hope the Bush administration got the hint last week. Finally
someone --- the Supreme Court, specifically --- took it to task
for overstepping its bounds. The Court, in a 6-3 ruling, pulled
the plug on the administration's program of siccing the Drug
Enforcement Agency on Oregon doctors who help terminally ill
patients die. Since Oregon voters approved the Death with Dignity
Act a decade ago, 208 people have used the law to die. Religious
conservatives, ignoring both individual and states' rights, have
been gunning for the law ever since.
In 2001, in a sneaky workaround, former attorney general John
Ashcroft applied the federal Controlled Substances Act (designed
to reign in drug traffickers) to docs who prescribe pain medication
to terminally ill patients. Surely the DEA has something better
to do than charge into hospices shackling weary physicians
and confiscating their little white prescription pads. Then
again, it's probably a lot easier and safer than actually fighting
the illegal drug trade, where drug dealers carry Glocks and
the only lives they value are their own.
Last week's rather narrow ruling was about an overstepping
administration meddling in state law. The larger debate about
assisted suicide, however, touches on many factors such as
pain management and, for disability rights activists, the fear
that society could use the law for sinister ends.
To assisted-suicide advocates like Timothy Quill, director
of the Palliative Care Program at the University of Rochester
Medical Center, the ruling was a relief.
"The most important thing," he says, "is if
the decision had gone the other way, it would have empowered
the Drug Enforcement Agency to get involved in end-of-life
decisions, and that would have been terrible." Quill says
the DEA's job is important, but it's not their business to
be second-guessing doctors.
Oregon's assisted-suicide law --- the only one of its kind
in the country --- is considered "open," meaning
decisions are made with the knowledge of two doctors who must
agree that the seriously ill patient is of sound mind, not
depressed, and has fewer than six months to live.
But for Quill, this case is not just about the right to die.
It's also about pain management. A ruling in the federal government's
favor might have stopped some of the practices of assisted
suicide, Quill says. "But it would have had huge unintended
consequences in terms of under-managing pain."
If you've ever been to a doctor (or are just married to one),
you know they're notoriously chintzy with pain medications.
In addition, they tend to underestimate the pain you'll experience
during a procedure. When I hear a doctor --- or my husband
--- say, "you may experience some mild discomfort," I
start popping Tylenol with codeine.
But I never knew the doctors' side of the story until Quill
explained that when dealing with painkillers, doctors are very
cautious, fearful of being investigated for over-prescribing.
This fear has a chilling effect on pain management.
At the end of life, however, abuse of painkillers is typically
not a major concern, Quill says. Comforting the dying person
is. Because excruciating pain can compound the fear and anguish
of a dying person, it's important that doctors feel safe prescribing
strong pain killers.
Quill offers an example. "Some people at the end of life
require large amounts of pain medication as part of their care," he
says. "Some medications may even prolong life. Imagine
an inexperienced DEA agent who sees a patient on increased
amounts of pain medication and that patient dies. There may
be a misinterpretation that the pain medication caused the
For Chris Hilderbrant, director of advocacy at Rochester's
Center for Disability Rights, and for many disability rights
groups, the idea of assisted suicide is terrifying in a society
which they see as valuing money over human lives.
"What's particularly dangerous now is there's already
a blame put on our community for the cost of Medicaid," Hilderbrant
says. He worries that there is already a perception that, as
he puts it, "'you people are a burden on the taxpayer.'"
"Take that and expand it, and see that people who are
a burden and who are also suffering can choose to end their
suffering and reduce the burden on society," he says.
And Hilderbrant recalls a letter to the editor in the Democrat
and Chronicle a few years ago that said once people turn 75,
they should receive no life-sustaining care. "There is
an attitude out there that doesn't value our lives very highly," says
If you've ever fought to get coverage for a procedure or medication,
you know our health-care system is all about profit. What if
society opted for the $35-$50 lethal medication used in assisted
suicides rather than pay thousands of dollars for long-term
medical care? This dark view is put forth by Marilyn Golden,
policy analyst for the Disability Rights Education and Defense
Fund, who cites studies drawing correlations between for-profit
managed care and pressure on physicians to offer assisted suicide.
For his part, U of R physician Timothy Quill says it's all
about having sympathy for patients who, at the end of life,
are not just in terrible pain but are "tired of dying,
of feeling out of control." It's hard to imagine him supporting
a system that administered lethal drugs to people who really
don't want to die. But then, in a country where the federal
government freely removes hard-fought individual and state
rights, someone else might.