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Jagged Little Pills: Physician-assisted suicide could ease the transition of terminally ill patients.

Mercy or Murder?

Assisted suicide bill challenges conventional notions on death and dying

By Joy Lanzendorfer

In this new year, California will revisit yet another controversy. Local assemblywoman Patty Berg is writing a physician-assisted suicide bill with Lloyd Levine, D-Van Nuys. The bill, patterned after Oregon's 1997 Death with Dignity Act, will be introduced to legislators in mid-February and will be the second time California has considered whether to legalize physician-assisted suicide. Voters failed to approve Proposition 161, California's Death with Dignity Act, in 1992.

Sebastopol City Council member Linda Kelley hopes Berg and Levine's bill will fare better than Proposition 161. She supports physician-assisted suicide not only because she's a critical care nurse at Santa Rosa Memorial Hospital, but also because of personal experience.

Several years ago, Kelley's friend, a fellow nurse from Santa Rosa Memorial, was in the advanced stages of AIDS. He told Kelley that he'd secured medication to hasten his death in case the illness got intolerable. Though he never ended up using the medication--slipping gently into a coma before passing away--having it on hand gave him peace of mind.

"He had autonomy over his life," says Kelley. "The medication gave him a sense of relief. He wasn't as worried about the indignity that a lot of patients suffer. It was a quality-of-life issue."

In Oregon, the path Kelley's friend chose--to have the medication on hand, just in case--has turned out to be the most common choice among patients. Since Oregon's Death with Dignity Act was passed in 1997, only 171 people--a quarter of those who were prescribed lethal medication--actually committed suicide. The majority chose to die naturally.

It's having the choice that's important, insist advocates of the bill. As such, proponents say the bill improves their quality of life. "This is about relieving suffering," says Berg. "People expect to be spared from unnecessary pain, and that expectation should be met, even at the end of their lives. Maybe even especially at the end of their lives."

While Gov. Arnold Schwarzenegger has not said where he stands on physician-assisted suicide, formidable groups oppose the issue, including many religious organizations.

"Even in the face of old age or progressive illness, suicide is not an honorable option, but an utter renunciation of one's own life and the communities to which one belongs," says Bishop Daniel Walsh, Diocese of Santa Rosa. "Assisted suicide is not an act of mercy, but of betrayal. It violates the justice and mutual trust that are the basis of every genuine relationship of life."

In Oregon, physician-assisted suicide is open to people with terminal illnesses, but not such chronic illnesses as multiple sclerosis. Patients must apply verbally and in writing to their doctor for assistance with suicide. After a 15-day waiting period, the doctor can prescribe apainless, but lethal, medication. The patient must take the pills--usually the barbiturate Secobarbital combined with antivomiting medicine--without help from anyone else.

While physician-assisted suicide is not euthanasia, opponents argue that it is a slippery slope leading to legalized murder.

"It just hasn't happened," says Carole van Aelstyn, acting executive director of Compassion in Dying's Northern California office. "People are not flocking to Oregon to use this law. The record from Oregon shows it has one of the highest morphine rates per capita and one of the highest hospice rates. The law isn't being abused."

The California Medical Association (CMA) has opposed previous attempts to legalize physician-assisted suicide, though it will reserve opinion about the current bill until the association has read it. The CMA is primarily concerned about potential abuse of the law, in which physicians and family members, rather than patients, would make crucial decisions.

In Oregon, the Department of Health meticulously monitors the law to make sure abuse doesn't happen, according to van Aelstyn. Berg and Levine's bill would set up a similar system here. Under the Oregon law, if the doctor thinks the patient is depressed, the person must undergo an evaluation by a mental health professional and be deemed mentally competent. The California law would likely be the same.

Still, some say physician-assisted suicide will blur the definition of what it means to be suicidal. In normal circumstances, planning to die is connected to mental illness.

"One of the problems with this issue is that suicide is not a rational decision," says CMA spokesperson Ron Lopp. "It's usually a psychologically abnormal event associated with depression."

Proponents say that the desire for physician-assisted suicide by terminally ill patients is different from the desire of otherwise healthy people to kill themselves. Ideally, the terminally ill patient will have gone through the five stages of accepting death--denial, anger, bargaining, depression and acceptance--before considering the option of physician-assisted suicide.

"For someone to acknowledge the irrefutable fact of their own imminent demise and seek to participate in that process is not something that you could reasonably label suicidal," says Will Shuck, a spokesperson for Berg.

While no one needs permission to commit suicide, proponents believe that the aid of a physician will help terminally ill patients end their lives safely and painlessly. The law, in their view, would protect patients while giving them more choices.

At the same time, physicians could feel conflicted about this issue, since it goes against their vows to be "healers, not killers," according to Lopp.

However, he acknowledges that doctor-assisted suicide is a complex issue. Some medical professionals support it and others don't. For many, the morality surrounding the issue is not cut-and-dry.

"It's a decision society should make," says Lopp. "But I'm just not so sure it's a decision the government should make."

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From the January 5-11, 2005 issue of the North Bay Bohemian.

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