TOP STORY: HOW TO DIE: Doctors divided over how and when to help people die

c. 1996 Religion News Service PORTLAND, Ore. _ Why should physicians help terminally ill patients end their lives? Here in Oregon the question is already out of date. For the past two years, the question here has been when _ and how. Now that the U.S. Supreme Court has agreed to review right-to-die cases from […]

c. 1996 Religion News Service

PORTLAND, Ore. _ Why should physicians help terminally ill patients end their lives? Here in Oregon the question is already out of date. For the past two years, the question here has been when _ and how.

Now that the U.S. Supreme Court has agreed to review right-to-die cases from the states of New York and Washington, medical professionals throughout the country are asking the same question. If physician-assisted suicide becomes the law of the land, what are doctors going to do about it?


The American Medical Association officially remains opposed to assisted suicide.

“Physicians should never be put in a position to act with the intent to end the lives of their patients,” said Dr. Nancy W. Dickey, the AMA’s board chairwoman, responding to the Supreme Court’s decision to hear the issue.

In recent years, a growing belief in individual control of one’s own life has eroded traditional opposition to assisted suicide. In 1994, Oregon became the first state to allow it, but legal challenges have stalled implementation of the new law.

Forty-four states still consider it a crime to help others hasten their deaths, but polls show most people support the practice, and physicians rarely are prosecuted for the offense. Recent news reports suggest that many are growing impatient with legal roadblocks to assisted suicide.

In Oakland County, Mich., voters became so fed up with a local prosecutor who was pursuing assisted suicide activist Dr. Jack Kevorkian that they voted him out in the last primary.

In Victoria, B.C., a suicide society is selling a special plastic bag, called an “Exit Bag,” to help people kill themselves. It costs $30 but is only effective after swallowing barbiturates.

In Australia, a 66-year-old carpenter with prostate cancer recently took his own life with the help of a computerized suicide machine. His physician, Dr. Philip Nitschke, provided the machine and described how it works.

In the nation’s capital, a proposal to use federal Medicaid funds to reimburse assisted-suicide services in Oregon prompted lawmakers to introduce a bill that would block such funding.


“Society must not allow doctors to be killers as well as healers,” former Surgeon General C. Everett Koop told reporters while promoting the measure.

The legislative attack reminded Janet Good, an assistant to Kevorkian who is herself terminally ill, of the abortion wars. “I see the exact same tactics that were used on women’s right to choose,” she said.

But Elie Stutsman, a Portland, Ore., attorney and spokesman for Death with Dignity, sees the legislation as a favorable portent.

“It’s a signal we’ve come to a new point in the debate,” he said. “The issue no longer is the legality of assisted suicide, but _ as in the abortion debate _ how can opponents restrict access?”

The controversy about assisted suicide forces doctors to wear both a public and private face.

In public, mainstream medicine is unequivocally opposed to physician-assisted suicide.

The AMA’s Dickey calls it a “misguided and unethical practice.”

“Patients must trust their doctor,” she said.

But in private, doctors who treat dying patients say something quite different.

A survey of Oregon physicians released in February showed that 60 percent said doctor-assisted suicide should be legal in some cases. And 46 percent said they might be willing to prescribe a lethal dose of medication for a terminally ill patient if it was legal to do so.


The survey, published in the New England Journal of Medicine, also revealed deep doubts about just how to end a patient’s life. Half of the 2,761 Oregon doctors who responded to the survey said they were not sure what kind of drugs to use.

There’s no assurance that any agency will set medical standards for physician-assisted suicide. Officials of the Oregon Medical Association have said they probably won’t do that.

The survey, the first to look at Oregon doctors’ attitudes toward assisted suicide, reported that 187 doctors, 7 percent, had actually written life-ending prescriptions. Of that number, 124 said their patients had taken the medication.

Surveys in other states had similar results.

In a 1994-95 Washington state study, 12 percent of the physicians who responded reported receiving at least one request for assisted suicide in the previous year. Of the 156 patients who asked for suicide, 38 received prescriptions.

In a 1994 Michigan survey, 39 percent of the doctors polled favored a law allowing physician-assisted suicide for terminally ill patients with intractable pain.

Dr. Mark Rarick, a Portland oncologist, said support for assisted suicide among doctors cuts across party lines. “Right and left both support government allowing the patient to make the decision,” he said.


Jim Kronenberg, associate executive director of the Oregon Medical Association, said many doctors feel about assisted suicide the way they feel about abortion. “Most physicians see it as an issue of patients’ choice,” he said.

But he said more physicians would be directly affected if assisted suicide becomes legal. That’s because few doctors are called upon to terminate pregnancies, but many doctors have terminally ill patients.

“If it becomes the law of the land, a much larger proportion of physicians will have to face the issue,” he said.

The debate points to just one thing for Alicia Super, a registered nurse who coordinates national efforts by Catholic health care organizations to improve care for the dying: Doctors and nurses need to do a better job of helping people die.

Super attended 55 focus groups in 11 cities across the United States, trying to find out how the health care system could help dying patients and their families.

Although the study is not completed, Super said people aren’t afraid of death.

“They’re afraid of the final phase of life before dying,” she said. “Most were willing to go through that final phase with adequate support.”


But mundane problems such as worker productivity get in the way of physicians and nurses helping patients die, she said. And often, health insurers won’t reimburse for time spent holding the hands of dying patients.

Dr. Susan Tolle, director of the Center for Ethics in Health Care in Portland, welcomed the Supreme Court’s attention to assisted suicide.

“Past trends have been that every time there’s been a vote, an injunction, or a court ruling, the medical profession is more interested in the care of the dying,” she said.

MJP END RNS

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