Washington coalition files suicide initiative

Like Oregon's law, the measure would allow doctors to help terminally ill end their lives

By Don Colburn, The Oregonian, Jan. 10, 2008

Using Oregon's Death With Dignity Act as the model, a coalition led by former Gov. Booth Gardner launched a campaign Wednesday to allow Washington doctors to prescribe a lethal drug overdose to a terminally ill patient on request.

To reach the November ballot, the initiative must get about 225,000 valid signatures from Washington residents by July 3.

In 1991, Washington voters rejected a more far-reaching measure that would have permitted doctors not only to prescribe a lethal drug dose on request but also to administer the drug if the patient couldn't swallow it -- a practice some call voluntary euthanasia. The Oregon law forbids that.

Oregon is the only state where it is legal for a doctor to prescribe a drug overdose that, if used as directed, will end the patient's life. At least 292 terminally ill Oregonians have ended their lives under the law since it took effect 10 years ago. That accounts for slightly more than 1 in 1,000 deaths in the state -- fewer than either backers or opponents first expected. Updated figures covering 2007 are due out in March.

The issue remains one of the most passionately argued in U.S. medicine and politics. Proponents frame the debate in terms of personal choice, death with dignity and freedom from pain. Opponents say assisted suicide violates the Hippocratic tradition of "first, do no harm" and undermines the doctor-patient relationship by turning physicians from healers into accomplices of death.

The Washington initiative, like Oregon's law, will face strong opposition from right-to-life groups, the Roman Catholic Church, the American Medical Association and the Bush administration.

In large measure, the campaign will be fought over language. Opponents call the practice legalized by Oregon's Death With Dignity Act "physician-assisted suicide" or "medical killing." Backers, led by a group called Compassion & Choices, avoid the word "suicide," calling it "physician aid in dying" or "hastened death."

A Pew Research Center poll in 2006 found that 46 percent of U.S. respondents supported a right to assisted suicide, and 45 percent opposed it. Both sides agree that support for the practice rises when the word "suicide" is not used to describe it.

"If Compassion & Choices of Washington wins the battle of language, it will have won," said Dr. Charles Bentz, a Portland internist who is president of Physicians for Compassionate Care, which opposes the Oregon law.

In Oregon, a patient must ask for the prescription once in writing and twice orally -- with the oral requests separated by 15 days. Two doctors must certify that the patient is of sound mind, with a life expectancy of six months or less. Gardner, 71, who has Parkinson's disease, is not terminally ill as defined by the law.

The prescribing doctor also must inform the patient of alternatives to a lethal drug dose -- including hospice care. The dying patient must swallow the drug without help.

Proponents argue that Washington's new initiative will fare better than the 1991 measure in part, because Oregon's law has passed the 10-year mark without political scandal, if not without controversy. And the U.S. Supreme Court in 2006 upheld Oregon's law against legal challenge by the Bush administration.

Proponents cite Oregon's experience as proof that relatively few people will end their lives and that hospice care can thrive in a state with such a law.

Bentz challenges that picture. He calls "Death With Dignity" a euphemism for situational killing.

"Doctors should not have a license to kill," he said. Legalizing lethal prescriptions damages the integrity of medical practice, he said, and harms patients.

"For people who are suicidal at the end of life -- and there are reasons -- having assisted suicide as an option shortcuts appropriate medical care," he said. "Instead of getting treatment for depression, they get a lethal prescription."

When Oregon's law took effect in 1997, backers hoped and detractors feared that other states would follow suit. None did, although at least 18 states have seen ballot measures proposed or bills introduced on assisted suicide. Most went nowhere. Hawaii came close to adopting a law similar to Oregon's in 2002.

In California, opponents have argued that an Oregon-type law would not work or be acceptable in California, because the two states differ so sharply in size and demographics.

"It's going to be difficult for opponents to argue that Washington is so different from Oregon," said George Eighmey, executive director of Compassion & Choices of Oregon, which works with more than two-thirds of the Oregonians who end their lives that way.

"Washington is just a bigger Oregon," he said.

Early opponents fought the Oregon measure as unethical, unworkable and unjust. They raised fears that residents of other states would move to Oregon simply to avail themselves of Oregon's law; that patients would feel undue pressure from relatives; and that the law would be used disproportionately by the poor, the less educated and the uninsured.

"None of those things happened," Eighmey said.

Most of the Oregonians who ended their lives under the Death With Dignity Act had cancer. They include slightly more men than women. Half were older than 70, half younger. Most died at home while under hospice care, and almost all had some form of health insurance. They tended to have more formal education than the general population.

For more information about Oregon's law: http://egov.oregon.gov/DHS/ph/pas

Don Colburn: 503-294-5124; doncolburn@news.oregonian.com.

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