Oregon Revisits Assisted-Suicide Debate

Residents of the only state with right-to-die law will vote again this fall on its validity

A clear majority of Americans surveyed agree that doctors should be allowed to hasten death under some circumstances.

But in the privacy of the polling booth (or in the stillness of prayer), it appears to be another matter. And especially when a loved one is involved, most people still are very hesitant to accept physician-assisted suicide as something that should be legally or morally acceptable.

Or to put it more simply, the head and the heart may be reaching different conclusions on this profound issue.

In June, the United States Supreme Court ruled that there is no constitutional "right to die." But the justices left it up to the states to pass laws banning - or allowing - doctor-assisted suicide.

The national debate is now shifting to Oregon, where a key test will come this fall.

Voters here will be asked to reconsider support of a "death with dignity" ballot measure narrowly passed in 1994. Supporters say it would provide a strictly-regulated opportunity for patients diagnosed as terminally ill to ask for their physician's help in committing suicide.

But opponents have held up the initiative in federal courts. State lawmakers in Oregon, as a group more Republican and more conservative than they were three years ago, put the issue back on the ballot in an apparent bid to repeal the measure.

Supporters are frustrated - but not deterred - by having to face better-funded opponents again.

"The more people consider it, the more people come to understand the complexities of end-of-life care, the more reasonable it appears that, yes, individuals should have some choice in the matter of how and when and under what circumstances they die when they're stuck in this prolonged dying process," says Barbara Coombs Lee, director of the Seattle-based group Compassion in Dying.

But Ms. Lee, who is a medical nurse and a lawyer, allows that "this does not translate into political support in state legislatures."

"There's ... a mismatch right now between the opinion of a majority of the people and the moralist agenda of many politicians in state legislatures," she says.

For example, since Oregon's "Measure 16" passed three years ago, not a single bill allowing physician-assisted suicide has passed in the more than 20 states where such bills have been introduced. In only one state - Michigan - is there a signature-gathering effort to follow Oregon's lead.

Thirty-five states now have laws outlawing physician-assisted suicide or euthanasia. And earlier this year, the United States Senate unanimously voted to forbid the use of federal funds to pay for or promote such procedures.

But while lawmakers at the state and federal levels may be more conservative these days, it also is clear that those professions dealing most directly with the issue are wrestling over it as well.

The issue is a struggle for medical doctors. A key tenet of the Hippocratic oath is that "I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect."

Some doctors publicly advocate helping certain patients end their own lives. Seven percent of Oregon physicians surveyed by the New England Journal of Medicine had written prescriptions for a lethal dose of medication.

Marcia Angell, executive editor of the New England Journal of Medicine, asserts "the highest ethical imperative of doctors should be to provide care in whatever way best serves patients' interests, in accord with each patient's wishes, not with a theoretical commitment to preserve life no matter what the cost in suffering."

But the American Medical Association balks at that view. "Physician-assisted suicide is against the code of medical ethics and incompatible with the physician's role as healer and caregiver," says Thomas Reardon, chair of the AMA Task Force on Quality Care at the End of Life. "It is not a constitutional right."

Here in Oregon, the state medical association has moved from a neutral position on the "death with dignity" measure to opposition.

Lawyers, too, are divided.

Earlier this month, the American Bar Association refused to recommend reporting and monitoring standards for states that may legalize physician-assisted suicide. The lack of action by the ABA frustrates proponents of physician-assisted suicide, who note that on abortion - the ABA is officially pro-choice. "How can the delegates ignore what is becoming an equally pressing issue, not just for women ... but for the majority of Americans who want the option of physician-aided death?" asks Faye Girsh of the right-to-die group Hemlock Society USA, which has 80 chapters in 40 states.

Religious groups can be found on both sides as well. The Roman Catholic Church and the National Right to Life Committee are firmly opposed, and work hard in states when the issue comes up for a vote.

On the other hand, a task force of the Episcopal Diocese of Newark, N.J., concluded that "assisted suicide can be theologically and ethically justified."

"Christian theology demands respect for human life and recognizes that human life is sacred," the task force wrote. But in "exceptional cases," task force members agreed, "assisting a suffering person in accomplishing voluntary death can be morally justified as part of the healing process ... it enables a person to die well."

OREGON'S measure allows a patient diagnosed as terminally ill to request from his or her physician a prescription for a lethal amount of medication to be self-administered. There is a 15-day waiting period, a second medical opinion is required as to the patient's condition (including sound mental state). The act prohibits "lethal injection, mercy killing, or active euthanasia."

Under the law, physicians and pharmacists may refuse to take any role in suicide if their conscience so dictates.

But some opponents are concerned that laws allowing doctor-assisted suicide - no matter how well regulated - could be abused.

The American Association of Retired Persons (AARP) has not taken a position, indicating mixed feelings among the elderly who may desire a sense of personal autonomy about health matters in their later years.

Arguing against a constitutional right to assisted suicide, acting US Solicitor General Walter Dellinger warned it could lead to "the deaths of many persons who are not competent, not terminally ill, and not truly ready to die, but who are steered toward suicide" by physicians or family.

This apparently is happening in the Netherlands, where doctors are not prosecuted for assisting deaths. The Dutch government reports that doctors perform euthanasia without patient consent in about 1,000 cases a year.

In congressional testimony last year, Herbert Hendin of the American Suicide Foundation, stated: "The Netherlands has moved from assisted suicide to euthanasia, from euthanasia for the terminally ill to euthanasia for the chronically ill, from euthanasia for physical illness to euthanasia for psychological distress and from voluntary euthanasia to nonvoluntary and involuntary euthanasia."

Despite the opposition, Lee of Compassion in Dying says, "Our greatest success is that it really has elevated the discussion to a new level. Ten or 15 years ago it would have been dismissed out of hand," she says.

ASSISTED-SUICIDE CHRONOLOGY

* 1973: First case in Netherlands of physician aid in dying; results in judicial guidelines for doctors who assist a suicide.

* 1976: Parents of Karen Quinlan get approval to disconnect their comatose daughter from a respirator.

* 1980: Hemlock Society, the major assisted-suicide advocacy group, founded.

* 1988: First ballot intiative, The Humane and Dignified Death Act, in California, fails for lack of signatures.

* 1990: Dr. Jack Kevorkian assists his first patient, Janet Adkins of Oregon, in ending her life.

* 1994: Federal court in Washington State rules ban on assisted suicide is unconstitutional. Fifty-one percent of Oregon voters support legalization.

* 1997: The Supreme Court declares that there is no constitutional "right to die," but does not rule out states passing right-to-die laws, including doctor-assisted suicide.

Source: The Hemlock Society

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