A patient falls ill in one of Voltaire’s philosophical tales and the author observes: “Despite the attention and ministrations of the leading medical doctors of Europe, he survived.”
This is the sardonic wit we should apply to a debate today: Should a physician who has sworn to do no harm be allowed, legally, to help a patient kill himself with prescribed lethal doses of barbiturates?
This is not about Dr. Kevorkian, the infamous Dr. Death, now serving a prison term for murder. The courts finally would not accept his oxymoronic euphemism of “assisted suicide.” (You can wound the language as well as the person.) Physicians in Oregon, however, can become doctors of death under state law, having received the imprimatur of the people in a statewide referendum. But such doctors still need the help of the feds. Federal law trumps state law in the administration of drugs under the Controlled Substances Act, which governs powerful prescription drugs like morphine that alleviate pain, but which can also kill. Loophole-lovers, aware of the problem, sought a federal accomplice for assisted suicide in Oregon and found one in Janet Reno, the attorney general in the Clinton administration. She gave them a pass, promising not to prosecute. John Ashcroft, who replaced her, has reversed that, and a federal judge has stayed his decision, at least temporarily.
There are two issues here. One is philosophical in its consideration of life-and-death issues. The other is legalistic and constitutional, whether a state’s rights in this matter should supersede federal authority. Like most of our most complex decisions, liberal and conservative attitudes conflict and overlap. Black-and-white reasoning is simplistic and inadequate. There are shades of gray in both arguments. (There’s no rainbow here.)
Certain professors of medicine argue that, when a patient is dying in great pain and chooses to end both pain and life, a doctor in good conscience should be able to relieve the agony and abide by the patient’s wishes. But, even if the doctor doesn’t intend for a patient to die, he can accidentally kill if he administers dosages high enough to alleviate excruciating pain. Hence, Mr. Ashcroft’s policy could make doctors fear prosecution, curtailing their ability even to prescribe the necessary dosages for pain medication. Consider what you would want for your mother or father, your child or your husband or wife, or even yourself, when pain drains human dignity in those last hours of life.
On the other hand, no one should be licensed to kill. This is the argument of a coalition of groups that have contended vigorously against such laws in state legislatures, and includes many doctors and nurses, as well as hospice workers, disability-rights activists, pro-life supporters and various defenders of the poor. They argue that the sanctity of life is paramount and worry about the potential for abuse of patients who are most vulnerable to pressures of family, the cost of care, psychological guilt, and the work of “do-gooders” who consider themselves to be saviors or saints in reducing suffering.
The strongest argument against the Ashcroft decision, it seems to me, is that doctors would be inhibited from prescribing necessary doses of morphine to eliminate pain because they fear prosecution. The attorney general has specifically said and assured the Oregon Medical Association that excessive scrutiny of doctors’ prescriptions for morphine use would not be initiated by the federal government.
In states that have outlawed assisted suicide such as Michigan, Louisiana and Rhode Island the evidence shows that doctors have actually increased their use of morphine in alleviating pain.
There’s a persuasive argument for states’ rights, since Oregon voters twice affirmed by wide margins their decision to approve of assisted suicide. However, the attorney general based his decision on an 8-0 U.S. Supreme Court decision (United States vs. Oakland Cannabis Buyers’ Cooperative) that said California could legalize medical marijuana, but that such legalization could not prevent the federal government from enforcing federal law which disallows the use of marijuana. The court convincingly backs up Mr. Ashcroft’s decision.
The spectre of death hovers close over us as we mourn those who died in the September 11 attacks and the Nov. 12 airliner crash in New York City. Fear of death assumes a new urgency in the age of terrorism. The values that sanctify life seem all the more precious. Ultimately, assisted suicide is not so much a slippery slope as the complete contradiction of the ancient physicians’ oath to preserve life and to ensure that death be not proud.