Shoddy medical care created 'rational suicide.' - Oregon's Measure 16 - Column

National Catholic Reporter, Oct 28, 1994 by Colman McCarthy

Political enlightenment comes all but naturally to Oregonians. They send to Congress such reliable progressives as Mark Hatfield, Ron Wyden and Elizabeth Furze. No state has roadways with more bike lanes or bike paths. The Oregon Peace Institute works with schools to expose children to the techniques of nonviolent conflict resolution. The state's small liberal arts schools - the University of Portland, Willamette University, Reed College, George Fox College - shine as educational jewels.

And on Election Day next month, Oregon voters will have still another option to go forward: by embracing life-enhancing medicine and rejecting physician-assisted suicide.

The issue is Measure 16, a ballot initiative that would allow physicians to provide lethal drugs to patients wanting to kill themselves. Measure 16 has shown signs of strength: 67,000 petition signatures were needed to get it on the ballot; 105,000 came in.

Physician-assisted suicide has surface appeal: If I'm terminally ill, my choices ought to include asking a physician to help me end it. This last right goes by the phrase "rational suicide." This suggests that reason and logic are in control, rather than clinical depression, which repeated studies have shown is almost always the dominant decisional force in suicides.

The publicity generated by Michigan's Jack Kevorkian and such pro-assisted suicide groups as the Hemlock Society has pushed the question of what other choices are available before asking physicians to use their killing skills. In Oregon, opposition to the proposed law is led by a coalition of medical, religious, legal and retarded citizens' groups.

Among the physicians who believe that their calling is to comfort, not kill, their patients is Dr. Robert M. Julien, an anesthesiologist at St. Vincent's Hospital and a medical school professor for 28 years. "I feel that a physician's role," he told an interviewer recently, "and the role of the ethicist in medicine - and the people involved in pain management - is to be aware that bad deaths can be converted into good deaths. Part of the problem is we don't like to talk about death - and to talk about good deaths and dignified deaths. Death with dignity doesn't mean death by suicide."

By pain management, Julien and other opponents of Measure 16 are focusing on a comparatively new field of medicine. Two years ago, the Agency of Health Care Policy and Research - part of the federal Department of Health and Human Services - reported that patients' acute pain was generally undertreated. In 23 million surgical operations, physicians adequately relieved the pain of only half the patients.

Julien tells of new techniques and procedures for people suffering intractable or incapacitating pain in use at the Portland hospital where he practices. In one, "a very tiny catheter, about the size of the lead of a pencil, is placed through the skin and into the spinal canal. It is tunneled under the skin, either to an external injection port or to a subcutaneously implanted pump. Patients receive continuous injections of morphine into the spinal canal. Most patients can be pain-free as a result."

Pain relief and pain management remain a small but slowly expanding branch of medicine. One physician knowledgeable in its methods offers more hope for terminally ill patients than a dozen Kevorkians.

No moral judgment should be imposed on people choosing physician-assisted suicide. Their desperation is the result of what the New York State Task Force on Life and Law - a group of two dozen governor-appointed physicians, lawyers, philosophers and civil libertarians who unanimously rejected physician-assisted suicide - has called "the pervasive failure of our health care system to treat pain and diagnose and treat depression."

The failure increases the chance that those suffering from treatable mental illness - mostly depression - will choose suicide because the other choices 6f medical treatment and human compassion aren't there.

Voters in two states - Washington and California - have defeated physician-assisted suicide bills. Oregonians, benefited by the informed discussion that is typical for that state, can be the third state to say no. They can also send a message nationally that the solution is not to eliminate sick people but to get rid of low-quality medical care that drives patients into hopelessness.