Physician-Assisted Suicide: An Issue That Won't Die

November 10, 1991|By SARA ENGRAM | SARA ENGRAM,Sara Engram, deputy editor of the editorial pages of The Evening Sun, writes "Mortal Matters," a column about death and dying.

Washington state voters had a chance to step into uncharted legal and ethical territory last Tuesday. They declined the opportunity.

Despite polls showing that almost two-thirds of Americans favor allowing physicians to assist in the suicide of a terminally ill patient, voters in Washington state defeated an aid-in-dying initiative by a margin of 54 percent to 46 percent.

While not a landslide, those numbers represent a clear defeat. But in listening to supporters of this and similar measures, you might think it was a resounding victory:

"We think we advanced the issue by miles," says Kirk Robinson, president of Washington Citizens for Death with Dignity. "They [the initiative's opponents] could hold us back this time, but they can't hold this issue back, because people want this choice. They fundamentally want it."

"It's a small setback, but by no means will it kill the right-to-die issue. It's gotten too big," says Kris Larson, editor of the Hemlock Quarterly, published by the Hemlock Society, which advocates legalizing physician-assisted suicide for terminally ill people.

As the dust settles after Washington state's hard-fought, even bitter campaign, it seems clear that however you describe the issue -- aid-in-dying, physician-assisted suicide, mercy killing, death with dignity, legalized euthanasia -- it's one that is likely to be with us for years to come.

Already, Californians are gathering signatures to place a similar measure on next year's ballot. Citizens in Oregon and Florida have set up exploratory efforts for 1994.

Jack Nicholl, a veteran of California's public interest politics who is now campaign director for Californians Against Human Suffering, sees the 46 percent support for the Washington proposal as an impressive showing that bodes well for future efforts -- especially given the complicated political terrain in which this initiative was fought.

"When I saw that tax reform, term limits and abortion were all on the ballot, I got worried," he says. "It's hard to get a clear vote with so many other issues to draw out potential opponents."

In Mr. Nicholl's view, events elsewhere in the nation also played a part -- particularly the news in late October, during the height of the campaign, that retired pathologist Jack "Dr. Death" Kevorkian had helped two more women to die in a Michigan park.

Those women would not have qualified for aid-in-dying under either the Washington or California proposals, since they were not terminally ill. Their conditions were chronic, but would not cause death within six months.

Moreover, the measures require that one of the two doctors who certifies that a patient is terminally ill and mentally competent must be a treating physician. In other words, the doctor must be one who has an established relationship with the patient, rather than someone who, like Dr. Kevorkian, advertises his eagerness to help people die.

Mr. Nicholl and many other supporters of the Washington initiative believe that Dr. Kevorkian gave opponents a chance to hone in on lurking fears that giving physicians this license for the first time in the history of Western civilization (with the egregious exception of Nazi Germany) would open the way for zealots to abuse the law.

As one supporter said, Dr. Kevorkian put a human face on people's fears.

Mr. Nicholl believes, however, that the Kevorkian argument could easily work in favor of aid-in-dying initiatives. One lesson he will apply to the California campaign is the need to stress the fact that the safeguards of the initiative would help to guard society against the exploits of zealots like Dr. Kevorkian.

Safeguards became a major issue in Washington, with opponents claiming that the process could be easily abused and supporters countering with allegations that ads warning of abuses were blatant falsehoods. As a result, future initiatives may spell out in more detail the process that must be followed by both physicians and patients.

But many supporters of aid-in-dying point out that adding more safeguards won't satisfy anyone. "The additional safeguards issue was a red herring," Mr. Robinson says. "You could give them a telephone book of safeguards and they wouldn't support Like abortion, this is an issue on which many people already have clear opinions. Supporters of the concept are convinced that, while side issues may confuse enough voters to sway election results a few percentage points, the tide of public opinion is clearly moving in their favor.

Although many physicians support these initiatives, the medical establishment worked vigorously against the Washington initiative, and will undoubtedly oppose similar efforts in other states.

Yet the aid-in-dying movement is, in a way, the medical equivalent of term limits. Just as millions of voters across the country express disgust with politics, they also, in many cases, continue to register confidence in their own elected representatives.

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