Federal Ruling on Assisted Suicide Sparks Debate. (Law Upheld, Ashcroft Rebuked)
Perlstein, Steve, Clinical Psychiatry News
A federal court's denial of the Bush administration's attempt to nullify Oregon's assisted suicide law has rekindled debate over the issues of assisted suicide and federal intervention into physicians' practices.
In his April 17 ruling, U.S. District Court Judge RobertJones found in Portland that Attorney General John Ashcroft did not have the legal authority to decide that doctors acting in compliance with an Oregon law allowing physician-assisted suicides were in violation of the federal Controlled Substances Act. The decision in Oregon v. Ashcroft did not deal with the constitutionality of the Oregon law, but Judge Jones was quite critical of Mr. Ashcroft and his handling of the situation.
Judge Jones said in his ruling that the attorney general had attempted to "stifle an ongoing, earnest, and profound debate in the various states concerning physician-assisted suicide. The citizens of Oregon, through their democratic initiative process, have chosen to resolve the moral, legal, and ethical debate on physician-assisted suicide for themselves by voting--not once, but twice--in favor of the Oregon act."
Voters approved the Oregon Death With Dignity Act in 1994 and again in 1997. The law allows terminally ill patients with fewer than 6 months to live to request a lethal dose of drugs, but only after two doctors confirm the diagnosis and declare the patient mentally competent to make the request. But on Nov. 6, Mr. Ashcroft fulfilled one of President Bush's campaign promises by declaring that any physician prescribing a lethal dose of pain medicine was in violation of federal law because such a prescription was not a "legitimate medical purpose."
The Ashcroft directive suited Dr. N. Gregory Hamilton just fine, and he was highly critical of Judge Jones' decision in the case. "The message to the patient is that your life is no longer worth living," said Dr. Hamilton, a Portland psychiatrist and the spokesman for Physicians for Compassionate Care, the Oregon organization leading the charge against assisted suicide. "What we need to do is to treat suicidal tendencies in the gravely ill just like we do with anyone else."
But surveys suggest that Dr. Hamilton might not hold the majority opinion among psychiatrists, either in Oregon or nationally. In a 1994 survey of 322 Oregon psychiatrists, 68% felt that physician-assisted suicide should be permitted; 59% said it can be morally acceptable. A 1997 national survey of 292 forensic psychiatrists found that 66% believed the practice was ethical in certain circumstances; 63% thought it should be legalized in certain cases.
Dr. Linda Ganzini, professor of psychiatry at Oregon Health Sciences University, Portland, conducted both surveys. She said her research found that although many terminally ill patients consider ending their own lives under Oregon's law, very few actually go through with it. Studies conducted before the law was passed showed that between 10% and 26% of eligible patients "showed a strong interest" in assisted suicide, she said, but since the act went into effect in 1998, the rate of deaths from assisted suicide in Oregon has been 9 per 10,000 deaths in the general population. …