Oregon Patient With Dementia Given Suicide: Decision Falls Upon HMO Administrator

William L. Toffler, M.D. is the Physicians for Compassionate Care (PCC) National Director

The psychiatrist who evaluated her declared Kate Cheney, an 85-year-old woman with growing dementia, ineligible for assisted suicide. This declaration was made because of her cognitive impairments and because her family appeared to be pressuring her, according to an October 17, 1999, Oregonian article by Erin Hoover Barnett (Is Mom Capable of Choosing to Die? p. G1-2). She could not remember recent events and people, including the names of her hospice nurses or her new doctor. This doctor had been assigned to Mrs. Cheney when her disgruntled daughter demanded a different physician for her mother, after her original doctor appeared less than enthusiastic about assisted suicide for her. When the psychiatrist said she was not eligible for assisted suicide, the daughter and the new doctor did not accept the opinion as the safeguard it was supposed to be. Instead, they sought another opinion from a second mental health professional since there is nothing in the Oregon law to stop them from doing so.

The psychologist admitted the patient could not even remember when she was diagnosed with terminal cancer, although it had only been a few months ago. She also wrote that the patient’s “choices may be influenced by her family’s wishes and her daughter, Erika, may be somewhat coercive” (p. G2). Nevertheless, she approved the suicide.

The final call came down to a single Kaiser administrator, Dr. Robert Richardson. He gave the go-ahead for giving a lethal overdose to this elderly woman under pressure from her family. It was his call.

Kaiser Permanente is a fully capitated HMO with a profit sharing plan for its doctors.

As predicted, it can be seen that once assisted suicide is legalized there is no way to protect the vulnerable and mentally ill.