Good strategies & bad
Callahan, Daniel
ETHICS WATCH DANIEL CALLAHAN GOOD STRATEGIES & BAD Opposing physician-assisted suicide The state of Oregon has been notable in recent years for some policy innovations, not all of which...
...Society will not force them to choose PAS...
...Not necessarily, for other bills to that end are possible and have been proposed...
...In short, opposition to PAS seems to be prevailing nationally...
...More important will be the evolution of PAS as a practice in Oregon over a number of years, particularly when—and if—it loses public and media attention and the number of patients wanting to avail themselves to it increases, as is generally expected...
...Liberal opponents of PAS, of which there are many, believe the strongest case against it is the danger it poses to the poor and the weak, those unable to defend themselves from coercion and social rejection...
...Earlier this fall, the House of Representatives passed Bill H.R...
...The House bill is not likely to do much in relieving physician worries, most of which do not have a basis solely in legal worries...
...I can't...
...But what if it "works," that is, what if few abuses are actually uncovered or simply don't exist to any meaningful degree...
...Because that is possible, a strategy dependent upon the existence of abuses to condemn the practice is a bad gamble...
...That most of the first cases of PAS in Oregon came from people who feared a loss of control, not pain and suffering—similar to the pattern in Holland—lends some credibility to my hypothesis...
...They will choose it themselves...
...Surely abuse could happen, but it is far more likely that it is members of the educated middle and upper classes who are most at risk...
...Right now, with the exception of OreComtnonweal 7 December 3,1999 gon, the struggle against PAS is being won...
...Attacked by many at the outset—a way of picking on the poor, it was said—the policy has worked exceedingly well, becoming a model for consideration by a number of countries (though, oddly, by no other states...
...Moreover, there is nothing in the present federal drug enforcement rules to preclude the use of controlled substances to relieve pain, even at the risk of death...
...It is as much their fear of accidentally killing someone by their pain relief as it is a fear of the law that hampers many physicians in their use of palliative care...
...There is no legal remedy for that problem—rooted in their education and common practice—only better education and a long process of changing medical mores...
...There are two popular but mistaken arguments against PAS, one drawn upon by the Left, the other by the Right...
...Since only fifteen people officially availed themselves of the right of PAS in its first year, 1998, that claim does not mean much...
...As someone who has spent fifteen years or so actively opposing euthanasia and physician-assisted suicide, and working to advance palliative care, this is the kind of bill I wish I could like...
...Yet if the House bill does not win support in the Senate and ultimately fails, will that not set back the important palliative-care initiative the bill undertakes to promote...
...Commonweal 8 December 3,1999...
...It strikes me as flawed, unwise legislation that will do more harm than good in the struggle against PAS...
...I know that some groups, and many of my friends and other opponents of PAS, have worked hard to get the bill passed...
...The two that are most striking are its Medicaid program and its law on physician-assisted suicide (PAS...
...Doctors simply should never be given that kind of power...
...First, the Oregon law is a badly written law, subject to no meaningful public oversight, and open to serious abuse (by allowing people to shop around for permissive physicians, and by shielding physicians from careful scrutiny in their decisions...
...If any dignity was being taken from them, they were the ones doing the taking...
...In this case, the voters of Oregon in 1994 exercised their legal right to use the ballot initiative to approve PAS...
...Its Medicaid program, which prioritizes some 734 medical treatments, is dependent on its annual state budget to determine how far down the list it can go to provide those treatments...
...But that program has faded from attention at the moment, overshadowed by Oregon's PAS law...
...Again, the first Oregon cases in 1998 showed that some people rejected palliative care altogether, while others started it but then stopped...
...According to its supporters, Oregon's PAS legislation is no less successful, showing that a responsibly administered law can avoid the pitfalls and calamities its critics have predicted...
...As for the strategies to be used in opposing any extension of the Oregon law to other states, and for showing the faults of that law as it is written, I offer two thoughts...
...That effort failed and those who sought to overturn the 1994 vote lost by an even greater margin, 60 percent to 40 percent...
...In 1990, the Drug Enforcement Administration explicitly affirmed the right to use narcotic analgesics to treat pain, knowing full well, as do all doctors, that there is always a risk of death in doing so...
...The combination of the American love of self-determination, a rapid rise in the number of elderly, and the kind of long, drawn-out deaths that are the mark of the regnant chronic diseases, is likely to make PAS ever more attractive as time goes on...
...The argument from the Right is that, somehow, an embrace of PAS is a way of forsaking the innate worth and dignity of terminally ill patients who only need improved pain control...
...That tactic is a poor way to advance opposition to PAS...
...It is said that PAS is a societal way of singling out such patients to deny them the dignity and value of their lives by setting aside their legitimate needs...
...ETHICS WATCH DANIEL CALLAHAN GOOD STRATEGIES & BAD Opposing physician-assisted suicide The state of Oregon has been notable in recent years for some policy innovations, not all of which please people in other parts of the country...
...2260, the "Pain Relief Act of 1999...
...It is surely useful to watch out for them, but it is far better to argue that the practice is intrinsically wrong, by virtue of its legitimation of suicide, and by its perversion of long-standing, well-grounded medical traditions...
...Second, while I am not much swayed by the argument from states' rights, I am enough of an Aristotelian to think prudence is always important in debates of this kind...
...But in 1997, opponents tried to get the legislature to overturn that vote, occasioning much indignation at what was clearly an attempted end run...
...I am not happy to be saying this...
...They are the ones who think control of one's body is the greatest value in life, and that dependence and bodily decay are a threat to their dignity...
...But the greatest danger of PAS is the social legitimation of suicide as a way of dealing with the suffering and sorrows of life...
...But I have come to think that, if PAS (and euthanasia) are to be effectively combated over the long run, great care must be taken with the arguments used and the strategies chosen...
...Prudence would dictate not attempting, once again, what looks like an underhanded tactic to nullify the Oregon law...
...But this is a scarcely credible interpretation of what is going on, since the purpose of the Oregon law is to allow patients to choose PAS...
...All the more reason to be careful in choosing how to press the case against it...
...Its purpose is two-fold: to thwart Oregon's attempt to allow physicians to use controlled substances, ordinarily opioids, to assist patients in committing suicide, and to advance palliative-care research and education...
...Other bills in state legislatures do not even make it out of committee, and no other state seems on the verge of following Oregon...
Vol. 126 • December 1999 • No. 21
