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)
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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.

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