Physician Assisted Suicide (PAS)

Court activity; legislative
attempts; physician survey

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U.S. Supreme Court decision - 1997:

The Supreme Court rendered its decision on the New York and Washington cases, on 1997-JUN-26. They found that the average American has no constitutional right to a physician assisted suicide. The vote was 9 to 0, an unusual, unanimous decision. Thus, the New York and Washington laws which ban such suicides are constitutional. On the other hand, the court implied that there is no constitutional bar that would prevent a state from passing a law permitting physician assisted suicide. Oregon has done exactly this. So, the battle must be fought on a state by state basis. Chief Justice Rehnquist wrote:

"Throughout the nation, Americans are engaged in an earnest and profound debate about the morality, legality and practicality of physician-assisted suicide. Our holding permits this debate to continue, as it should in an democratic society"

This is a disadvantage to the "pro-life" camp who are working to make certain that freedom to choose assisted suicide remains unavailable to all Americans. The ruling means that they will have to prevent all 50 states from passing permissive laws. If even one state passes such a law, then at least wealthy patients will be able to relocate to that state, satisfy the resident requirements, and obtain help in dying.

The Supreme Court decision was very narrow in scope. It only ruled on whether the public had a general right to assisted suicide. The case was originally brought by six terminally ill individuals in intractable pain who wanted access to assisted suicide. But by the time that the court heard legal arguments, all six had died. Thus, the court was unable to rule on whether terminally ill individuals should have a right to assisted suicide. Instead, they made a decision on whether citizens generally had that right.

Many of the justices indicated that certain groups within society might have a constitutional right to access to suicide (e.g., individuals who are terminally ill and in intractable pain). If a case were brought by such a person, then the court might find in their favor. The trick will be to find a person who can survive a terminal illness long enough for their case to wander through the judicial system and reach the Supreme Court. If even one of the original six patients had been able to survive, the court's decision might have been very different. They might have ruled that people generally had no legal right to obtain assistance in dying, but that terminally ill patients in pain did have.

Some justices discussed the dual effect theory. This is a situation in which a physician prescribes an adequate level of morphine or other drugs to control pain, even while knowing that it will shorten the patient's life. They found that this was acceptable behavior. Some of the justices expressed concern about any laws which permitted assisted suicide; they were worried that such laws might be abused, and that they might be the first of a series of laws which might generate a "slippery slope" towards a society that has wide-open assisted suicide, without effective controls.

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Pain Relief Promotion Act:

The main purpose of this bill is to block access to physician assisted suicide in the state of Oregon. Although the title of the bill implies that it is intended to promote pain relief," it would probably have the opposite effect. Many doctors would likely be concerned about a DEA agent reviewing prescriptions. They would feel pressured to under-prescribe pain medication, leaving their patients in agony, to avoid prosecutions.

1996-JUL: Bill passes House subcommittee: A bill was passed by the Constitution Subcommittee of the Judiciary Committee of the House of Representatives. Called the "Pain Relief Promotion Act," the bill is actually aimed to prevent individuals from obtaining help in suicide from their doctors. If it becomes law, it would prevent the use of federally regulated drugs in physician-assisted suicide. It would prevent the U.S. Attorney General from making exceptions -- for example in the case of Oregon which has a state law permitting such suicides. The bill also supports the "use of federally controlled substances for the alleviation of pain, even if the risk of death increases in the process." It would establish a research program into the management of pain at the Department of Health and Human Services.

Ben Mitchell, professor of bioethics and contemporary culture at Trinity Evangelical Divinity School in Deerfield, IL commented that physician assisted suicide "is a barbaric answer to pain...When you think about it, it just makes sense. There's not a single drug approved by the Food and Drug Administration for use in killing a human being. Drugs are designed to treat illness, not kill patients. The bill introduces a little bit of sanity into the culture of death. This will not stop the euthanasia and assisted-suicide movement in this country, but it will slow it down a bit." Pro-choice individuals and groups who support an person's right to choose assisted suicide believe that forcing a person to remain alive when their continued life has become unbearable, is itself barbaric.

The bill is clearly unconstitutional. The U.S. Supreme Court decision of 1997 implied that states can pass laws which permit physician assisted suicide, and that individuals have a right to take advantage of these laws if they wish. The Federal Government can hardly pass a law to prevent such access.

	1999-OCT: Bill passes the House: The Pain Relief Promotion Act was passed by the House, by a vote of 271 to 156. Lori Hougens, spokesperson for National Right to Life was pleased. She said: "Congress has just sent a very strong bipartisan message that the appropriate role of a doctor is to be helping his patient, not to be pushing them off a bridge...Doctors should not be killing their patients, they should be helping them." ₁ If passed, the law would place physicians in a dreadful situation. The law stipulates that a doctor can prescribe a narcotic for the relief of pain, even if it has the undesirable side effect of shortening a patient's life. But if they misjudge the dose, give the patient too much medication, and cause that patient's quick death then the physician may be charged under the act, and end up with a 20 year jail sentence. Each physician who prescribes a narcotic for pain relief will worry about a DEA investigator looking over their shoulder, evaluating the dose and trying to guess the doctor's intent. The trick would be to prescribe insufficient medication to accelerate the patient's death too much, and catch the attention of the federal officials. Physicians are liable to err on the side of their own safety and prescribe inadequate medication to control the pain. A lot of patients will be in severe, continuous agony if this bill becomes law. On the other hand, the law does recognize that doctors would be able to prescribe narcotics even if they have the side effect of shortening a patient's life somewhat. Such dosages are common place throughout North America. However, they are on legally shaky ground in many jurisdictions. Passage of the law would legalize this very common method of pain control. Some physicians currently leave their patients in agony out of fear of being charged with murder because they shortened the patient's life by even a small amount. Doctor's will now be able to prescribe some level of medication, and reduce their patient's agony, without endangering themselves.
	2000-DEC-15: Bill dies for the year: The US Senate adjourned for the year without voting on the Act. The bill was dead, but could have been revived in 2001. ₂
	2001-NOV: "Conquering Pain Act of 2001" introduced: Senator Ron Wyden (D-OR) introduced a bill, S1024, which has been referred to a Senate committee. An identical bill, HR2156, was introduced by Rep. Darlene Hooley (D-OR); it was referred to a House subcommittee. Unlike the earlier Pain Relief Promotion Act, this bill seems to be a genuine effort to improve pain management. Introduced by two members of Congress from Oregon, it did not attack the Oregon physician assisted suicide law. It was referred to the Committee on Health, Education, Labor, and Pensions where it died. ₅

Survey of Physicians:

Dr. Diane Meier of Mount Sinai School of Medicine in New York, NY led a survey of 1,902 doctors during the year 2000 on the topic of physician assisted suicide._2,3 They polled doctors who specialized in aging, infectious diseases, cancer and diseases which affected kidneys, nerves and lungs. These were the areas of medicine where they felt that requests for assisted suicide might commonly surface. They found that:

6.4% of those who responded admitted that they had helped at least one patient commit suicide.

They speculate that actual number is probably much larger, as many doctors would be unwilling to disclose criminal acts that they have performed.

"...requests for assisted suicide or euthanasia are frequently made to physicians who practice in specialties in which they are likely to care for dying patients, and that the decision to honor such a request is not rare in the United States."

Among the group that had helped at least one patient to die, 53% said that the assisted-death of their most recent patient was caused by a lethal injection. The rest wrote a prescription for pills that would cause death.

29% of the doctors agreed to help in a suicide because their patient was in severe pain. 78% did it because their patient was in severe discomfort other than pain.

Their patients gave many reasons for wanting to die:

	79% cited discomfort other than pain
	53% cited loss of dignity
	52% cited fear of uncontrollable symptoms.

It would appear that laws which restrict physician assisted suicide to cases involving terminal illness with intractable pain will only handle the wishes of a minority of those persons who seek assisted death.

References:

Jeff Johnson, "Pain relief promotion act passes house," Family news in focus, at: http://www.family.org/cforum/fnif/news/a0008306.html
John Giglio, "Misnamed 'Pain Relief Promotion Act' Fails as Congress Adjourns," 2000-DEC-16, American Pain Foundation, at: http://www.painfoundation.org/page_policy.asp
"Doctor-assisted Suicide Not Rare in U.S., Study Finds," Reuters News Agency, 1998-APR-23.
Article, New England Journal of Medicine, 1998-APR-23.
"S.1024; Title: A bill to amend the Public Health Service Act to provide for a public response to the public health crisis of pain, and for other purposes," Thomas, Library of Congress, at: http://thomas.loc.gov/