RIGHT TO DIE UNDER ATTACK

This week, the U.S. Supreme Court heard the case of Gonzales vs. Oregon,
the culmination of the Bush administration's long fight to overturn
Oregon's popular Death With Dignity Act. The outcome will have far-reaching
effects.

The Oregon law permits doctors to write prescriptions for a lethal dose of
sleeping pills or similar drugs that dying patients can take if they find
their suffering unbearable. It has been in effect for almost eight years,
and there is ample evidence that it is working exactly as intended. Only
about 30 patients a year use it, but many more say that they find peace of
mind in having the option to do so if they choose. Oregon is the only state
with such a law.

The Bush administration argues that Oregon doctors writing such
prescriptions are violating the federal Controlled Substances Act --
legislation enacted in 1970 to try to stop prescription medicines from
being diverted to street use. Oregon counters that its law has nothing to
do with drug trafficking; it's about medical care, and states, not the
federal government, regulate the practice of medicine. There is nothing in
the Controlled Substances Act that speaks to what is an appropriate medical
use of drugs, because that wasn't its intent.

Oregon is right. The Bush administration is seizing on an irrelevant
federal law as an excuse to overturn a state law, even though the move
flies in the face of Republican rhetoric about states' rights and
federalism. It also puts the administration at odds with the libertarian
wing of the Republican Party, which believes the government should stay out
of the private lives of individuals.

Why is the administration fighting such an odd battle? Physician- assisted
suicide is one of the religious right's signature issues, used mainly as a
wedge in the battle against abortion rights. It lets foes of abortion claim
that their commitment to life is absolute and has nothing to do with
women's rights. The administration is quite willing to throw over
Republican principles about federalism and individual freedom to appease
the religious right.

Individual freedoms

The Oregon law is very much about individual freedom. No patient is
required to use it, nor must doctors be involved if they don't wish to be.
It is an individual choice. At the beginning, there were concerns that
dying patients, particularly the poor and vulnerable, might feel pressured
to end their lives. But the number of patients who request prescriptions
under the law remains small, and they tend to be more affluent and better
educated -- that is, less vulnerable -- than average.

Pain is not the usual reason patients give for wanting to end their lives;
more common are symptoms that are harder to relieve, such as weakness and
loss of control over bodily functions. In states that have no right-to-die
law, such patients are sometimes sedated to the point of unconsciousness,
then allowed to die of dehydration, or encouraged to stop eating and
drinking to hasten death. But there is something disturbing, even bullying,
about forcing people to bring about their deaths in slow motion instead of
giving them the means to do so quickly. One would be hard put to find a
moral distinction.

Opponents argue that it could be a distraction from good palliative or
hospice care, which, they believe, can almost always provide adequate
relief. But far from being a distraction, the availability of physician-
assisted suicide in Oregon has led to better palliative care. In what can
only be considered a win-win competition, both proponents and opponents of
the law are working to make assisted suicide rare by promoting the
aggressive treatment of the symptoms of dying. The state now is widely
regarded as having the best end-of-life care in the country. Still, there
will always be some whose suffering can't be relieved and who desperately
want a quicker, more humane death.

If the Supreme Court decides in Oregon's favor, it is likely that
physician-assisted suicide will gradually become widely available, state by
state. This is exactly what Justice Sandra Day O'Connor envisioned in an
earlier decision in two unrelated cases. In 1997, she suggested that
although the Constitution does not itself embody a right to assisted
suicide for terminally ill patients, the states may make it legal through
their legislative processes.

If Oregon prevails and other states follow, that does not mean
physician-assisted suicide will become common. It will probably be rare, as
it is in Oregon. But there is no way to exaggerate the comfort provided to
patients and their families by knowing that if suffering becomes
unbearable, there is a way out. That is why all Americans should be rooting
for Oregon.

Marcia Angell is a former editor in chief of the New England Journal of
Medicine.