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GOP TARGETS ASSISTED SUICIDE - Latest move to ban practice would focus on physician intent

bulletSeattle Post-Intelligencer Monday, March 19, 2001
By JUDY HOLLAND Post-Intelligencer Washington Bureau

WASHINGTON -- Foes of assisted suicide are pressing U.S. Attorney General John Ashcroft to reverse a Clinton administration policy and ban physicians from prescribing powerful drugs to help patients kill themselves.

Republican supporters of a ban twice failed in the 105th and 106th Congresses to enact legislation that would subject doctors to 20 years in prison if they prescribed such drugs to cause a patient's death. Now they are trying to end the practice through administrative action by asking Ashcroft to interpret the federal Controlled Substances Act to mean that physicians cannot prescribe regulated drugs to cause death.

Such an interpretation would reverse a 1998 ruling by Attorney General Janet Reno that states have the power to define the legitimate medical use of these drugs. Sen. Don Nickles, R-Okla., the assistant Republican leader in the Senate, wants to make it a matter of physician intent.

If the prescribing physician merely intends to reduce a patient's pain, the doctor wouldn't have a legal problem. If the intent were to cause death, the physician would be subject to criminal prosecution. Nickles says Reno "stretched" federal law in an "absurd" way. "I have brought this to the administration's attention," Nickles said. "I think the previous attorney general was wrong, and I hope it's reversed ."

But supporters of assisted suicide warn that changing the rule would empower law enforcement officials to make subtle medical judgments after the fact and that physicians could be subjected to investigation and prosecution over whether they intended to treat pain or kill a patient. John Russell, spokesman for the criminal division of the Justice Department, said the matter is "under review ."Any  Ashcroft ruling agreeing with Nickles would threaten the assisted-suicide program in Oregon -- the only state in the nation that allows terminally ill patients to die with a doctor's help.

Oregon voters narrowly approved physician-assisted suicide by referendum in 1994 and by a wider margin in 1997. Since 1997, 70 people have used Oregon's law to end their lives, including 27 people last year, according to the Oregon Health Division. Under Oregon law, a patient must be mentally competent and terminally ill with less than six months to live to qualify for physician-assisted suicide. Two physicians must be involved and the patient must make two requests to die, one of them in writing that is witnessed by a non-family member. Over the past decade, voters in California, Michigan, Washington and Maine have rejected physician-assisted suicide programs. Legislation to legalize the practice is now pending in New York and Hawaii.

The assisted-suicide issue is expected to grow in national prominence because of progress in medical technology to extend life at some level and the aging Baby Boom generation. President Bush voiced opposition to physician-assisted suicide on the campaign trail. Ashcroft didn't address the issue during his Senate confirmation hearings earlier this year but, as a Republican senator from Missouri, he sponsored a 1997 law banning federal funding for assisted suicide. Nickles and Rep. Henry Hyde, R-Ill., have tried twice unsuccessfully to persuade Congress to ban the use of federally controlled drugs for assisted suicide.

The latest version, which died last year, also would have protected physicians who intend to treat severe pain in a terminally ill patient but sometimes hasten the death of a patient, in what is known as the "double effect." Oregon's political leaders disagree on the merits of the practice. Oregon Gov. John Kitzhaber, a Democrat who is an emergency medicine physician, argues that people with terminal illnesses should have the ability to control their own death. Sen. Ron Wyden, D-Ore., a chief defender of his state law, said he is personally opposed to physician-assisted suicide but defends Oregon's right to decide what is legitimate medical practice. Wyden said Oregon's attorney general is ready to "go into court very quickly" if the Justice Department bans use of the drugs to end human life.

Sen. Gordon Smith, R-Ore., says he's morally opposed to assisted suicide. "For me, it's an ethical boundary about licensing physicians to relieve pain, but not giving them a license to kill," Smith said.

Smith predicts the Justice Department will move shortly to ban the use of controlled drugs for assisted suicide. However, he also is urging the administration to allow physicians to prescribe powerful drugs more liberally to stop pain. Smith faces a tough reelection battle in 2002 and Senate Republican leaders hope to avoid any legislative action that could cause him friction at home on this volatile issue. Any Republican loss in next year's election could hand control of the chamber to Democrats.

The issue does not split along party lines.Sen. Joseph Lieberman, D-Conn., said he would support a Bush administration ban on the use of federally controlled drugs for assisted suicide. "Doctors should do everything they can to reduce pain, but not to administer drugs to end life," Lieberman said. "I think we go over a line then."

Lieberman said doctors need to learn more about pain control and should be protected from prosecution "if they prescribe pain killers that may increase the possibility of death so long as their specific intention was not to end life."

Estelle Rogers, executive director of the Death with Dignity National Center, a non-profit advocacy group focused on advancing the legalization of assisted suicide, expressed concern that physicians won't be free to treat pain aggressively if the Bush administration bans use of the drugs to cause death. Rogers said doctors' intentions in giving large doses of powerful medication could be easily misunderstood, leaving them open to prosecution.

bulletSOURCE: GOP targets assisted suicide Latest move to ban practice would focus on physician intent Seattle Post-Intelligencer Monday, March 19, 2001 By JUDY HOLLAND POST-INTELLIGENCER WASHINGTON BUREAU WASHINGTON

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