X-Message-Number: 10196 Date: Fri, 07 Aug 1998 21:09:50 -0700 From: Arizonans for Death with Dignity <> Subject: Hospital policies in Oregon From the Register-Guard newspaper, Eugene, Oregon August 7, 1998 Houses of healing set policies on helping life come to an end By JOE ROJAS-BURKE The Register-Guard More than three years after voters first approved doctor-assisted suicide in Oregon, some hospitals and health systems are still working out how to respond to a patient who asks for death by prescription. Resolving the matter has turned out to be far more complicated than simply deciding whether to allow the practice within the walls of a hospital or at the hands of employees. Institutions willing to provide assisted suicide, for instance, have stumbled on the problem of how to make sure that conscientious objectors on staff aren't unwittingly involved in an assisted death. For health systems fundamentally opposed to assisted suicide, the great dilemma is meeting the medical and spiritual needs of dying people without abandoning those who choose to hasten death. "Nobody is taking this lightly, whichever side you're coming at it from, because there are so many things that have to be considered," said Bridget Carney, director of ethics for PeaceHealth, the Catholic-sponsored nonprofit corporation that runs Sacred Heart Medical Center in Eugene. PeaceHealth's staff began writing a policy on assisted suicide in 1994, Carney said. In June the corporation adopted a final policy that forbids employees from participating in assisted suicide. However, the policy makes accommodations, such as allowing doctors to talk about the option with patients, and allowing staff to care for a patient up until the suicide. McKenzie-Willamette Hospital in Springfield has yet to adopt a final policy, but officials have said the hospital's intent is to stay out of discussions between doctors and patients about assisted suicide. From the patients' point of view, the prolonged absence of clear hospital policies may be discouraging doctors from going along with requests for assisted suicide, even though patients' homes, not hospitals, are expected to be the setting for most assisted suicides. The reason is that in many communities, hospitals run some of the largest home health and hospice programs and doctors' offices. "How many doctors are willing - but they are on their own with no guidance, no cooperation with a hospital - therefore they say no to patients not because they are against it but because they don't want to be the first one to do this on their own?" said Penny Schlueter, 57, of Pleasant Hill. Schlueter, who taught at Lane Community College until ovarian cancer forced her to retire, takes comfort from the knowledge that physician-assisted suicide is an option in her long struggle with cancer - even though she may never take a lethal dose of medication. Measure 16 allows a doctor to provide lethal medication to a terminally ill adult who asks for assisted suicide. The doctor has to document that the patient is making a voluntary choice and get a second doctor's opinion. The law has been in effect since last October, when a court-ordered injunction expired. McKenzie-Willamette spokeswoman Kay Bryant said the staff has struggled to square the suicide law with the hospital's mission statement "to improve community health and quality of life." "The bottom line is, we have providers in this organization to whom this law is very troubling," Bryant said. "It goes against all of their training." "The guiding principle has been how to address compliance with the law while not forcing anyone to participate who is not comfortable doing so," she said. "We have to look at things like, let's say, a pharmacy tech receives an order for a lethal prescription from a physician. What if that pharmacy tech is not comfortable? What do we do then?" Oregon Health Sciences University, the state medical school and teaching hospital in Portland, has taken the lead in crafting a policy that allows assisted suicide. OHSU adopted a final policy last November. The policy resolves several problems by giving a designated staff person - the patient advocate/ombudsman - responsibility for handling assisted-suicide cases. The advocate, for instance, keeps doctors advised of the legal requirements, helps arrange confidential second-physician opinions, and contacts willing pharmacists for filling the prescription. "The most important thing was to establish a method of confidentiality for all parties, to ensure that there was a method for the patient to make the request, and then to ensure that each person's confidentiality was maintained," said Barbara Glidewell, the registered nurse who serves as patient advo- cate/ombudsman at OHSU. The policy remains untested, Glidewell said, because no patients have sought assisted suicide through OHSU facilities. PeaceHealth's Carney said her organization struggled to balance the rights of individuals to make informed choices about health care with the Catholic position that assisted suicide is never acceptable. "It's not our job to lecture the patient one way or another," Carney said. "The patients decide what they want. We won't support (assisted suicide). We will make a point of assessing to make sure there isn't anything we missed, whether there are other reasons why they are choosing this. But it's not our job to be badgering the patient at that point." The stance taken by Catholic health systems remains disturbing to advocates of the suicide option. Schlueter said the large presence of Catholic systems in many communities, including Eugene, can impose a barrier to patients seeking assisted suicide. "It bothers me that if a doctor is independent and leasing an office space from PeaceHealth, that lease determines the medical care that goes on in an office." PeaceHealth's policy stipulates that participation in assisted suicide in an office space leased from PeaceHealth "may result in the loss of lease." Schlueter declined for the sake of privacy to say whether she had found a willing doctor. But she said, "It's not an easy thing, I can tell you that. The option is not readily available." However, some backers of assisted suicide are encouraged by the accommodations emerging even at Catholic institutions. Judith Fleming, executive director of the nonprofit advocacy group Compassion in Dying, praised the PeaceHealth and the Sisters of Providence systems for finding a way to provide hospice care to patients who intend to take lethal prescriptions. "So far I will tell you, by and large, we are very, very respectful of the decisions and the support that Catholic hospices are giving the patients," Fleming said. In time, she said, "I believe a majority of institutions will look in good conscience for a way to put the requests of the patients at the forefront." -------------------------------------------------------------------------- This message sent by Arizonans for Death with Dignity David Brandt-Erichsen, AzDD Website Manager <> or <> http://www.hemlock.org/hemlock/arizona or http://www.azstarnet.com/~davidbe/hemlock Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=10196