How will the end come? Effects of a physician-assisted suicide law

Oregon made it legal in 1997, but the U.S. Justice Dept. still pushes to take action against physicians who assist suicide. Two terminally ill patients and their doctors (one who supports assisted suicide and one who opposes the concept) relate how the law has affected them.

Ken Stevens, MD, and Mary Morrison: It's not compassionate.
Keith White, MD, and Tom Creelan: The option can be comforting.

By Andis Robeznieks, amednews staff. Aug. 12, 2002.

Ken Stevens, MD, and Mary Morrison: Assisted suicide is not compassionate

Some doctors in Oregon may think offering to assist in a terminally ill patient's suicide is a sign of compassion. Ken Stevens, MD, is not one of them.

Twenty years ago, his first wife was dying of cancer. She asked her doctor if there was anything more he could do. In response, he offered to prescribe an extra-large dose of pain killers.

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"When we walked out the door, she said, 'He wants me to kill myself,' " Dr. Stevens recalled. "It was very devastating to have her physician say, very subtly, that her life wasn't worth living."

Shannon Stevens died June 1, on their oldest child's 17th birthday.

"That really sensitized me to how patients and families feel," he said. "It made me realize how much patients and their families depend on having trust in doctors, and assisted suicide really puts that to the test."

A Portland-based oncologist, Dr. Stevens aims in his practice to offer hope as well as comfort. He admits he wasn't always good with the latter.

"I learned by experience," he said. "When I was a resident, I saw a patient who had advanced lung cancer and he asked, 'What could possibly happen to me?' " The young Dr. Stevens told the man how the cancer could spread to his brain, then his bones and then his liver.

"He said, 'If all that's going to happen, I might as well go out and shoot myself,' " Dr. Stevens said. "I realized I had said the wrong things. Now I ask, 'What have you been told and what more do you need to know?' That way, I follow the lead of the patient."

Mary Morrison is a patient of Dr. Stevens. She moved to Oregon to live with her son, Ron, when she was no longer able to work or drive. Ron went to the same church as Dr. Stevens, and he arranged for her to become his patient.

"Dr. Stevens has been wonderful -- to know and be a friend of," she said.

Morrison was still living in California when she heard about Oregon's assisted-suicide law. She originally thought it was "a great thing," but has since changed her mind after hearing her son's arguments against it. And she said she doesn't feel Dr. Stevens' opposition to assisted suicide is denying her a choice.

"No, not at all," she said. "I feel like, if I want, I can totally stop treatment at any time and not be forced into doing anything I don't want to do."

Morrison praises the care she's received from Dr. Stevens and his colleagues, nurses and other hospital staff. "It's a huge hospital, but they know you by name," she said. "They say, 'Hi, Mrs. Morrison, how are you today?' and they make you feel at home and comfortable."

Dr. Stevens graduated from the University of Utah School of Medicine, Salt Lake City, in 1966 and has treated between 8,000 and 10,000 cancer patients. Helping them make the most out of the rest of their lives has become an area of expertise.

He is a strong believer that cancer patients should not have to live in pain, and he said he has no qualms about prescribing pain medication to those who need it. Despite his public opposition to assisted suicide, some patients get confused when they receive their prescriptions.

"I've had patients where, when I'm writing a prescription for opioids or morphine, say, 'How many do I need to kill myself?' " he said. "I tell them the medicine is for their pain, and not their suicide. That's what they want to hear."

Dr. Stevens said physicians should try to convince terminally ill patients that their lives still have value. "I have people say, 'I'd rather die than have a colostomy or be in a wheelchair.' But a person can be disabled or be dependent on others and still have great dignity in their lives.

"We have a great opportunity to relieve their suffering -- and sometimes cure them. We shouldn't be helping to do them in."

Keith White, MD, and Tom Creelan: It's comforting that the option is there

Keith White, MD, has never assisted in a dying patient's suicide, but he's not opposed to the practice or to his state's Death with Dignity law. "I feel that the patient should be able to determine how much suffering they can do and when they're going to die," said the Independence, Ore., family physician. "I don't know how that affects other people -- besides upsetting their sensibilities."

Despite his support for the law, Dr. White said he doesn't bring the subject up with his terminally ill patients. "It's comes up maybe three or four times every six months," he said. "It's mostly old people or people with a terminal illness who can see the end coming. It usually starts with 'I don't think I'll even do it, but ....' "

Artist Tom Creelan, one of Dr. White's patients, has kidney cancer. He said suicide isn't something he's seriously considering, but he likes that it's a choice available to him.

"I would have to be in dire, dire straits and in untreatable, unbearable, excruciating pain to even consider it," Creelan said. "But knowing that option is there, if I choose it, does give me some comfort -- knowing that I don't have to suffer unbearable pain -- if it comes to that."

Married with twin 22-year-old sons, Creelan was diagnosed with cancer in July 1999 and given about 6 months to live. He believes that, in part, the peace of mind he feels knowing assisted suicide is an option may have helped his longevity.

Dr. White thinks there could be some truth to that. "Health is sort of between your ears in many ways," he said. "It's also in your heart and how you feel. I don't want to make any big health claims, but that's what I've heard from patients."

He added that Creelan knows his position on physician-assisted suicide.

"He knows if he wants to do it, I'm fine with it," Dr. White said. "It's an option. The bigger part is end-of-life care, and physician-assisted suicide is just a small part of that."

When treating a terminally ill patient, Dr. White said he finds that it's best not to delay giving bad news.

Creelan said he appreciates the open communication with Dr. White. Hearing bad news is never easy, he said, but it's good to get the conversation over with so a person can get on with whatever time they have left. "I think the scariest words people can hear in their lives are: 'You have cancer,' " he said. "I think everyone who hears those words goes into shock."

He said the news can have a "no-cebo effect" (the opposite of a positive placebo effect), where people give up and wait for the inevitable. While for others, including himself, the news makes them take stock of their lives.

"Every single day is like a lifetime," Creelan said. "This may sound strange, but -- in many ways -- cancer has enriched my life.

For a cancer patient, he said "every day and moment become almost sacred and something to be embraced and celebrated. I like to focus on staying alive -- not how I'm going to die."

Creelan began a series of color-pencil skyscapes a few months before his diagnosis. He continued on his art through his illness and believes it may have been his best work ever. "In retrospect, it was a premonition, and it foreshadowed that things are going to be changing," he said.

The 30- by 40-inch drawings capture Oregon's blue spring skies covered in black and white clouds, and were featured in an art exhibit posted in the governor's office in Salem.

"When they said they wanted it scheduled for September 2001, I said 'I don't know if I can make it,' but I did," he recalled. "I just got an exhilarating feeling, and I forgot I was sick."

Dr. White attended the reception for Tom's work. "I was astounded and impressed, and my wife was astounded and impressed -- and she has an art degree," Dr. White said. "It meant a lot to me to be there because, a lot of times, I don't get to see what my patients do."

On April 9, Creelan came down with pneumonia and was forced to retire from teaching after 30 years, but he is not giving up. "I want to live as long as I can, as comfortable as I can," he said. "There's a lot of value in being alive, and it's something I want to cling to for as long as I can."

Note Tom Creelan died July 18 in his home of natural causes. According to the Salem Statesman Journal, his last drawing was an incomplete work showing a field and pool of water. He titled it "Unfinished Reflection."