In March 1998, an Oregon woman dying of breast cancer asked her physician to prescribe a drug that would allow her to end her life. The doctor agreed. Later in the month she took the medication. With that action, she became the first person in the United States to commit suicide with the help of a doctor -- legally.
This has come to be known as "physician-assisted suicide." A physician honors a patient's voluntary request for a lethal dose of medication, which the patient later administers to him- or herself. It's legal only in the state of Oregon, and has been only since late 1997.
A few other states are making efforts to legalize assisted suicide. But soon Congress may put a stop to it everywhere.
The Pros and Cons
The issue of physician-assisted suicide is emotional and controversial -- it ranks right up there with abortion. According to Clarence H. Braddock III, MD, a faculty member of the University of Washington?s departments of medicine and medical history and ethics, the arguments in favor of legalizing assisted suicide generally run along these lines:
- People should be able to control their own lives.
- Some terminally ill patients are allowed to end their lives by refusing medical treatments; in all fairness, those who don't have that option should be allowed to choose death. * Death is a compassionate way to relieve unbearable suffering.
- Legal or not, assisted suicides occur, and it would be better if they were brought into the open.
The arguments against legalization, Braddock says, usually go something like this:
- Taking a life under any circumstances is immoral.
- Assisted suicide has great potential for abuse. People without family support or adequate finances, as well as the depressed, could be pressured to choose death.
- Physicians can be wrong about estimating how much time a patient has left, causing unnecessary deaths.
- The public will lose its confidence in the medical profession if physicians get into the business of helping people kill themselves.
An Age-old Debate
Physicians have been divided over the issue of assisted suicide since the birth of Western medicine some 2,000 years ago. "The ancient Hippocratic Oath enjoins physicians to 'neither give a deadly drug to anybody if asked for it, nor make a suggestion to this effect,'" oncologist Ezekiel Emanuel writes in the March 1997 Atlantic Monthly. "The oath was written at a time when physicians commonly provided euthanasia and assisted suicide for ailments ranging from foot infections and gallstones to cancer and senility. Indeed, the Hippocratic Oath represented the minority view in a debate within the ancient Greek medical community."
Two thousand years later, though, opposition to assisted suicide is the majority view within the medical community. After Oregon passed its assisted-suicide law, 67% of the state's physicians said they still would refuse to participate in an assisted suicide -- and even those physicians who have helped patients terminate their lives said they did so reluctantly, according to a survey conducted by the Oregon Health Division. "It was an excruciating thing to do," said one doctor in the survey.
Opposition from Congress
Last October, the U.S. House of Representatives passed the Pain Relief Promotion Act, which would undermine Oregon's law and dampen other states' efforts to legalize assisted suicide. The Senate is likely to consider the bill sometime this year.
The Pain Relief Promotion Act would make it illegal for a doctor to prescribe a controlled substance if he or she knows that the patient plans to use it to commit suicide. The act's net effect is to take away a physician's only realistic means of assisting a suicide.
The bill has a host of supporters, including the American Medical Association, which officially opposes physician-assisted suicide, and several House members who are physicians. The most strident of the latter group is family physician Tom Coburn, a Republican from Oklahoma. While arguing in favor of the act in October, he denounced physicians who take part in assisted suicides. "As soon as doctors have made the decision that they are the givers or takers of life, they no longer are physicians," he said.
But others, such as psychiatrist Jim McDermott, a Democratic representative from Washington, oppose the Pain Relief Promotion Act. McDermott feels Congress should not legislate how physicians help their patients cope with serious illnesses.
McDermott and fellow opponents also fear that passage of the act will make physicians hesitate when prescribing pain medications for nonsuicidal patients. "Every day in the legitimate and accepted treatment of terminally ill patients, physicians prescribe controlled substances in dosages that will hasten death," John A. Kitzhaber, M.D. -- the Democratic governor of Oregon and an emergency room physician -- wrote in the Washington Post in November 1999. "This leaves thousands of cases each year in which the intent of the physician could be questioned. Faced with the specter of investigation by the Drug Enforcement Administration, prison, or loss of their practice, many doctors will treat pain less aggressively than is required for full relief."
No matter what legislation Congress and state governments pass, and no matter what position organizations such as the AMA take, assisted suicide -- like euthanasia -- will remain a personal matter. To end the life of a terminally ill patient will continue to be a decision that a patient and the patient?s family and physician reach privately.