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
