Court's Decision on Help With Suicide Leaves Doctors in a Gray Zone
By Amy Goldstein
The Supreme Court's decision upholding laws against assisted suicide leaves doctors in a murky zone. They may not legally help people end their lives, but they must continue to make delicate personal choices when terminally ill patients tell them they want to die.
How doctors respond and how much help they are willing to give has been dictated until now by a blend of law, professional norms and their own consciences. The court's ruling, while reinforcing the right of lawmakers to ban assisted suicides, will do little to unify the decisions that doctors make in the privacy of their offices, according to physicians and activists in Washington and elsewhere.
"We know doctors have helped people die, probably since the beginning of the doctor-patient relationship. And that is going to continue unregulated, unmonitored," said Faye Girsh, executive director of Hemlock Society U.S.A., the nation's largest group that advocates patients' right to die.
What the high court's ruling may do, people on both sides of the debate predict, is intensify the spotlight that already has begun to focus on the quality of death. "The interest in assisted suicide has been a wake-up call to physicians," said Thomas Reardon, chairman of the board of trustees of the American Medical Association, which opposes assisted suicide. "If we meet our patients' needs, we don't think the interest in assisted suicide will be there."
But other physicians predict that, as the U.S. population ages, more patients will want doctors' help in ending their lives, yesterday's ruling notwithstanding. A century ago, the average American died at age 46, typically following an accident or a brief, intense illness. Now the average life span is 77, and most people die of chronic ailments developed months or years before their deaths.
The lengthening of life and the changing nature of death have created new ethical and medical quandaries. Physicians who treat terminally ill patients are left largely to draw their own distinctions to heed the law or not, to deter patients from suicide or not, to urge patients to prolong treatment or encourage them to decide when enough is enough.
In that climate of ambiguity, many doctors heed the distinction, reinforced by the court yesterday, between passively withdrawing treatment vs. actively producing death. "Everyone has the right to say, `Keep your hands off me,' " said geriatrician Thomas Finucane, chairman of the ethics committee at Johns Hopkins Bayview Medical Center in Baltimore. Patients also have a right to pain medication, even if it accelerates their death, Finucane said.
But sometimes the boundaries between passive and active help are blurry.
Peter Hawley, medical director of the Whitman Walker Clinic, the Washington area's largest provider of AIDS services, said even though he would never help a patient commit suicide, he has prescribed pain medication to patients who have told him they want to end their lives. "Ultimately, you can try to never prescribe enough at any one time to cause them to overdose," Hawley said. "But you don't know what someone else is prescribing them, and people can get [pills] from friends."
Reuben Copperman, a retired internist who answers the hot line for the local Hemlock Society, said he will instruct callers on what kind of drugs are toxic. "I give advice, but I don't feed them the overdose," he said.
Other doctors go further. One Washington physician with a large AIDS practice said he has helped four terminally ill patients die by administering Valium on top of a morphine drip. "I don't care what the court says," said the physician, who requested anonymity. "If that is what my patient wants and what the family wants and what I want, we are going to do it."
Joanne Lynn, director of George Washington University's Center to Improve Care of the Dying, said the nation's health care system would have been ill-prepared if the court had legalized assisted suicide. Physicians have not reached a consensus, for example, on the definitions of when patients are terminally ill and when they are mentally competent to choose their own deaths.
But Michael W. Shilby of Washington feels thwarted by the court. At 41, Shilby has AIDS and has told his doctor he wants to commit suicide when the quality of his life becomes unbearable. The court's ruling, he said, "is another hurdle to jump over in pursuit of what I want to be eased off the planet with the least pain possible."
© Copyright 1997 The Washington Post Company