The Consensus on Assisted Suicide

Abstract

By the close of 2001, according to Oregon public health officials, physicians in the state had lawfully prescribed a lethal dose of barbiturates for 139 patients. Ninety of these patients ingested the substance and died (http://www.ohd.hr.state.or.us/news). To date, Oregon remains the sole U.S. state to authorize physicians, as part of recognized medical care (and subject to certain regulatory constraints) to dispense prescription drugs for use in suicide. The Oregon law has served as a lightning rod for concerns as to whether prescribing drugs for suicide is a part of medicine, and the law has stayed on the books by the skin of its teeth. First enacted by voters through the initiative process in 1994, the law survived a constitutional challenge and a second referendum vote before going into effect in late 1997. Most recently, Oregon's suicide law has been targeted by United States Attorney General John Ashcroft under the Controlled Substances Act, which charges the Attorney General with determining which physicians are fit to prescribe controlled substances, such as barbiturates. Among the law's criteria for this judgment is whether a physician's prescription practices serve legitimate medical purposes. Ashcroft found assisting a patient's suicide to be medically illegitimate (refusing to defer to Oregon's judgment on this point) and warned physicians that those using controlled substances for this purpose risk the loss of their prescribing privileges. Federal judges based in Oregon, frustrated by this latest salvo against the Oregon law, enjoined Ashcroft's directive in the name of states' rights. The Attorney General appealed, and a ruling will soon be issued by the United States Court of Appeals for the Ninth Circuit. Clearly, the root question persists of whether prescribing lethal drugs is valid medicine. And yet, since this question first galvanized the public in the early 1990s (with Jack Kevorkian's suicide machine and Dr. Timothy Quill's description in the 1991 New England Journal of Medicine edition of the suicide of his patient Diane) many words have been spoken, articles written, and committees convened in an effort to make headway on the matter. Although at times it appears that agreement is elusive, two very different books of essays on physician-assisted suicide, both published in 2002, indicate that at least among expert observers some areas of consensus are emerging. The Case against Assisted Suicide: For the Right to End-of-Life Care, edited by doctors Kathleen Foley and Herbert Hendin, pulls no punches regarding its concerns, but is by no means a facile screed or polemic. The varied essays are uniform in their attention to careful argument and nuance, each penned by an author who has spent a significant part of his or her career as a close observer and student of this difficult phenomenon. The authors appear to have used the occasion of this book as a chance to present key aspects of their thought in a particularly full and rich manner, making this a unique and valuable resource for those seeking to understand concerns raised by physician-assisted suicide. Assisted Suicide: Finding Common Ground, edited by attorney Lois Snyder and philosopher Arthur Caplan is a collection of essays that are the consensus statements (with dissents, in some cases) of a multidisciplinary expert panel convened prior to the effective date of Oregon's suicide law. The panelists were chosen to include some who favored and some who opposed the practice, and the group as a whole was charged with identifying areas of consensus. In order to do this, they were expressly instructed to avoid the very question that so divides us today, namely, whether assisting in a suicide is medicine. The result is a book that, perhaps understandably, is somewhat rough around the edges, but which is a truly fascinating document that appears materially to have succeeded in meeting its goals. …