First, my position is that I support physician-assisted suicide as an option. I think that if it is what the patient truly wants after rational contemplation, not just an acute moment of despair, euthanasia should be granted.

However, Oregon’s Death with Dignity Act has many flaws, and does not ensure quality end-of-life care for patients.

One problem is the insufficient collection of reports and transparency.

The data collected is limited to epidemiological data and basic information from the prescribing physician. No interviews are conducted with the doctors who declined from prescribing PAS or from the nurses, social workers, and family members/caregivers involved in the patient’s care.

Thus, Oregon’s reports must draw conclusions from this limited data. There is lack of transparency with no public record and the Death with Dignity Act does not allow any independent researcher to analyze the reports.

If two or more physicians disagree on the use of euthanasia, there is no standing process or medical review to resolve the discrepancies between the doctors. In Oregon, the opinions of the dissenting doctors are often discarded.

A thorough inquiry and the addressing of the patient’s physical, psychological, and social issues may lead to relief of the patient’s suffering, and many of them may changing their minds.

In a study by the Oregon Health and Science University, among the patients who received significant palliative care interventions, 46% changed their minds, whereas only 15% of those who did not receive these alternative interventions changed their minds.

In Oregon, it is not necessary for the prescribing doctor to be specialized in palliative care. Thus, they may not be able to recognize and present all the available alternative treatments. They are also not required to refer the patient to a palliative care specialist.

I think a positive revision would be to make sure that every PAS patient has not only her primary care provider, but a palliative care specialist to guide her through her end-of-life treatment.

Another contentious issue is the influence of family members and caregivers on the patient’s decision to have PAS. Sometimes, the patient’s family or caregiver might convey that they are a burden, adding to the patient's desire and resolve for PAS. Medical professionals should have conversations with the patient’s family members, to get an overall sense of the family/caregiver dynamics and pressures. In Oregon, doctors can evaluate the patient’s situation and finalize the decision in as little as 15 days. This may not be enough time to really get to know the patient and her full situation, including family dynamics and social, psychological, and medical conditions.

Steps need to be taken to ensure that patients receive quality end-of-life care. Every PAS patient should be provided with psychotherapy, treatment for depression if necessary, and palliative care. It is not enough simply to address whether the patient is competent enough to make the decision for assisted suicide, but also address the underlying depression and other issues they may have, so that they may be relieved from their suffering.