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Group Attacks Administration's Efforts to Undo Oregon's Assisted Suicide Law

http://www.medscape.com/viewarticle/443787

Oct 30, 2002
By Todd Zwillich
Reuters Health
WASHINGTON

The president of the leading advocacy group for Oregon's physician-assisted suicide law blasted US Attorney General John Ashcroft Wednesday, accusing him of acting on his "personal beliefs" in the Bush Administration's attempts to disable the law.

Barbara Coombs Lee, who heads the Portland-based Compassion in Dying Federation, said that Ashcroft is exercising a "personal vendetta" against the state by threatening to charge doctors and other healthcare professionals with felonies if they prescribe lethal doses of drugs under Oregon's assisted dying law. Ashcroft was taking the action, she said, because of his apparent belief that assisted dying is "morally wrong."

"John Ashcroft has no authority to do this," Lee told reporters.

Ashcroft issued a notice last November warning physicians or others who participate in an assisted suicide under the Oregon law that they could face prosecution for violating the federal Controlled Substances Act. The notice concluded that prescribing drugs for the purpose of ending a life did not qualify as a legitimate medical use of the drugs.

A US District Court judge ruled in April that the Bush Administration lacked the authority to use the act to police doctors in Oregon, a ruling the Justice Department quickly appealed. The state is due to file briefs next week in the 9th Circuit US Court of Appeals in an attempt to permanently overturn Ashcroft's enforcement notice.

No one has ever been prosecuted under the notice because of a court order restraining federal law enforcement officials from acting against doctors.

Oregon first enacted a law allowing physician-assisted suicide after a successful ballot initiative in 1994. Voters rejected a repeal of the law in 1997, after which doctors began using it in limited circumstances.

Lee argued that the law has worked well, giving terminally ill patients in the state autonomy over their own deaths while enforcing safeguards to prevent abuse. Ninety-one patients are documented to have died with a lethal medication dose from November 1997 to the end of 2001.

Lee said that about 300 ill patients inquired about the law in 2001 and that 21 actually received a lethal dose of medication. Most cases involve a high dose of barbiturates.

The Oregon law requires two doctors to certify that a patient is terminally ill and is likely to live less than 6 months before proceedings for a physician-supervised death can begin. Patients must also receive counseling about hospice care and other end-of-life care, and must request the lethal medication on at least three separate occasions.

Physicians must also attest that the patient is mentally fit to request their own death.

But federal lawyers argue that the use of the drugs clearly violates the Controlled Substances Act because doctors are using them to help kill patients.

"The Attorney General has permissibly concluded that suicide is not a legitimate medical purpose. That determination is supported by the text of the [Controlled Substances Act] and by ordinary English usage, which demonstrate that medicine involves the practice of healing, not killing," reads a Department of Justice brief in the 9th Circuit appeal.

The brief continues: "There are important medical, ethical, and legal distinctions between intentionally causing a patient's death and providing sufficient dosages of pain medication to eliminate or alleviate pain."

Several state medical societies are expected to file "friend of the court" briefs in support of Oregon's federal case, including the California Medical Association, and the New York Medical Society. The American Medical Association, which supported congressional efforts to overturn the Oregon law, has declined to file a brief in the case.

The Oregon Medical Society was solicited for its support but also declined to file a brief, Lee said.

Several organizations are defending the Bush Administration in the case, which is expected to go before a 3-judge panel next spring. The National Right to Life Committee, The US Conference of Catholic Bishops, and a 2000-member group known as Physicians for Compassionate Care have all filed brief's on the administration's behalf.

Using medications to assist a patient's death "is absolutely not a legitimate medical use," said Dr. Gregory Hamilton, a psychiatrist who is a spokesman for Physicians for Compassionate Care. Hamilton pointed out that a 1997 Supreme Court decision concluded that assisted suicide is incompatible with the practice of medicine.

"The Ashcroft decision is a very good decision because no state has the right to unilaterally exempt itself from federal law," he said.

A Justice Department spokesperson was not immediately available for comment.
 

© 2002 Reuters Ltd