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High court's early task: assisted suicide case
By Howard Mintz
Mercury News
The U.S. Supreme Court begins its term this week with a matter of life and death.
As California and other states consider legislation that would allow doctor-assisted suicide, the high court on Wednesday will review the Bush administration's challenge to Oregon's one-of-a-kind law that gives terminally ill patients the right to end their lives with medication.
The arguments, which could give new Chief Justice John Roberts his first hot-button social issue to address, are the culmination of a three-year legal struggle between the federal government and right-to-die advocates pushing to expand their movement beyond Oregon's borders.
The case has mobilized both sides of an issue that has consistently provoked social, ethical and moral debate over whether states should have the right to permit doctors to prescribe lethal doses of medicine to terminally ill patients. And the outcome could influence long-stalled legislation to duplicate Oregon's law in states that include California, where such a bill is pending.
But backers of allowing the practice in California say they won't depend entirely on the Supreme Court's decision.
``I can't imagine a ruling that would make me throw in the towel,'' said Assemblywoman Patty Berg, a Santa Rosa Democrat who is the co-sponsor of a hotly debated bill to allow the hastening of death for the terminally ill.
The stakes are high in the Supreme Court.
`Ashcroft Directive'
The Bush administration, backed by an array of religious and conservative organizations, argues that states do not have the right to enact doctor-assisted suicide laws because they run afoul of federal drug laws. Former Attorney General John Ashcroft put that policy in place in 2001, issuing a directive that warned doctors they could lose their licenses if they prescribe drugs to assist suicide.
The so-called ``Ashcroft Directive,'' which switched the position held by the government during the Clinton administration, concluded that there is no ``legitimate medical purpose'' that justifies dispensing a federally regulated drug for aiding the death of a patient.
The federal government's position is similar to its successful argument against states such as California that passed laws allowing the use of medicinal marijuana. The Supreme Court has twice found that federal drug laws that ban the sale or use of marijuana trump state medical pot laws.
Legal experts, much like the medical profession, are divided on how the Supreme Court might rule. Some say that Oregon's law could be on shaky ground because of the broad reach of federal powers to regulate drug enforcement.
``If the federal government decides to basically pre-empt a decision of a state, whether to legalize medical marijuana or assisted suicide, the federal government has the authority to do that,'' said Brad Joondeph, a Santa Clara University law professor and former law clerk for Justice Sandra Day O'Connor.
But others point to the Supreme Court's last major ruling on the issue of doctor-assisted suicide, when the justices found eight years ago that there is no constitutional right to hasten your own death. That ruling nevertheless included an invitation for states to experiment with legislation that would allow doctor-assisted suicide under strict regulation.
``This is really a case about states' rights,'' said Erwin Chemerinsky, a Duke University law professor.
To date, an Oregon federal judge and the 9th U.S. Circuit Court of Appeals have sided with Oregon, prompting the federal government to appeal to the Supreme Court. In Oregon, 208 patients used the law to end their lives between 1997 and 2004, according to state figures.
Polls in California have consistently shown support for a law like Oregon's, despite the fact efforts to enact a law here have failed in the past. Last week, the Public Policy Institute of California released a poll showing that 58 percent of state residents favor allowing doctors to give terminally ill patients ``the means to end their lives,'' with 38 percent opposed.
Contentious debate
But the issue remains contentious. While the Catholic Church and other religious organizations say laws that permit suicide are immoral, supporters of aid in dying say the term suicide should no longer be used to describe the practice. Advocates say the word suicide can influence people to oppose what they now prefer to call ``death with dignity.''
Dr. Robert Brody, who heads the pain consultation clinic at San Francisco General Hospital, supports a law because he believes doctors and patients are already agreeing to fatal doses of medication under the radar.
``It would change the underground practice and bring it more into the open where it can be regulated,'' Brody said.
Others say such laws violate a doctor's oath to save lives.
``It's bad public policy, bad medicine and a bad idea,'' said Dr. H. Rex Greene, a San Mateo oncologist who has become a spokesman against doctor-aided suicide.
Greene, who describes himself as a ``left-wing liberal'' who generally thought ``anything with John Ashcroft's name on it is bad,'' hopes the Supreme Court will put the brakes on the doctor-assisted suicide movement.
But Oregon's backers say a win in the Supreme Court could inspire new laws across the country.
``There has been a bit of a cloud on the Oregon law with this lawsuit pending,'' said Kathryn Tucker, legal director for Compassion & Choices, the organization behind the Oregon law. ``When that cloud is lifted, it will really galvanize the movement in other states.''
speederdoc said:My feelings are very mixed on this issue. Both sides make compelling arguments imo. If physician-assisted death is allowed, there needs to be extraordinarily stringent restrictions and safeguards placed on its use. I really would prefer that it not be allowed, which is the ultimate safeguard on preventing misuse.
There are always ways to ease and even hasten patients' deaths without actually causing them.
Those are some of the potential problems (this is another example of the "slippery slope"). A good physician and appropriate hospice care can enable patients to die with dignity and limited discomfort. I prefer to let a higher power than myself decide when it is someone's time to die. It's my job to decide when death is imminent and unpreventable, and make the process easier.no1tovote4 said:We can see the problems that will arise in the future by looking at many of the European nations that allow such things to take place. Especially among those where the goverenment covers insurance cost. Many times it becomes legislated when you will die rather than it being a choice of the patient.
Hagbard Celine said:I think there is a very good argument for doctor assisted suicides. Especially for those with terminal diseases. What's the basis for keeping this illegal?
Well, no need for me to post..you have said exactly what I've been composing this morning..If I were in the Docs' shoes I think I'd do the same. Then again, it is an end run around the issue, isn't it?speederdoc said:Those are some of the potential problems (this is another example of the "slippery slope"). A good physician and appropriate hospice care can enable patients to die with dignity and limited discomfort. I prefer to let a higher power than myself decide when it is someone's time to die. It's my job to decide when death is imminent and unpreventable, and make the process easier.
Here is a related post I made on another board a while back:
One thing I tell family members, if applicable, is that "he went quickly, without suffering." I don't think it is much consolation to those who haven't seen someone die slowly, with pain, but I tell them anyway. It's horrible how the most common cancers in men (prostate) and women (breast) both tend to go to the bones and cause unrelenting pain. Lung cancer is just as bad, if not worse, because those patients are often gasping for breath AND in pain.
Oncologists do not like to discuss "end-of life issues" for the most part, I guess they see it as failure, or maybe they just repress it. When a terminal patient is near death, and they haven't been educated on their options, it is often left to me to help them through the process. The big question is always ventilator or no ventilator. Of course it is ridiculous to put a terminal patient on a ventilator so they can die in even more discomfort, and take longer to do so. But the (sometimes) tricky part is deciding when to give up all hope for cure or prolongation of life and focus on comfort.
Giving up is not easy for some of these fighters, but eventually there comes a time. A recent patient of mine, a 44 year old woman, had breast/lung/liver/bone cancer, breathing (gasping)with only one lung (the other was filled with tumor and had long collapsed), exhausted all chemo options, too short of breath to lie down for radiation, couldn't hardly swallow (tumor squishing her esophagus), horrible pain. She was clearly dying, and was miserable. After a long discussion with her and her husband, they decided to focus on comfort rather than "cure." There is no cure for someone in that condition, except death. The nurses kept asking me, "Aren't you going to intubate her (put a breathing tube in)? She can't breathe! She's going to die!" All I could say was, "Yes she is. Give her some more morphine."
I have had one or two nurses refuse to give morphine because they did not want to "cause a patient's death." They made me give it myself. They do not understand that you are not causing anyone to die, you are helping them through the process. I have never killed anyone, but I have hastened a few deaths in the course of easing some suffering, and I am proud of that.
I don't think any physician wants to administer a lethal dose of medication, it is specifically against the Hippocratic Oath (so is abortion by the way, but that's another story):
http://www.med.umich.edu/irbmed/eth...ippocratic.html
Morphine is a wonderful drug, however, and ideal in many situations. If the patient and family understand that it will help their pain and may hasten their death (slows/stops breathing in high doses), and they want it given, then it should be given. There is no law against that. We don't need more laws, we need more reasonable physicians and nurses.
Every see the mess on the walls from a 12 gauge?Nuc said:Why should the doctors assist? Why not just do it yourself? The only negatives are that insurance sometimes doesn't pay out, and some religions consider suicide a sin.
speederdoc said:Those are some of the potential problems (this is another example of the "slippery slope"). A good physician and appropriate hospice care can enable patients to die with dignity and limited discomfort. I prefer to let a higher power than myself decide when it is someone's time to die. It's my job to decide when death is imminent and unpreventable, and make the process easier.
Here is a related post I made on another board a while back:
One thing I tell family members, if applicable, is that "he went quickly, without suffering." I don't think it is much consolation to those who haven't seen someone die slowly, with pain, but I tell them anyway. It's horrible how the most common cancers in men (prostate) and women (breast) both tend to go to the bones and cause unrelenting pain. Lung cancer is just as bad, if not worse, because those patients are often gasping for breath AND in pain.
Oncologists do not like to discuss "end-of life issues" for the most part, I guess they see it as failure, or maybe they just repress it. When a terminal patient is near death, and they haven't been educated on their options, it is often left to me to help them through the process. The big question is always ventilator or no ventilator. Of course it is ridiculous to put a terminal patient on a ventilator so they can die in even more discomfort, and take longer to do so. But the (sometimes) tricky part is deciding when to give up all hope for cure or prolongation of life and focus on comfort.
Giving up is not easy for some of these fighters, but eventually there comes a time. A recent patient of mine, a 44 year old woman, had breast/lung/liver/bone cancer, breathing (gasping)with only one lung (the other was filled with tumor and had long collapsed), exhausted all chemo options, too short of breath to lie down for radiation, couldn't hardly swallow (tumor squishing her esophagus), horrible pain. She was clearly dying, and was miserable. After a long discussion with her and her husband, they decided to focus on comfort rather than "cure." There is no cure for someone in that condition, except death. The nurses kept asking me, "Aren't you going to intubate her (put a breathing tube in)? She can't breathe! She's going to die!" All I could say was, "Yes she is. Give her some more morphine."
I have had one or two nurses refuse to give morphine because they did not want to "cause a patient's death." They made me give it myself. They do not understand that you are not causing anyone to die, you are helping them through the process. I have never killed anyone, but I have hastened a few deaths in the course of easing some suffering, and I am proud of that.
I don't think any physician wants to administer a lethal dose of medication, it is specifically against the Hippocratic Oath (so is abortion by the way, but that's another story):
http://www.med.umich.edu/irbmed/eth...ippocratic.html
Morphine is a wonderful drug, however, and ideal in many situations. If the patient and family understand that it will help their pain and may hasten their death (slows/stops breathing in high doses), and they want it given, then it should be given. There is no law against that. We don't need more laws, we need more reasonable physicians and nurses.
Exerpt from the Oath of Hippocrates: I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my Art.
Mr. P said:Every see the mess on the walls from a 12 gauge?
I know...just thought I'd ask..no1tovote4 said:Yes, but that isn't the only way to do that at home. I can think of many different ways that are relatively painless and leave no more mess than dying in your sleep.
Mr. P said:I know...just thought I'd ask..
Hagbard Celine said:I think there is a very good argument for doctor assisted suicides. Especially for those with terminal diseases. What's the basis for keeping this illegal?
The worst (oder) I ever had to deal with was crisp 3rd degree burned flesh mixed with gasoline. Yeah, the guy poured gas on himself had lite it up cuz his GIRLFRIEND left him. He died 12 hrs later.no1tovote4 said:One of my first calls on a Fire Dept was a "strange smell" call. We had to put down the dog, he had fed on a portion....
The smell was so bad we put on our SCBAs and could actually still smell it.
Mr. P said:The worst (oder) I ever had to deal with was crisp 3rd degree burned flesh mixed with gasoline. Yeah, the guy poured gas on himself had lite it up cuz his GIRLFRIEND left him. He died 12 hrs later.
But, I learned a dab of Vicks vapor rub in each nostril works wonders for masking such things.
my wife (emt) told me the worst one was a olde woman who's uterus had fallen out and started to rot....
Typical of EMTs to talk about gross stuff in a matter of fact way no mattermanu1959 said:my wife (emt) told me the worst one was a olde woman who's uterus had fallen out and started to rot....
she used to tell me these stories over dinner when we first started dating
Mr. P said:Typical of EMTs to talk about gross stuff in a matter of fact way no matter
what's going on..I got used to it..
Maybe we need another thread for "All" these things we've seen.
I didn't see the other thread, so I'll continue. While they weren't the worst odor I had smelled, these two cases were bad for other reasons.Mr. P said:Typical of EMTs to talk about gross stuff in a matter of fact way no matter
what's going on..I got used to it..
Maybe we need another thread for "All" these things we've seen.
