American College of Physicians: Internal Medicine — Doctors for Adults ®


Other initiatives fail in Washington

Oregon voters reaffirm physician assisted suicide law

From the December 1997 ACP Observer, copyright 1997 by the American College of Physicians.

By Jennifer Fisher Wilson

Three years after Oregon citizens narrowly voted to legalize physician assisted suicide, state legislators returned the controversial issue to voters and gave them another chance to decide. This time the vote was decisive, reaffirming individuals' right to physician assisted suicide.

It was not the only health care related initiative to be defeated in this year's elections. In Washington state, voters rejected a plan that would have guaranteed them access to their own physician, more tightly regulated guns and legalized the medical use of certain drugs.

But clearly the most closely watched vote was Oregon's physician assisted suicide initiative. While California and Washington have voted against similar initiatives in the past, Oregon became the first state in the nation to legalize physician assisted suicide in 1994 with Measure 16.

But because the measure passed by a slight 51% to 49% margin, the Oregon state legislature was unsure of how to implement it. Subsequent legal challenges kept the law from going into effect. When the Supreme Court finally heard the case this year, it ruled that states in fact have the right to outlaw physician assisted suicide.

In an attempt to settle the issue once and for all, Oregon's legislators offered citizens another chance to go to the polls. Oregonians didn't shy away from the topic, and in the biggest voter turnout in years they chose three to two against repealing physician assisted suicide. Leaders of Oregon's assisted suicide campaign called the vote a turning point for the death-with-dignity movement.

James B. Reuler, FACP, the College's Governor for Oregon, said that just two days after the vote he had already been asked by one patient about how he could get assistance under the new law. The law allows doctors to give lethal doses of drugs, but not lethal injections. It also limits physician assisted suicide to patients who have six months or less left to live, as determined by at least two doctors. The patient must be of sound mind and must make a written request to die.

There's still a way to go before the law can be translated into practice, according to Dr. Reuler, who works at the Veterans Affairs Medical Center in Portland. The Clinton administration has made strong statements about the implementation of the law, he explained, and the Drug Enforcement Agency (DEA) is now reviewing its policies about prescribing controlled substances for this use. The DEA has warned that the measure violates federal narcotics law and that doctors risk losing their licenses by writing prescriptions to help patients commit suicide.

"As of right now, I don't think any doctor would be comfortable going forward with the measure," Dr. Reuler said. However, legal issues surrounding implementation are expected to be cleared in the next six months. The Oregon Medical Association is already working to provide guidance for practicing physicians about the practical issues of implementing the law.

There may be other factors that prohibit some physicians from participating in physician assisted suicide, Dr. Reuler said. Catholic-affiliated health centers, for example, have already forbidden their physicians from doing so.

Besides, Dr. Reuler added, physicians in Oregon have focused more on quality in end-of-life care since passage of the physician assisted suicide measure three years ago. "For most practicing physicians and internists—whichever side of the fence they're on with physician assisted suicide—implementation of the measure will not be a huge issue for their practice," he said. "In the daily practice of most physicians, the issues surrounding end-of-life care and comfort are most important. Measure 16 will provide an additional option for some patients and some physicians."

Because of the ongoing controversy regarding physician assisted suicide, many Oregon health care centers have developed end-of-life care teams.

Besides opposition from the Catholic church and antiabortion groups, the American Medical Association has opposed legalizing physician assisted suicide. Patients' right to quality end- of-life care should preclude them from having to resort to physician assisted suicide, according to Thomas Reardon, MD, the chair of the AMA Board of Trustees. "The decision by the citizens of Oregon . is a serious blow to their health and safety," he said.

In nearby Washington state, residents passed up an initiative that would have allowed them to keep their doctors when they switched jobs or health plans. The initiative would have also given consumers more access to information on health plans.

Supporters of Initiative 673 say that confusion over the proposal led to its defeat, as did allegations from health insurance companies that it would increase health care costs for consumers by 20% and decrease the quality of medical care.

Supporters blame the ballot name, which mentioned nothing about patient choice or access. Analysts also point to the state's insurance companies, which spent about five times as much on adveertising as supporters of the initiative.

"We were voted down because people didn't know what the initiative was all about," said Teresa Wippel, the campaign manager for the Coalition for Patient Choice (PRO). "They raised enough doubts in peoples' minds that they just weren't sure about the initiative."

The initiative lost by a two-to-one margin despite endorsements from several state legislators, senior citizens organizations and labor unions. The campaign, however, lacked support from the Washington State Medical Association. According to Ms. Wippel, the society declined to support the initiative because it included naturopaths and chiropractors in addition to physicians.

Voters in Washington also turned down a gun regulation initiative that would have required guns sold or transferred to have a trigger lock. The proposal would have also required all new handgun owners to complete an eight-hour training course to earn a mandated safety license. Heavy campaigning from the National Rifle Association led to defeat of the proposal by a two-to-one ratio. More than a fifth of citizens in the state are gun owners.

Also in Washington, voters defeated a proposal to legalize the medical use of marijuana and other drugs including heroin, morphine and LSD. The initiative would have made it legal for seriously or terminally ill patients to use these drugs under the recommendation of at least two physicians. Physicians would have had to cite scientific research showing the drugs' effectiveness. The initiative also carried a clause calling for more lenient treatment of people convicted of drug possession.

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