Supreme Court, lawmakers take on assisted suicide

It's said that there's no such thing as bad publicity, but the public attention recently given to physician-assisted suicide has not led to a flurry of states legalizing the practice.

Despite the U.S. Supreme Court recently announcing it would hear a case involving assisted suicide, lawmakers in four states introducing assisted-suicide bills and protests against the way Academy Award-winning film "Million Dollar Baby" treated the subject, assisted suicide to date is still legal in only one state: Oregon.

And that state's law is under continuous fire from those who oppose the practice.

The Supreme Court announced Feb. 22 that it would hear the U.S. Justice Dept.'s appeal of a 9th U.S. Circuit Court of Appeals 2004 ruling involving Oregon's law. In the decision, the appellate court said then-U.S. Attorney General John Ashcroft overstepped his authority when he proclaimed that Oregon doctors who wrote lethal prescriptions no longer could prescribe federally controlled substances.

But even if the Supreme Court reverses that decision, it will not necessarily outlaw assisted suicide.

"Some people incorrectly say that the Supreme Court is going to overturn the Oregon law," said Ken Stevens, MD, a Portland-based oncologist and vice president of the anti-assisted-suicide group Physicians for Compassionate Care. "The Oregon law would still stand, but they could not use federally controlled substances for that purpose. They would have to use something else."

Peter Rasmussen, MD, a plaintiff in the court case, said using another substance might be easier said than done.

"I've heard people propose different cocktails of drugs that may provide a sure, dignified and peaceful death, but I'm not convinced there would be anything as good as the barbiturates," said Dr. Rasmussen, a hospice physician in Salem, Ore. "I would hesitate in offering a patient a medication that had the chance of making a patient suffer before he died."

The Oregon Medical Assn. said it will not get involved in the appeal.

In Oregon, physicians are allowed to write -- but not administer -- lethal prescriptions for mentally competent adult residents who have been diagnosed as having six months or less to live. The law has allowed 171 people to hasten their deaths between 1998 and 2003.

Oregon's law also has been used as a model for several bills introduced this year.

States debate assisted-suicide bills

State lawmakers in Arizona and Hawaii already have defeated physician-assisted suicide measures proposed there this year. State medical societies in both states opposed the bills.

But legislative efforts in California and Vermont are just getting started. Most in organized medicine hope to see the bills defeated.

The American Medical Association opposes physician-assisted suicide, calling it "fundamentally incompatible with the physician's role as healer." Most state medical societies also have lent support to forces opposing assisted-suicide bills.

"Physicians are caregivers, and they want to do what's best to help their patients live," said Arizona Medical Assn. spokeswoman Andrea Smiley. "Arizona physicians can likely expect this to come up again, but ... it's unlikely our policy against physicians assisting in death will change."

At press time, the California Medical Assn. had not formally reviewed its state's proposed legislation, but no surprises are anticipated once it has.

"We have not yet taken an official position on the bill but, historically, we have opposed this sort of thing," said CMA spokesman Ron Lopp.

But Lopp added that there was a resolution asking the CMA to reverse its policy. Physicians are expected to vote on the matter at the CMA House of Delegates meeting March 19-24.

In Vermont, the medical community has been active, with doctors lining up on both sides of the issue. The Vermont Medical Society opposes the bill.

Retired family physician Carmer Van Buren, MD, serves on the steering committee for Death With Dignity Vermont and said the longer the debate goes on, the more likely voters and politicians will begin to support assisted-suicide legislation. The nonprofit political action group, which has four physicians on its six-person board of directors, supports physician-assisted suicide.

"I think people understand it better now and recognize that it really isn't a 'physician bill,' because physicians are not obligated to do anything they don't want to do," he said.

Burlington, Vt., family physician Robert Orr, MD, leads the Vermont Alliance for Ethical Healthcare, which opposes assisted suicide and supports improving palliative care. Dr. Orr said Vermont's bill is unnecessary because terminally ill patients already can refuse treatment.

Dr. Orr extrapolated Oregon statistics to match Vermont's smaller population and said assisted suicide would result in three to five hastened deaths a year.

"It seems like we should be working harder to take care of these people instead of opening a door with a slippery slope on the other side," he said.

Both Drs. Van Buren and Orr said the U.S. Supreme Court's decision to take up the Oregon case will not have much influence in Vermont's debate on the issue. But Dr. Orr said people with disabilities have played an active role in the issue, making the opposition coalition broader than just doctors and religious groups.

Based in suburban Chicago, Not Dead Yet is a national activist organization for the disabled that has garnered attention for protesting the sympathetic portrayal of assisted suicide in the film "Million Dollar Baby." The group's president, attorney Diane Coleman, said Not Dead Yet is growing increasingly focused on the issue as more people who use Oregon's law report that they are doing so out of concerns of becoming "a burden."

"How can that be an acceptable reason?" she asked. "Instead of getting the help they need -- both physical and psychologically -- they're getting assisted suicide."