Gentle into That Good Night

November 13, 1994|By SARA ENGRAM

In Oregon, the public has handed a term-limits notice to the health-care system that created the American way of prolonging death.

Oregon voters sent a message Tuesday when they approved a ballot measure setting out conditions in which physicians can assist in the suicide of terminally ill people. The margin wasn't overwhelming -- 52 to 48 percent -- but it was a message the medical community and public-policy makers should pay attention to.

Twice before, in Washington in 1991 and in California the following year, voters passed up the opportunity to legalize physician-assisted suicide, even though opinion polls in both states had found strong support for the idea. In the end, doubts about safeguards, as well as strong opposition from religious groups and significant parts of the medical community, combined to defeat measures legalizing physician-assisted suicide by margins of 54 to 46 percent in each state.

In Oregon, similar forces were at play but the measure survived, in part because it was drawn more narrowly than the other proposals. The new Oregon allows a physician to prescribe -- but not administer -- a lethal dose of drugs.

There are safeguards: A patient who is judged to have six months or less to live will be able to ask a doctor to prescribe a fatal dose of drugs. At least two doctors must agree that the patient's condition is terminal, and the patient must ask for the prescription three times, the last time in writing. Doctors then must wait 15 days before filling the final request for a lethal prescription.

Proponents of the new law say that it brings into the open a process that happens frequently already. But many opponents believe that bringing it into the open causes more problems than it solves. Now that Oregon has opted for openness rather than ambiguity in the right-to-die arena, we can hope that its experience in the coming years will serve as a useful lesson for the rest of the country.

There is a strong case to be made for allowing physicians to help their patients hasten death. One of the most eloquent came from Dr. Timothy Quill, a physician who prescribed an overdose of barbiturates for a woman dying of leukemia. He later wrote about the case in the New England Journal of Medicine.

His patient was determined to live to the fullest whatever life she had left. She persuaded Dr. Quill that she could do that better if she knew that when her misery became too great, she could hasten her death.

Anecdotal evidence suggests that Dr. Quill is not alone, that many caring physicians feel that good medical care recognizes when death is inevitably near and helps patients face it in a humane way.

But many other physicians have equally strong objections to playing a role in hastening death. They argue that medical care should preserve life, and that giving doctors a role in ending it is a dangerous precedent.

That argument, strong as it is, strikes many Americans as hollow, especially in families that have endured the nightmares that life- prolonging technology can inflict. Many people would join voters in Oregon in asking whether a prescription for a fatal dose of drugs is really more terrifying than what happens in hospitals every day, as families keep lonely vigils over loved ones hooked up to machinery that only prolongs the process of dying.

Like term limits, physician- assisted suicide is a way of expressing disgust with a system that seems impersonal and deaf to pleas for common sense. But, in a contradiction sometimes apparent in term-limit debates, the voters who support physician-assisted suicide are also expressing enormous confidence in the health-care equivalent of incumbents -- their own physicians.

The right-to-die debate will continue to make headlines in this country. But other factors will play large roles in the outcome of the discussion.

One is health-care reform -- finding a way to guarantee access to health care and ensure that financial considerations won't play an undue role in requests for help in dying. (It's worth noting that Oregon is also the first state to experiment with a form of spreading access to health care for low-income people by limiting the kinds of conditions Medicaid will pay for.)

Another large influence will be the ability of the health-care professions to restore a sense of humanity to medical care -- whether it's more attention to pain control, better communication between patients, families and physicians, or more humane solutions for housing and caring for elderly people who need some help in their daily routines.

Oregon has pushed the debate forward, but its ground-breaking law is far from the final word.

Sara Engram is editorial-page director of The Evening Sun. Her column appears here each week.

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