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The Debate Over Physician-Assisted Suicide Continues

The Debate Over Physician-Assisted Suicide Continues

Patients who choose to request a physician's assistance in ending their lives usually do so because they want to exercise control over the end of their lives, they do not wish to be a burden or dependent on others for their care, they see their futures as assuredly worse than their current lives, or they are struggling to find a meaning in their continued existence.

These are among the findings of Linda Ganzini, M.D., M.P.H., and her colleagues, who have studied the views and experiences of patients and caregivers in Oregon since the state legalized physician-assisted suicide in 1997 with the Death with Dignity Act.

"We have surveyed physicians, social workers, hospice nurses and other health care professionals who have cared for these people," Ganzini told Psychiatric Times. She added that most of the professionals "have agreed that depression is not an important reason, which is not what I expected to see."

Oregon is the only state in which patients can legally receive prescriptions for life-ending medications. If the federal government has its way, however, physicians writing such prescriptions could face loss of prescribing privileges under the Controlled Substances Act.

U.S. Attorney General John Ashcroft issued a directive in 2001 declaring that assisted suicide is not a "legitimate medical purpose." A federal court has enjoined the government from enforcing its directive and, at press time, the 9th Circuit Court of Appeals is considering whether or not to uphold the injunction. In all likelihood, the issue will wind up being appealed to the U.S. Supreme Court by whichever side loses in the Court of Appeals.

In a statement issued by the U.S. Department of Justice, Assistant Attorney General Robert D. McCallum Jr. argued, "Pain management, in contrast to assisted suicide, has long been recognized as a legitimate medical purpose justifying physicians' dispensing of controlled substances. There are important medical, ethical, and legal distinctions between intentionally causing a patient's death and providing sufficient dosages of pain medications to eliminate or alleviate pain."

In addition, the statement pointed out, Ashcroft's directive "promotes the ability of physicians to use federally controlled substances to manage pain. Physicians should feel confident that they may prescribe federally controlled drugs to relieve pain, even if their prescriptions may have the unintended effect of hastening the patient's death, without fear that their prescriptions will be subject to greater questioning, investigation, or monitoring."

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