Voting on Dying


October 13, 1991|By SARA ENGRAM | SARA ENGRAM,Sara Engram is deputy editor of the editorial pages of The Evening Sun.

In a gray office building in Seattle, dozens of volunteers are working with cheerful intensity, calling supporters, stuffing envelopes and carrying out all the other chores that are part of a well-orchestrated political campaign.

They are working not for a candidate, but for a cause -- one to which they bring a special passion. If they are successful, Washington state will take a bold step in right-to-die territory by making it legal in certain circumstances for a physician to help a terminally ill person to die.

Initiative 119 has attracted an impressive amount of grass roots support: 223,000 people (73,000 more than necessary) signed the petition to put the measure on the Nov. 5 ballot; and of the $1 million the campaign had raised by the end of September, about 80 percent of it had come from individual donors contributing $30 or less. The initiative's supporters hope to raise as much as $1.3 million.

The initiative also has some powerful enemies. Human Life of Washington, an affiliate of the National Right to Life Committee, has asked the national organization for $1.5 million to combat the initiative. The state's Catholic Conference is also mobilizing against the measure.

And although a number of physicians have gone of record in support of the initiative, the Washington State Medical Association announced it would join in working to defeat the measure -- a signal that the medical establishment is not yet willing to support the concept of aid-in-dying.

But the public may be. Opinion polls show that a majority of Americans favor the concept of aid-in-dying, in which physicians under controlled circumstances can help dying people by lethal injections or other means. In recent weeks, a book describing ways to hasten death for terminally ill people has been at the top of its category on the New York Times' best-seller list. It's worth noting that the methods described by the book depend on the cooperation of a sympathetic physician who is willing to prescribe the proper medications.

Ironically, the medical association's opposition to the measure makes it allies with the groups it has opposed on right-to-die issues. In 1979, Washington state passed the nation's second Natural Death Act, affirming patients' rights to refuse medical treatment even if that decision shortens their life, and establishing that a properly executed living will is a valid legal document.

But the act had loopholes -- notably, it did not define what is meant by "imminent" death and it did not specify that a persistent vegetative state or an irreversible coma can be classified as a terminal condition or that artificially administered food and hydration is life-sustaining treatment that can be removed or refused.

For a decade, the medical association and many groups now supporting Initiative 119 tried to get these reasonable amendments through the legislature, but they were thwarted by right-to-life groups and the Catholic Conference.

When the latest effort failed to emerge from committee, the petitions began circulating to define "imminent" death as meaning within six months or less and to close the law's other loopholes. But the petition went further, to include aid-in-dying -- a step beyond where any other state has gone. It's also a step no other country has officially taken.

The Netherlands is frequently mentioned as a place where dying patients who are mentally competent can request and receive a lethal injection or other aid-in-dying. But although the Dutch parliament may vote on the issue this fall, active euthanasia is not technically legal there. Rather, each case is carefully reviewed by prosecutors and, by an agreement worked out between the medical and legal communities, no criminal charges are pursued if certain conditions are met.

A staple of the euthanasia debate in this country is the argument that allowing a physician's active involvement in the death of a patient would breach the trust that is important in any doctor-patient relationship.

But anyone with a pulse on public opinion on this issue has to wonder: If abuse of the relationship is such a danger in this country, why does this issue attract such widespread support?

Americans are beginning to question a medical system that would reject aid-in-dying as abusive, but that every day allows people to linger without sufficient pain medication, or that sustains life despite the protests of patients and families, or that allows people to die because they have no health insurance.

The American people are demanding more control over end-of-life decisions in part because they distrust a medical system that is inefficient, impersonal and often cruel -- and in part because they do place great trust in the individual physicians they will ask for help when death draws near.

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