Seeking to assure a timely suicide Strategies include stockpiling of drugs, approaches to doctors

Issue goes to high court

Opponents urge more hospice care, better pain relief

December 29, 1996|By Sandy Banisky | Sandy Banisky,SUN NATIONAL STAFF

SAN FRANCISCO -- It's an insurance policy of sorts, and Richard Goldman stores it in his refrigerator vegetable bin: "Want to see?" he asks, unwrapping dozens of brown vials of morphine.

He has guarded the lethal drugs for years -- a do-it-yourself suicide stash willed to him by a dying friend, for use if Goldman, 47, decides he cannot face a lingering death from AIDS. But he'd rather not have to rely on these leftovers, with their expired use-by dates.

He'd rather have his doctors' help.

On Jan. 8, the Supreme Court will hear arguments on whether terminally ill patients have a constitutional right to end their lives with a doctor's help.

The question has special urgency in San Francisco. Here, acquired immune deficiency syndrome has created a large, young, assertive caseload of patients who have been forced to think about death.

Here, people from many segments of the community -- patients, doctors, nurses, ethicists, hospice workers, the disabled, people concerned with AIDS and people concerned with other illnesses -- have been pushed to consider whether they back legalizing assisted suicide.

There are people like Richard Goldman who stockpile drugs, planning to kill themselves alone if they have to. There are patients in support groups who routinely discuss suicide, trading formulas for fatal mixtures of medications. Some leave pills to friends, a legacy for suicide. Some share advice on approaching a skittish doctor obliquely, so as not to jeopardize the physician's license. ("I still can't sleep, Doctor. I need more of those pills you gave me last week.")

In the AIDS community, many people say they know physicians who occasionally, quietly help. Some San Francisco medical professionals have argued out a set of model guidelines for doctors, should the practice become legal. Even without legal sanction, one doctor estimates about 25 percent of AIDS deaths are assisted suicide.

"That kind of death is common and unreported," says Goldman, trained as a physician's assistant and now leader of an AIDS support group.

There's even a new vocabulary, for those who say the word "suicide" connotes desperation. They prefer the term "self-deliverance."

But for all the people arguing in favor of assisted suicide, there are many vocal opponents.

"What will happen to this society if we countenance the killing of sick and dying people?" asks Wesley J. Smith, an Oakland attorney whose book on assisted suicide will be published next year.

Instead of legalizing assisted suicide, Smith says, people should be fighting for more hospice care and better pain relief, to ease the last days of the dying. They should be guaranteeing counseling for clinically depressed patients, to help them cope with their illness.

"We're patting ourselves on the back about how sophisticated we are and how we stand up for individual rights. We look at [Dr. Jack] Kevorkian killing people, and we shrug our shoulders: If they want to die, they want to die. Don't we care about each other?"

The questions prompted by the issue are endless: Is every life worth living? Whose pleas for suicide help should doctors heed? Only people who are terminally ill? Patients in unrelenting pain? The disabled? Children? The profoundly depressed?

An issue of personal rights

For some people who have had to consider death, the issue is not complicated. It is one of personal rights.

Richard Goldman believes he should be able, without fear, to ask a doctor for help in dying.

"AIDS has changed the face of health care as we know it," he says. "People with AIDS have demanded to be a partner in their health care. We're no longer pawns doctors can write prescriptions for. We want to be partners in how we live and how we die."

Goldman directly sought his doctors' promises of help should he one day choose suicide. "It was such a relief to hear them say, 'I'll be there. We've done it. We'll continue to do it.' "

If they had refused, Goldman says, he would have sought "new doctors." But raising the issue was not easy. "It's like asking a physician to commit a crime."

Now on protease inhibitors, a new AIDS treatment, Goldman feels better than he has in years. His deep fatigue has eased. The AIDS-related cancer that nearly killed him in 1989 has not returned. It's unknown how long the new drugs will be effective.

He's not sure if he will ever use the morphine he has stored away. But he wants to know it's there. "It's just another option that's available to me."

Need to bring it into open

In San Francisco, doctors and patients say that many physicians will help when confronted with patients begging for aid with suicide. But few doctors will talk about it -- even to each other.

Dr. Fred Marcus, a Redwood City, Calif., oncologist, is one of the rare physicians who bluntly says that patients need to be able to ask for legal help with suicide.

Assisted suicides occur now, Marcus says, "more frequently than the public is aware. It's clandestine. It's underground. That's why it needs to be legislated and controlled."

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