Flaws in the Oregon model for Assisted Suicide

Our duty of care Webinar September 8 2025

The ‘Assisted Dying’ Bill is coming before the House of Lords on September 12 and 19 for its second reading. Over 200 Lords want to speak and thus it has been extended to two sessions.

Dr Mark Konrad, a psychiatrist in the USA spoke of the many flaws in the “Oregon model”

Psychiatrists will have to add suicide ‘assistance’ to their long held role of suicide prevention.

In the UK suicide prevention day is 10.9.25.

Assisted suicide is so called because the person has to self-administer a cocktail of drugs. Some 100 pills taken unsupervised/ witnessed or unwitnessed over 1-2 hours.

There must be no coercion but this is not monitored and is probably impossible to assess.

The American Medical Association has had several debates on terminology but as yet continues to use Assisted Suicide rather than Assisted Dying.

Euthanasia is when a lethal cocktail of drugs is quickly administered intravenously. This is the preferred method of those wishing for termination of life.

Luxembourg, Belgium, the Netherlands and Canada use euthanasia almost exclusively

The USA only allows assisted suicide. It takes place in 13 state jurisdictions. Oregon and California are pressing for euthanasia.

There is always an inevitable expansion of what is on offer.

All are ‘off book’ – unregulated experiments of what will kill most efficiently

In ‘1984’ George Orwell wrote that if thought can corrupt language, then language can corrupt thoughts.

The definition of suicide: Death caused by self-directed behaviour with the intention to die.

UK 2017: Assisted suicide should not be called by that name – use assisted dying.

We now have:

1. Suicide as a pathology
2. De-pathologised suicide – provide not prevent.

Hippocrates differed from other philosophies of his time. His number 1 priority was no poisons.

(Pathological) Suicide in Oregon has increased following the removal of the taboo on assisted suicide

What must be considered is the Moral Injury to doctors who normally seek to prevent suicide now being expected to provide it. Suicide and assisted suicide are indistinguishable

People argue that ‘things are okay in Oregon’. But are they?

How does it work in Oregon? They were the first in 1998.

The patient must be

1. Terminally ill. This is vaguely defined as death expected within 6 months. It is not stated whether this will happen with or without treatment.
2. Have the capacity to make a decision. This is controversial
3. Not be being coerced. There is no statutory definition of this.

The decision must be voluntary and a second request made after 15 days. The 15 day wait has not been a requirement since 2023. If the expected life span is less than 15 days the second request can be made at any time, even on the same day.

Concerns about the Oregon model.

The state is not scrupulous about this. There are flaws.

• No witnesses are required. No one sees whether it is carried out. Only 2/3 of prescripted drugs are used.
• No way to distinguish between ‘Grandma can we help you’ and "Grandma, you promised you would do this ( to save money). There is no statutory definition of coercion and no physician is able to decide if coercion is present.
• No mandatory health assessment. If a physician thinks there is a mental health issue they can consult a psychiatrist. In Oregon you can refuse a treatment which might forestall death.
• In the late 90's 33% were referred for mental health assessment. In 2024 less than 1% were so referred
• This is a subspecialty in psychiatry. “After 35 years experience I do not feel qualified to assess capacity.” The usual guidance is a 9 page long assessment. In Oregon there is one question. “In your opinion is this patient able to follow medical information and communicate health care decisions or does a family member know the meaning of the patient’s gestures?”
• There is no input about palliative care
• There is no minimal length for the relationship between the doctor and the patient. So there is a lot of ‘doctor shopping’.

In 2022 2% of doctors (142), wrote ‘assisted dying’ prescriptions. Most wrote 1 or 2

4 doctors wrote 33% of the prescriptions

1 doctor wrote 57% of the prescriptions

“Everybody likes hamburgers. No one wants to kill the cow”

• There is no tracking of the medicines. One third are unused. There is no call back on the drugs.
• Expansions in Oregon: 2022 removed the residency requirement. Anyone can avail themselves of assisted dying. 2023 reduced the 15 day waiting period. Prescriptions can be given by ‘telehealth’ over the phone. This can also be done for remote areas in Scotland. Moral injury: it is less morally injurious to do it over a computer than face to face. Anything that makes it easier makes it easier.

Major lessons from the USA

It always starts with the low hanging fruit – the presentation of the worst cases.

People fear loss of autonomy, being a burden on the family, the ongoing cost. Only 10% cite “terrible pain”.

It is impossible to stop the movement going for the higher fruit. Arguing for fairness, justice and parity.

Pain is expanded to include psychological pain – e.g ‘terminal anorexia’

Parity: why are you leaving me out?

The accelerating push affects residency, the length of the doctor patient relationship, the level of medical expertise required.

The proponents of these laws are always very highly focused and singular in their mission. They are well funded and endorsed by celebrities

The opponents are fragmented from different groupings: the religious, campaigners for disability rights

Medical societies start by opposing. Then advocates convince them to go neutral.

Polls are held which are not answered by 2/3 the membership. So 51% of 33% of the members are found to be in favour. That is 16% of the membership. The leadership may also be zealous proponents. So the Royal College of Physicians changed the rules by which decisions were made.

Cost savings. Money is the driver. Insurance companies give approval for paying for the drugs but not for other procedures. Cost effectiveness is the driver, not ethical or good public policy.

Advice

There is power in numbers and in a collective voice.

Become involved in the leadership of societies

Speak with a collective voice

Arguments

Because society says ‘jump’ we do not have to ask ‘how high?’

Just because something is legal does not make it ethical

Slavery used to be legal

In Nazi Germany it was illegal to hide Jews from the Nazis.

Do not be swept along by what society wants

We should not always give the patient what they want

Aiding and abetting suicide is never clinically required. It is all suicide.

True conscientious objection is not even to facilitate a referral to someone who will ‘do it’. You are still part of a chain of referral.

State of the art palliative care is well-developed but not available as widely as it should be

“When it appears that there is nothing more to be done, there is much left to do”. Cicely Saunders.

Patient autonomy? Is a misnomer. It is the individual doctor who has to decide whether the patient’s illness is terminal and whether they have the capacity. It is very easy to feel that ‘my discomfort with your condition’ equals your right to end your life. It is NOT the patient’s decision, it is the doctor’s. The doctors are the gatekeepers.

Note that in psychiatry overriding a patient’s autonomy is regarded as reasonable.

Baroness Meacher in the Lords spoke of how awful it must be to be doubly incontinent. She was rebutted by Baroness Tanni Grey Thompson who said she herself was doubly incontinent and lived with it. “You are projecting what you think about my quality of life”.

Train MPs to write the prescriptions for life-ending drugs. Let them do the deed. This is not health care treatment. Get it out of the ‘House of Medicine’. It is changing a tragedy and a taboo into a ‘good’.

In Canada there are MAID houses where people go to ‘celebrate’ the ending of a life in this way. This is one step from a duty to do it. An opportunity becomes a duty. It is celebrated as an opportunity for organ donation.