The president of the D.C. Medical Society said yesterday he expects widespread use of a new "death with dignity" law by Washington residents who would rather be allowed to die than be kept alive in a terminally ill or hopelessly comatose condition.
"I think many people will use it," said Lewis H. Biben, a practicing medical doctor and president of the society. "I've got all kinds of old people who come in all the time and say, 'I don't want any life-saving measures when I become terminal. I don't want to be on a machine.' "
Biben described the legislation, sponsored by D.C. City Council member Polly Shackleton (D-Ward 3), as "far-sighted" and essential in an era when medical technology can artificially sustain a patient's heart and lungs for prolonged periods.
"This was very difficult legislation to draft ," said Biben, whose organization endorsed the bill. "Most families who have gone through a long-term illness, such as painful bone cancer, would be able to appreciate this."
The City Council on Tuesday gave preliminary approval to the measure, which would enable adults 18 years and older to file affidavits with their physicians refusing heroic medical treatment should they become fatally ill or lapse into a hopeless coma.
At least two doctors would be required to certify that a patient suffered from a "terminal condition" before the affidavit would become effective under the bill. A patient at any time could cancel the affidavit, and safeguards were added to prevent relatives from coercing patients into signing.
A doctor who certified that his patient was terminally ill would be obliged under the law either to honor his patient's request to be left to die or to transfer the patient to another doctor who would comply. The patient's family would have to be consulted before the transfer was made.
Any doctor violating terms of the law would be subject to a maximum penalty of a $5,000 fine and suspension or revocation of his or her license under the city's Healing Arts Practices Act.
Shackleton criticized yesterday a story that appeared in some editions of Tuesday's Washington Post for failing to clarify that a doctor would not be in violation of the bill if he chose to transfer his patient to another physician, rather than honoring the patient's request to be left to die.
She also disputed the contention of Paul Armstrong, a New York lawyer and an authority on the "death with dignity" issue, that the D.C. law would be the toughest of its kind in the country. Shackleton said the D.C. law was "virtually identical" to a Kansas law, passed in 1979, which holds that: "Failure of an attending physician to comply with the declaration of a qualified patient and to effect the transfer of the qualified patient shall constitute unprofessional conduct" as defined by Kansas law.
"The Kansas statute, on its face, would possibly impose professional conduct charges for failure to comply with the declaration even if the physician does transfer the patient," Shackleton said. "Our bill does not and therefore is less stringent."
However, an aide to Shackleton conceded yesterday that Shackleton's interpretation of the Kansas statute was not universally held.
Moreover, the maximum penalties under the Kansas law are suspension or revocation of a physician's license, but not a fine, as would be the case under the D.C. law.
Sol Edelstein, director of George Washington University Hospital emergency services, said yesterday that the new law probably would prove to be most valuable in treating elderly people, "who may not have full mental facilities" at a critical moment.
Terminally ill patients brought into his emergency room usually have decided in advance, in consultation with their family doctors, whether they want to be kept alive at any cost, according to Edelstein.
"We ask the patient's physician whether to use heroic means," he said. "Unless notified otherwise, we go ahead 100 percent" to try to keep the patient alive.
The bill drew fire earlier this month from the Most Rev. James Hickey, Catholic archbishop of Washington, who warned that it "could contribute to a declining respect for human life."
However, the Rev. Ernest R. Gibson, executive director of the Council of Churches of Greater Washington, asserted yesterday that individuals "certainly have the right to ask that they be allowed to die if there is no chance for them living."