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11/4/2005
OHSU doctor says assisted suicide decreasing good medical practice
Ed Langlois


The legalization of assisted suicide is eroding medical advances and decent treatment, says one leader of a coalition of doctors who find the practice troubling.

Dr. Kenneth Stevens, a veteran professor of radiation oncology at Oregon Health Sciences University, criticizes Oregon's assisted-suicide law for devaluing human life and for reversing the healing role of physicians.

He and other Oregon doctors who oppose their state's law say legal lethal prescriptions tend to result in fewer efforts on the part of doctors to find a solution to patients' distress.

'Once a patient has the means to take their own life, there can be decreased incentive to care for the patient's symptoms and needs,' Dr. Stevens said during a panel discussion last month at the University of Oregon.

He cited testimony from The Netherlands, where one doctor was at a loss to address a gastrointestinal obstruction because the patient had wanted euthanasia and then changed his mind.

Dr. Stevens also raises an Oregon case - that of Michael Freeland. Freeland was a depressed lung cancer patient who had been admitted to a mental hospital unit. When his doctors were planning for his discharge to his home, where he already had lethal drugs, a palliative care consultant wrote that he probably needed attendant care at home, but providing for that additional care may be a 'moot point' because he had 'life-ending medication.' The doctor who gave the lethal prescription did not act to treat the pain or offer palliative care, Stevens says.

'This seriously physically ill and mentally ill patient was receiving poor advice and medical care because he had lethal drugs,' Dr. Stevens told the audience of students and members of the general public.

End-of-life care gets better in states that ban assisted suicide, Dr. Stevens argues. A 2003 paper by Americans for Integrity in Palliative Care said that 11 states enacting or strengthening bans saw per-capita use of morphine increase.

Dr. Stevens contradicted the notion that those who oppose the Oregon law, including the Catholic Church, are creating a situation in which people will suffer.

'Pain is not the issue,' Dr. Stevens said. 'There is not one case in Oregon of assisted suicide being used for actual untreatable pain. Pain can be treated. Assisted suicide has been used for psychological and social concerns.'

Dr. Stevens explained that it is ethically appropriate and acceptable to treat a patient for pain, even if the treatment may shorten life. The point is that the treatment is being given to treat the pain and not specifically to cause death.

Many physicians, Dr. Stevens said, are writing prescriptions for lethal drugs to patients they have not seen previously. One Salem doctor says that is the case for three fourths of his assisted-suicide patients.

For more evidence of the diminution of treatment, Dr. Stevens said, one need go no further than the Oregon budget. In 2003, the Oregon Health Plan stopped paying for medicines for 10,000 poor Oregonians. In 2004 and the first half of this year, an additional 75,000 Oregonians were cut from the Oregon Health Plan, to keep the state budget balanced. The state does pay for assisted suicide as part of its health coverage for the poor, though the amount is relatively small.

The topic of euthanasia has surfaced in post-hurricane Louisiana. The state's attorney general has subpoenaed 73 people in connection with a probe into possible euthanasia murders at Memorial Medical Center.

A doctor and a nurse manager said that three days after Hurricane Katrina flooded New Orleans, they overhead medical staff having discussions about euthanizing patients they thought might not survive the ordeal.

Following the allegations, the attorney general has asked that autopsies be performed on all 45 of the bodies of the dead patients taken from the hospital after the storm.



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