear precedent of Jesus' countless efforts to alleviate suffering through his healing ministry, makes clear that there is no obligation incumbent upon the Christian to endure suffering for its own sake.
There are individuals who experience their own suffering in serious illness as an opportunity for the deepening of their faith. There are those whose suffering allows them to feel a more profound sense of identification and solidarity with the suffering of others, even of their Lord. For these people, suffering associated with serious illness has significant, even magnificent meaning. There is no intent here to wrest that sense of purpose away. The intent is to offer freedom to those who might otherwise feel enslaved to a biblically driven mandate to suffer virtuously and without release. Such a mandate is not theologically defensible, and is thus in force for no faithful Christian.
Our society and church accept the ethical principle of autonomy. Christians, however, throughout the centuries have set limits on human autonomy based upon the understanding of the scriptures and church traditions. Orthodox approaches to Christian ethics have always ruled out suicide in any form. As discussed in other parts of this document, circumstances have changed, requiring a review of these ethical positions. Modern technology has created a dissonance with the past.
Contemporary medicine has generated a variety of choices previously unavailable to the individual. This has resulted in a growing tension between individual, God, family, church, and society. When on ponders exercising a choice regarding the time and circumstance of his or her own death, all of these dimensions will need to be carefully explored.
When considering the possibility of voluntary assisted death, the first issue to be encountered is whether the person's circumstances make such an action a morally viable alternative. We offer the following criteria as a measure of that ethical defensibility, recognizing that fulfillment of the same does not constitute a mandate for assisted suicide, but an affirmation of the further pursuit of the possibility. Such affirmation would depend upon compliance with all of these:
If the determination has been made that an individual's condition makes voluntary assisted death a reasonable and ethical alternative, that individual will need to move toward a specific decision regarding whether to exercise that alternative.
No single rigid set of ethical rules or guidelines is sufficient for decision making given the ever changing complexity of present daily life. The task force recognizes the multiplicity of ethical considerations and systems which must be embraced by an individual contemplating the alternative of voluntary assisted death, and by those persons who have been asked to assist in the actualization of that death. The process of ethical decision making becomes one of dialectic reflection, seeking truth not in moral absolutes, but in the dynamic tension existing between seemingly opposite, but equally held principles.
It may be likened to navigating a boat on a river, with the opposing shores defining and directing the journey. The opposing truths of each shoreline shape the creative tension from which responsible decisions can emerge. Christian decision making which seeks to determine whether voluntary death can be considered as an ethically sound option move carefully and deliberately between the shorelines. Such dialectic thinking, both for one who considers dying and for one who considers assisting, will profoundly engage the conflict begotten of mutually honored moral values existing in dynamic tension, such as:
Finally, if this process leads a person to a decision to seek voluntary death or to assist in that ultimate passage of another, we offer these final three criteria to be met on order that the decision be morally sound:
While ethics is complicated by the opinions of academic, scientific, sociological, philosophical, psychological, cultural, legal, and theological disciplines, the above strives to find a balance that meets the needs of the person faced with this difficulty situation. An ethical guideline, however, is no guarantee that the final decision will be ethical.
We believe that there are cases and circumstances where involuntary prolonged biological existence is a less ethical alternative than a conscientiously chosen and merciful termination of earthly life. In such an exceptional environment, voluntary assisted death may indeed be part of the healing process because it enables the person to die well.
Several pastoral issues related to assisted suicide have broad implications for both individuals and the community. The pastoral challenges surrounding assisted suicide are substantial. Our society is still struggling with the role of death as an inseparable component of life and as the first step toward immortality, redemption, and ultimate healing. The legal specifications and requirements regarding assisted suicide are beyond the scope of this report.
In the course of modern history, cures for many diseases and other technical advances have prolonged biological life. Yet with them, new challenges and opportunities have emerged for the patient and loving care givers alike. One particular challenge emerges when medical advances artificially extend biological life while offering no hope of relief or recovery. Attempts to keep a person alive regardless of the physical and psychological consequences may actually become an act of aggression rather than an act of caring and kindness. Often, decisions made by care givers and the medical profession in an attempt to avoid pain, suffering or death are counter productive and ultimately prolong an excruciating process. Assisted suicide is not the only solution to such physical and mental pain. Rather, it may be viewed as a new complication, further confusing the issues around death and dying. Yet in a situation where the process of dying has become grossly undignified, assisted suicide has the potential to alleviate meaningless pain and suffering.
The Wider Church Community
The task force identified the need for a commitment to parish-based Christian education. The areas for education include demystification of death, suffering as part of life, and other end of life issues. Death is not easily dealt with by our society. We use euphemisms when describing death, deny its existence as a normal and final process of mortal life. The denial of death and the unrealistic sanitization and sentimental portrayals by the media demonstrate a need for education.
In our baptismal vows, we promise to "respect the dignity of every human being" (BCP p. 305). The right to dignity is for a lifetime, in every moment even the last. Therefore, dignity in death may have greater value than our need to sustain life.
We need to teach that death is part of the fabric of life. The dignity of all persons throughout life, from infancy to death, needs to be understood from a Christian perspective. Biblical witness regarding suffering, death, sin and life are essential. Above all else, any such exploration must proceed from the vantage point of Easter, embracing Christ's resurrection and promise of eternal life.
The Patient
The patient who has requested assisted suicide presents many pastoral challenges and opportunities. Initial pastoral interactions are to be confidential and need to include the possible impact of assisted suicide on those individuals belonging to the intimate and immediate community of the patient. Reasons for the request need to be explored as well as why the patient came to decide that assisted suicide was an available option.
It is important that open and honest discussion take place regarding all available options for management of physical, emotional, and psychological suffering. When a decision is reached to pursue assisted suicide, it is critical for the patient to determine which other persons need to be informed of this decision. To commit suicide without informing intimate others is hurtful and potentially damaging to the survivors.
The Family and Other Loved Ones
The psychological pain associated with the potential loss of a loved one frequently requires and involves pastoral intervention. In an effort to prevent loss, loved ones may demand life-prolonging intervention at all costs, even if it leads to the indignity of the patient. Loved ones who are asked to support a patient who has chosen assisted suicide need pastoral support.
In many cases, the loved ones may not wish to assist physically or emotionally or even concur with the patient's wishes. Where the patient and the loved ones disagree, the autonomy and self determination of the patient is paramount.
The Medical and Other Professional Staff
The medical staff involved with the treatment and care of the patient will also need psychic and spiritual support. Death is often viewed as a failure among the medical profession, even though it is the natural outcome of living. Medical staff may be requested to assist in a suicide. For the medical professional, suicide may be in conflict with personal spiritual beliefs and may be viewed as being incompatible with professional standards and treatment goals. Personal integrity should always be honored in medical personnel who have the right to choose for themselves which procedures they are willing to perform.
For those professionals who choose to assist in a patient's suicide, spiritual counsel and pastoral care should be constantly available. Because of the possible inflammatory nature of this issue, the potential for both professional damage and community repercussions, and the uniqueness of each patient's case, medical professionals are likely to be struggling with this issue on an ongoing basis.
The Clergy
Because of the gravity of life and death issues clergy also require pastoral care. The church community needs to be aware of the clergy's need for support in providing pastoral care to all individuals participating in the care of dying patients.
1. Christian theology demands respect for human life and recognizes that human life is sacred.
2. Modern science has created a situation where biological existence may be extended far beyond the point where a reasonable quality of life exists.
3. There are circumstances where involuntarily prolonged biological existence is a less ethical alternative than a conscientiously chosen and merciful termination of earthly life.
4. In such exceptional cases, assisting a suffering person in accomplishing voluntary death can be morally justified as part of the healing process, because it enables a person to die well.
5. As Christians we are all called upon to offer pastoral care and comfort to persons who find themselves or their loved ones in such a difficult situation.
6. The issue of assisted suicide and death requires additional education, and prayerful discussions leading to a more informed community and congregation.
7. We encourage individuals to enter into the discussions of how to implement the concepts that have be discussed in this report.
Resolved: That we affirm that suicide may be a moral choice for a Christian when: a person's condition is terminal or incurable; when pain is persistent and/or progressive; when all other reasonable means of amelioration of pain and suffering have been exhausted; and when the decision to hasten death is a truly informed and voluntary choice free from external coercion. Assisting another in accomplishing voluntary death under these circumstances may be an equally moral choice.
Resolved: That the report of the Task Force on assisted suicide be forwarded to the General Convention of the Episcopal church and the New Jersey legislature for their consideration.
Resolved: That during 1996 the Diocese commit to a program of education for all congregations of the Diocese on the subject of issues related to assisted suicide and death.
Appendix 1 - Survey of Scriptural Sources concerning Suicide
ZlMRI (I Kings 16:12)
In the years immediately following the post Solomonic division of the kingdom (977 BCE) the Northern Kingdom went through an initial period of great instability. In large measure this was due to the fact that dynastic monarchy was not really their thing, rather a manifestation of Judean covenant theology.
Nadab, son of Jeroboam, succeeded his father and reigned for just two years until assassinated by Baasha who went on to a relatively long reign. He was followed briefly by his son Elah who, in turn was assassinated after two years by Zimri. After seven days on an otherwise uneventful reign, the army under Omri rallied against Tirzah (Zimri's city of residence). Seeing the writing on the wall in this volatile political climate, Zimri went into his house, set it ablaze over him, and thus ended his life, in and out of politics.
Zimri's fate is clearly presented by the Deuteronomic Historian as the negative consequence of his sinful life (cf. I Kings 16:19).
AHITHOPHEL (11 Samuel 17:23)
Ahithophel was originally a prophetic advisor to King David and was seen in the most hyperbolic of terms. Note the attitude reflected in 16:23:
"the counsel which Ahithophel gave was as if one consulted the oracle of God; so was all the counsel of Ahithophel esteemed, both by David and by Absalom"After the rape of Tamar by Amnon and Absalom's murder of the latter, Absalom returns from exile and is eventually forgiven by David. However, still bitter over his father's failure regarding Amnon, and now quite uncertain of his place in the drama of dynastic succession, Absalom launches a rebellion against David. Ahithophel defects to the Absalom camp, becoming his primary advisor and prophet. When Absalom occupies the city of Jerusalem after David has fled, it is on Ahithophel's advice that he makes the power play of violating David's harem.
Meanwhile, David has sent another prophet named Hushai into the camp of Absalom as a confederate to mitigate against the counsel of Ahithophel. Once the above power play with the concubines succeeds, Ahithophel wants to take twelve thousand troops out to finish David. Recognizing the effectiveness of this strategy, Hushai counsels Absalom against it and prevails with the young rebel.
The episode closes in 17:23
"When Ahithophel saw that his counsel was not followed, he saddled his donkey, and went off home to his own city. And he set his house in order, and hanged himself."
Likely this suicide is not so much an overreaction to rejection as it is a panicked response of self protection. After all, if David was not finished quickly and decisively his retribution would be swift and brutal, particularly against one held in contempt as a traitor.
SAUL (I Samuel 31:4-5)
In his final battle with the Philistines, Saul is severely wounded by archers. Fearful of the abuse that he would endure at the hands of the Philistines he requests that his armor bearer run him through. This is the only biblical example of a request for assisted suicide. The armor bearer is afraid to comply (after all, this is God's anointed) and refuses. Saul then falls on his own sword to take his life. Seeing the king dead inspires the armor bearer to go and do likewise. At this point in the text we would appear to have a double suicide which evokes no particular word of judgement by the author. However, it should be noted that this may be seen by the author as the inevitably pathetic end to tragic life marked by clear instability and the withdrawal of the once bestowed divine charisma.
But the story unexpectedly continues...
As I Kings opens, David is brought news of Saul's death by an Amalekite. On examination, he testifies that Saul met his death through the agency of the witness himself. According to this tradition, regardless of what the armor bearer thought, Saul was not dead after the self inflicted sword wound. The Amalekite tells David that Saul requested to be killed "for anguish is come upon me, because my life is yet whole in me." David has him summarily executed. David points out that the offense is having lifted his hand against the Lord's anointed. Remember that when David himself had the opportunity to end Saul's life while Saul was seeking his own, he refused to do so on the same theological principal.
The judgement against the Amalekite is clear here. However, we must not overlook the secondary agenda on the new king. One would not want to endorse the precedent of slaying the Lord's anointed when one is the newest in the Messianic succession.
JUDAS (Matthew 27:3-5)
Having betrayed Jesus into the hands of hostile religious and civil authorities, Judas repents and tries to return the thirty pieces of silver. He confesses his sin to them and is met with cruel indifference. In desperation he throws down the money and hangs himself tragically alone.
The sin of Judas, the betrayal, is thus unredeemed and unredeemable within the text. Suicide is the poignant punctuation point of judgement upon Judas as it disallows any possibility of redemption within the Gospel narrative. Perhaps that is why his story ends this way.
Measure 16
Proposed by initiative petition voted on at the General Election, November 8, 1994.
QUESTION: Shall law allow terminally ill adult patients voluntary informed choice to obtain physician's prescription for drugs to end life?
SUMMARY: Adopts law. Allows terminally ill adult Oregon residents voluntary informed choice to obtain physician's prescription for drugs to end life. Removes criminal penalties for qualifying physician-assisted suicide. Applies when physicians predict patient's death within 6 months. Requires:
ESTIMATE OF FINANCIAL IMPACT: No financial effect on state or local government expenditures or revenues.
THE OREGON DEATH WITH DIGNITY ACT
SECTION 1 - GENERAL PROVISIONS
1.01 DEFINITIONS - The following words and phrases, whenever used in this
Act, shall have the following meanings:
(1)"Adult" means an individual who is 18 years of age or older.
(2)"Attending physician" means the physician who has primary responsibility for the care of the patient and treatment of the patient's terminal disease.
(3)"Consulting physician" means a physician who is qualified by specialty or experience to make a professional diagnosis and prognosis regarding the patient's disease.
(4)"Counseling" means a consultation between a state licensed psychiatrist or psychologist and a patient for the purpose of determining whether the patient is suffering from a psychiatric or psychological disorder, or depression causing impaired judgment.
(5)"Health care provider" means a person licensed, certified, or otherwise authorized or permitted by the law of this State to administer health care in the ordinary course of\business or practice of a profession, and includes a health care facility.
(6)"Incapable" means that in the opinion of a court or in the opinion of the patient's attending physician or consulting physician, a patient lacks the ability to make and communicate health care decisions to health care providers, including communication through persons familiar with the patient's manner of communicating if those persons are available. Capable means not incapable.
(7)"Informed decision" means a decision by a qualified patient, to request and obtain a prescription to end his or her life in a humane and dignified manner, that is based on an appreciation of the relevant facts and after being fully informed by the attending physician of:
(8)"Medically confirmed" means the medical opinion of the attending physician has been confirmed by a consulting physician who has examined the patient and the patient's relevant medical records.
(9)"Patient" means a person who is under the care of a physician.
(10)"Physician" means a doctor of medicine or osteopathy licensed to practice medicine by the Board of Medical Examiners for the State of Oregon.
(11)"Qualified patient" means a capable adult who is a resident of Oregon and has satisfied the requirements of this Act in order to obtain a prescription for medication to end his or her life in a humane and dignified manner.
(12)"Terminal disease" means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within six (6) months.
SECTION 2
WRITTEN REQUEST FOR MEDICATION TO END ONE'S LIFE IN A HUMANE AND DIGNIFIED
MANNER
2.01 WHO MAY INITIATE A WRITTEN REQUEST FOR MEDICATION An adult who is capable, is a resident of Oregon, and has been determined by the attending physician and consulting physician to be suffering from a terminal disease, and who has voluntarily expressed his or her wish to die, may make a written request for medication for the purpose of ending his or her life in a humane and dignified manner in accordance with this Act.
2.02 FORM OF THE WRITTEN REQUEST
(1) A valid request for medication under this Act shall be in substantially the form described in Section 6 of this Act, signed and dated by the patient and witnessed by at least two individuals who, in the presence of the patient, attest that to the best of their knowledge and belief the patient is capable, acting voluntarily, and is not being coerced to sign the request.
(2) One of the witnesses shall be a person who is not:
(3) The patient's attending physician at the time the request is signed shall not be a witness.
(4) If the patient is a patient in a long term care facility at the time the written request is made, one of the witnesses shall be an individual designated by the facility and having the qualifications specified by the Department of Human Resources by rule.
SECTION 3 - SAFEGUARDS
3.01 ATTENDING PHYSICIAN RESPONSIBILITIES The attending physician shall:
(1) Make the initial determination of whether a patient has a terminal disease, is capable, and has made the request voluntarily;
(2) Inform the patient of:
(3) Refer the patient to a consulting physician for medical confirmation of the diagnosis, and for a determination that the patient is capable and acting voluntarily;
(4) Refer the patient for counseling if appropriate pursuant to Section 3.03;
(5) Request that the patient notify next of kin;
(6) Inform the patient that he or she has an opportunity to rescind the request at any time and in any manner, and offer the patient an opportunity to rescind at the end of the 15 day waiting period pursuant to Section 3.06;
(7) Verify, immediately prior to writing the prescription for medication under this Act, that the patient is making an informed decision:
(8) Fulfill the medical record documentation requirements of Section 3.09;
(9) Ensure that all appropriate steps are carried out in accordance with this Act prior to writing a prescription for medication to enable a qualified patient to end his or her life in a humane and dignified manner.
3.02 CONSULTING PHYSICIAN CONFIRMATION Before a patient is qualified under this Act, a consulting physician shall examine the patient and his or her relevant medical records and confirm, in writing, the attending physician's diagnosis that the patient is suffering from a terminal disease, and verify that the patient is capable, is acting voluntarily and has made an informed decision.
3.03 COUNSELING REFERRAL If in the opinion of the attending physician or the consulting physician a patient may be suffering from a psychiatric or psychological disorder, or depression causing impaired judgment, either physician shall refer the patient for counseling. No medication to end a patient's life in a humane and dignified manner shall be prescribed until the person performing the counseling determines that the patient is not suffering from a psychiatric or psychological disorder, or depression causing impaired judgment.
3.04 INFORMED DECISION No person shall receive a prescription for medication to end his or her life in a humane and dignified manner unless he or she has made an informed decision as defined in Section 1.01(7). Immediately prior to writing a prescription for medication under this Act, the attending physician shall verify that the patient is making an informed decision.
3.05 FAMILY NOTIFICATION The attending physician shall ask the patient to notify next of kin of his or her request for medication pursuant to this Act. A patient who declines or is unable to notify next of kin shall not have his or her request denied for that reason.
3.06 WRITTEN AND ORAL REQUESTS In order to receive a prescription for medication to end his or her life in a humane and dignified manner, a qualified patient shall have made an oral request and a written request, and reiterate the oral request to his or her attending physician no less than fifteen (15) days after making the initial oral request. At the time the qualified patient makes his or her second oral request, the attending physician shall offer the patient an opportunity to rescind the request.
3.07 RIGHT TO RESCIND REQUEST A patient may rescind his or her request at any time and in any manner without regard to his or her mental state. No prescription for medication under this Act may be written without the attending physician offering the qualified patient an opportunity to rescind the request.
3.08 WAITING PERIODS No less than fifteen (15) days shall elapse between the patient's initial oral request and the writing of a prescription under this Act. No less than 48 hours shall elapse between the patient's written request and the writing of a prescription under this Act.
3.09 MEDICAL RECORD DOCUMENTATION REQUIREMENTS The following shall be documented or filed in the patient's medical record:
3.10 RESIDENCY REQUIREMENT Only requests made by Oregon residents, under this Act, shall be granted.
3.11 REPORTING REQUIREMENTS
(1) The Health Division shall annually review a sample of records maintained pursuant to this Act.
(2) The Health Division shall make rules to facilitate the collection of information regarding compliance with this Act. The information collected shall not be a public record and may not be made available for inspection by the public.
(3) The Health Division shall generate and make available to the public an annual statistical report of information collected under Section 3.11(2) of this Act.
3.12 EFFECT ON CONSTRUCTION OF WILLS, CONTRACTS AND STATUTES
(1) No provision in a contract, will or other agreement, whether written or oral, to the extent the provision would affect whether a person may make or rescind a request for medication to end his or her life in a humane and dignified manner, shall be valid.
(2) No obligation owing under any currently existing contract shall be conditioned or affected by the making or rescinding of a request, by a person, for medication to end his or her life in a humane and dignified manner.
3.13 INSURANCE OR ANNUITY POLICIES The sale, procurement, or issuance of any life, health, or accident insurance or annuity policy or the rate charged for any policy shall not be conditioned upon or affected by the making or rescinding of a request, by a person, for medication to end his or her life in a humane and dignified manner. Neither shall a qualified patient's act of ingesting medication to end his or her life in a humane and dignified manner have an effect upon a life, health, or accident insurance or annuity policy.
3.14 CONSTRUCTION OF ACT Nothing in this Act shall be construed to authorize a physician or any other person to end a patient's life by lethal injection, mercy killing or active euthanasia. Actions taken in accordance with this Act shall not, for any purpose, constitute suicide, assisted suicide, mercy killing or homicide, under the law.
SECTION 4 IMMUNITIES AND LIABILITIES
4.01 IMMUNITIES Except as provided in Section 4.02:
(1) No person shall be subject to civil or criminal liability or professional disciplinary action for participating in good faith compliance with this Act. This includes being present when a qualified patient takes the prescribed medication to end his or her life in a humane and dignified manner.
(2) No professional organization or association, or health care provider, may subject a person to censure, discipline, suspension, loss of license, loss of privileges, loss of membership or other penalty for participating or refusing to participate in good faith compliance with this Act.
(3) No request by a patient for or provision by an attending physician of medication in good faith compliance with the provisions of this Act shall constitute neglect for any purpose of law or provide the sole basis for the appointment of a guardian or conservator.
(4) No health care provider shall be under any duty, whether by contract, by statute or by any other legal requirement to participate in the provision to a qualified patient of medication to end his or her life in a humane and dignified manner. If a health care provider is unable or unwilling to carry out a patient's request under this Act, and the patient transfers his or her care to a new health care provider, the prior health care provider shall transfer, upon request, a copy of the patient's relevant medical records to the new health care provider.
4.02 LIABILITIES
(1) A person who without authorization of the patient willfully alters or forges a request for medication or conceals or destroys a rescission of that request with the intent or effect of causing the patient's death sh= all be guilty of a Class A felony.
(2) A person who coerces or exerts undue influence on a patient to request medication for the purpose of ending the patient's life, or to destroy a rescission of such a request, shall be guilty of a Class A felony.
(3) Nothing in this Act limits further liability for civil damages resulting from other negligent conduct or intentional misconduct by any person.
(4) The penalties in this Act do not preclude criminal penalties applicable under other law for conduct which is inconsistent with the provisions of this Act.
SECTION 5 SEVERABILITY
5.01 SEVERABILITY Any section of this Act being held invalid as to any person or circumstance shall not affect the application of any other section of this Act which can be given full effect without the invalid section or application.
SECTION 6 FORM OF THE REQUEST
6.01 FORM OF THE REQUEST A request for a medication as authorized by this act shall be in substantially the following form:
REQUEST FOR MEDICATION TO END MY LIFE IN A HUMANE AND DIGNIFIED MANNER
I, _________________________, am an adult of sound mind.
I am suffering from ______________________________, which my attending physician has determined is a terminal disease and which has been medically confirmed by a consulting physician. I have been fully informed of my diagnosis, prognosis, the nature of medication to be prescribed and potential associated risks, the expected result, and the feasible alternatives, including comfort care, hospice care and pain control.
I request that my attending physician prescribe medication that will end my life in a humane and dignified manner.
INITIAL ONE:
_____I have informed my family of my decision and taken their opinions into consideration.
_____I have decided not to inform my family of my decision.
_____I have no family to inform of my decision.
I understand that I have the right to rescind this request at any time.
I understand the full import of this request and I expect to die when I take the medication to be prescribed. I make this request voluntarily and without reservation, and I accept full moral responsibility for my actions.
Signed: ________________________
Dated: _________________________
DECLARATION OF WITNESSES
We declare that the person signing this request:
(a) Is personally known to us or has provided proof of identity;
(b) Signed this request in our presence;
(c) Appears to be of sound mind and not under duress, fraud or undue influence;
(d) Is not a patient for whom either of us is attending physician.
_______________________________________Witness 1/Date
_______________________________________Witness 2/Date
NOTE: One witness shall not be a relative (by blood, marriage or adoption) of the person signing this request, shall not be entitled to any portion of the person's estate upon death and shall not own, operate or be employed at a health care facility where the person is a patient or resident. If the patient is an inpatient at a health care facility, one of the witnesses shall be an individual designated by the facility.
EXPLANATORY STATEMENT
This measure would allow an informed and capable adult resident of Oregon, who is terminally ill and within six months of death, to voluntarily request a prescription for medication to take his or her life. The measure allows a physician to prescribe a lethal dose of medication when conditions of the measure are met. The physician and others may be present if the medication is taken.
The process begins when the patient makes the request of his or her physician, who shall:
A consulting physician, who is qualified by specialty or experience, must confirm the diagnosis and determine that the patient is capable and acting voluntarily.
If either physician believes that the patient might be suffering from a psychiatric or psychological disorder, or from depression causing impaired judgment, the physician must refer the patient to a licensed psychiatrist or psychologist for counseling. The psychiatrist or psychologist must determine that the patient does not suffer from such a disorder before medication may be prescribed.
The measure requires two oral and one written requests. The written request requires two witnesses attesting that the patient is acting voluntarily. At least one witness must not be a relative or heir of the patient.
At least fifteen days must pass from the time of the initial oral request and 48 hours must pass from the time of the written request before the prescription may be written.
Before writing the prescription, the attending physician must again verify the patient is making a voluntary and informed request, and offer the patient the opportunity to rescind the request.
Additional provisions of the measure are:
This measure does not authorize lethal injection, mercy killing or active euthanasia. Actions taken in accordance with this measure shall not constitute suicide, assisted suicide, mercy killing or homicide, under the law.
Anyone coercing or exerting undue influence on a patient to request medication, or altering or forging a request for medication, is guilty of a Class A felony.
COMMITTEE MEMBERS: APPOINTED BY: Barbara Coombs Lee Chief Petitioners Eli Stutsman Chief Petitioners Pat McCormick* Secretary of State William E. Petty, M.D.* Secretary of State Mitzi Naucler Members of the Committee * Member dissents (does not concur with explanatory statement)
(This committee was appointed to provide an impartial explanation of the ballot measure pursuant to ORS 251.215.)
Appendix 3 - Bibliography
Ahronheim, George; Weber, Doron, Final Passages: Positive Choices for the Dying & Their Loved Ones, (S&S Trade, 1992)
AIDS Alert, "AIDS caregivers struggling with assisted suicide: new Oregon law already being challenged. (includes related information)", (AIDS Alert v10 n1 p12(3), Jan, 1995)
Aly, Gotz; Chroust, Peter; Pross, Christian; Cooper, Belinda- Translator; Kater, Michael H.-Frwd., Cleansing the Fatherland: Nazi Medicine & Racial Hygiene, (Johns Hopkins, 1994)
Baird, Robert; Rosenbaum, Stuart E., Euthanasia (Buffalo: Promethus Books)
Bakan, David, Disease, Pain & Sacrifice: Toward a Psychology of Suffering (Beacon Press. 1971)
Battin, M. Pabst, Ethical Issues in Suicide, (Englewood Cliffs: Prentice Hall, 1982)
Betzold, Michael, Appointment with Doctor Death, (Momentum Bks, 1993)
Burt, Robert A., "Lethal measures; Oregon's suicide law carries privacy principle too far.", (Los Angeles Daily Journal, Los Angeles Daily Journal v107 n235 col 2 p6)
Cain, Brad, "Judge asked to lift order banning assisted suicide. (Oregon)", (Chicago Daily Law Bulletin v140 n247 col 2 p1, Dec 19, 1994)
Callahan, Daniel, Setting Limits: Medical Goals in an Aging Society, (S&S Trade, 1987)
Catholic Health, Euthanasia & Assisted Suicide: Positioning the Debate, (Catholic Health, )
Cina, Stephen J.; Raso, Dominic S.; Conradi, Sandra E., "Suicidal cyanide ingestion as detailed in 'Final Exit.' ('Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying')", (Journal of Forensic Sciences 39 n6 1568-1570, Nov, 1994)
Cundiff, David, Euthanasia Is Not the Answer: A Hospice Physician's View, (Humana, 1992)
Dority, Barbara, "A quantum leap for the right to die. (passage of Oregon Death with Dignity Act) (Column)", (Humanist v55 n1 p32(2), Jan-Feb, 1995)
Gianelli, Diane M., "Oregon doctors fear fallout from assisted suicide.", (American Medical News v38 n4 p1(3), Jan 23, 1995)
Gibeau, Dawn, "Ethicists alarmed at Oregon law: growth of assisted-suicide efforts feared.(1994 Oregon Ballot Measure 16)", (National Catholic Reporter v31 n6 p5(1), Dec 2, 1994)
Grief, Judith; Golden, Beth A., AIDS Care at Home: A Guide for Patients, Caregivers, & Loved Ones & People with AIDS, (Wiley, 1994)
Gomez, Carlos F., Regulating Death, Active Euthanasia, Religion and the Public Debate, (New York: Free Press, 1991)
Hamel, Ron, Choosing Death, Active Euthanasia, Religion and the Public Debate, (Philadelphia: Trinity Press, 1991)
Hardigg, Viva, "An Oregon doctor weighs life and death. (Mark Rarick)", (U.S. News & World Report v117 n24 p37(1), Dec 19, 1994)
Holt, Cody, "Suicide: to aid, or not to aid. (Oregon's law on physician-assisted suicide)", (American Druggist v211 n2 p10(1), Dec, 1994)
Humphry, Derek, Final Exit: The Practicalities of Self-Deliverance & Assisted Suicide for the Dying, (Hemlock Society, 1991)
Johnston, Brian P., Death As a Salesman: What's Wrong with Assisted Suicide, (New Regency, 1994)
Katz, Ian, "Death wish. (Oregon, US, Death With Dignity Act)", (Guardian p2.2(2), Dec 6, 1994)
Kaufman, Deborah, "Options beyond assisted suicides. (response to Dec. 12, 1994 Christian Science Monitor article on Oregon's passage of assisted-suicide law)", (Christian Science Monitor v87 n38 col 3 p20, Jan 20, 1995)
Kellner, Mark A., "Christians use courts to fight assisted-suicide measure. (Oregon)", (Christianity Today v39 n1 p54(2) , Jan 9, 1995)
Kevorkian, Jack, Prescription Medicide: The Goodness of Planned Death, (Prometheus Bks, 1991)
Lester, David-Editor; Tallmer, Margot-Editor, Now I Lay Me Down: Suicide & the Elderly, (Charles, 1994)
Los Angeles Times, "Assisted suicide ban held constitutional. (in Michigan)", (Los Angeles Times v114 col 4 pA21, Dec 14, 1994)
Los Angeles Daily Journal, "On legal suicide ... a bold initiative. (from the Sacramento Bee) (Editorial)", (Los Angeles Daily Journal v107 n239 col 1 p6, Dec 13, 1994)
Los Angeles Daily Journal, "A vote for death. (On Legal Suicide) (from the Indianapolis Star) (Oregon) (Editorial)", (Los Angeles Daily Journal v107 n239 col 1 p6, Dec 13, 1994)
Los Angeles Daily Journal, "On federal rulings ... fatal inconsistency. (from the Tacoma, Wash. News Tribune) (Editorial)", (Los Angeles Daily Journal v108 n7 col 1 p6, Jan 11, 1995)
Malcolm, Andrew H., Someday -- The Story of a Mother and Her Son, (New York: Alfred A. Knopf, 1991)
Marker, Rita, Deadly Compassion: The Death of Ann Humphry & the Truth about Euthanasia, (Morrow, 1993)
McCuen, Gary E.-Editor, Doctor Assisted Suicide: And the Euthanasia Movement, (Ideas in Conflict Ser. G E M, 1994)
McWilliams, Peter, What Jesus & the Bible Really Said about Drugs, Sex, Gays, Gambling, Prostitution, Alternative Healing, Assisted Suicide, & Other Consensual "Sins", (Prelude Press, 1994)
Melton, John Gordon, The Church Speaks Out on Euthanasia, (Detroit: Gale Research, 1991).
Morse, Christopher, Not Every Spirit, (Trinity Press, 1994)
New York Times , "Assisted-suicide ban upheld in New York. (three terminally ill people, who have since died, lose challenge to New York State assisted suicide law)", (New York Times v144 col 5 pB8(L), Dec 16, 1994)
NYS Task Force on Life & the Law Staff, When Death Is Sought: Assisted Suicide & Euthanasia in the Medical Context, (NYS Task Force, 1994)
Pines, Deborah, "Ban on physician-assisted suicide upheld: no fundamental right under Constitution.", (New York Law Journal v212 n116 col3 p1, Dec 16, 1994)
Rauscher, William V., The Case Against Suicide, (New York: St. Martin's Press, 1989)
Shannon, Thomas A.; Walter, James J.-Editor, Quality of Life: The New Medical Dilemma, (Paulist Pr, 1991)
Skolnick, Andrew A., "Topics go from aiding suicide to reporting news as bioethics groups hold first 'mega-meeting.' (American Society of Law, Medicine & Ethics; Society for Health and Human Values; Society for Bioethics Consultation; American Association of Bioethics) (Medical News & Perspectives)", (JAMA, The Journal of the American Medical Association v272 n21 p1642(2), Dec 7, 1994)
Sulmasy, Daniel P., "Managed care and managed death.", (Archives of Internal Medicine v155 n2 p133(4), Jan 23, 1995)
Weg, John G., "To live, to keep alive, to let die. (Editorial)", (Chest v106 n6 p1646(3), Dec, 1994)
Wennberg, Robert N., Terminal Choices, Euthanasia, Suicide, and the Right to Die, (Grand Rapids: Wm. B. Eerdmanns Publishing, 1989)
Young, Ernle W., Alpha & Omega: Ethics at the Frontiers of Life & Death, (Addison-Wesley, 1989)
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