Saturday, July 5, 1997

Issue of assisted suicide is far from settled

By Tom Schaefer

Knight-Ridder Newspapers

If you think the issue of physician-assisted suicide has been decided, think again.

Although the Supreme Court has upheld two state laws prohibiting the practice, the matter is far from settled.

"Our holding permits this debate to continue, as it should in a democratic society," Chief Justice William Rehnquist wrote in last week's 9-0 decision. In other words, expect more right-to-die cases in court.

And with that possibility looming, I'd like to share the warning of Dr. Zbigniew Zylicz, medical director of one of three hospices in Holland.

Since 1984, the Dutch government has agreed not to prosecute any doctor for assisting in suicides. And the result, Zylicz says in the June issue of St. Anthony Messenger, is that euthanasia - the next step after assisted suicide - has become quite common.

Zylicz contends that Dutch doctors no longer have the creativity and experience to solve difficult pain- management problems. "They are losing the art of medicine - the basis of our profession."

What has happened in Holland could happen in the United States, he says. Once assisted suicide is legalized, it becomes expected and is immediately experienced as a right. "There is a pressure on doctors to do euthanasia, even if they don't want to," Zylicz says of the situation in Holland.

In fact, a Dutch government study in 1991 found that in more than 1,000 cases of euthanasia, physicians admitted they actively caused or hastened death without any request from the patient.

From assisted suicide to mercy killing.

"People keep denying the slippery slope even as it is more and more obvious," he says.

Thankfully, there's good news. Twenty Dutch hospices are in the planning stages, and Zylicz's three-month training sessions in managing pain (palliative care) have a waiting list of interested doctors. There is also talk of setting up professorships in palliative care at several universities - a first in Holland.

While that country remains the exception among nations in allowing legalized suicide, efforts to force the issue elsewhere, including in the United States, likely will increase. After all, choice has become the pre-eminent value in decision-making.

That's why it's important for hospices to get out their message. Their practice of providing palliative care for terminally ill patients has helped countless people face death in peace and with minimal pain.

Even Timothy Quill, a physician who was a plaintiff in one of the Supreme Court cases on physician-assisted suicide, calls hospices "the standard of care for people who are dying."

And interest in such care is increasing.

In the mid-1970s, there were only a handful of hospices in this country. Today, there are more than 3,000 hospice programs with 4,400 hospice professionals.

Tom Welk, director of education at Hospice Inc. in Wichita, Kan., said more people have been asking questions about hospice service in the past couple of years than did in the previous 13.

Even physicians, historically reluctant to talk with patients about dying, are beginning to understand their palliative as well as their curative roles. A study reported in a recent issue of the Journal of the American Medical Association found that the number of articles about terminal care in the past three years, compared to all that was written in the 1970s, has more than quadrupled.

"All of these things are opening eyes that we can do more for the dying," Welk said.

While hospices can't assist with every terminal case most insurance programs require a patient's prognosis for death to be six months or less they do provide a supportive approach that aids a patient's physical, emotional and spiritual pain, usually making the dying process more peaceful.

And as Welk rightly notes, those who are terminally ill need to know that in a hospice "we're not going to abandon you. We're going to stick by you and take care of your needs."

Meanwhile, the debate over acceptable ways of dying will continue - in courts, in state legislatures and in the privacy of homes and hospitals. And the siren call of assisted suicide will entice many to champion it.

What is yet unknown is how many will heed the call - and how much closer we'll move to the edge of the slippery slope.

(Tom Schaefer writes about religion and ethics for the Wichita (Kan.) Eagle. Write to him at the Wichita Eagle, P.O. Box 820, Wichita, KS 67201.)

(c) 1997, The Wichita Eagle (Wichita, Kan.).

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