More MS news articles for November 1999

Assisted suicide: A right or a surrender?

http://www.usatoday.com/news/washdc/ncssun04.htm

11/21/99- Updated 11:10 PM ET

By Patrick McMahon and Wendy Koch, USA TODAY

Patrick Matheny, a 43-year-old craftsman almost completely paralyzed from Lou Gehrig's disease, tapped a goodbye note using a computer mouse strapped to his foot.

He made a printout for his parents and paid his funeral expenses.

Then, on March 10, he retreated to his trailer and asked his brother-in-law, Joe Hayes, to help him prepare a chocolate drink laced with 90 capsules of doctor-prescribed barbiturates.

Hayes mixed the final dose and held the glass as Matheny slowly swallowed the lethal concoction with a straw and ended his life.

"This is what he wanted to do," says his father, Bob, a retired police officer.

"Pat was independent as heck."

About 30 terminally ill patients in Oregon have taken their lives in the two years since the state became the first in the nation to enact a law allowing physician-assisted suicide.

Other Oregonians might not have that option if a bill passed Oct. 27 by the House of Representatives, and pending in the Senate, becomes federal law.

Nor would anyone anywhere else in the United States.

For the first time, Congress is trying to set a national policy against assisted suicide, an emotional issue that until now has been left to the states.

It's acting because the Supreme Court, unlike with abortion, has declined to chart a national course.

The court ruled in 1997 that there is no constitutional right to physician-assisted suicide, which leaves states to decide.

It upheld two state bans but did not overturn Oregon's twice-approved law.

President Clinton and most members of Congress oppose assisted suicide, but polls show that three-fifths of adults say doctors should be allowed to help terminally ill people in severe pain take their own lives.

The House bill reflects the increasing national interest in end-of-life issues, especially as the parents of baby boomers approach their final years.

It raises questions about a state's right to establish medical practices and a doctor's role in treating suffering patients.

Perhaps the most contentious question is this: Should people be allowed to help others commit suicide?

Opponents warn of a "slippery slope" on which other states could follow Oregon and vulnerable people could be pressured to feel that it's their "duty to die."

Oregon's limited experience suggests that their worst fears have not been realized, at least not yet.

Because Oregon is the only state that has sanctioned physician-assisted suicide, it serves as a laboratory for how it might work elsewhere.

Since its law first passed in 1994, there's been no copycat rush by other states. Voters in Michigan rejected a similar referendum last year.

The issue is pending in other states:

Maine voters will likely consider next year an initiative similar to Oregon's suicide law.

California's Legislature is considering a bill to allow physician-assisted suicide.

An Alaska appeals court may hear a case next year by two terminally ill residents who are seeking to overturn their state's ban of the practice.

Assisted suicide is one of several social issues, including medical marijuana and tobacco control, where states -- not Congress -- have led the way.

However, advocates have found that legalizing assisted suicide is difficult.

They have encountered effective and well-financed opposition from right-to-life and Catholic groups.

They've also seen how ghoulish image of Jack Kevorkian, the most well-known practitioner of physician-assisted suicide, has made voters skittish.

They say the bill pending in Congress is likely to dissuade other state efforts.

The bill also seems to be exacerbating rifts within the right-to-die movement.

It has prompted some advocates to look for suicide alternatives that would still be legal even if the legislation were enacted.

The bill would impose criminal penalties on doctors who use federally controlled drugs such as barbiturates to cause death. It would not bar other methods.

"We're trying to develop non-felonious ways to do this," says Derek Humphry, author of the best-selling how-to-die manual Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying and a founder of the Hemlock Society.

He helped organize a conference earlier this month in Seattle to showcase alternatives such as gas masks and paper bags.

The authors of Oregon's law are aghast at such non-medical methods.

They say that controlled substances are more reliable and less painful and can be offered within the context of a patient's medical care.

Oregon's Death with Dignity Act requires that an applicant be an adult resident with a terminal illness.

Two doctors must determine that the patient has less than six months to live and is mentally competent.

The patient must request a lethal dose both orally and in writing and wait at least 15 days to obtain it.

The patient is supposed to self-administer the dose.

A study released in February reported that of the 15 patients who used the law to take their lives in 1998, 13 had cancer.

Their average age was 69.

All took barbiturates, which are federally controlled drugs.

There are no official statistics for this year, but the law's supporters say it has been used at about the same rate as in 1998.

The study, done by epidemiologists at the Oregon Health Division, says that the terminally ill patients were motivated more by concern about losing their independence than by fear of pain or worry about finances.

"In every talk I've had with patients, I've never known pain to be the major reason for assisted suicide.

It's more loss of control, loss of dignity," says Peter Rasmussen, an oncologist in Salem, Ore., who has helped at least two patients through the process.

"Anybody can commit suicide," but Oregon's process is "predictably comfortable, painless."

Opponents say Oregon's law is already leading to euthanasia, in which other people administer lethal doses to the dying.

They cite Matheny's case.

"The guy couldn't swallow and somebody had to help him,'' says N. Gregory Hamilton, president of Physicians for Compassionate Care in Portland, Oregon.

The group was formed to oppose the state law.

A district attorney concluded in Matheny's case that the help was legal.

And Matheny's father says his son swallowed the lethal concoction on his own.

"He had a Whopper from Burger King just two days before," Bob Matheny says.

"It took him a long time, but of course he could swallow.''

Hamilton particularly objects to arguments that the Americans With Disabilities Act gives the disabled the right to help in using Oregon's law.

"What we need to be doing is treating pain, not ending people's lives."

For that reason, Hamilton hails as "enlightened" the House bill, by Rep. Henry Hyde, R-Ill., and its Senate version, by Sen. Don Nickles, R-Okla., that would effectively overrule Oregon's law.

That bill, entitled The Pain Relief Promotion Act, has spurred debate for how it links assisted suicide and pain management.

Health-care groups are divided.

The American Medical Association supports the bill, but about a dozen of its state chapters do not.

The Oregon Medical Association is asking the AMA to reconsider its position, which it will discuss at a meeting in San Diego Dec. 1-4.

Under the bill, doctors would still be allowed to prescribe controlled drugs as long as they intend to relieve pain, not cause death.

Hyde says it would improve pain management and possibly lessen suicidal impulses.

"Suicide is the ultimate act of despair," the lawmaker says.

"The opposite of alleviating pain, it is a surrender to hopelessness when there are other options that reject the culture of death."

Advocates say Congress has a responsibility to act.

They say no state, on its own, should be able to nullify the federal Controlled Substances Act, which stipulates that certain drugs be used for "legitimate" medical practice.

But critics say the bill might expand the investigative role of federal law enforcement agents and thus scare doctors away from treating pain aggressively.

They also say states should be able to decide medical practices.

"There is no need for uniformity here," says Rep. Barney Frank, D-Mass.

"What we are saying here is that 'we, the United States Government, will compel one to live against one's will."

Clinton has not said whether he would veto the bill, which failed to pass the House by a veto-proof margin.

Two years ago, he signed a separate measure that bars patients from using federal programs, such as Medicare, to pay for doctor visits or drugs needed for assisted suicide.

However, Justice Department spokeswoman Gretchen Michael says that the administration ultimately opposes the bill as "an unwarranted expansion of federal authority."

To many in Oregon, even those opposed to their pioneering law, the bill being debated in Washington grates on what they see as their right to self-determination. Sen. Ron Wyden, D-Ore., who voted against the state law, says he will filibuster the bill when it reaches the Senate floor.

Nickles says he will not bring it up until next year but says he expects to have enough votes to prevail.

Bob Matheny, 68, says he and his wife had no idea that anyone in their family would use the Oregon law when they voted for it .

He recalls how pleased they were when their son returned to college at the University of Oregon while working as a carpenter in Eugene.

He earned a bachelor's degree in sociology in 1994, graduating Phi Beta Kappa.

Only a few years later, Patrick Matheny developed Lou Gehrig's disease, an almost-always fatal progressive nervous system disorder .

As it got worse, he told his family his plans.

"He wanted to die in his trailer" just outside his parents' home, his father says.

"He was happy there."

So with help from the Oregon Health Sciences University in Portland, he obtained a lethal dose.

He waited several months before deciding that the time was right.

"I've heard people say, 'If he had a good support system, he would have stuck around.' Well, they didn't know Patrick," Bob Matheny says.

"We've seen people fight like heck to stay alive, and that's fine. But when the time comes, they ought to have the option."