Oregon Assisted-Suicide Law at Risk

WASHINGTON — Congress is aiming to overturn Oregon’s law allowing physician-assisted suicide for terminally ill patients and make it a federal crime for doctors everywhere to prescribe narcotics to help those patients end their lives.

The measure could send a physician to prison for 20 years for prescribing a drug such as morphine to help patients kill themselves, according to lawyers in Oregon and California who have analyzed the bill.

A House committee is expected to approve the bill today. It could go before the full House this month and the Senate before the end of the year. Sen. Ron Wyden (D-Ore.) has promised a filibuster. A White House aide, asked if President Clinton would sign such a measure if one reached him, called the issue particularly delicate and said no decision had been made.

California and several other states, mostly in the West, have begun considering similar proposals. In California, a bill patterned on Oregon’s was voted out of committee in the legislative session ending last week and is expected to go before the full Assembly next year.

The Oregon law took effect in 1997 after the state’s voters approved an assisted-suicide ballot initiative and then decisively rejected an initiative to repeal it. In contrast to opponents’ fears, only 23 people requested lethal prescriptions in 1998, the law’s first full year in effect, and 15 used them, Oregon Health Department physicians said.

Oregon Gov. John Kitzhaber, an emergency medicine physician and a Democrat, strongly believes that people with terminal illnesses “should have the ability to control their own death to the extent that that is possible,” said the governor’s health policy advisor, Mark Gibson. “He doesn’t believe the federal government needs to be telling Oregonians how to manage the last several days of their lives.”

But here in Washington, the bill’s Republican sponsors have abandoned their traditional support for states’ rights.

“The federal government is not going to sanction the use of controlled substances for the purpose of killing people,” said Rep. Charles T. Canady (R-Fla.), a member of the House Judiciary Committee who sponsored the bill. “If that’s controversial, let the controversy go on.”

The Oregon assisted-suicide law specifically permits doctors, at a patient’s request and after a waiting period, to prescribe a lethal dose of drugs. U.S. Atty. Gen. Janet Reno said last year that Oregon had a right to waive the federal Controlled Substances Act for drugs prescribed for assisted suicide--an opinion that the proposed new federal law would nullify.

This year’s bill, sponsored by House Judiciary Chairman Henry J. Hyde (R-Ill.), sanctions the administration of narcotics for treating pain even when they hasten death. Although a number of state and county medical societies still oppose the bill, that language reassured the AMA and the National Hospice Organization, which now support it.

The legislation would also require that local, state and federal law enforcement officers be trained in what kinds of treatments constitute appropriate pain management. “This says the whole field of pain control is legitimate,” said Richard Doerflinger, an associate director of the National Conference of Catholic Bishops.

Doerflinger said the bishops, who have been actively lobbying for the legislation, worked with hospice groups as well as members of Congress to ensure that the legislation focused only on assisted suicide. “We think dying patients need assistance--but assistance in living and having pain relief and companionship and moral support,” he said.

Some physicians are not so sure.

Steven Heilig, director of public health and education for the San Francisco Medical Society, said the bill would still heighten doctors’ fears of being penalized for prescribing appropriate pain medication. “It’s dangerously close to politicians’ practicing medicine,” he said.

Critics are particularly concerned about the bill’s provision of criminal penalties for physicians found to have intentionally dispensed a narcotic to assist in a suicide. Law enforcement officers, the say, could easily misinterpret large doses of morphine meant to relieve the pain of pervasive cancer.

Even without a federal criminal statute, studies of therapy for cancer-related pain found that more than half of patients were under-medicated. In a 1986 study of nearly 900 physicians, 86% said most cancer patients were under-treated. Many physicians acknowledged that they feared raising the suspicions of local medical boards or running afoul of state laws.

The looming fight in Congress, however, centers as much on states’ rights as on pain management.

“Some of those who are so passionate about states’ rights lose their ardor pretty quickly when a state doesn’t happen to agree with them on a policy,” Wyden said. “What the bill is all about is to laser in on the laws of the state of Oregon and throw the popular will of its voters in the trash can.”