Country's Doctors Remain Divided Over Physician-Assisted Suicide
By Susan Okie
America's doctors remain deeply divided on the issue of whether it should become legal for a physician to help a terminally ill patient commit suicide by prescribing lethal drugs.
Some, like Timothy Quill, a doctor who is one of the plaintiffs in an assisted suicide case being argued today before the Supreme Court, believe that providing a means of suicide can sometimes be part of providing good medical care. Others contend that helping patients to kill themselves fundamentally conflicts with a doctor's duty to do no harm.
"I think there's very diverse opinion within the profession, just like there is within the society at large," said Quill, a professor of medicine and psychiatry at the University of Rochester Medical School. "I do think most physicians are welcoming the conversation about these issues, because at least those who work with seriously ill patients are facing them on a regular basis."
At the heart of the debate over physician-assisted suicide, according to many experts, is the failure of the medical system, and of society at large, to meet a larger and more complex challenge: caring for the physical and emotional needs of dying patients.
"Most of the people who favor an option of legalized assisted suicide are fearful of ending up in the hospital with no choices, and suffering," said Christine K. Cassel of Mt. Sinai School of Medicine, who is president of the American College of Physicians. "To my mind, that we absolutely have to fix."
The Supreme Court will hear oral arguments today on two cases, from New York and Washington, in which federal appeals courts ruled that state laws banning physician-assisted suicide were unconstitutional. At issue is whether Americans have a constitutional right to have a doctor help them die.
Some recent surveys have suggested that as many as 60 percent of American doctors now support legalization of physician-assisted suicide. But many physicians are "astounded" that the Supreme Court may soon conclude that it is a patient's constitutional right, said William A. Knaus, chairman of the department of health evaluation sciences at the University of Virginia School of Medicine.
"That the Supreme Court is even considering it is breathtaking to many of us," Knaus said. If the court upholds the lower courts' decisions, he added, "the next day, every person in this country could walk into a doctor's office or health care facility and demand suicide. What would we do?"
If the Supreme Court lets the lower court decisions stand, doctors would be legally allowed to prescribe lethal drugs to a terminally ill, mentally competent patient who requested them. Euthanasia the administration of a lethal drug by a doctor would still be illegal. No doctor would be required to assist a patient to commit suicide. Only one state, Oregon, has approved a law legalizing physician-assisted suicide, and court decisions have so far prevented it from taking effect.
The American Medical Association and some 45 other medical organizations have filed briefs in the Supreme Court cases opposing legalization of the practice.
But some medical groups support the practice, including the country's largest organization for medical students, the 30,000-member American Medical Student Association, which filed a brief in favor of legalization. "Students are simply being more progressive, I think, in reflecting the general societal understanding that there needs to be better training for physicians and more rights for patients," said AMSA President Andrew Nowalk.
Cassel said that among individual doctors, there has been a significant shift of opinion toward the view that assisting a dying patient with suicide may, in some cases, be ethical. A recent survey of practicing doctors in the state of Washington found that, during one year, 16 percent received a request from a patient for assisted suicide and about 4 percent complied.
"People understand that these things do happen," Cassel said. "Physicians do, very rarely I suspect . . . help their patients die. And that's an individual decision made by an individual doctor and patient."
Proponents of legalizing assisted suicide argue that making it legal would bring the practice out into the open so that it could be regulated to prevent abuses.
Those opposed to legalizing assisted suicide cite concerns that, in the current era of managed care and limited medical resources, suicide or euthanasia may be forced on poor, elderly or disabled patients. They also argue that the debate is diverting attention from the urgent need to improve the way the American medical system cares for terminally ill patients.
"We are talking about suicide as a society mainly because we have done so little to serve the dying and thus, when we face death, we see so few supportive options," said Joanne Lynn, director of George Washington University's Center to Improve Care of the Dying.
At a news conference yesterday sponsored by the American Geriatrics Society, Lynn and other speakers called on health care organizations to develop criteria for assessing the care of dying patients, including such areas as pain control and treatment of depression, and to make hospitals accountable for their performance by considering such criteria when making decisions about accreditation and payment by federal insurance programs such as Medicare.
"What we are doing is to substitute a constitutional right to patient-assisted suicide for good care of the dying," said Kathleen M. Foley, co-chief of Pain and Palliative Care Services at New York's Memorial Sloan-Kettering Cancer Center.
Quill, however, contended that the two subjects are inseparable. "This question [of physician-assisted suicide] only makes sense in the context of good care for the dying," he said. "When a person starts talking about wanting to die, the challenge is trying to figure out why that's coming up right now and is there anything that we can help with."
He said very few terminally ill patients want physician-assisted suicide, but that most want to know it's available if they ever feel they need it. "I think a considerable number of people . . . would seek some reassurance from their doctor that, `Gee, if things get really horrible, will you be there for me,' " he said. "That's the fundamental commitment that I believe we should be making."
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