X-Message-Number: 8752 Date: Mon, 10 Nov 1997 10:53:33 -0700 From: David Brandt-Erichsen <> Subject: Oregon update From the PORTLAND OREGONIAN (November 10, 1997) -------------------------------------------------------------------------- OMA WILL FOLLOW SUICIDE PROVISIONS The state medical group will list resources for doctors wanting information on how to help a terminally ill patient die By Patrick O'Neill of The Oregonian staff Oregon's largest association of doctors would just as soon see the new physician-assisted suicide law go away. But now that voters have strongly reaffirmed the Death With Dignity Act, a statement of philosophy announced Sunday vows that the Oregon Medical Association will observe the provisions "to the letter." Further, Dr. Charles E. Hofmann, an internist from Baker and president of the 5,700-member association, told its governing body Sunday that, sooner or later, "we're going to get calls, and we've got to be ready." With that in mind, the OMA's nine-member executive committee, which met through the weekend, issued a report that: Tells doctors the association will produce a list of resources for physicians who request information about how to perform an assisted suicide. But it will not provide a recipe for a lethal dose of medication. Threatens to seek legal action to stop a new Oregon Board of Pharmacy regulation that would force doctors to specify in writing that a prescription is intended to end a patient's life. The committee said the rule violates patient confidentiality and held out the possibility of filing for an injunction to void it. Directs the OMA's legal counsel to investigate a U.S. Drug Enforcement Agency determination that prescribing lethal medications violates federal narcotics law. Oregon doctors aiding in suicides could jeopardize their livelihoods because they could lose their license to prescribe some drugs. Says the association will follow any proposed legislative changes in the law and will submit any proposed changes to its membership for review. Encourages the Task Force to Improve the Care of Terminally Ill Oregonians to rush completion of a handbook to guide caretakers through the ethical thicket of assisted suicide. The task force, headed by Dr. Susan Tolle of the Center for Medical Ethics at Oregon Health Sciences University, includes 25 representatives of hospitals and medical professional organizations, including the OMA. Task force representatives have told Hofmann that the document won't be ready for months. The statement of philosophy promises that the OMA will "observe the provisions of Measure 16 (the Death With Dignity Act) to the letter of the law and will provide its members with the resources to do likewise." The executive committee decided it was inappropriate, however, for the association to give guidance in specific medical procedures, including assisted suicide. But it will give doctors who ask for help with assisted suicide a list of resources that they can call upon outside the organization. The new philosophical statement balances on a razor's edge of past policy: The association opposes the Death With Dignity Act as flawed and would welcome a repeal. And the OMA remains neutral on the question of physician-assisted suicide itself, saying individual doctors have the right to decide for themselves whether to participate in the practice. The executive committee's closed-door session came during the regularly scheduled biannual meeting of the 313-member House of Delegates, the OMA's governing body. Physician-assisted suicide was not on the agenda, but association leaders wanted to give the membership guidance in response to the lightning-fast events of last week: The vote reaffirming Oregonians' support of physician-assisted suicide. The revelation that on Oct. 27, the 9th U.S. Circuit Court of Appeals lifted an injunction that had blocked the Death With Dignity Act, passed by voters in 1994 as Measure 16. The Oregon Board of Pharmacy ruling on prescription specifications. And the DEA threat of doctor sanctions under narcotics laws. Assisted suicide has divided the OMA, which has struggled to accommodate members who both favor and oppose assisted suicide. When Measure 16 was put to voters in 1994, the association took a neutral position, saying its House of Delegates was deeply divided on the issue. In April, the association changed its stance and opposed Measure 16 because of what delegates perceived as flaws in the law. At the same time, the body remained neutral on the concept of physician-assisted suicide. Hofmann said the association's opposition to Measure 16 and its neutrality on assisted suicide have been difficult to explain. During the weekend meeting, it was clear that physicians were struggling with the ramifications of the law. Dr. Michael Lewis, a Portland pulmonologist, told of ordering large doses of medication to make a dying patient feel more comfortable the previous night. The drugs almost certainly hastened the patient's death, he said. Easing the pain of terminally ill patients with narcotics is considered standard medical practice, even though death may come sooner, and it is not considered to be physician-assisted suicide. Lewis said he doesn't plan to change his practice. But still, he's worried about public reaction. "I'm a little concerned," he said. "Will the public construe that as physician-assisted suicide? What will the OMA do to educate the public?" Dr. Christopher Nogeire, a Eugene cancer specialist, said only two of his patients have committed suicide in 18 years of practice. Nogeire said he opposes assisted suicide and would not participate. "People seem to struggle more to live than to die," he said. The OMA statement of philosophy includes three main elements under which the association: Advocates "good, competent and compassionate palliative care at the end of life." Will observe the provisions of the Death With Dignity Act "to the letter of the law and will provide its members with the resources to do likewise." Will examine any proposal to change the act to make sure it won't adversely affect physicians' ability to adhere to their ethical and moral responsibilities "regardless of their position on physician-assisted suicide." Hofmann said he expects that the Oregon Legislature will ask the association for advice on assisted suicide at some point. He and other doctors at the weekend meeting said there was no sign that terminally ill patients are rushing to seek suicide assistance under the law. Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=8752