Death debate includes physician-assisted suicide
By DEBORAH WOOLSTON
Scripps Howard News Service
Dale Gilsdorf says he will kill himself at the point when his lung and brain cancer make life intolerable.
"When I don't know who I am and fade in and out, that's an important sign. When I don't know my daughters and they fade in and out, that's an important sign. When I get a glump of those things together, maybe it's time to go," says the 59-year-old psychologist.
"Pain is not an issue because I have a high pain tolerance. Loss of independence and control, those are big items. I want to be independent and not slobber all over the place and be this shriveled-up human being."
Gilsdorf, who is divorced, says his two grown daughters support his plan to die of an overdose of black market sleeping pills.
Until the cancer was diagnosed in June 1996, his opinion of assisted death as an end-of-life alternative was strictly philosophical.
At the edge of a mainstream movement to give dying patients control over their medical care is a struggle to legalize physician-assisted suicide. That struggle has produced a Supreme Court ruling giving states the authority to establish or deny a so-called right to die. It has led to the nation's first state-sanctioned plan to let doctors provide fatal prescriptions for terminally ill patients. It also has focused on the macabre circus atmosphere of Michigan pathologist Dr. Jack Kevorkian.
Gilsdorf lives in Olympia, Wash., where the fight to legalize assisted suicide started in 1991. If Gilsdorf lived in Oregon, 100 miles to the south, he would not have had to go to the streets for a lethal dose of sleeping pills.
In Oregon, voters approved the world's only physician-assisted suicide law in the Nov. 4, 1997, election, by a 60-40 majority.
Oregon's Death with Dignity Act applies to mentally competent state residents age 18 or older who are terminally ill. They may request a lethal dose of medication from an Oregon-licensed attending physician.
There are procedures and restrictions:
-- The request must be made three times over a 15-day period and may be canceled at any time.
-- This is "assisted suicide" because the patients must take their own fatal prescription.
-- Attending physicians who prescribe the lethal dose are required to determine if the patient qualifies as adult, competent and terminal, then inform the patient of diagnosis, prognosis and alternatives to suicide, as well as the risks and results of the lethal medication. Dying, for example, can take five hours and longer, according to available figures in this little-researched subject.
-- Backup confirmation is required from a consulting physician, and from a licensed psychologist or psychiatrist if the patient's mental competency is in doubt.
-- The doctor has to fill out a battery of paperwork to document the procedure and keep track of who is using the law and why.
No doctor is required to prescribe the fatal dose; but if he refuses, he must turn over the patient records to another who is willing.
These life-ending cases are legally confidential and kept by the Oregon Division of Health. In its only report so far, the division said in August that eight patients had died from using prescribed lethal drugs and two others had received the drugs but died before taking them.
Moving in the other direction, a new law criminalizing assisted suicide went into effect Sept. 1 in Michigan. That legislation was passed in reaction to Kevorkian, who claims to have helped more than 90 people end their lives.
The bodies of Kevorkian clients have turned up in places like motel rooms and abandoned vehicles around the Detroit area. Some relatives of these suicides question how sick or how sane some clients were when they received Kevorkian's help. Michigan prosecutors gave up their attempt to stop Kevorkian after four juries failed to convict him.
The new law makes it explicitly illegal for anyone who knows that someone intends to kill himself to provide means, help or participation. Violation would be a felony punishable by up to five years in prison or a $10,000 fine.
Trying to reverse the legislation, an advocacy group called Marion's Friends has put an initiative on the Nov. 3 ballot that would overturn the state law and legalize physician-assisted suicide in the state.
If Marion's Friends wins a majority, legalization will cancel the Assisted Suicide Ban Bill. But for now it is a felony in Michigan for anyone who knows that someone intends to kill himself and to provide the means, help or participate in the act.
Elsewhere in the United States, proponents of legalized physician-assisted suicide have fought and lost most battles. The New York challenge ended in the Supreme Court's 1997 decision. California voters turned it down in 1992; the Florida Supreme Court said no in 1996.
Hawaii, a Democratic state known for tolerance, will take up the issue when the legislature meets in January.
The debate in Washington, Oregon, Michigan and several other states reflects a wide division of opinion across the nation and a sympathy for the idea of easing suffering, even if it means shortening lives.
A nationwide survey conducted by Scripps Howard News Service for this series of stories found strong support for some form of medical help to end the life of suffering, terminally ill patients.
Although not necessarily endorsing the Oregon law, 68 percent said physicians should be allowed to painlessly end the life of a dying and suffering patient when the patient requests it. Nearly as many, 65 percent, agreed that the family should make this decision if the patient is unable to do so.
Religious beliefs appear to influence this issue, however. People who have attended religious services in the previous week were twice as likely to oppose such euthanasia as people who have not gone to church lately. Those who consider themselves "born again" Christians are also more likely to oppose medical assistance in ending life. Nonetheless, a majority of every major demographic group in the poll of 1,014 people supported the idea.
Gilsdorf turned to an organization called Compassion in Dying about his decision to die. The nonprofit organization with chapters in Washington, Oregon and California operates on two levels. The political side lobbies to legalize assisted suicide - what it calls "hastening death." The patient care side offers information including how-to-die instructions, emotional support, counseling, patient-physician facilitation and presence at death for terminally ill people who meet its guidelines.
"I can't think of a more meaningful role than helping a dying person make some rational decisions," said William Fagan of Keyport, Wash., a new volunteer case manager with CID. "We're not in the business of snuffing people out. We're helping people face a difficult situation."
"We feel people should make up their own minds and know all the options," said Rev. Michael Bonacci, executive director for CID of Washington. "We feel we were given free will and so we have to make the decision."
"I'm clearly in the secular camp," said Gilsdorf, who was an assisted suicide supporter for more than 12 years before his own doomsday diagnosis. "I have no problem at all with abuse."
But others disagree.
"God has created us and it's God's timing, not our own," said Sister Sharon Park of the Washington State Catholic Conference. "It's a simple argument of individualism. We're talking about a culture that legitimates that certain people can kill."
"The medical profession believes strongly in the physician's commitment to prolong life and relieve suffering. There's no accommodation for physician-assisted suicide," said Dr. Mark Adams, a Bremerton surgeon and president-elect of the 8,000-member Washington State Medical Association.
"I don't have a problem with alleviating pain even if alleviation could accelerate cessation of life," Adams said, referring to a relatively common practice of favoring high doses of painkillers when terminally ill patients are suffering.
A recent survey published in the Journal of the American Medical Association reported that 10 percent of the doctors who responded said they quietly help their patients die, even when it is illegal.
Meanwhile, opponents of Oregon's unique law haven't given up. One group is pursuing a challenge to the law through the federal court appeals system.
And in Congress, the proposed Lethal Drug Abuse Prevention Act of 1998, sponsored by Reps. Henry Hyde (R-Ill.) and James Oberstar (D-Minn.) and Sen. Don Nickles (R-Okla.), would let the Drug Enforcement Administration revoke the legal authority of doctors, pharmacies and other health providers to prescribe narcotics and other dangerous drugs if they are found to have prescribed lethal doses.
Deborah Woolston is a reporter for The Sun in Bremerton, Wash.