PORTLAND, Ore. — Kaiser Permanente Northwest (KPNW) is actively looking for doctors who are willing to participate in physician-assisted suicide — even if the victim is not the doctor's patient.

The Register obtained an electronic memorandum detailing the request, sent out to 829 Oregon physicians.

The Aug. 6 memorandum reads, in part: “KPNW has complied with implementation of the Oregon Death With Dignity Act (for Oregon residents ONLY) since it became law. The use of this law by KPNW patients and physicians has been administered by our Regional Ethics Service. Recently our Ethics Service had a situation where no attending M.D. could be found to assist an eligible member in implementing the law for three weeks, during which time this person was suffering and actively dying.”

The memorandum adds that this situation “can be very distressing to critically ill patients and their families.”

The e-mail memorandum includes the four guidelines doctors must perform in order to comply with Oregon law. In addition, it asks doctors if they will act as an attending physician for their patients or for members who are not their patients.

Oregon became the only state to legalize assisted suicide in 1994, when Oregon voters approved Measure 16, but a federal judge in 1995 placed an injunction on the law before it took effect.

The practice of physician-assisted suicide became legal on Oct. 27, 1997, when the 9th U.S. Circuit Court of Appeals removed the injunction. A few weeks later on Nov. 4, Oregon voters rejected an attempt to repeal physician-assisted suicide.

Voters in four other states have rejected attempts to legalize the practice: Washington in 1991, California in 1992, Michigan in 1998 and Maine in 2000. In addition, 14 of the 38 states that have bans on the practice have decided to strengthen those laws within the past eight years.

This latest development is “frightening,” according to Dr. Gregory Hamilton. A Catholic physician based in Portland, Hamilton co-founded Physicians for Compassionate Care in 1994 to oppose physician-assisted suicide.

“This e-mail indicates that Kaiser HMO not only allows assisted suicide, but they are lending administrative support to assisted suicide to make sure it can happen,” Hamilton said.

That Kaiser Permanente found so few doctors willing to participate in physician-assisted suicide comes to no surprise to Hamilton.

“Kaiser HMO cannot find enough doctors for two reasons,” he said. “No. 1: Doctors do not want to OD [overdose] patients. No. 2: They don't have to kill their patients. They can manage pain.”

The real impetus behind the HMO's tors for two reasons,” he said. “No. 1: Doctors do not want to OD [overdose] patients. No. 2: They don't have to kill their patients. They can manage pain.”

The real impetus behind the HMO's recruitment e-mail is not simply concern for suffering patients.

“If Kaiser succeeds in recruiting doctors to perform assisted suicide, the profit is potentially huge,” he said.

Hamilton noted the cost of drugs for assisted suicide amounts to about $60 as opposed to approximately $40,000 to aggressively treat a terminal patient's pain.

“If you get 10 patients, that's $400,000 in savings. It's not huge in a medical budget, but it's a chunk of change,” he said. With active recruitment, that profit could swell and seniors would be left in the cross hairs, Hamilton said.

“Assisted suicide is not some kind of individual right. It gives power to the HMO, the insurance companies and the whole medical bureaucracy,” he said.

Kaiser Permanente Northwest denied it had any financial incentive to encourage patients to choose physician-assisted suicide.

“That is outrageous and unfounded,” said Dr. Al Weiland, medical director of Kaiser Permanente's northwest region. “Such speculation is offensive because physicians are so deeply committed to the well-being of our patients.”

He added: “I don't want to leave any doubt — in regard to this law we have no financial incentives that can influence the individual discussions between one of our physicians and his or her patient.”

Weiland claimed Hamilton's charges were “unfounded” for several reasons. He noted that under Oregon law, a patient is only eligible for physician-assisted suicide if a doctor determines a patient would otherwise live for only six more months.

“By then, the more costly diagnostic and treatment phase of an illness is usually passed and most patients are already on hospice and being cared for at home,” Weiland said. “Second, very few patients make a request. Even fewer follow through with filling a prescription and fewer yet ever take the medication. Those who take it generally only do so shortly before they would have died from their illness.”

Weiland insisted his HMO is neutral on the issue of physician-assisted suicide.

“Kaiser Permanente hasn't taken a position either for or against Oregon's Death With Dignity Act. But we do respect the decision that Oregon voters have twice made to give the terminally ill the right to request from a physician a prescription with which they could end their life,” he said.

Hamilton said Kaiser Permanente cannot claim neutrality on the issue. With Oregon's law, HMOs have to decide whether they will permit their doctors to assist in a patient's suicide, he said. The only HMOs to refuse physician-assisted suicide are Catholic, such Portland-based Providence Health System, Hamilton said.

“To find doctors to perform physician-assisted suicide is certainly not neutral. It is taking a position,” Hamilton said.

He also denied the HMO had no financial incentives.

“Anybody knows that any HMO will save money if they OD a patient rather than give him medical care. It's not speculation,” he said.

Hopeful Sign?

Robert Castagna, executive director of the Oregon Catholic Conference, said the HMO's actions were “chilling.”

“There were no safeguards — that's what our campaign said,” Castagna said, referring to the unsuccessful campaign to prevent passage of the law by voters in 1994. “This was one of the potential abuses we pointed out. Here, eight years later, we have a health care company encouraging doctors to end the lives of people who aren't even their patients.”

He said the memo is “an extremely negative development that concerns the Oregon Catholic Conference greatly.”

But Castagna did, however, find something good about the memo: “It's a good sign that physicians don't want to engage in physician-assisted suicide,” he said.

For now, Castagna hopes a court decision will put an end to physician-assisted suicide. U.S. Attorney General John Ashcroft issued an opinion last November stating that Oregon doctors cannot prescribe federally controlled drugs such as barbiturates to assist a patient's suicide.

A federal court in April sided with the Oregon government, and the case will likely go to the Supreme Court.

“I'm hoping the federal courts will find Measure 16 is in violation of the Federal Controlled Substances Act,” Castagna said.

Such an action would not overturn Oregon's law but would render it almost unworkable, as physicians would have few if any remaining drugs to legally prescribe for assisted suicide.

In his 1995 encyclical Evangelium Vitae (The Gospel of Life), Pope John Paul II criticized attempts to call euthanasia merciful.

“True ‘compassion’ leads to sharing another's pain; it does not kill the person whose suffering we cannot bear,” the Holy Father wrote in section 66 of the encyclical. “Moreover, the act of euthanasia appears all the more perverse if it is carried out by those, like relatives, who are supposed to treat a family member with patience and love, or by those, such as doctors, who by virtue of their specific profession are supposed to care for the sick person even in the most painful terminal stages.”

Joshua Mercer writes from Minneapolis.