What Happens Now? Oregon and Physician-Assisted Suicide

Article excerpt

The professional landscape of medicine changed irrevocably on 4 November 1997 when Oregon voters decided by a 60 percent to 40 percent margin to oppose repeal of the state's Death with Dignity Act. Professional organizations, from the state medical association, to hospice, to pharmacists, are now formulating practical guidelines and responses to patients' requests for assistance in dying as the Death with Dignity Act took legal effect in mid-November.

In March, the first two legal physician-assisted suicides in Oregon were announced, engendering an elevated level of public awareness, and, not surprisingly, an increase in the number of queries. It has also been suggested that Oregon's lead will soon be picked up by other states. There is a pressing need for a vigorous exchange of information, knowledge, and experience as the consequences of this act unfold.

Trouble within the Medical Profession

In the aftermath of the November vote, the Oregon Medical Association (OMA) produced a "statement of philosophy" regarding physician-assisted suicide that acknowledges the association's past internal struggle with this contentious issue, but reconciles itself to the necessities of the present. The OMA's statement articulates a commitment to quality health care, an obligation to honor the sanctity of the patient-physician relationship, and a responsibility to be cautious and vigilant about any proposed changes to the Death with Dignity Act as it stands. Nothing in the statement clearly separates the post-assisted suicide from the pre-assisted suicide era as far as health care is concerned; nothing clearly emphasizes the changes that are inevitable within the physician-patient relationship.

The hollowness of the OMA's "statement of philosophy" may come as no surprise in light of the internal battles that the organization has endured regarding its position on the Death with Dignity Act since the dawn of the Oregon debate. Originally neutral on the matter because of seemingly unresolvable internal disagreements, the OMA managed to calm the discord during the repeal attempt sufficiently to come out in opposition to the act and in support of repeal. That position, however, was a rather passive one, leading the electorate to believe physicians still did not have much to say on the matter.

Following the failure to repeal the Death with Dignity Act, the OMA has in essence changed its stance for a third time, offering what some might say is the only reasonable response: compliance under the law. For example, the OMA has prepared a "compliance checklist" to assist physicians in the implementation of the Death with Dignity Act, but this stands outside any document that could situate the needs of a profession within an environment that contradicts what a majority of its members believes is the role of health care provider.

For those who pay attention to such things, the flip-flop of the OMA has been perplexing. A law, a stance on which would seem to be of fundamental importance to the practice of medicine, so disrupts the continuity of consensus-building that the major professional organization for physicians in the state cannot position itself at the forefront of the debate.

Granted, there may ultimately be no reliable reasons to view physicians as any more qualified to decide these kinds of profound ethical issues than their patients. Many pieces of the aid in dying puzzle are outside of what has traditionally been considered good medical practice. As far back as the Hippocratic Oath, suicides has been viewed as anything but the jurisdiction of physicians. Still, it raises some disturbing notions about leadership and professionalism when such important opportunities for public education are missed. But putting these issues aside for the time being, what are the realities for the medical profession in the climate created by the legalization of physician-assisted suicide? …