Assisted Suicide: Opponents of assisted suicide present their case: among their arguments, insurance companies will decide who dies. 

By Ann Potempa Anchorage Daily News, January 22, 2001 

Dr. Gregory Hamilton doesn't waste time on abstract topics. He'd rather not philosophize on what it really means for a doctor to "do no harm." He has other things to talk about besides analyzing whether a patient has the right to choose how and when he'll die. Instead, Hamilton wants to get back to the concrete terms, the specific reasons why Alaska's court system should not approve letting physicians help ailing patients die. 

Doing so would devalue the lives of terminally ill people and make them feel pressured to commit suicide, he said. "Clearly, Alaska has the right and the responsibility to uphold its laws protecting its citizens against the danger doctor-assisted suicide poses to vulnerable individuals and to the general welfare of society," Hamilton concludes in a brief submitted to the Alaska Supreme Court. 

Hamilton is a psychiatrist in Oregon, home of the Death With Dignity Act. Oregon's voters approved the act, which allows terminally ill and mentally competent patients to receive a doctor's prescription for lethal drugs that the patients must swallow on their own. The act has been contested by several groups, including Hamilton's Physicians for Compassionate Care. 

Regardless, patients and physicians are using the act. Oregon had more than 40 deaths from physician-assisted suicide as of last fall. Barbara Coombs Lee, the executive director of Compassion in Dying, shared that statistic before she came to speak in Anchorage last September. The Daily News covered the efforts of Lee and her group to encourage Alaska to permit physician-assisted suicide. "Terminally ill patients, people who are dying, do not realize control and choice at the end of life," she said in September. Choices are taken from them, Lee said, especially for assisted death and controlling pain. 

On Friday, Hamilton will visit Anchorage to talk about the other side of the issue. Local groups, including the Alaska Catholic Conference and the Anchorage Christian Medical and Dental Fellowship, are sponsoring Hamilton's visit to several cities in Alaska. 

"From the perspective of the Alaska Catholic Conference, we promote the protection of human life from conception to natural death," said Bob Flint, the group's executive director. People shouldn't step over the line of medical care and kill others, he added. "Killing people is not compassionate care," he said. 

As president of Physicians for Compassionate Care, Hamilton represents doctors who don't believe it's right to help their patients kill themselves. The physicians cover many medical specialities, but they agree that they should strive to heal the patient, minimize pain and provide comfort care until natural death. "We will never give a deadly drug to anyone even if asked, nor will we suggest suicide," reads the group's online pledge to patients. 

On Saturday evening at the Loussac Library, Hamilton will address the assisted suicide lawsuit now being considered by the Alaska Supreme Court. Several years ago, Anchorage attorney Robert Wagstaff brought a suit to the state's Superior Court contesting the criminal status of assisted death. The suit had two plaintiffs: Kevin Sampson, a man dying from AIDS, and Jane Doe, a doctor dying from cancer. In 1999, the Superior Court ruled in favor of Alaska's ban on physician assisted suicide. Wagstaff appealed to the state Supreme Court. 

The plaintiffs have since died, but Wagstaff is arguing on their behalf as a part of a class- action suit. Wagstaff's argument is that Alaska's laws making assisted suicide a felony are too broad and infringe on the right to privacy provided by the state constitution. 

Hamilton disagrees. "Assisted suicide is not a private act," he said. "When you include a doctor in a suicide, you include a complex medical, social and economic system in which patients find themselves caught up and subject to influence, if not pressure." 

Hamilton listed the other dangers of physician-assisted suicide in his court brief. Determining the core requirement of the Death With Dignity Act, that a patient is actually terminally ill, is difficult for a physician, he said. On top of that, the physicians are required to make sure patients are mentally able to understand the consequences of assisted suicide. If a doctor thinks a mental illness is interfering in a patient's judgment, assessment by a psychiatrist is required. 

But in a contested case in Oregon, a terminally ill woman sought a second opinion when the first psychiatrist ruled that she didn't have the ability to completely understand physician-assisted suicide. The case Hamilton is referring to involves the death of Kate Cheney, an elderly Oregon woman who was dying of cancer. People have argued about the steps leading up to Cheney's physician-assisted suicide. According to a report in Portland's The Oregonian newspaper, psychiatrists wondered if Cheney was being pressured by her daughter to complete the suicide. Hamilton uses Cheney's case to suggest that terminally ill patients can be influenced by family members, medical organizations and insurance providers to use suicide to end their lives. 

He said he knows of health maintenance organizations that will cover assisted suicide at a higher rate than hospice care. Laws that allow physician-assisted suicide discriminate against the terminally ill by failing to provide the same protection of their lives that healthy people enjoy, Hamilton said. He argued that once the law is in place, it could be expanded to include worrisome provisions. 

The current Oregon act requires that patients must be able to swallow the lethal drug, but Hamilton sees the possibility that lethal injection may become acceptable. Other critics of the law worry that it will lead to physician-assisted death of people who are only disabled, yet not terminal. 

"That will happen," Hamilton said. "There's absolutely no doubt about it." Just because Hamilton disapproves of physician-assisted suicide doesn't mean his patients haven't approached him to help them with it. "I've had probably hundreds of patients ask to give them overdoses over the years, and they all change their minds," he said. Feeling suicidal is a symptom of an underlying problem, Hamilton said. 

If he treats their depression or finds a way to cure their pain, patients discover their life is worth living. Physicians for Compassionate Care tries to teach doctors about treating pain. There are available drugs to ensure that people do not suffer as they die, he said. Although those in favor of physician-assisted suicide say there are safeguards to ensure that Oregon's law is used correctly, Hamilton has to disagree. "There really, virtually, are not protections in the Oregon law," he said. "They say there are, but there aren't." 

Daily News health reporter Ann Potempa can be reached at mailto:apotempo@ada.com