Physician-assisted suicide dead in Hawaii?

Doctors are credited with thwarting the bill's passage in the state Senate; similar legislation is pending in Arizona and Vermont.

By Andis Robeznieks, amednews staff. March 10, 2003.

Even as U.S. Attorney General John Ashcroft works to overturn Oregon's law that legalized physician-assisted suicide, bills seeking to enact similar laws have been introduced this year in Arizona, Hawaii and Vermont.

"You have Ashcroft trying to squelch this whole movement, but these bills keep popping up," said Estelle H. Rogers, executive director of the Death with Dignity National Center in Washington, D.C.

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Rogers said proponents thought Hawaii would be the most likely state to join Oregon in legalizing physician-assisted suicide, after a bill introduced by its governor last year was approved by the state House yet narrowly defeated in the state Senate.

But now there's a new governor and other things to deal with.

"There was every intention of moving this forward this year [in Hawaii], but a lot of events have eclipsed this as an issue," she said.

91 people committed physician-assisted suicide in Oregon between 1998 and 2001.

There also appears to be another factor in the physician-assisted suicide debate: Physicians.

Legislator Colleen Hanabusa sponsored the physician-assisted suicide bill in Hawaii's state Senate and said physicians helped keep the bill bottled in committee and killed its hopes for passage this year.

"It's basically for all intents and purposes -- no pun intended -- dead in the Senate," she said. "It was mostly the doctors who took the lead. It was a different [public relations] campaign this time around. It wasn't framed in a church kind of presentation."

Keeping watch

Although chances for passage look slim, the Hawaiian Medical Assn. pledges to keep its guard up.

"I think it will continue to resurface, because I think proponents of assisted suicide were encouraged by the activity last year," said HMA Executive Director Paula Arcena. "It is a top priority for us to oppose this bill and see that it doesn't get passed."

Honolulu internist, rheumatologist and pain management specialist James McKoy, MD, was in the forefront of the opposition effort, which included seminars with legislators, newspaper editorials, and appearances on local television and radio.

Although Hanabusa said the debate focused less on religion and more on medicine this time, Dr. McKoy credits the Christian Medical and Dental Assn. with giving him needed literature and research materials to get his message across that the pain of terminal patients can be treated.

"There's the argument that patients are kept alive on artificial life-support, which is baloney," he said. "Patients have the right to refuse treatments that only prolong dying."

Dr. McKoy said ending someone's life is not something physicians should do. "People say, 'If I'm 70 or 80 years old and incapacitated, I don't want to live,' well, that's a personal decision. ... Why put it on the medical profession? We're healers, not killers."

Dr. McKoy argues that legalizing physician-assisted suicide will make it a substitute for palliative care, but retired surgeon Richard C. Austin, MD, disagrees. He's become an advocate for the "Death with Dignity" bill in Vermont.

"We're looking at it as an extension of palliative care rather than a substitute," Dr. Austin said. "We thought there were a few who were not relieved by palliative care."

He said the Vermont bill mirrors the Oregon law and includes carefully designed qualifications and checkpoints to "avoid abuse." In Oregon, 91 people have committed physician-assisted suicide over four years. With Vermont's smaller population, Dr. Austin said that would translate to three to five people a year in his state.

Dr. Austin, who practiced for 30 years before retiring in 1994, said memories of cancer patients who suffered a "miserable demise" helped shape his views. He also thinks some doctors are illegally assisting in suicides already, and legalizing it will give these doctors some legal protection and allow some monitoring to see how widespread the practice is.

"We're battling the AMA's ethical opinion, the position of the Catholic church and the conservative right," he said. "We feel they have a right to their opinions, but ethics is a dynamic subject and, ultimately, hierarchies are going to change the attributes of their ethical advocacy to reflect their constituencies."

In Arizona, the Arizona Medical Assn. said they were actively opposing the "Aid-in-Dying" bill now in the state Legislature, said spokeswoman Andrea Smiley.