PHYSICIANS FOR COMPASSIONATE
CARE NEWS
Affirming An Ethic That All Human Life is Inherently Valuable
Vol.1, No.2, Spring 1998
CLINICAL GUIDELINES: Non-Participation in Doctor
Assisted Suicide
These recommendations are intended to protect our
patients, preserve our own moral integrity, and maintain
our right not to participate in assisted suicides.
Post a copy of your professional ethics so that patients
are informed in advance of your principles. *
Avoid initiating discussion of assisted suicide in
the context of discussing patient treatment options,
because initiating such discussion suggests the doctors
approval of the patients suicide.
Continue to treat suicidal ideation as a symptom
requiring diagnosis and treatment. Just as with any
other patient who brings up suicide, if the seriously
ill patient expresses suicidal thoughts, this symptom
should be taken seriously. The suicidal thoughts
should be discussed with the patient and included
in the overall treatment plan. Case consultation,
family meetings, referral for counseling, psychiatry
referral for medication evaluation, pastoral care,
pain management consults, and palliative care may
all be appropriate treatment interventions for the
suicidal, seriously ill patient.
If the patient insist upon discussing suicidal ideation
in terms of political “rights” rather
than as a clinical problem, remind the patient that
you value all human life including theirs and that
you want to continue to work with them. Reassure
the patient that treatment of pain, discomfort, or
depression is very likely to help them feel their
live is still worth living.
Continue to offer good care. The patient is free
to transfer to another doctor at their own initiative
without your suggesting such a move. The law does
not require the physician to refer the patient to
a doctor who will participate in the suicide.
Decline to refer for assisted suicide, because to
refer for suicide will contribute to the patient's
discouragement, compromise the physician's moral
integrity, and be considered by an act of participation.
The law states specifically, “No health care
provider shall be under any duty, whether by contract,
by state or by any other legal requirement to participate...”(127.885
4.01.Immunities. no. (4)).
* (The PCC ethics statement is printed inside this
issue. A copy of professionally printed ethics is
available from PCC, a $10.00 donations is appreciated.)
Assisted Suicide and Medical Illness:
Herbert Hendin at PCC spring lecture
by Catherine Hamilton
Dr. Herbert Hendin, medical director of the American
Foundation for Suicide Prevention and Professor
of Psychiatry at New York Medical College, delivered
a compelling and learned presentation to PCC members
and friends titled “Assisted Suicide and
Medical Illness: with Reference to the New Oregon
Law.
In his opening remarks, Dr. Hendin said: “People
assume that seriously or terminally ill people
who wish to end their lives are different from
those who are otherwise suicidal...such people
are not significantly different from people who
meet other crises with the desire to end the crisis
by ending their lives.” Hendin went on
to say that “frightened patient are likely
to listen to doctors who suggest assisted suicide.”
Doctor Hendin further demonstrated that when the
seriously ill patients’ fear and untreated
physical symptoms are effectively addressed in
treatment, the desire for assisted suicide disappears.
On the other hand, “Ignorance of how to care
for the complex issues of severely ill patients
is the most likely rationalization for a doctor
to comply to assisted suicides,” Hendin contended.
In a series of case presentations, Dr. Hendin
found that, “Doctors felt free to ignore
patient autonomy when they knew how to help the
patient.” However, “Patient autonomy
was in essence a rationale for assisted suicide
when doctors felt helpless and did not know what
to do.” According to Hendin, the danger in
Oregon is in the fact that: “Under the Oregon
law...They (the doctors) are not required to inquire
into the source of the desperation that underlies
such a request or to be knowledgeable about the
alternatives that may relieve it.”
When Dr. Hendin was asked by a member of the audience
what doctors in Oregon should do with a patient
who is requesting assisted suicide, he said: “I
don’t think it would be difficult to help
a suicidal, severely ill patient get over suicidal
desires, even if it is the law. It wouldn’t
be any different than helping any other patient
who was suicidal.”
The cultural effects of assisted suicide leading
to complacency and stigmatization of a particular
group within a population is addressed in Dr. Hendin’s
new book, Seduced by Death, but he added that the
dangerous results of accepting assisted suicide
is a medical profession and a general population
that has no conceptualization of any other response
to elderly or terminally ill, except assistance
in suicide.
In conclusion, Hendin said that Oregon doctors
should improve the quality of care at the end of
life. “Knowledge of how to minister to the
physical and psychological needs of terminally
ill people is the most promising development in
medicine. Our challenge is to bring that knowledge
and that care to all patients who are terminally
ill.”
Doctor Hendin is one of the worlds leading experts
in the study of suicide. He helped start the American
Society of Suicide Prevention at a time when he
had little interest in the subject of assisted
suicide. As the Dutch experience unfolded, however,
Hendin visited Holland with no particular position
on what public policy in the area of assisted suicide
and euthanasia should be. After four trips to the
Netherlands and extensive interviews and research,
each trip lasting up to six weeks, he became increasingly
convinced of the dangers of assisted suicide.
Oregon Health Plan to Fund Suicides?
Public hearing held
Testimony falls on deaf ears
“They called it a hearing, but they didn’t
listen,” claims Sandy Willows, director of
Friends of Seasonal and Service Workers, one of
nearly a dozen Oregon groups who testified against
the Oregon Health Plan funding suicides of the
poor. Here’s what some of them said:
“Having a rationed state health care plan
for the poor and disabled that offers suicide as
an alternative to good care is a recipe for disaster.” N.
Gregory Hamilton, M.D., Physicians for Compassionate
Care.
“Under this plan(Oregon Health Plan) life-saving
surgeries have been denied and children with leukemia
allowed to die...It is outright unethical for the
state to fund physician-assisted suicide, death,
when it is eliminating life-giving services. ” Victoria
Jerome, M.D., Coalition of Concerned Medical Professionals.
“Instead of offering life saving treatments
and medical care to alleviate suffering, the state
will offer assisted suicide. Why? The answer is
economics.” Christopher Day, Ph.D. Northwest
Seasonal Workers Association.
“We believe that since the Oregon Health
Plan continues to cut funding for many treatments
that help the poor get well and stay well, it should
certainly not offer itself the cheaper way out:
encouraging people to save the state money by killing
themselves.” Alan Hakimoglu, Friends of Seasonal
and Service Workers.
“It is not appropriate for the Commission
to consider including doctor-assisted suicide as
part of a “condition\treatment” on
the Priority List, when the guidelines for prioritization
of condition\treatment by the Commission include: ‘Ability
of the treatment to prevent death’ and ‘avoidance
of death.’” Dr. Kenneth Stevens,
M.D., Chairman, of Radiation Oncology Dept. at
OHSU and PCC Board Member.
“Funding suicides for the poor and disabled
is a direct threat to the lives of disabled citizens
which are stigmatized by the Oregon law.” Ellie
Jenny, Not Dead Yet, an advocacy group for the
protection of disabled citizens.
Not one poor person who receives the Oregon Health
Plan came to the hearings pleading for suicide
as an option on their state HMO. All the groups
represented the poor and disabled and protested
against such ranking. But the Oregon Health Commission
voted 10 to 1 to rank assisted suicide as a “health
service,” number 260 out of 745 services.
No one on the Commission seemed to pay much attention
to the fact that the Assisted Suicide Funding Restriction
Act blocks federal funds from being used for suicides.
The state health plan is funded largely by federal
Medicaid dollars.
From the President
The reaction of Physicians for Compassionate Care
to the reported death of an Oregon woman by assisted
suicide was one of profound grief for the patient,
the profession of medicine and each and every American.
To treat one person’s life as if it were
not equally meaningful and valuable, diminishes
and devalues all seriously ill individuals. All
of the rest of us enjoy the protection of society
and the profession of medicine against despondency
and suicidal ideation; but this one group, those
with serious, perhaps terminal illnesses do not
enjoy that same protection. For the rest of us,
hope and treatment would be offered. The meaningfulness
of our lives would be recognized, we would not
be handed a lethal potion. This death diminishes
all of us. One suicide that takes place within
the doctor-patient relationship is too many. It
is a betrayal of trust.
No suicide occurs in a vacuum. It takes place
in a powerful social and emotional context. There
is no autonomy within the doctor-patient relationship.
The doctor-patient relationship is highly charged
emotionally, and there is a power differential
heavily weighted toward the doctor’s side.
When a doctor agrees with a patient’s suicidal
ideation and hands them a lethal potion, he or
she is giving that patient the message that there
is no hope, that their life is no longer as valuable
and as meaningful as the lives of others.
To give even one patient this message, to participate
in the suicide of even one patient, stigmatizes
and devalues each and every person with a serious,
perhaps terminal illness. By allowing one class
of citizens to be treated as if their lives were
not as valuable as the lives of the rest of us,
we endanger each and every American.
N.Gregory Hamilton, M.D.
Friends of Seasonal Workers Solicits Physicians
Volunteers
Friends of Seasonal Workers (FSW) asked us to
help them find physicians to volunteer time for
health care clinics. FSW helps citizens of Oregon
who often are not eligible for health care coverage,
to obtain the medical care and other professional
services needed. After discussion by the PCC Board
of Directors, it was decided that since we uphold
a principle that values all human life equally,
and because we are not a one issue organization,
it is entirely appropriate for PCC to help FSW
find physician volunteers. PCC is very grateful
to Friends of Seasonal Workers for their clear
opposition to assisted suicide and their protest
against the state funding suicides of the poor
through the Oregon Health Plan. To volunteer a
few hours a week, once a month, or even a one time
only donation of time, call: (503) 228-1826.
PCC proposes changes
Dr. Kenneth Stevens, professor and Chairman of
Radiation Oncology at OHSU and PCC Board Memeber,
testified at the Oregon Health Division hearing
on assisted suicide reporting rquerments. He emphasized
that it is the standard of the practice of medicine
to properly document and evaluate the outcomes
of new treatments and medical services. The Oregon
Health Division should follow the same scientific
standards to collect and evaluate information regarding
doctor-assisted suicides in Oregon that are used
to evaluate all new treatments in medicine.
The Oregon Health Division administrative rules
should obtain information to answer the following
questions:
1. How many patients start the Process?
2. How many of the patients who start the process
receive a prescription?
3. How many of the patients who receive a prescription
have it filled?
4. What drugs and quantity of drugs are prescribed?
5. How many of the patients who have a prescription
filled actually take the drugs?
6. What happens to those who start consuming the
drugs?
a. How many consume all of the drugs?
1) How many die?
2) What are other outcomes, complications, etc.?
b. How many do not consume all of the drugs?
1) How many die?
2) What are other outcomes, complications, etc.?
7. What other devices (suffocation bags, etc.)
are used in addition to drugs to assist in suicide?
8. How long after consuming the drugs does death
occur?
9. Who witnesses and documents what happens to
the patient when the drugs are taken?
10.What are the demographics of these patients:
age, race, gender, economic status, etc.?
Instead of accepting such recommendations, the
Health Division seems bent on defining reporting
requirements so vaguely that no useful information
can be gathered, and there is no provision for
enforcement’s of the so-called requirements
to be reported. The Health Division appears to
be assuring secrecy and anonymity for doctors and
care providers over and above the need to protect
Oregon patients.
Other recommended newsletters:
Life at Risk: a chronicle of Euthanasia
Trends in America
3211 4th Street
Washington DC 20017-1194
Ph: (202) 541-3020 Fax: (202) 541-3054
International Anti-Euthanasia Task Force Update
PO Box 760
Steubenville, OH 43952
Ph: (740) 282-3810
PCC Officers
N. Gregory Hamilton, MD
President
William M. Petty, MD
Vice President
Mark Kummer, MD
Treasurer
Miles J. Edwards, MD
Secretary
William L. Toffler, MD
National Director
Board Members
Pamela J. Edwards, MD
Thomas Pitre, MD
Kenneth R. Stevens, MD
Paul D. Stull, MD
Regional Directors
Gerald B. Ahmann, MD
Medford
Thomas Comerford, MD
Bend
Carl R. Jenson, MD
Coos Bay
Marvin M. John, MD
Hermiston
Robert DuPriest, MD
Eugene
Richard M. Thorne, MD
Salem
George Middlekauf, MD
Roseburg
PCC ADDRESS:
P.O. Box 6042
Portland, Oregon 97228
503-533-8154 Phone
503-533-0429 Fax
www.pccef.org
PCC News Editor: Catherine Hamilton |
