Morality, not legality, drives right-to-die issue With passage of act in Oregon, decisions shift to doctors, dying

June 22, 1998|By Jean Marbella | Jean Marbella,SUN NATIONAL STAFF

Penny Schlueter is suffering through the final stages of ovarian cancer, weak and ravaged from a battle fought hard but unsuccessfully with surgery and chemotherapy.

Troy Thompson is suffering as well, from the Lou Gehrig's disease that has paralyzed him so totally that he can only communicate with blinks of his eye.

Both are terminally ill, and both share a unique option: As residents of Oregon, they live in the only state that allows their doctors to help them commit suicide if and when they decide they've had enough.

Schlueter plans to avail herself of that option; Thompson will not.

For Schlueter, the Death With Dignity Act is a hard-won right, approved on two separate occasions by Oregon voters and upheld against legal challenges that went as high as the Supreme Court. The final remaining roadblock was lifted by Attorney General Janet Reno, who ruled June 5 that the Drug Enforcement Administration will not arrest doctors who write life-ending prescriptions for terminally ill patients.

For Thompson, by contrast, Death With Dignity offers horror, not relief. He is a plaintiff in a suit charging that the Death With Dignity Act is unconstitutional because it treats the terminally ill as second-class citizens.

But for now, the law is in effect. The controversy, which has played out largely on the theoretical level, has become real and personal: If you are terminally ill, will you end your own life? If you are a physician, will you help?

"It's not a legal thing now," said Dr. Bonnie Reagan, who chairs the ethics committee of her Portland hospital and serves on the task force that wrote guidelines for implementing the law. "It's personal morality now."

Four Oregonians are known to have killed themselves with their doctors' assistance. While the law requires that these suicides be reported, the state agency keeping the records has said it will not announce any figures until the number reaches 10.

Other patients apparently have initiated the process only to die naturally before they could take the prescribed drugs.

The law is designed with checks and balances to give both patient and physician an out at various points: The patient must request the prescription twice orally and once in writing. The physician has to determine that the patient has six months or less to live, and a second physician must confirm that prognosis. Then the patient has to wait 15 days before receiving the medication. The patient must ingest the medicine; the physician cannot inject it.

Dr. Peter Rasmussen, a Salem oncologist who has confirmed helping one patient kill himself, says that he expects more patients and physicians to use the law as Oregonians become more comfortable with it. But he and other supporters of the law doubt that assisted suicides will ever become widespread.

"Patients do want to live and we're usually able to make them comfortable enough not to choose to end their lives," he said. "It's extremely time consuming to go through all the hoops, talking with the patient, talking to the families."

But even if the numbers are not great, Rasmussen said, the need is there. And, even before the law took effect, there was a long-standing if unofficial tradition of doctors occasionally helping some end-stage patients die. (A recent national survey found that 7 percent of doctors said they had helped a patient die.)

"It always has gone on," Rasmussen said. "One reason I'm in favor of the law, it brings it out in public where it can be discussed in the light of day."

A cry for help

For those on the other side of the issue, the next move is simple: The law is in effect, but they can elect not to carry it out.

"I've decided I will not cooperate with it," said Dr. William Petty, a Portland oncologist. "I won't refer to doctors who will assist in suicide. I will not get involved whatsoever."

Patients have asked him to help them die: an elderly woman whose cancerous tumors kept recurring and causing her intense pain, and another patient who feared her final days would be spent in a vegetative state on a respirator.

"I find out why they're asking for suicide," Petty said. "A cry for suicide is, as everyone knows, a cry for help."

With both patients, he was able to prescribe medications that eased their pain and, while they both ultimately died, they were comfortable to the end, Petty said.

"Suicide was not what they wanted; control was," he said. "People fear losing their autonomy. There is this specter of horrible deaths that is just not true. We've all seen a bad death in our lives. That's what we tend to replay. But we have the best pain management in the world available."

As Oregon continues to grapple with the law, other states are watching closely.

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