10 GET DRUGS UNDER OREGON SUICIDE LAW

* The state's first report on the effects of legalizing assisted suicide
finds eight of the patients used the drugs to die

Ten Oregonians -- five men and five women -- have obtained lethal
prescriptions since the state's physician-assisted suicide law went into
effect nearly 10 months ago. Eight used the medication to die. The other
two died of their illnesses, the Oregon Health Division reported Tuesday.

The Health Division's much-anticipated report is the first official public
accounting of what the practice of assisted suicide looks like in Oregon,
the only state in which it is legal. Still, medical leaders urged caution
about drawing too many conclusions from such a small sample.

In order to protect the confidentiality of individual patients, the Health
Division waited until it had a "critical mass" of assisted suicide cases.
But the state agency, charged with collecting information on compliance
with the law, decided not to wait until 10 people had actually used the
prescriptions to die.

"There are people who get these prescriptions and don't use them," said Dr.
Katrina Hedberg, deputy state epidemiologist with the Health Division.
"That's why we wanted to release the information this way. Not everyone who
is getting these prescriptions actually takes the medication."

Nine primary physicians wrote the prescriptions for the 10 patients, the
report said. That fact appears to contradict predictions by opponents that
one or two physicians would become "death doctors," Hedberg noted.

All patients received medical evaluations by a second doctor to confirm a
terminal illness prognosis and all complied with a mandated 15-day waiting
period between first and second requests for a lethal prescription, the
report said.

Five of the deaths were in the Portland area, Hedberg said, with the other
five spread throughout the state. Of the 10 who died, all were Oregon
residents; their average age was 71. One had heart disease; the others had
cancer.

Of those taking lethal medications, the number of days between getting the
prescription and death ranged from the same day to 16 days, for an average
of two days. The two patients who obtained a prescription but didn't use it
died of their illnesses an average of 10.5 days after the prescription was
written.

Dr. Nancy Crumpacker, a Tualatin oncologist, said she thinks two of her
cancer patients were included in the report as the two who died before
using the medication. She said a Health Division official interviewed her
about both cases after the patients died from their illnesses.

Crumpacker said the pain of both patients was well controlled. She said one
of the patients, a woman, wanted the prescription as a way out if she
became ill enough to have to go to a nursing home. The woman had hospice
care and never decided to use the drugs. The woman was referred to
Crumpacker for evaluation to obtain a lethal prescription. The other
patient, a man, told Crumpacker he would use the prescription rather than
going back into the hospital, where he felt he would be unable to enjoy his
family. The man was Crumpacker's patient for 1BD years.

A hot-button issue among opponents during the campaign to repeal the
assisted suicide law last fall was the notion that some patients would die
lingering, painful deaths and might vomit the medication.

Hedberg said that of the eight deaths by lethal medication, none reportedly
suffered complications. It took patients an average of 40 minutes to die.
In one exceptional case, it took seven hours. However, that patient was
unconscious and "in no pain or distress or anything like that," Hedberg
said. All of the patients fell unconscious within 20 minutes of taking the
medication, she said, with an average lapse of five minutes.

Hedberg said relatively few people appear to be using assisted suicide. By
point of comparison, in a comparable nine-month period in 1996, the most
recent year for which firm figures are available, 20,931 people died from a
variety of causes in Oregon, 5,706 of them from heart disease and 5,104
from cancer.

To comply with the Oregon law, a doctor must submit forms to the Health
Division indicating that each of the law's safeguards has been met and that
the prescription was written. The Health Division then matches death
certificates with the paperwork. If the death certificate does not clarify
whether the patient used a prescription to die, the Health Division calls
the doctor to check.

If the Health Division hears of assisted suicide cases that have not been
reported, officials attempt to follow up with doctors. The state Board of
Medical Examiners would investigate complaints of doctors who might not
have followed the law. So far, no doctors have been disciplined for
noncompliance.

Hedberg said that in their paperwork and in interviews she and a Health
Division colleague completed with some of the physicians, she has found
that doctors have been cautious and detailed in their approach to patients
using the law.

The Health Division is conducting in-depth interviews with doctors of
patients who have obtained lethal prescriptions under the law. A report of
all 1998 assisted suicide deaths, to be released in early 1999, will
include a summary of the interviews.

Dr. Patrick Dunn, chairman of the Task Force to Improve the Care of
Terminally-Ill Oregonians, which wrote an ethics guide to the law, said,
"The numbers of patients and physicians who are participating would appear
to be relatively low."

He cautioned: "This should be viewed as very early, that we need to be very
cautious, that we need to try to understand what it is that drives patients
to this decision-making. Is it because of inherent values or are there
unmet needs?"

Arthur Caplan, director of the Center for Bioethics at the University of
Pennsylvania, said he was "shocked" that it took so long for 10 people to
use the law. "I would have thought many more would pursue this option. It's
fascinating. It does not represent a groundswell of people rushing to
physician-assisted suicide."

Caplan, a nationally known ethicist, said he thinks the relatively small
number of deaths indicates that there have been improvements in end-of-life
care in Oregon.

He said he thinks the Health Division could reveal more information without
jeopardizing patient privacy.

"I understand the concern about privacy and I respect it," he said. "No one
has to make their dying into a case study for policy examination." However,
he said, the information released by the Health Division raises as many
questions as it answers.

The ethicist said he would like information to include, for example:

* Discussions between doctors and patients, what kinds of medical
alternatives were offered, who else was present during discussions, whether
spiritual advisers were involved.

* Confirmation of the patient's terminal illness, whether it was confirmed
after death by an autopsy and, in cases of cancer, what kind of cancer was
involved.

* Whether patients had spouses, friends or other emotional support.

Assisted suicide opponents expressed sadness and skepticism about the
Health Division's report.

"Today's news confirms the tragic path on which the practice of medicine
and the doctor-patient relationship is headed in Oregon and the United
States," said the Oregon Catholic Conference, calling assisted suicide a
"violation of medical ethics."

The conference called on doctors "to reassert their commitment to
compassionate care through a ministry of comfort care including pain
control, hospice care, spiritual and supportive care of the dying and their
loved ones."

Dr. Gregory Hamilton, president of Physicians for Compassionate Care, said
the information the state collects doesn't protect patients because it is
"what the doctors involved chose to report, and there is no punishment or
fine for doctors who do not report.

"All we can tell from the report . . . is that some individuals are having
their lives devalued and stigmatized by the state of Oregon -with lethal
consequences," Hamilton said.

Supporters of the law called a news conference Tuesday to herald their view
that the report speaks favorably of how assisted suicide is being handled.

"This just verifies how extraordinarily rare it is in Oregon for someone to
assist their death under the Oregon Death With Dignity Act," said Barbara
Coombs Lee, who co-wrote the law and now leads the group Compassion in
Dying. "Now we have some evidence that, in fact, it really is proceeding in
a very conscientious and a very moderated and rational way in Oregon."

Lee said Compassion in Dying assisted two of the eight patients in the
Health Division report who obtained and used lethal drugs to die.
Compassion announced the first case, a woman in her 80s with breast cancer,
publicly in March. The second family requested total privacy.

Lee said her organization has had 200 inquiries about assisted suicide
since the law went into effect, 50 from patients. She said 25 of those
patients were eligible under the law. In addition to the two who used
lethal medication to die, eight of the 25 had either begun or completed the
process to obtain a prescription but died of their illnesses instead.
Fifteen of the patients are in the process of obtaining a prescription.

The Hemlock Society has also worked with patients interested in pursuing
assisted suicide and has acknowledged counseling and finding a doctor for
one patient who completed the act.

In recent weeks, leading Republicans in Congress have sought to prohibit
doctors from prescribing lethal doses of regulated drugs to terminally ill
patients.

In the House, a bill introduced June 5 by Rep. Henry Hyde, R-Ill., has
passed the Judiciary Committee, which Hyde chairs. It could go to the House
floor for a vote after a review by the Commerce Committee that must be
completed by Sept. 18.

In the Senate, a companion bill offered by Assistant Majority Leader Don
Nickles, R-Okla., awaits review by the Judiciary Committee. A vote has not
been scheduled.

In a report accompanying Hyde's bill, the Judiciary Committee instructs the
federal Drug Enforcement Administration to review regularly -- "on at least
a quarterly basis" -- the very reports that the Oregon Health Division used
to release its information Tuesday.

Those records, along with doctors' records, are subject to subpoena and
"will indicate unequivocally" whether a doctor has broken the law by
prescribing controlled substances such as narcotics to assist in a suicide,
the report says.

Once the DEA determines that a doctor participated in a suicide, it could
strip the doctor of privileges to prescribe federally controlled drugs
"without need for further investigation."

The Clinton administration opposes doctor-assisted suicide in principle but
officials have opposed the Hyde and Nickles bills, calling them flawed.

Administration officials also have said the bills would divert the DEA's
attention and sap resources from the agency's primary mission, stopping
illegal trafficking of drugs.

Patrick O'Neill and Jim Barnett of The Oregonian staff contributed to this
report.