Will the 'Right' to Die Become a 'Duty'?

Oregon's assisted suicide law works its way into the fabric of society

PORTLAND, Ore.—It was sold as a law rooted in openness and compassion. At least that's how backers described the proposal to give Oregon the groundbreaking distinction of leading the way in legalizing doctor assisted suicide. Stop the needless suffering, they said, and put the heart-wrenching decision-making into the family's hands, where it belongs.

That's not what has come to pass.

“Before the November vote, proponents of the suicide law said it would empower patients and families in making difficult personal decisions,” said Richard Doerflinger, a public policy analyst for the U.S. Catholic Conference in Washington, D.C. “Opponents warned that the power to assist suicides would give doctors even more unreviewable control over the life and death of depressed patients—and the ‘right to die’ could become more of a government-approved duty than an individual choice. Guess who seems to have been right?”

Last month an Oregon agency opted to shift taxpayer funds to pay for assisted suicide for the poor. That move is expected to generate another conflict between state and federal officials.

Despite heavy opposition from the Oregon Catholic Conference of Bishops and others, the Oregon Health Services Commission approved payment for lethal drugs under the state's health plan for the poor. However, a law passed by Congress in April 1997 blocks federal spending on assisted suicide.

“It looks as though the state is deliberately provoking another federal-state conflict,” Doerflinger said. “The Federal Assisted Suicide Funding Restriction Act does not allow a state to integrate assisted suicide into its federally approved benefits package and then claim a mere paper separation of state and federal funds. It has to be in a separately administered program.”

Oregon's 1994 voter initiative legalizing assisted suicide is already facing scrutiny for possible violation of federal narcotics law. U.S. Attorney General Janet Reno is expected to announce any day whether doctors can legally prescribe lethal drugs under Oregon's law.

“Many Oregon citizens object in good conscience to physician-assisted suicide,” the state's Catholic bishops told the health commission in prepared testimony. “They should not be compelled to pay for physician-assisted suicide through the Oregon tax system and thereby be forced to contribute to an act which violates their conscience.”

Nonetheless, the commission, in a 10-1 vote, included assisted suicide in the Oregon Health Plan under the category “comfort care.” The plan is the state's health-insurance program that covers 270,000 poor residents. It makes the money allocated to it go further by creating a prioritized list of medical treatments.

“The poor, who are among the weakest and most vulnerable people in Oregon, should not be victimized through the inclusion of physician-assisted suicide in the Oregon Health Plan,” the bishops wrote.

The bishops asked that symptom control, pain management, and pastoral care be the focus of end-of-life treatment. They said they support hospice care and public support for the “social needs” of patients. A state study from last year indicates that the poor, the disabled, and the mentally ill are most likely to have suicidal thoughts.

Catholic teaching traditionally gives special consideration to those on society's fringes, the poor, and the weak. Oregon's bishops maintain that assisted suicide will slowly erode into a “duty to die” or even involuntary euthanasia. The bishops say the poor and elderly will become victims because they lack influence.

Assisted-suicide proponents told the Health Services Commission that because most voters approved of the suicide law twice the procedure should be covered for all Oregonians who choose it. In November, by a 20% margin, state voters chose not to repeal the law permitting assisted suicide first narrowly passed in 1994.

Will these wranglings in the Pacific Northwest make a difference elsewhere? “The developments in Oregon on physician-assisted suicide definitely and tragically set a national precedent,” said Bob Castagna, executive director of the Oregon Catholic Conference. “The nation should be aware of and concerned about the developments on physician-assisted suicide. Because we're setting the precedent, it can be exported as public policy to other states.”

That sounds just like what the Hemlock Society and others behind Oregon's controversial law are hoping. In December, the Hemlock Society also said it supports legalizing non-voluntary euthanasia in cases of “a minor or incompetent adult” who never sought to die. The group adds that this should only be permitted in cases involving terminal illness.

“As life expectancy increases,” said the Hemlock Society, “chronic diseases proliferate and medical science can lengthen life almost indefinitely. We must find ways to provide help to people who wish to hasten the dying process.”

Some, including most Catholics, are deeply disturbed by such a view of society's role. What can be done to respond?

Castagna urges action. At least five other states are considering new laws against assisted suicide, or have defeated legislation similar to that passed in Oregon. Castagna said it's not too early for voters to write their legislators, stressing opposition to following Oregon's frightening lead. Castagna is not without hope; he said various appeals that could bear fruit are currently underway, including through the courts and through Congress.

Relief could come from the government. Reno and the Justice Department are reviewing a decision by the federal narcotics chief who in November said he would remove the prescribing licenses of doctors who authorize poison for patients seeking suicide. A spokesman for the U.S. Drug Enforcement Administration has said that lethal prescriptions violate the Controlled Substances Act.

Some Oregon pharmacists are seeking to require doctors to list which prescriptions of barbiturates were intended for suicide. This would allow a pharmacist to choose not to participate in helping someone kill themselves.

“Not to be outdone, Oregon's doctors have become newly protective of their own privacy,” Doerflinger said, adding that the Oregon Medical Association is crying physician-patient “confidentially.” The doctors contend that this extends even to withholding from pharmacists who give the drugs to patients the purpose of those potentially lethal prescribed drugs.

Doctors and counselors report that at least 10 terminally ill patients have officially asked to invoke Oregon's assisted suicide law. They say no one has had a chance to use the drugs to die. During the 15-day waiting period the law requires between request for death and prescription of the lethal pills, about half of those making the request have died. A report from the Oregon Health Division on the number of actual suicides via the law is not expected until the end of the year.

The health office has ordered county registrars to neither confirm nor deny if a death has occurred in their county.

“The state is also working to ensure that families and ordinary Oregonians will be kept in the dark regarding the deaths of their loved ones,“ Doerflinger said. “Assisted suicide proponents said that legalization would allow assisted suicide to come out into the open, where it could be regulated to prevent abuse. Now the practice is wrapped in a conspiracy of silence, and no one will know about the abuses.”

Meanwhile, the legality of assisted suicide remains shaky. Feb. 17, U.S. District Judge Michael Hogan listened to arguments in favor of restarting a 1994 suit against the practice. That suit was dismissed by the Ninth Circuit Court of Appeals. Plaintiffs say the court did not focus on if the assisted suicide law places a “stigmatic injury” on the terminally ill because their lives are categorized as not as important to protect as others. A ruling on the case before Hogan is not expected for at least another month.

Hazel Whitman writes from Portland, Ore.

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