A doctor chooses when to die

Oregon physician-surgeon Allison B. Willeford, MD, has long supported physician-assisted suicide. Now he's ready to use the law -- as a patient.

By Andis Robeznieks, amednews staff. July 14, 2003.

For 30 years, Allison B. Willeford, MD, secretly kept a bottle of pills on hand, just in case he decided he'd had enough of personal struggles that included a divorce, three bouts with cancer, and the stress and exhaustion of a general medicine and surgery practice in rural Molalla, Ore.

Dr. Willeford says he never seriously considered opening that bottle of pills. But he wanted the right to end his life when and how he saw fit.

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The personal also was political; well before Oregon made physician-assisted suicide legal in 1997, he spoke out for it. Now Dr. Willeford, 78, in an assisted-living facility and on his fourth bout of cancer, is speaking out louder than ever, knowing that with his kidney cancer diagnosed as terminal, his voice might not be around for long.

He's going through the state-prescribed process of getting a prescription for a fatal dose of secobarbital that, if he swallows it, will kill him.

Dr. Willeford is not the first physician to seek a colleague's help in ending his life. But he is the most vocal about it. Seeing still-massive opposition to the Oregon law, including a continuing court fight initiated when U.S. Attorney General John Ashcroft threatened to pull the DEA license of any physician who prescribed a lethal dose of barbiturates, Dr. Willeford wants to make himself a public example for physician-assisted suicide.

"Not for me, but if I can get any publicity for the cause, I'd like it to come out," Dr. Willeford said. "Right at this present time, I have no intention of killing myself, but I can see somewhere down the line, I might. And, if I don't go through this rigmarole now, I might not be able to later."

Dr. Willeford's cause is not embraced by much of the medical profession, including the AMA, which has policy against physicians' involvement in a patient's suicide.

Oncologist Kenneth Stevens, MD, president of the anti-assisted-suicide group Physicians for Compassionate Care, said he was concerned a doctor would want to use physician-assisted suicide. "With [Dr. Willeford's] particular type of cancer, it's pretty slow-growing; he could still live a long life. I hope he continues to enjoy life."

The partners in Dr. Willeford's former practice are split over Dr. Willeford's desire to get a lethal prescription. One, Dr. Willeford's treating physician, agreed to the request. The other, citing feelings against physician-assisted suicide, did not. Two physician signatures are required for a prescribed lethal dose of pills; Dr. Willeford is seeking that second signature through an advocacy group.

A long history of contention

Since Oregon's law came to be after two referenda, 198 lethal drug doses have been prescribed, and 129 taken. Of the 38 people who committed physician-assisted suicide last year, most were married, white male cancer patients around 69 years old. Reasons given for ending their lives included: Losing autonomy (84%), decreasing ability to participate in activities they enjoyed (84%) and losing control of bodily functions (47%).

The Oregon affiliate of the physician-assisted suicide advocacy group, Compassion in Dying, records the occupation of people it "guides through the process," said executive director George Eighmey. According to Nancy Crumpacker, MD, a physician affiliated with the group, five other doctors have legally obtained lethal prescriptions in Oregon. Four used them.

Dr. Crumpacker, a retired oncologist who has written lethal prescriptions, said there is added significance when doctors choose physician-assisted suicide. "Physicians are more aware of the realities of dying than many because of what they've seen."

Dr. Willeford has faced death before. In 1963, he was diagnosed with malignant melanoma and told he had three years to live. But then it became clear his melanoma would not recur.

Other cancers did occur though. About 15 years ago, Dr. Willeford was diagnosed with prostate cancer, which resolved after a prostatectomy and radiation treatments. A few years ago he had squamous skin cancer cells removed from his cheek.

Dr. Willeford now has kidney cancer with metastases to his lungs. It was discovered in August 2002, during a heart valve replacement. He goes to dialysis three times a week and takes medication for hypertension.

The end is in sight, he said. "I'm getting shorter of breath and I'm eating less -- and that's the main symptom. I've never seen a dying patient with a good appetite."

Frank R. James, MD, whom Dr. Willeford hired in July 1980 and one of the physicians who took over his practice after he retired, concurs. Dr. James is Dr. Willeford's primary care physician, and he signed the necessary papers to start processing the assisted-suicide request.

Dr. James said Dr. Willeford's kidney cancer has produced nodules in the lungs that cannot be removed or treated. "If I thought there was a way to treat the problem, it would be different. I'm honoring his decision to die the way he wants."

Oregon requires that any physician agreeing to write a lethal prescription determine the patient is terminal -- defined as having an incurable and irreversible disease that will, within reasonable medical judgment, produce death within six months.

It also requires that the patient is not clinically depressed, does not have Alzheimer's disease or another form of dementia, and is not being coerced. If a physician suspects mental health problems, the patient can be referred to a psychiatrist.

Dr. Willeford said that, although he is not pleased to be in his current condition, he is not clinically depressed, and he scoffed at anyone who might suggest that depression is the source of his assisted-suicide advocacy.

"I could just stop taking dialysis and kill myself that way, but I would not know when it would happen," Dr. Willeford said.

With a lethal prescription, Dr. Willeford said, death would come at the time and place of his choosing. His five grown children have been told, and he would like them to be present when that time comes.

ADDITIONAL INFORMATION:

Weblink

Opinion of the AM's Council on Ethical Judicial Affairs on physician-assisted suicide (www.ama-assn.org/ama/pub/category/8459.html)

Aricle, "Physician-Assisted Suicide: The Law and Professional Ethics," in the AMA Virtual Mentor Policy Forum (www.ama-assn.org/ama/pub/category/9422.html)

Oregon Department of Human Services physician-assisted suicide reports (www.ohd.hr.state.or.us/chs/pas/pas.cfm)

Physicians for Compassionate Care Educational Foundation (www.pccef.org)

Compassion in Dying of Oregon (www.compassionindying.org/or/)