When Washington state voters were asked to decide whether...

Coping/Mortal Matters

February 03, 1992|By Sara Engram | Sara Engram,Universal Press Syndicate

When Washington state voters were asked to decide whether to legalize physician-assisted suicide last fall, the medical establishment lined up solidly against the proposal. Yet the initiative got significant support from independent groups of physicians.

Obviously, there is as much difference of opinion on these end-of-life issues among doctors and other medical professionals as among the rest of the population.

But the difference between a physician and the rest of us is that under proposals like the one in Washington state, doctors would be the people who actually carried out the requests of dying people. For them, it's reality, not just a theory.

Recently, the Hemlock Society of Maryland undertook a survey of Maryland physicians on these issues and came up with some interesting results.

Most striking was the response to the question of whether assisted suicide should be legal. Of 302 physicians who responded to the survey, a surprising majority of 184, or 61 percent, answered yes to the following question: "As a general medical principle, do you feel that terminally ill patients should have the option of requesting aid-in-dying (i.e., assistance in suicide) to bring life to an end?"

The question drew only 100 no votes (33 percent), while 18 doctors (6 percent) had no response to the question.

Interestingly enough, that question drew more positive responses than a follow-up question asking whether physicians should be the ones to carry out such requests if they are legal. Only 47 percent of the respondents agreed that the responsibility should lie with physicians, while almost 36 percent disagreed.

When asked if they themselves would be willing to assist a terminally ill and suffering patient who was asking to die by providing a lethal dose of drugs if that action were legal, only 44 percent indicated they would, while more than 45 percent said no and 10 percent offered no response.

When asked directly whether they had ever assisted a patient to die by providing a prescription for, or administering a lethal dose of, drugs at the patient's request, the overwhelming majority, 94 percent, said they hadn't. But 13 respondents, or 4.3 percent, did answer yes.

Many more -- 45 percent -- said they had played a role in hastening death by disconnecting life-support equipment. And when asked how they would deal with requests of this nature, more of the physicians were comfortable with the requests when they came directly from the patient, rather than the family: 73 percent said they would agree to disconnect life support at the request of a terminally ill patient, while only 63 percent would do so at the request of the family.

In general, large majorities of the physicians expressed approval of advance directives like living wills and the durable power of attorney, and would encourage their patients to execute them. But only 43 percent said they were "usually promptly notified of the existence of this document" when a patient who has one is admitted to the hospital.

The response to one important question carried good news and bad news. The question was: "Do you consider it appropriate to prescribe medications such as morphine to relieve the pain of patients who are dying, even if the quantity hastens death?"

The good news is that the overwhelming majority -- 87 percent -- answered yes.

The bad news is that 10 percent of the respondents said no, which means that dying patients under their care could spend their final days or hours consumed by pain -- an inexcusable lapse in compassionate medical treatment.

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