X-Message-Number: 8768
Date: Wed, 12 Nov 1997 13:31:27 -0700
From: David Brandt-Erichsen <>
Subject: Oregon update

The Oregonian newspaper (Nov 12) reports:-

Doctors get advice on suicide questions

Two physicians' groups offer guidelines on reconciling personal beliefs and
patients' rights 

Dave Hogan of The Oregonian staff 

Doctors grappling with physician-assisted suicide are beginning to get
written guidance. The Oregon Medical Association on Tuesday started
offering doctors a "Compliance Checklist" outlining their rights and
responsibilities under the law.  And Physicians for Compassionate Care,
which opposes assisted suicide, will send a letter Thursday to its 1,000
Oregon members giving recommendations on how to refuse to participate in
the state's Death With Dignity Act.

"Our members need to feel they have some guidelines from a larger group
that they belong to, to help validate what they're doing, so that they
don't feel all alone," said Dr. Greg  Hamilton, a board member of
Physicians for Compassionate Care. Hamilton signed the letter along with
Drs. William Toffler and William Petty, other leaders of the organization.

Both the letter and the checklist demonstrate doctors' efforts to
collectively come to terms with how to proceed through the legal and
ethical thicket of the new law. But whether asking doctors to state their
position on assisted suicide -- as the Physicians for Compassionate Care
letter urges -- will polarize them remains to be seen.  "We all want to do
the right thing for our patients at the end of life. We're all trying to
help our patients," said Dr. Leigh Dolin, a Portland internist who voted
for the law but worries about the intense scrutiny such a process brings.
"It's scary for a physician to be in this position."

The Oregon Medical Association checklist addresses all doctors, whatever
their position on assisted suicide. Though the 5,700-member organization
views the Death With Dignity Act as seriously flawed, it remains neutral on
the issue of assisted suicide itself and has promised to strictly observe
provisions of the law.

The Compliance Checklist tells doctors they have a right to refuse a
request to participate in an assisted suicide but warns them that they "may
not abandon the patient." It advises such doctors to cooperate in referring
patients to other physicians who will help them carry out the suicide.

Physicians for Compassionate Care, on the other hand, advises its members
that they can choose not to mention assisted suicide as an option for a
patient and
can decline to make a referral. Patients would be on their own to choose
another doctor.  

Much of the OMA checklist reminds doctors who participate in the assisted
suicide process to carefully document each step of the way and to make
certain the suicide is voluntary.  The OMA document contains a copy of the
form that a patient requesting suicide is required to sign as part of the
law. James Kronenberg, association spokesman, said the organization sees no
reason why a physician cannot now start the assisted suicide process.

The Physicians for Compassionate Care letter describes its recommendations
to doctors who oppose assisted suicide as "intended to protect our patients
and maintain our moral integrity."  The letter recommends that doctors post
in their waiting rooms a statement of their views on patient care,
including their refusal to write a lethal prescription. The letter suggests
treating the desire for suicide as a symptom requiring diagnosis and
treatment.

Physicians who support assisted suicide spoke favorably about the
Physicians for Compassionate Care letter, provided the recommendations do
not block
patients' rights to receive aid in dying.  "It is very appropriate and I
think it's very necessary for physicians ... to let their patients know
very early what their position is, so that if the patient feels very
strongly, they can find a new primary care physician in a timely manner,"
said Dr. Peter Goodwin, a leader of Physicians for Death With Dignity.
Goodwin said physicians willing to participate in assisted suicide are more
likely to discuss the issue privately with their patients rather than
posting their position.

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