Doctors divided on assisted suicide

Initiative 1000, which would allow doctors to write lethal-dose prescriptions for terminally ill, competent adult Washington residents, appears to be about patients.

It would enact the "Washington Death with Dignity Act," which is filled with language about letting patients end their lives in a "humane and dignified" manner.

But really, the proposal is all about doctors. If they follow the rules set forth in the initiative, it would protect them from prosecution for "promoting a suicide attempt" — a felony under state law — for helping those patients die.

So where do doctors stand?

Despite statements from the official state physicians organization, doctors in Washington remain deeply divided on the issue, as they have been for years.

In July, the Washington State Medical Association (WSMA), which represents nearly 7,000 doctors in Washington, said it opposes the measure and that its "opposition was emphatically voted on" at last year's meeting.

In fact, WSMA members never voted on the initiative.

And a survey WSMA commissioned last year actually found slightly more doctors approved of the provisions of I-1000 than opposed them.

In the survey, completed by Elway Research, 50 percent of doctors responding said they would support a measure like I-1000 while 42 percent would oppose it. Female physicians were more likely to support such a law.

Although only 502 of WSMA's nearly 7,000 members responded, pollster Stuart Elway, who compared characteristics of those who responded with members as a whole, said he was confident it was a "representative sample."

And WSMA's president didn't quibble about the poll's meaning.

"The opinion poll would indicate quite accurately that physicians are quite split on the issue in Washington state," said Dr. Brian Wicks, an orthopedic surgeon in Silverdale, Kitsap County. "We realize there is a lot of emotion on this — we realize there are people who feel strongly on both sides."

Dr. Thomas Preston, a retired cardiologist, is one of those who feels strongly about the issue.

Preston, along with three other doctors, three dying patients and a right-to-die group, sued the state in 1994 for the right to help patients who wanted to hasten their deaths. Lower courts agreed that patients had a right to die, but the U.S. Supreme Court in 1997 rejected that notion. It upheld the state law that makes it a crime for doctors to help patients kill themselves.

Preston argues that WSMA should have avoided taking a stand on I-1000. "Clearly, if they are to represent their physicians, they should take no position," he said. "I think it's unethical to maintain a position contrary to a plurality of its members."

Profoundly conflicted

Most larger surveys have shown that doctors here — and elsewhere in the country — are profoundly conflicted on this issue.

In a national survey in 2005, 59 percent said doctors should be "given the right to dispense prescriptions to patients to end their life," while 41 percent disagreed.

In a 1994 study published in the New England Journal of Medicine, slightly more than half of Washington doctors said they favored allowing doctors to prescribe lethal medication, and even to administer it — known as euthanasia — in some circumstances, although most would not be willing to participate in either.

So the announcement that the WSMA had "emphatically" voted to oppose I-1000 came as a surprise to some.

What happened at the meeting last fall was this: A resolution asking the WSMA for neutrality on the issue was dropped when it appeared to have little support. The only related resolution that was approved by the organization's top rule-making body, entitled "Support for Quality End of Life Care for Citizens of the State of Washington," makes no mention of the initiative.

That resolution says the WSMA supports quality end-of-life care "without participation in hastening death or providing a means for patients to hasten their own death," and reiterates support for its previous position that physicians should not "intentionally cause death."

Wicks, the WSMA president, says he's personally opposed to I-1000, even though under the initiative's provisions any doctor could opt out of providing the prescription.

"I can't reconcile the act of giving a patient a lethal dose of medicine with the express purpose of killing themselves with the commitment I made at the end of medical school to help patients," he said.

If a patient is in distress — whether because of pain or fear of becoming helpless or a burden — "then let's address that, and make it more comfortable for them," he said.

"I feel there are many other ways of achieving your goals of comforting the dying, the sick, without stepping in and doing the active killing of a patient."

As he predicted, others strongly disagree.

"In the medical world we are finding more ways to keep bodies going when death ought to happen," said Dr. Sarah Weinberg, a Seattle-area retired pediatrician who donated to I-1000.

"More people are saying, 'Wait — I don't want to die that way,' " she said. "This legislation is about giving the power to the patient who fears that kind of death, who feels, 'It's my life, let me do it.' It's giving patients that choice."

Some doctors are uncomfortable with patients who, when faced with the inevitable, ask " 'When can we get this over with? I'm ready,' " said Weinberg, who has attended many relatives' deaths.

She has no patience with doctors who say, in effect: " 'I'm going to wait for the good Lord to take you,' " Weinberg said. It's the doctor's "good Lord" — not necessarily the patient's, she said.

"It's an arrogant answer."

Doctors should zero in on their patients' wants and expectations and "leave our own biases out of it," she said. "But there are a lot of professionals who are not capable of that."

A double standard?

Preston says some doctors maintain a double standard.

After the failure of Initiative 119, a 1991 measure that sought to allow doctors to prescribe and administer lethal doses of medication to terminally ill patients who requested it, Preston polled about 300 doctors in Seattle.

His results, published in the Journal of Law, Medicine & Ethics in 1994, found that while nearly half said they opposed euthanasia, 70 percent said they wanted it as an option for themselves. The findings, Preston said, showed many doctors are "not willing to do unto their patients as they would have done unto themselves."

These days, Preston says, most patients die after having had their lives prolonged by medical interventions, such as chemotherapy, surgery or getting a pacemaker or defibrillator. "The whole purpose of modern medicine is to thwart natural dying," he said.

One study, published in the Journal of the American Medical Association, noted that 20 percent of Medicare patients with metastatic cancer start a round of chemotherapy within two weeks before death.

For patients caught in what Preston calls "extended dying," the "time and mode of dying are set by medical decisions — by people like me." Or by "the resident on call in the middle of the night," he likes to say.

"So why should not the patient be entitled to make this ultimate decision?"

Wicks, the WSMA president, notes that the organization also opposed I-119 in 1991. He says I-1000 is "a nasty initiative that is a quick and easy fix for a problem" and is the "wrong direction for medicine and society."

Donors who identified themselves as doctors have contributed about $17,000 to the Coalition Against Assisted Suicide, which is opposing I-1000, and about $29,000 to the Yes on I-1000 campaign.

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com

"People are saying, 'Wait — I don't want to die that way.' This ... is about giving the power to the patient."

Dr. Sarah Weinberg

"I can't reconcile the act of giving a patient a lethal dose ... with the commitment I made ... to help patients."

Dr. Brian Wicks