DEFENDERS OF SUICIDE LAW SAY IT WORKS SMOOTHLY

PORTLAND, ORE. - Richard Holmes knows he doesn't need a doctor's
prescription for a powerful sedative to end his life.

He could turn on his car's ignition and sit in his closed garage. Or he
could swallow a bottle of the liquid morphine that he takes to ease the
pain from the cancer that has spread to his liver.

But a solitary and perhaps violent suicide is not the kind of death Holmes
wants. Nor does he wish to spend his last days in a painkiller-induced fog,
unable to talk with his children and grandchildren.

"That is a bad legacy to leave," said Holmes, 72. "I don't want to die not
knowing if it's day or night, not knowing anybody in my family. I want to
know what's going on and do it myself if I'm going to do it: Say adios. "

So, in recent weeks, Holmes filled a prescription for a lethal dose of
Nembutal, a fast-acting barbiturate that would put him in a coma in minutes
and would probably kill him in hours. Like some other terminally ill
Oregonians, he rushed to acquire the drug upon learning of a move in
November by U.S. Attorney General John Ashcroft to block Oregon's
4-year-old assisted-suicide law.

Although the law remains in force, its future is in doubt. In his directive
to nullify the law, Ashcroft said that "prescribing, dispensing or
administering federally controlled substances to assist suicide" violated
the Controlled Substances Act passed by Congress in 1970.

The Justice Department's move, which would punish Oregon doctors who help
patients end their lives, was put on hold for at least four months after a
federal judge issued a restraining order. Holmes - with other patients - is
a plaintiff in a suit challenging the Justice Department's directive. By
the time the case is decided, he may be dead.

"I've lived my life the way I want to. I should die the way I want to,"
Holmes said. "I personally think it should be a law in every state in the
whole country."

Whatever eventually happens to Oregon's law, the nation's first experiment
with physician-assisted suicide has offered new lessons about how people
choose to face death.

Although many in Oregon and elsewhere consider assisted suicide immoral,
the law has not had the dire consequences that some opponents predicted.
State officials and researchers say there is no evidence the law has been
used to coerce elderly, poor or depressed patients, nor has it caused
significant migration of terminally ill people to Oregon. Instead, some
data suggest it may have prompted doctors in the state to improve their
care of the dying.

"From my point of view, the law has worked smoothly," said cancer
specialist Peter Rasmussen of Salem, Ore. His patients often bring up
assisted suicide, he added, but few want to use the law. Instead, "They're
talking about the fact that they think it's good that it's available."

Among people in Oregon who have used the law to end their lives, it appears
the most common motive was a desire for autonomy. Holmes' wish to control
the time and manner of his death was echoed in interviews with other
patients and family members of people who died by assisted suicide, as well
as in a survey of Oregon doctors who have cared for such patients.

Knowing that assisted suicide is an option, even if they never use it,
seems to comfort some sick people by offering a measure of personal choice
in the face of terrifying illnesses that may rob them of control over pain,
sleep, movement, awareness, breathing and bodily functions.

"I felt reassured after speaking with my doctor" about assisted suicide,
said Jim Romney, 56, a former school superintendent who was diagnosed last
June with amyotrophic lateral sclerosis, a fatal neurological disease that
causes progressive paralysis. "I felt almost liberated because I now knew
how I could die. It was a matter of when."

A survey of more than 2,600 Oregon doctors published last year found about
5 percent had received requests from patients for a prescription for lethal
medication since the law took effect.

About one out of six patients who requested a prescription received one,
and one out of 10 used it to commit suicide, said Linda Ganzini, a
professor of psychiatry at Oregon Health Sciences University who conducted
the study.

During the first three years of the law's existence, 96 patients used it to
obtain prescriptions and 70 used the medication to end their lives,
according to data collected by the state health department.

The law requires that any Oregon resident requesting a prescription for
lethal medication must be certified by two doctors as terminally ill with
less than six months of life expectancy and as mentally competent to make
such a decision. A written request by the patient must be witnessed by two
people who are neither family members nor participants in the person's
health care.

If a doctor suspects depression or mental impairment, the patient must also
be evaluated by a psychiatrist or psychologist.

In 68 of 142 cases described in Ganzini's survey, the request for a
prescription prompted the doctor to take other measures, such as improving
pain treatment, referring the patient to a hospice or prescribing
anti-depressants. Almost half of those who received such interventions
changed their minds about assisted suicide, Ganzini reported.

In no case did a doctor prescribe lethal medication for a patient whom the
physician considered to be depressed.

The law still has many opponents. In Ganzini's surveys of Oregon doctors,
about one-third have consistently said they oppose assisted suicide as
morally wrong.

Providence Health System, a Catholic health care organization that operates
three hospitals in Portland, prohibits its doctors from participating in
the law, said the Rev. John F. Tuohey, the system's medical ethicist.

"As public policy, it's wrong to take life, whether it's my taking my own
or the state taking a criminal's or somebody else's," Tuohey said.

Some physicians and ethicists argue that suicide may be a valid personal
choice but that doctors, as healers, should never hasten death. The
traditional philosophy of the hospice movement has been that dying should
be neither hastened nor prolonged, said Ann Jackson of the Oregon Hospice
Association.

Other critics of the law maintain that the desire to commit suicide is
virtually always a sign of depression, a treatable mental condition.

"When people have committed doctors and families to take care of them, they
don't have to kill themselves," said N. Gregory Hamilton, a psychiatrist
and past president of Physicians for Compassionate Care, a doctors group
opposed to assisted suicide. "For a doctor to give a patient a lethal
prescription . . . sends with it a message to the patient that the doctor
doesn't value their life."

Studies suggest that about half of terminally ill people who wish to hasten
death are not depressed. Even among psychiatrists, there is disagreement
about whether a dying person who is depressed can, nevertheless, make a
well-reasoned decision to commit suicide.

"I was trained that anybody who would consider suicide is, by definition,
mentally ill," said Rasmussen, the Salem cancer specialist. Rasmussen said
he gradually changed his opinion during the debates that led to passage of
state referendums on assisted suicide in 1994 and 1997. Since the law took
effect, he has written prescriptions for lethal medication for several
patients who requested them.

"I have seen depressed patients," he said. "But I have also seen people who
seemed to be mentally competent and talked about wishing to die."