PHYSICIAN-ASSISTED SUICIDE

ARONER BILL SPARKS A THOUGHTFUL AND NEEDED DEBATE

The conventional wisdom about Assemblywoman Dion Aroner's controversial bill
to legalize and regulate physician-assisted suicide, which surprised many
when it survived a vote of the Assembly Judiciary Committee recently, is
that it won't possibly get the nod from the whole Assembly, much less the
Senate, or a governor who is averse to risk.

But despite AB 1592's dim chances for passage this year -- which the author
herself acknowledges -- the bill has started a needed conversation in the
Legislature, and some serious soul-searching among its members. Many
recognize the need to give terminally-ill patients some control over the
unendurable suffering that can sometimes mark the last days of their lives
and to provide more options for how they approach those final days. Aroner's
bill lays a solid foundation for a discussion that California lawmakers can
no longer afford to avoid.

Public opinion polls over the past decade have shown steady support (ranging
from 70 percent to 75 percent) among Californians for the choice of
physician- assisted dying. Californians don't appear interested, however, in
legalizing the practice without putting some major safeguards in place. In
1992, California voters rejected Proposition 161, a proposal far broader
than the Aroner bill that would have allowed doctors, much as the renegade
Jack Kevorkian did on his now infamous videotape for "60 Minutes," to
directly administer lethal doses to terminally ill patients. That flaw was
compounded by a dangerous lack of safeguards to ensure that patients would
not be pressured to end their lives by impatient family members or a
cost-conscious medical system.

By contrast, Aroner's bill would allow a willing doctor to honor repeated
requests of terminally ill patients for prescription drugs that they
themselves could take to end their lives. Two physicians would have to agree
that the patient had less than six months to live and was mentally
competent. The prescription could be written only after the patient made two
distinct requests, separated by a waiting period of two weeks, and after a
detailed discussion of both the consequences of taking the prescription and
the patient's alternatives, including pain control and hospice care. In an
effort to ensure that the action would be completely voluntary on the part
of the patient, AB 1592 would make it a felony for any doctor, or HMO or
insurance company to suggest the idea. The request would have to be
initiated by the patient.

These safeguards, modeled directly after a law passed by Oregon voters in
1994, appear to have prevented abuses there. The Oregon Health Department
reports that last year, the first in which the much-challenged law was in
force, 23 people with terminal illnesses received prescriptions for lethal
medication to end their lives. Fifteen of them died after taking the drugs.
Six died from their underlying illnesses, having chosen not to use the
prescriptions, and two more were still alive as of Jan. 1, 1999. Suicide
seekers did not flood into Oregon, as some had feared; only one of the 23
requesting patients had lived in the state for less than a year.

One of AB 1592's strongest opponents, the California Medical Association,
argues that the bill contradicts the medical profession's central healing
mission. CMA calls instead for greater access to hospice care and pain
relief for suffering patients. Both are unquestionably needed. But the fact
remains that the terrible pain of some diseases -- cancers of the throat and
brain, for example -- can't always be relieved at the end. That pain, or the
fear of being kept alive by technologically advanced methods against their
wishes or the distaste for the way heavy doses of morphine make them feel,
drives some patients and their families to desperate measures to end their
suffering.

Ironically, the CMA does not oppose the life-ending practice, used in an
unknown number of instances in California and across the nation, of
"terminal sedation," in which doctors sedate suffering patients and then --
in consultation with the family, or by a doctor's own decision if no family
is present -- withdraw nutrients and hydration, which eventually results in
death. Some doctors are already participating in decisions about the timing
of patient deaths. Why not give that power to competent patients who want
it?

People who are dying in pain deserve humane options that guarantee their
right to self-determination. Aroner is trying to nudge her colleagues down
the road toward creating one of those options. However emotional and
contentious the discussion must be, the time has come to engage it.