Assisted Suicide

The ODDA was drafted by attorneys in consultation with interested health care professionals and became effective on October 27, 1997, after three years of failed court challenges and an unsuccessful repeal effort. While these challenges were pending, the Oregon Health Division-the agency charged with overseeing and regulating ODDA practices-produced a list of requirements for physicians to follow in implementing the act (Oregon Health Division 1997:1). According to the Oregon Health Division, the attending physician has the following responsibilities (Oregon Health Division 1997:1):

1. to determine whether the patient has a terminal illness, is capable, and has made the request voluntarily;

2. to inform the patient of his/her diagnosis and prognosis, the risks and probable result of taking the prescribed medication, and the feasible alternatives including comfort care and pain control;

3. to refer the patient to a consulting physician for confirmation of the diagnosis and determination that the patient is capable and acting voluntarily;

4. to refer the patient for counseling if, in the opinion of either the attending physician or the consulting physician, the patient may be suffering from any mental disorder, including depression, causing impaired judgment;

5. to request that the patient notify next of kin (the patient does not have to comply); and

6. to offer the patient the opportunity to rescind the request at any time.

The division also produced detailed confidential report forms and a protocol for interviewing physicians who prescribe medicine under the provisions of the new law. These epidemiological data provided profiles of patients who received prescriptions, patients who actually used the prescriptions to end their lives, and the physicians involved and circumstances surrounding these events.

The fifteen reported deaths consummated eight years of tense political struggle over the expansion of patients' rights to control the time, place, and manner of death. The efforts included ballot measures in three states besides Oregon-Washington (1991), California (1992), and Michigan (1998)-and two cases decided by the United States Supreme Court-Washington v. Glucksberg (Compassion IV 1997) and Vacco v. Quill (Quill III 1997).

The Netherlands has been the leading country in this approach toward the law and dying. The Dutch devised and overseen the evolution of a policy of nonprosecution of voluntary euthanasia within guidelines established by the legal system, the political parties, and the medical profession. However, the Dutch maintained their criminal statutes in this area (Griffiths et al. 1998; Legemaate 1995). Only in 2000 have the Dutch passed laws to fully legalize their twenty-five-year experience with euthanasia ("Dutch Take Step" 2000). Australia (Brough 1997), Colombia, and Switzerland (Associated Press 1999b) have instituted various decriminalization schemes, but Australia's was rescinded, Colombia's is not yet fully operational, and Switzerland's resembles the Dutch in a policy of nonprosecution. Thus Oregon is the first entity in the world to implement a regulatory regime for legalized physician-assisted suicide.

But Oregon does not stand alone in death with dignity reform efforts. Reformers in Washington and California attempted ballot initiatives several years before 1994 (and reformers in Michigan and Maine have failed since 1994). And while court challenges and a repeal effort blocked implementation of the ODDA , two court challenges moved through the federal courts and were finally decided by the U.S. Supreme Court.