A clear majority of Americans surveyed agree that doctors
should be allowed to hasten death under some circumstances.
But in the privacy of the polling booth (or in the stillness
of prayer), it appears to be another matter. And especially when a
loved one is involved, most people still are very hesitant to
accept physician-assisted suicide as something that should be
legally or morally acceptable.
Or to put it more simply, the head and the heart may be
reaching different conclusions on this profound issue.
In June, the United States Supreme Court ruled that there is
no constitutional "right to die." But the justices left it up to
the states to pass laws banning - or allowing - doctor-assisted
The national debate is now shifting to Oregon, where a key
test will come this fall.
Voters here will be asked to reconsider support of a "death
with dignity" ballot measure narrowly passed in 1994. Supporters
say it would provide a strictly-regulated opportunity for patients
diagnosed as terminally ill to ask for their physician's help in
But opponents have held up the initiative in federal courts.
State lawmakers in Oregon, as a group more Republican and more
conservative than they were three years ago, put the issue back on
the ballot in an apparent bid to repeal the measure.
Supporters are frustrated - but not deterred - by having to
face better-funded opponents again.
"The more people consider it, the more people come to
understand the complexities of end-of-life care, the more
reasonable it appears that, yes, individuals should have some
choice in the matter of how and when and under what circumstances
they die when they're stuck in this prolonged dying process," says
Barbara Coombs Lee, director of the Seattle-based group Compassion
But Ms. Lee, who is a medical nurse and a lawyer, allows that
"this does not translate into political support in state
"There's ... a mismatch right now between the opinion of a
majority of the people and the moralist agenda of many politicians
in state legislatures," she says.
For example, since Oregon's "Measure 16" passed three years
ago, not a single bill allowing physician-assisted suicide has
passed in the more than 20 states where such bills have been
introduced. In only one state - Michigan - is there a
signature-gathering effort to follow Oregon's lead.
Thirty-five states now have laws outlawing physician-assisted
suicide or euthanasia. And earlier this year, the United States
Senate unanimously voted to forbid the use of federal funds to pay
for or promote such procedures.
But while lawmakers at the state and federal levels may be
more conservative these days, it also is clear that those
professions dealing most directly with the issue are wrestling over
it as well.
The issue is a struggle for medical doctors. A key tenet of
the Hippocratic oath is that "I will neither give a deadly drug to
anybody if asked for it, nor will I make a suggestion to this
Some doctors publicly advocate helping certain patients end
their own lives. Seven percent of Oregon physicians surveyed by the
New England Journal of Medicine had written prescriptions for a
lethal dose of medication.
Marcia Angell, executive editor of the New England Journal of
Medicine, asserts "the highest ethical imperative of doctors should
be to provide care in whatever way best serves patients' interests,
in accord with each patient's wishes, not with a theoretical
commitment to preserve life no matter what the cost in suffering."
But the American Medical Association balks at that view.
"Physician-assisted suicide is against the code of medical ethics
and incompatible with the physician's role as healer and
caregiver," says Thomas Reardon, chair of the AMA Task Force on
Quality Care at the End of Life. "It is not a constitutional
Here in Oregon, the state medical association has moved from
a neutral position on the "death with dignity" measure to