Ashcroft's position echoes the American Medical Association's Code of Medical Ethics, which states, "Physician-assisted suicide is fundamentally incompatible with the physician's role as a healer, would be difficult or impossible to control, and would pose serious societal risks."
In his order blocking the Department of Justice directive, U.S. District Judge Robert Jones said in a press release that the department was attempting to "stifle an ongoing, earnest and profound debate in the various states concerning physician-assisted suicide." While the debate is ongoing, no other state has followed Oregon's lead. Voters in California, Michigan, Maine and Washington state have rejected assisted-suicide ballot measures, and the Maine legislature defeated a bill that would have implemented an Oregon-style plan. Forty states explicitly forbid physician-assisted suicide; six states prohibit it through common law. Only three states other than Oregon--North Carolina, Utah and Wyoming--do not have laws prohibiting physician-assisted suicide.
Vermont's legislature considered measures in 2003 on both sides of the issue, as well as one that attempted to strike a middle ground. Two bills (S 112, S 181) would have allowed physician-assisted suicide, one would have prohibited it (H 275), and two others would have created a commission on palliative care (H 318, H 419). All failed to reach the floor, but their introduction led to a series of physician forums around the state under the auspices of the Vermont Medical Society. The issue is expected to be reviewed at the society's annual meeting.
Within psychiatry, there are two broad schools of thought regarding the issue, according to Ronald Baron, M.D., chair of the committee on suicidology of the American Academy of Psychiatry and the Law. "When I was with the American College of Forensic Psychiatry, we had the attorney for [Jack] Kevorkian [M.D.] as a speaker. When we put it to a vote after the presentation, the younger psychiatrists were against assisted suicide, while the older psychiatrists who had elderly patients were for it."
(Kevorkian, a Michigan physician, was sentenced to 10 to 25 years in prison in 1999 for giving a patient a lethal injection. He reportedly assisted at least 130 patients with ending their lives between 1990 and 1998--Ed.)
"What I see as a clinician is different from what people who are younger are seeing," Baron explained. "As you get older, and have various kinds of diseases, and your relatives and friends die, you sometimes have a problem finding a motivation to live. A lot of them are relieved to have a fatal illness or some way that will terminate their lives. But there is another group of psychiatrists who say, 'Treat the depression. Many patients will cheer up and have a better life.' Suicide prevention is really the treatment of depression."
Among psychiatrists in Oregon, Ganzini, who is professor of psychiatry at Oregon Health and Sciences University, found that 54% supported physician-assisted suicide when she surveyed them five years ago. Nearly 75% of the state's psychologists supported the law, while between20% and 33% of all health careprofessionals were opposed to it.
"The highest level of support was among hospice social workers and psychologists," Ganzini reported. "The lowest level--48%--was among hospice nurses. The biggest reason for opposing it is that suicide is not morally acceptable; that it's not an appropriate role for a health care provider and that it is not morally acceptable for people to choose to hasten their death. The strongest relationship for these people was how important religion is in one's life."