TV outlet stirs debate with airing of suicide how-to video

An Oregon cable station, pointing to proposed federal legislation that would undercut the nation's only physician-assisted suicide law, broadcasts the Hemlock Society's "Final Exit."

By Vida Foubister, amednews staff. Feb. 21, 2000.

Oregonians, whose "Death with Dignity" law could be overturned by legislation pending in the Senate, were shown an alternative to physician-assisted suicide this month.

Pubic access television aired the video version of Derek Humphry's controversial book Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying in Eugene. A co-producer of the weekly series "Cascadia Theatre of Action" approached Humphry about debuting the 34-minute video, which was produced last year.

"It was just another media outlet to me," said Humphry, founder of the Hemlock Society and president of the Euthanasia Research & Guidance Organization. "There's a great hunger by the public for knowledge about how to take their life as a form of insurance against an ugly death."

But the broadcast has once again raised questions in the only state that allows physician-assisted suicide about whether people have a right to die, and, if so, who can participate in their death.

"What Derek Humphry's doing is very dangerous," said N. Gregory Hamilton, MD, president of Physicians for Compassionate Care, a Portland group that opposes physician-assisted suicide. "It carries with it a message that suicide is OK and here's how you do it. Oregon's assisted-suicide law carries that same message, that if you have a serious illness or an intractable depression or a drug problem that you don't think you can get out of, maybe suicide's the solution."

A physician's role

By graphically describing how-to-die techniques, the video takes suicide out of the medical context and into the realm of "self-help." Yet in an interview, Humphry emphasized that he begins the video by saying, "Go to your doctor, tell him you feel like ending your life because of the suffering and see how the doctor reacts."

Although the AMA has long-standing policy opposing physician-assisted suicide, it has none on suicide.

"What you do with your life is a societal issue, not a medical issue," said Herbert Rakatansky, MD, chair of the Council on Ethical and Judicial Affairs. "The AMA is not going to solve the existential problem of suicide."

The video's broadcast also raised concerns among doctors who support Oregon's law, particularly in light of a recent study published in Lancet that found the will to live fluctuates substantially among dying patients.

"The advantage of physician-assisted suicide is that there are opportunities for the physician to identify depression, to respond to issues that are driving the person to suicide," said Peter Rasmussen, MD, a medical oncologist in Salem.

The Final Exit techniques aren't the best way for people to end their lives, he added. "At least in Oregon there's a much more humane alternative that has medical oversight."

Advances in end-of-life care

Debates like the one triggered by the video in Oregon can have positive implications for the field, said Tony Farrenkopf, PhD, a clinical psychologist who was involved in drafting the guidebook for the "Death with Dignity" law.

"Some of the tremendous inroads and progress [we've made] in improving the care for the dying, in terms of pain management, in terms of spiritual and social management, came from pressure from these end-of-life groups and legislative struggles," he said. "We're finding other approaches to deal with the suffering of the terminally ill that are more agreeable, that are less controversial and certainly very therapeutic."

Meanwhile, a national debate over federal legislation that could overturn Oregon's assisted-suicide law is expected during the current session as it is considered in the Senate.

The AMA supports the Pain Relief Promotion Act, which passed the House of Representatives last year and was used as a pretext for the video's airing.

Dr. Hamilton, who supports the legislation, said the "either you do it my way or the hard way" argument was ridiculous.

"Instead of promoting suicide indiscriminately on television, we need good education and research about pain and palliative care, we need protection for doctors who aggressively treat pain and we need to make it perfectly clear that assisted suicide and euthanasia are not legitimate uses of controlled substances," he said.