October 12, 2005
No Place for DEA in Oregon's Suicide Issue

By Froma Harrop

When it comes to medical ethics, the Bush administration has strong opinions and no idea what it's doing. It tramples doctor-patient relationships with Stalinist gusto. The most personal medical decisions become Washington's business, and very difficult situations are made even harder.

The administration is true to form in its challenge of Oregon's right-to-die law. Passed twice by Oregon voters, the law sets rules under which doctors may prescribe lethal medication to terminally ill patients who ask for it.

The Bush administration opposes the law on moral grounds and has been trying to overturn it. In 2001, Attorney General John Ashcroft asserted that the federal Controlled Substances Act gave him the power to revoke the prescription-writing privileges of doctors who helped patients die under the Oregon law.

But two lower federal courts supported Oregon's contention that states, not Washington, have the power to regulate the practice of medicine. The U.S. Supreme Court must now decide whether Washington has the right to go after doctors who do what the Oregon Death With Dignity Act says is legal.

Many Americans fear the prospect of a long and painful death. A right-to-die law offers people a way to escape those last, awful days. The law's critics assert that palliative medicine should make doctor-assisted "suicide" unnecessary, because it can take care of the pain and other discomfort.

Such arguments do not hearten givers of palliative care -- rather, they terrify them. Hospices administer a ton of drugs. Medications that stop the hurt may also hasten death. And there are a few cases in which painkillers don't work. This is a world of gray and no place for the federal Drug Enforcement Administration.

DEA agents go after addicts and dealers. Palliative-care professionals dread that federal officials, with no clinical experience, will be second-guessing their decisions. Some predict that doctors would become more afraid of prescribing painkilling medicine.

"This is a huge thing," says Dr. Timothy Quill, a professor of medicine at the University of Rochester, "and everyone in palliative care and hospices is holding their breath."

Quill is something of an expert on the matter. In 1991, a patient dying of leukemia asked him for barbiturates, under the pretext of helping her sleep. He gave them to her. The patient later took the drugs and died. Quill wrote about the case in the New England Journal of Medicine and became the center of a national controversy. New York State pursued misconduct charges, but a grand jury refused to indict him. Quill now runs his university's palliative care program.

Physician-assisted dying is not some new invention out of Oregon. Few talk openly about it, but many doctors help terminally ill patients end their lives. These are often slow-motion deaths in which patients are encouraged to stop eating and drinking. Or patients may undergo terminal sedation, where they are sedated into unconsciousness and soon die. Sophisticated patients know what to ask for.

There are lots of slippery slopes here, but the states seem able to police them. The big fat paradox in the attacks against Oregon's law is that its safeguards could tame a practice that is fairly common.

The law requires two doctors to determine that the patient has less than six months to live. The patient cannot be depressed. The patient must ask for the assisted death, wait 15 days and be told of alternatives, such as hospice care. The patients must take any prescribed lethal medications on their own.

Oregon actually has proportionally more referrals to hospices and more people dying at home than in other states. Patients seem more willing to enter hospice care if they know they have an escape should the pain become unbearable.

"The law encourages palliative care," Quill says, "because people are more explicit about what's bothering them." When physician-assisted dying is a crime, terminally ill people are afraid to be honest with their physicians. "They'll take the risk that they'll be labeled mentally ill and put in a psychiatric facility."

The Bush people would have DEA agents invading these discussions -- and making a miserable situation even more so for doctors, patients and their families. Here is another moral crusade that neglects to think out the consequences. Let's hope the Supreme Court stops it.

2005 Providence Journal Co. Distributed by Creators Syndicate

Froma Harrop

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