Death Returns To Our Valley
By Dr. Carolyn Gerster

Two years ago a physician-assisted suicide bill was introduced in the Health Committee of the Arizona House of Repre-sentatives. HB 2454 was heard, but not voted on, which killed the bill for that legislative session.

On January 19, 2005, House Bill 2313 was introduced. Proposed by 18 Democratic legislators, the measure would legalize physician-assisted suicide for those individuals with a "condition" which would likely cause death in six months. HB 2313 is patterned after Oregon's "Death with Dignity Law," which was also sponsored by the Hemlock Society. (The name has been sanitized; the group is now known by its new name, "End of Life Choices.")

HB 2313, like its predecessor, is deeply flawed, endangering the elderly, the disabled, the poor, and the chronically ill. Specifically, the areas of potential abuse are:

* The "attending physician" who prescribes the deadly dose of barbiturates is, in many cases, not the patient's family doctor, but one of a select group of euthanasia proponents who will see the patient one or two times before the killing takes place.

* The "consulting physician" is not required to be a specialist (oncologist, pain control, pulmonologist, etc.), but can vaguely be "experienced" to make a "diagnosis and prognosis" of the patient's disease.

* The most glaring of all the bill's many deficiencies is that no psychiatric examination is required, but only done if the consultant believes it is warranted. Studies have shown over 94% of those who commit suicide suffer from mental disorders, usually depression. Despite the knowledge that pain, anorexia, and weakness are all increased by depression, the number of psychiatric referrals in Oregon declined from 31% in 1998 to 5% in 2003.

* The patient is not required to notify parent, child, or spouse.

* The patient must make an oral and written request (or a video) for death followed in 15 days by a repeat request. However, the waiting period may be eliminated if the physician certifies that this "would serve only to extend the suffering of the patient." Thus, a same day, walk-in service may be envisioned.

* Two witnesses must sign the request, one of which may be the person inheriting the estate. The other witness could be the heir's best friend.

* To qualify for assisted suicide, the patient's M.D. must confirm that he or she will be dead in six months. Yet over half of Oregon's physicians admitted that they could not predict death within six months with any accuracy.

* Insurance companies may not ask whether a patient has signed a request for lethal poison prior to issuing a policy and are required to pay full benefits.

* A physician unwilling to kill a patient on request "must promptly transfer the patient" to a euth-anasia provider. A conscience-stricken physician is compelled to immediately seek out a "hit man."

* Amazingly, HB 2313 states that the prescribing of a lethal dose of sedative "does not constitute suicide, mercy killing, or homicide."

* Physician-assisted suicide is shrouded in secrecy. "Only a sample of records will be reviewed annually," according to the bill. The "information collected is not a public record and not available for inspection by the public."

The above provision makes any meaningful evaluation of possible abuse impossible.

* There is no penalty for not reporting. The sixth annual report of Oregon's Death With Dignity Act (3/10/04) indicated "there is no way to evaluate doctors who may act outside the provisions of DWDA."

Oregon Experience

The research is clear on this. Patients seek suicide because of depression, fear of being a burden to others (up to 63% of Oregon's victims), decrease of participation in activities (93%), loss of autonomy (93%), and loss of dignity (82%). What about "untreatable pain"? In the six years since Oregon's assisted suicide law went into effect, there's not been one documented case of suicide requested for that reason.

The growing concern over health cost containment, HMOs, and decrease in Medicare coverage have increased enthusiasm for euthanasia. In February 1998 physician-assisted suicide was added to services provided under the Oregon Health Plan. Assisted suicide is funded by the Oregon taxpayer. Some life-sustaining treatment, including adequate living assistance for the disabled and adequate pain relief in a hospice or home setting, is severely rationed by the state government.

Although under-reported, the number of physician-assisted suicides in Oregon is rising - - from 16 in 1998 to 42 in 2003, a total of 171 in six years - - and is probably only a fraction of the actual numbers.

In Arizona, a concurrent House Bill (2311), proposed by the same sponsors, provides that a patient diagnosed with a "terminal illness," confirmed by one attending physician and one consulting physician, be given prescriptions, in whatever dose, amount, and refills determined by the physician and the patient. In other words, it provides a complete open-ended "uncontrolled dispensing" of controlled substances.

Conclusion

The physician must be a patient advocate. The physician's allegiance is, and must be, to the patient only - - not to the hospital, the government, the HMO, or even to the family, when their wishes will hasten the patient's death.

Physicians should join together with disability advocacy groups, hospices, and professionals in medicine, nursing, pharmacy, and law, not only to insure control of pain and depression, but to ease the patient's loneliness, fear of abandonment, and address financial concerns.

Caring, when curing is not possible, is essential, but killing must never be an option. The doctor must not become an executioner.

Instead of destroying life, we must destroy the conditions which make life intolerable. (See also: Supreme Court Agrees to Hear Oregon Assisted Suicide Case and Assisted Suicide Proposal Returns to California.)

Dr. Gerster is the NRLC board member representing Arizona. She served as NRLC President in 1978-79.