Oregon suicides steady, still sharply divisive

E-mail this article Print this article

Peggy Sutherland wasn't thinking about becoming a statistic when she drank a lethal dose of medication prescribed by her doctor in Oregon last year.

As it turned out, Sutherland was among the 21 Oregonians who died in medically assisted suicides in 2001, according to statistics reported last week. At 68, female, white, well-educated, insured and dying of cancer, she closely fit the predominant demographics of those who died.

But unlike most of those Oregonians' relatives, Peggy Sutherland's family is publicly talking about her death, placing a human face on the debate that still swirls around the state's Death With Dignity Act.

In the four years the act has been in effect, 91 people have taken their lives with a doctor's assistance under the law. And as it has become increasingly entrenched in Oregon's medical world, the law is being closely watched by people in other states. In Washington voters turned down an assisted-suicide law in 1991, and the Legislature has since turned a cold shoulder to even milder measures.

In most cases, the events behind the statistics reported each year by Oregon epidemiologists remain elusive, protected by privacy laws, patient-doctor confidentiality and the unwillingness of families' to expose themselves to public rancor.

But when a family reveals details, as Sutherland's has, many of the troublesome issues may come into sharp relief.

To Sutherland's family, her peaceful death amid a loving family, after months of operations, hospitalizations, procedures and distress, was "a gift."

To opponents of medically-assisted suicide, it was a tragedy: She needed help, but instead received a piece of paper — her prescription — confirming her fear that her life simply wasn't worth living.

Support of children, doctors

Julie McMurchie says she can't understand how anyone could think it was wrong for her mother to have taken her life, or for her doctor to have helped her.

Facts about Oregon's assisted suicides • Of the approximately 30,000 Oregonians who died in 2001, 21 used state law to get and take lethal medication. • While the number was down from 27 in 2000, the difference was not significant, said Dr. Katrina Hedberg, deputy state epidemiologist. Since the law went into effect four years ago, the number of people using the law to die has remained relatively constant at one to three per month. • As in other years, most of the 21 had cancer, were better educated than average, and were beyond traditional retirement age (the average was 68 last year, 70 in 2000). Most were hospice patients (76 percent), and all had health insurance. • Sixty-two percent were female, and 95 percent were white. • Forty-four prescriptions for lethal doses of medication were written under the law in 2001, an increase from 39 in 2000. Fourteen died of their underlying illnesses and 11 were alive at the end of 2001. Some of the 21 who died last year got their prescriptions in 2000. • Seventy-six percent received secobarbital and 24 percent received pentobarbital after Eli Lilly stopped producing secobarbital in May 2001. Source: Oregon Department of Human Services, "Fourth Annual Report on Oregon's Death with Dignity Act."

A strong, independent woman who grew up near tradition-bound Philadelphia, Peggy Sutherland loved Oregon at first sight. Oregonians, she believed, were adventurous and innovative people who cherished autonomy.

And that's the way she lived her life. She raised her children to be independent thinkers and created an interesting life of her own, including a weekly bridge game she attended without fail after a divorce six years ago.

First diagnosed with lung cancer in 1986, she battled back before the disease began its fatal course in 2000. In her last year, she underwent three major surgeries, chemotherapy and radiation. The ordeal left Sutherland unable to stand the pain and discomfort despite everything doctors and nurses could do, McMurchie said.

At her Portland home, Sutherland gathered her five children and their spouses around her — four of them physicians — and told them what she wanted to do.

She wanted to die on her own terms.

Sutherland had grown too weak to stand, let alone travel to her beloved Oregon coast, where earlier in her illness she had insisted on going to die. Tumors were blocking her airways, and she faced the possibility of suffocating.

"What kind of death is that?" asked McMurchie.

Oregon law requires a 15-day waiting period to ensure a terminally ill patient is competent to decide to end his or her life.

When the 15th day came, Sutherland roused herself. Clear as a bell and surrounded by family and her longtime doctor, she drank a liquid mixed from drugs legally prescribed by her doctor.

In five minutes, McMurchie said, her mother was asleep. Fifteen minutes later, on Jan. 25, 2001, Peggy Sutherland died, after "looking out over the Willamette River, in a room filled with love," McMurchie and her siblings wrote in a statement supporting the Oregon law.

McMurchie said she knows critics contend that families such as hers are "killing" their relatives instead of offering them needed physical and psychological help.

But not only did Sutherland have pain specialists and cancer experts, one daughter who is a pulmonologist and critical-care specialist also was living with her, McMurchie noted.

"We were doing every possible thing we could do for her — all these children," McMurchie said.

"She was done. Who were we to say no?"

Treat pain, depression

No is exactly what should be said to patients such as Peggy Sutherland, says Dr. Gregory Hamilton, a Portland psychiatrist and assisted-suicide opponent.

Instead of saying, "OK, mom, that's fine, this is your right," families should respond, "I love you, I don't want you to do that. ... We'll take care of the pain and treat the depression," Hamilton said.

Hamilton, a spokesman for Physicians for Compassionate Care, supports U.S. Attorney General John Ashcroft's effort to impose federal penalties, including loss of prescription licenses, on doctors who prescribe any government-controlled medication that patients use to end their lives. The directive is on hold pending resolution of a lawsuit filed by patients, doctors and the state of Oregon against Ashcroft's order.

Hamilton said one of his big fears is that depressed patients will slip through the Oregon law's safeguards. The act, he added, only encourages "doctor shopping."

Primary-care doctors are "notoriously unable to diagnose depression," yet only three patients last year were referred to psychiatrists, Hamilton said.

According to the epidemiologists' report, prescribing doctors said their patients' main concerns were loss of autonomy, decreasing ability to participate in enjoyable activities and losing control of bodily functions. In only one case was "inadequate pain control" reported as a concern.

Hamilton refuses to accept assurances from families that patients who receive help to die aren't depressed.

"We don't have Peggy Sutherland's medical records. ... You probably don't know, if she's been divorced, if she felt abandoned. ... The family can say she wasn't depressed, but that doesn't mean she wasn't."

Respect of privacy

McMurchie bristles at Hamilton's criticisms.

"It's so paternalistic," she says. "They claim that these people are at the end of life, they've reverted to childhood, requiring our decision-making for them."

McMurchie recalled what one of her mother's friends said: "She taught us all so much about dying, because she did it with so much grace and integrity and didn't just fall into despair."

Peggy Sutherland was always open about her life — her disease, her pain, and everything else, McMurchie said.

It's true she and her husband of 40 years had divorced and she was seeing a therapist when she contracted cancer. But her thinking and decision-making were unimpaired, her daughter said.

"We would be happy for (Hamilton) to scrutinize any of my mother's medical records," McMurchie said. "He's trying to pretend we're being secretive when we're not."

But McMurchie said she would never require others in her mother's situation to reveal their records.

"They're dying. It's not about politics and making a big public statement. That's the whole point: it's a very personal decision."

Carol M. Ostrom can be reached at 206-464-2249 or costrom@seattletimes.com.