Assisted dying bill: ‘Oregon is no assisted dying utopia’

Supporters of my colleague Kim Leadbeater’s Bill to legalise assisted dying/suicide are well-intentioned but have been unable to assure people that well-documented abuses, horror stories, and mission creep in Canada, the Netherlands and Belgium won’t happen here.

These supporters cannot simply dismiss these countries as aberrations, as if they are somehow primitive jurisdictions whose failure to prevent abuses ought not to bother us; yet instead they cite the small US state of Oregon as the gold standard for legalisation.

Kim is aware of the failures to prevent abuses elsewhere and recently acknowledged we need to “get this right from the start, which some places have done, places like Oregon”.

Sarah Wootton, CEO of Dignity in Dying, the pressure group backing Kim’s Bill, concurs: “I believe the Oregon model is [the] right place for society”. Her group’s website similarly calls “for a law based on one that has worked safely in Oregon and has remained unchanged since 1997”, a highly questionable claim.

Lord Falconer, who has proposed legislation on seven occasions to introduce assisted suicide, has also praised the Oregon model on the grounds that its law “started as a terminal illness law and it has remained a terminal illness law”.

‘Assisted suicides in Oregon have been granted for anorexia’

We should therefore examine Oregon and decide if its practice is one we would wish to replicate. Let us begin with Charlie Falconer’s claim that Oregon’s “terminal illness law has remained a terminal illness law.” Laws can expand in two ways. In Canada, the law has changed explicitly – the requirement for death to be “reasonably foreseeable” was removed in 2021 for those seeking ‘Medical Assistance In Dying’.

However, the scope of a law can also expand more subtly, via its interpretation. Such has been the way in Oregon whose health authority now interprets “terminal illness” as any illness that would lead to death without treatment. This is quite different, of course, from how most of us understand terminal illness as a diagnosis where sadly death is inevitable regardless of any treatment offered.

The result of this interpretative sleight of hand is that assisted suicides have been granted in Oregon in recent years for diabetes, arthritis, a hernia and, most disturbingly, anorexia – hardly conditions generally considered ‘terminal’. It is highly doubtful that when Oregon introduced assisted suicide in 1997, such an understanding of the law was envisaged.

Nor am I persuaded that the definition of terminal illness in Kim’s Bill as a condition “which cannot be reversed by treatment” would be an adequate safeguard: what of the person with diabetes whose disease may be managed but not reversed or the person with anorexia where repeated attempts at treatment have as yet failed to reverse the illness?

READ MORE: Assisted dying vote tracker: How does each Labour MP plan to vote on bill?

‘Patients cite being a burden as motivation for their decision’

Dignity in Dying’s claim that the law in Oregon has been unchanged since 1997 fares little better when tested by reality. Oregon has in recent years dropped its residency requirement, opening the door for suicide tourism, and diluted a key safeguard by reducing its ‘cooling-off’ periods in some cases.

However, most frightening of all, are the reasons people in Oregon now choose assisted suicide. Since legalisation in 1997, official data reveals that in 47 percent of cases, patients have cited being a “burden” as a motivation for their decision; in contrast, only 28 percent have expressed concern about pain, the implicit reason given as a justification for legalisation in the rare, but emotive, cases so often flagged by assisted suicide supporters.

The fact that only 13 percent of assisted suicides in Oregon in the first year after legalisation attributed the motive to being a burden suggests assisted suicide laws create an environment over time where more people feel an obligation to die – the kind of slippery slope it is claimed Oregon has avoided.

‘Erosion of safeguards over time’

Similar concerns arise from the ease with which people can now be approved for assisted deaths in Oregon. Whereas an average of 28 percent of those who sought an assisted suicide were referred for psychiatric evaluation during the first three years after legalisation, only one percent of those who die under Oregon’s law now receive such an assessment, further demonstrating the erosion of safeguards over time.

Advocates for the Oregon model often highlight its safeguard that patients must have six or fewer months left to live. But once again Oregon’s practice has been unable to match its requirements on paper. Terminal illness prognoses are notoriously inaccurate and patients have lived for up to 1,009 days, almost three years, after requesting an assisted death, over five times longer than Oregon’s supposed maximum timeframe.

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‘MPs ought decisively to reject risky change in the law’

Perhaps most chilling, however, is the complication rate with assisted suicides in Oregon. Dignity in Dying maintains that “assisted dying in Oregon works. It prevents unnecessary suffering at the end of life”. The evidence suggests otherwise.

Annual complication rates for assisted suicides in the state have been as high as 14.8 percent. Patients are reported to have experienced difficulty swallowing, drug regurgitation and seizures, even regaining consciousness after ingesting ‘lethal’ drugs. Death can take many hours, in one case taking over five days.

The Health and Social Care Select Committee visited Oregon last year as part of its inquiry into assisted suicide. Notably, all the remaining MPs who were part of that inquiry oppose legalisation. If death rates matched those in Oregon, according to one expert there would be 7,500 assisted deaths a year in the UK.

Oregon is no assisted suicide Utopia. If it is the best model supporters can point to, MPs ought decisively to reject a risky change in the law.

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