Doctor-aided suicide: shifting politics

Physician-assisted suicide is spurring a political and moral debate of unprecedented intensity in American society.

While the issue has long been the subject of court disputes and the occasional ballot initiative, it is suddenly being fought over in Congress, the White House, both political parties - everywhere from the pulpit to dinner tables.

In Congress, opponents have advanced a bill that, in effect, would do away with Oregon's first-in-the-nation law allowing physician-assisted suicide. In the process, Republicans are cast in an unusual role of advocating Uncle Sam as "Big Brother," while Democrats take up the cause of defending states' rights.

The Justice Department is at odds with the US Drug Enforcement Agency over whether bans on "controlled substances" should include potentially lethal barbiturates and morphine used to alleviate patient suffering. The White House, meanwhile, is not sure whether President Clinton would sign an antisuicide bill.

Behind it all is the assertion by "pro-life" groups that officially permitted suicide - even in the name of compassion - is the moral equivalent of abortion. Rep. Henry Hyde (R) of Illinois, longtime leader of anti-abortion forces in Congress, is the main proponent of the antisuicide bill, which was recently approved by the House Judiciary Committee, where the vote split along party lines.

The House bill - the "Pain Relief Promotion Act" - does not specifically mention Oregon's "death with dignity" law, which was approved by voters in 1994 and again in 1997 when state lawmakers tried to overturn it. But it bans the use of federally controlled drugs for "assisted suicide or euthanasia."

At the same time, the bill encourages doctors to use opiates and other drugs to treat patients' suffering, "even if the use of such substance may increase the risk of death."

In congressional debate, Rep. Sheila Jackson-Lee (D) of Texas chided Republicans for their "big brother attitude [that would] effectively snuff out the voices of people in Oregon."

But, says Sen. Don Nickles (R) of Oklahoma, author of the Senate version of the bill, "a state law authorizing or permitting assisted suicide or euthanasia does not change the federal government's responsibility to prevent misuse of federally controlled, potentially dangerous drugs."

Within the medical profession, the question of palliative care (treatment specifically for pain) is getting renewed scrutiny because such treatment can, according to opponents, come close to physician-assisted suicide.

In years past, the concern has been that drugs such as morphine could cause addiction or - if overprescribed - death. This led some physicians to err on the side of prescribing small amounts, even though that might not provide sufficient relief.

Last year, the American Medical Association and the National Hospice Organization argued against proposed stricter bans on the grounds that doctors would be reluctant to prescribe medicine for pain treatment. With changes allowing for increased "risk of death" in such cases, the groups now give their support. The important change, according to group officials, relates to intent.

Other organizations, however, still oppose the bill, arguing that physicians will hesitate to give adequate treatment for fear of prosecution. The state hospice organization in Oregon and the medical associations in Oregon and Washington State are among them.

In its analysis of Oregon's law, the Drug Enforcement Administration had ruled that prescribing drugs controlled under federal law for purposes of assisting suicide is illegal. Attorney General Janet Reno overruled that reading of federal law, prompting the proposed legislation.

Americans, too, are divided. By wide margins in public surveys - sometimes more than 70 percent - they voice approval for physician aid in hastening death. Yet in every state but Oregon, ballot measures allowing such procedures have been turned down.

Even in Oregon, known for political and personal independence, there has been no rush to take advantage of the 1997 "death with dignity" law, allowing doctors under strict circumstances to prescribe lethal doses of drugs for certain patients diagnosed as having fewer than six months to live. In all of 1998, 15 people used it.

Two years ago, the US Supreme Court found no constitutional "right to die." Yet the ruling was not definitive on doctor-assisted suicide. Chief Justice William Rehnquist urged "this debate to continue, as it should, in a democratic society."

That debate continues in at least four states where laws similar to Oregon's are being considered. Alaska Superior Court Judge Eric Sanders recently ruled that "Alaskans do not have an undeniable right to physician-assisted suicide."

The White House has not said whether the president would sign the House bill. Mr. Clinton has expressed personal opposition to officially sanctioned suicide. Last year, in signing a bill that forbids the use of federal funds for doctor-assisted suicide, he said: "To endorse assisted suicide would set us on a disturbing and perhaps dangerous path."

(c) Copyright 1999. The Christian Science Publishing Society