Apparently, Many Doctors Help in `Hastened Death'

Article excerpt

Now and then, in his job as medical director of a San Francisco hospice agency, Dr. Robert V. Brody discovers that a patient has killed himself with help from a doctor.

The news rarely surprises him. In San Francisco, a city scarred deeply by the AIDS epidemic, doctor-assisted suicide has become a familiar thread in the complex tapestry of health care at the end of life.

"It's in the air," said Brody, chairman of the ethics committee at San Francisco General Hospital. "It is something that our patients know about and that they do." But it is also a crime. And so, although doctor-assisted suicide is widely acknowledged, there are no professional guidelines for it. Now, however, as the Supreme Court considers whether Americans have a fundamental right to die, medical practitioners have quietly begun grappling with the delicate matter of whether, or how, they might establish standards for helping people end their own lives. It is a quixotic effort at best and, like the debate over assisted suicide itself, fraught with controversy. But from New York to Oregon, small groups of health professionals have recently been asking themselves questions that were once unthinkable: Who is an appropriate candidate for assisted suicide? Should patients put their requests in writing? Should a second opinion be obtained? Should there be witnesses? A waiting period? Reports to the coroner? In San Francisco, where one survey of doctors who treat AIDS found that more than half had already helped a patient to die, a network of medical ethics committees has issued a formal protocol for the practice of "hastened death." It is to be published in the June issue of the Western Journal of Medicine, and although it is not the first set of guidelines to be published, it marks the first time any community has reached a consensus. "Most doctors don't want to deal with this at all, and that includes me," said Brody, who took part in the effort. "I wish it weren't part of life. But it is. And because it is, and because we are doctors, we can't put our heads in the sand." Among the requirements are a 48-hour waiting period and a patient consent form, signed in the presence of a witness. The group also drew up several sample forms, including a "physician checklist" that asks doctors to confirm, among other things, that the patient is mentally competent; that he is terminally ill and expected to die within six months; that he has been offered high-quality care to relieve pain; and that his choice to die has been "freely made, independent of financial, family, health insurance or other sources of coercion." To opponents of assisted suicide, such recommendations are entirely unrealistic; no policy statement, they say, could adequately envision the complicated array of questions that crop up at the end of life. "We are setting up guidelines in an ivory-tower hypothetical situation," said Dr. Diane Meier, a geriatrics expert at Mount Sinai Medical Center in New York. …