Four years ago, Oregon began a social and medical experiment with profound ethical implications: allowing physicians to help people end their lives. Now, the Bush administration has chosen the state, with its unique suicide law, as a place to shore up its conservative wing by asserting its "pro-life" political credentials.
Leading the effort is Attorney General John Ashcroft, an opponent of abortion and legalized suicide since his days as a US senator. Last week, Mr. Ashcroft ruled that under the federal Controlled Substances Act, doctors may not prescribe drugs for the purpose of hastening death. A federal judge immediately placed a temporary restraining order on Justice Department enforcement of Ashcroft's ruling, and the case is likely headed for the US Supreme Court.
The issue is complicated, as a series of legislative debates, ballot measures, and court cases around the country in recent years have shown. It involves medical ethics, federal drug law, questions of privacy, and the balance of legal and political power between states and the federal government.
Oregon's Death with Dignity Act became law in 1997, after voters twice had approved it at the polls by wide margins. It applies only to mentally competent adults who declare their intentions in writing, are diagnosed as terminally ill, and take the prescribed drug themselves orally after a waiting period. Oregon's law specifically prohibits "lethal injection, mercy killing, or active euthanasia."
Critics had predicted that vulnerable patients could be pressured by doctors or family members to end their lives, and also warned that out-of-staters might rush to Oregon to take advantage of its law.
Apparently, neither has happened. On average, roughly 20 people a year chose to end their lives under the law.
At the same time, what medical practitioners consider ideal end-of-life care has increased here, including palliative treatment for discomfort, hospice care (twice the national average), and care that allows patients to spend their last days at home with families and friends.
"Oregon's aid-in-dying law is working as intended," says Barbara Coombs Lee, president of the Compassion in Dying Federation, the assisted-suicide law's main advocacy group. "Very few people use medication to hasten their death, yet thousands obtain comfort knowing the choice is theirs if they experience intolerable suffering."
But for others, Oregon's law is as abhorrent as laws that allow abortion.
"The idea of assisted suicide is a poison pill that kills the dignity of a precious human life," says Ken Cooper, president of the Family Research Council in Washington, the conservative organization once headed by Republican presidential candidate Gary Bauer. "It invalidates the concept that once a person becomes unproductive, or is a burden on society, he loses his value and is unworthy of living."
The basis for the Ashcroft ruling is that federal law involving drugs supercedes state laws regulating medical practice. It's the same reasoning behind the Justice Department's recent crackdown on facilities in California and other states that allow the provision of marijuana for medical purposes.
"There are important medical, ethical, and legal distinctions between intentionally causing a patient's death and providing sufficient dosages of pain medication necessary to eliminate or alleviate pain," Ashcroft declared in his directive to federal Drug Enforcement Administrator Asa Hutchinson. "I hereby determine that assisting suicide is not a 'legitimate medical purpose' under [federal law] and that prescribing, dispensing, or administering federally-controlled substances to assist suicide violates the Controlled Substances Act."
The United States Conference of Catholic Bishops, antiabortion groups, and other conservative organizations hailed the attorney general's ruling.
Others see it as an unwarranted interference with a state law. Oregon Gov. John Kitzhaber (who is also a medical doctor) called it an "unprecedented intrusion" on the state's medical practices laws. Some critics suggest that Ashcroft's move could cause a "chilling effect" on doctors who prescribe pain-relieving drugs to patients diagnosed as terminally ill (since the same drugs in larger doses can cause death), thereby increasing suffering among such patients.
In previous cases, the US Supreme Court has ruled that assisted suicide is not a constitutional right. But the high court also did not declare the practice to be illegal, in essence inviting the states to grapple with the issue. Or, as Associate Justice Sandra Day O'Connor wrote: "There is no reason to think the democratic process will not strike the proper balance."
That would seem to suggest that Oregon was on the right track in following the wishes of most Oregonians as expressed at the polls.
But the Supreme Court also ruled unanimously in a case earlier this year that California's medical marijuana act violates the Controlled Substances Act.
One important question now is, should barbiturates and morphine (the legal drugs typically used in physician-assisted suicide) be seen in the same light as marijuana, which is an illegal drug?
Advocates of physician-assisted suicide say "no." Attorney General Ashcroft says "yes."