A major problem still facing Oregon physicians is the prospect that prescribing lethal drugs for assisted suicide could violate the federal Controlled Substances Act notwithstanding the new state law. U.S. attorney general Janet Reno has yet to resolve this issue. Senator Ron Wyden (D-OR), who opposes federal intervention, says that Ms. Reno's staff has concluded that the Drug Enforcement Administration (DEA) lacks authority to act against physicians who assist suicides; but the Justice Department says that the White House, the DEA and others are still being consulted [Catholic Sentinel (Portland), 1/30/98]. As of this writing, 68 House members and 28 Senators are known to have urged Ms. Reno to uphold the DEA's authority. The Catholic Health Association of the United States recently urged President Clinton to uphold the DEA's authority to prevent assisted suicide, while ensuring that the law is enforced carefully so as not to discourage the legitimate use of drugs for pain relief [PR Newswire, 2/6].

Also still unresolved is a dispute that arose in November between Oregon pharmacists, who insist on being informed when a prescription is intended for assisted suicide, and the Oregon Medical Association, which claims this would breach patient "confidentiality." The Board of Pharmacy points out that without notification, pharmacists cannot exercise their right of conscientious objection. Physicians say that notification would expose them to public scrutiny and possibly to federal drug charges. After the medical association petitioned the Oregon Court of Appeals to rescind the Board of Pharmacy's notification rule, Governor John Kitzhaber intervened in February to ask the State Board of Medical Examiners to craft a compromise [The Oregonian, 2/16].

The state of Oregon itself has become so zealous in guarding the privacy of assisted suicide decisions that some observers, like ethicist Courtney Campbell of Oregon Sate University, call its reporting provisions "completely inadequate to the point of being irresponsible and useless for public policy purposes" [American Medical News, 2/9]. Anecdotal reports from doctors and counselors suggest that at least 10 Oregonians have formally requested assisted suicide; but the Oregon Health Division will not even reveal the number or location of assisted suicides until it has amassed enough cases to render it impossible to identify individuals [The Oregonian, 2/19].

Meanwhile, the Oregon Health Services Commission has scheduled a meeting at Portland State University on February 26 to discuss "the placement of physician aid in dying on the prioritized list of health services" in Oregon's Medicaid rationing plan. The Commission says it is not interested in public comment on whether to subsidize assisted suicide for the poor, but only in comments on where to place this new "service" on the state's priority list, since the former question in its view was settled in November. In fact, public funding to assist the suicides of the poor was no part of the ballot question.

Even as Oregon takes its first clumsy steps toward institutionalizing assisted suicide, the practice's basic legal status remains unsettled. On February 17, U.S. District judge Michael Hogan heard arguments aimed at reviving the 1994 law suit against Oregon's statute. While that suit was dismissed last year by the Ninth Circuit Court of Appeals, plaintiffs say the court did not address whether the assisted suicide law inflicts a "stigmatic injury" on terminally ill persons by branding their lives as less worth protecting than others. They also seek to add a new plaintiff, 57-year-old lung cancer patient Peter L. Begin, who has standing to sue because a doctor has told him he has less than six months to live. Judge Hogan is not expected to rule until April [The Oregonian, 2/18].

Evidence grows that any policy restricting assisted suicide to "terminal" illness is transitional in nature. Euthanasia leaders argue that a wider range of conditions renders life not worth living.

Jack Kevorkian has long been criticized for assisting the deaths of non-terminal patients. "Terminal doesn't matter. Quality of life matters," he said in response to recent criticisms [Reuters, 12/31/97]. Hemlock Society USA has provoked controversy with a new statement suggesting a need for euthanasia when patients have dementia and "chronic diseases" [see page 3].

Now another national organization has added its voice to the chorus. Recent fundraising letters from "Compassion in Dying," which brought the assisted suicide issue to the Supreme Court last year, declare: "We have expanded our mission to include not only terminally ill individuals, but also persons with incurable illnesses which will eventually lead to a terminal diagnosis. The need for increased funding is even more crucial." The group's formal "Guidelines and Safeguards" for assisting suicide are now headed "Counseling and Support for Terminal Illness or Incurable, Progressive Illness."

Kevorkian Targets Mentally Ill

Jack Kevorkian has again tested the limits of assisted suicide by aiding the death of a man who had been treated for mental illness for 20 years. Franz-Johann Long, 53, of Bethlehem, Pennsylvania, died December 27. Kevorkian says Long had terminal bladder cancer and was competent to make a choice. But an autopsy showed only a small and treatable tumor that was not life-threatening. Long's family says he had attempted suicide before and used to tell people that he was a secret agent from the KGB [Detroit Free Press, 12/31/97].

On the same day Kevorkian and his associate Dr. Georges Reding delivered the body of 73-year-old Mary Langford of Tampa, Florida to the Oakland County medical examiner's office. She had breast cancer [Reuters, 12/28].

On January 7 Kevorkian and Reding attended the death of nursing home resident Nancy Ruth Rush, 81, of Belleville, who they say had lung cancer [Detroit News, 1/8/98]. Apparently Reding, who calls himself an apprentice to Kevorkian, then acted alone on January 18 to assist the suicide of 35-year-old Carrie Hunter of San Francisco, a transsexual woman who reportedly suffered from nausea and an enlarged spleen [Detroit News, 1/19]. Both men delivered the body of 52-year-old Jeremy Allen of Cambridge, Massachusetts to an Oakland hospital early on February 4; Allen, who Kevorkian claims had kidney cancer, died from a lethal injection [Reuters and UPI, 2/4].

On December 31 Kevorkian and Reding issued a manifesto urging the legislature to enact a ban on what they call "patholysis" ("Greek for freedom from suffering"), saying that "the ban itself will then be put on trial" [Detroit Free Press, 1/1; DeathNet Home Page, 1/2]. Meanwhile, Kevorkian's chief attorney Geoffrey Fieger announced in January that he will seek the Democratic nomination for governor of Michigan [UPI, 1/14].

"Mercy" Killings Not Exempt From Law

While Jack Kevorkian may continue to assist suicides with impunity, this has not been true for others -- even in Kevorkian's home state.

In Michigan, Dr. Ernest Stiller was convicted of second-degree murder in December for giving a lethal mix of drugs to a female patient, 35-year-old Loretta Sloan. On January 12 he was sentenced to serve from eight to 12 years in prison [American Medical News, 2/2].

In Buffalo, New York, John Bement was convicted of second-degree manslaughter in the death of his wife Judith, who had Lou Gehrig's disease. A jury deliberated about an hour before handing down the verdict. In 1996 Bement fed his wife at least 20 prescription pills mixed with vodka and pudding, then placed a plastic bag over her head to ensure her death. Bement says he has no regrets because he was following his wife's wishes. Sentencing is set for May 4 [AP, 2/21].

The Hemlock Society and Nonvoluntary Euthanasia: Revisiting a Controversy

The December 1997 Life at Risk quoted from a statement by Faye Girsh, executive director of Hemlock Society USA, reacting to a trial in which David Rodriguez of Louisiana was convicted of murder for shooting his father with Alzheimer's disease. The editor has received a critical letter from Ms. Girsh, saying that her quotes were taken "out of context" to give the impression that Hemlock favors nonvoluntary euthanasia for mentally incompetent persons. In the interest of fairness and an accurate public record, we here reprint the Hemlock Society's entire press release of December 3 to show the original context.

Mercy Killing: A Position Statement Regarding David Rodriguez

DENVER, Dec. 3 /PRNewswire/ -- The following statement is issued to Louisiana media by Faye Girsh, executive director of the Hemlock Society USA, the nation's oldest and largest right-to-die society, regarding the David Rodriguez case:

"The Hemlock Society USA advocates that a suffering person at the end of life should be able to receive compassionate help from a physician to end his or her life if that is the wish. This should be done lawfully and under conditions which ensure that the diagnosis is correct, the request is an enduring one, and that the person is mentally competent.

"Unfortunately, our proposal has been enacted as law in only one state -- Oregon. Even with such a law, there are many people suffering from chronic and terminal illnesses who either beg to have their lives ended or who are not competent to make this decision and are in those instances assisted to die by a loved one. In a few rare instances death has come this way with the help of a friend, family member, or physician. In Louisiana, David Rodriguez shot his father who had repeatedly begged to be killed so that he would no longer suffer. Cases such as this are prosecuted either under murder or assisted suicide statutes. Juries, who see these as crimes of compassion, are at a loss to render a just and appropriate verdict under existing law.

"We suggest that, if these cases are to be prosecuted, they should be treated as special crimes of compassion and evaluated separately. The criteria might include the person's wishes to die, the person's medical condition, the family's concurrence, the alternatives available, and the motives of the person being tried. In many of these cases the person who did the killing is a distraught family member who is put through the horrors and expense of a humiliating criminal process that eventuates in probation or a suspended sentence. There should be a way which would still protect innocent people from being murdered but also take into consideration that mercy killing is not a cold-blooded, malicious crime but one in which the motivation is kindness and relief of suffering.

"In the case of a minor or an incompetent adult, the law now allows life or death decisions to be made by a designated health care agent and/or a family member in most jurisdictions. If the Rodriguez death had been the result of a decision to forego life-sustaining medical treatment no criminal liability would have ensued. In such instances, the person 'dies naturally.' Some provision should be made for a situation in which life is not being sustained by artificial means but, in the belief of the patient or his agent, is too burdensome to continue. It is pathetic that a son should have to shoot a suffering father. Death should come in a more humane and less violent way.

"A judicial determination should be made when it is necessary to hasten the death of an individual whether it be a demented parent, a suffering, severely disabled spouse or a child. Consultants should evaluate what other ways might be used to alleviate the suffering and, if none are available or are unsuccessful, a non-violent, gentle means should be available to end the person's life.

"As life expectancy increases, chronic diseases proliferate and medical science can lengthen life almost indefinitely. We must find ways to provide help to people who wish to hasten the dying process. Clearly the popular sentiment is not to punish and incarcerate but to provide merciful alternatives for those who act out of love."

While Oregon in November reaffirmed its law allowing physician-assisted suicide, the trend in other states is different. At least five states are considering new laws against assisted suicide, or have defeated Oregon-style laws to allow it.

In Maine, despite a concerted lobbying effort by Hemlock Society USA and its state affiliate, a bill to allow physician-assisted suicide received a 12-to-1 "ought not to pass" recommendation from the legislature's Judiciary Committee on January 28. Under state legislative rules requiring a vote by the full legislature unless committee votes are unanimous, the House proceeded to reject the bill 99-to-42 on February 11. The next day the Senate rejected it 25-to-5 [Bangor Daily News, 2/12/98; AP, 2/13]. The state has considered such legislation three times before; the last time, in 1995, similar bills were rejected 10-to-3 in the House Judiciary Committee, 105-to-35 in the House and 24-to-10 in the Senate.

In New Hampshire, House Bill 1433 to legalize assisted suicide was effectively tabled for the year on February 5, when the House Judiciary and Family Law Committee voted 13-to-7 to refer the bill for interim study. The committee's judgment was affirmed by the full House on February 18, on a 223-to-86 vote. In October 1995 a similar bill was approved by the same committee 12-to-7, but then defeated by the full House 256-to-90 in January 1996.

In Virginia, a bill establishing civil penalties for assisting a suicide is moving closer to enactment. The ban was approved last year, but with a clause requiring that it be reenacted after the U.S. Supreme Court ruled on assisted suicide in order to take effect. While the ban was reaffirmed this year in the House Courts of Justice Committee (22-to-2) and the full House (77-to-20), a parallel Senate bill was referred back to committee after the Senate approved an amendment to allow penalties only against health care professionals. The bill's Senate supporters hope to bring up the House-approved version before the end of the session.

In Kansas, a bill to strengthen the state's law against assisted suicide was approved by the House 111-to-13 on February 17. HB 2531 clarifies the definition of assisted suicide, distinguishes it from legitimate pain relief and withdrawal of life-sustaining treatment, and provides for civil penalties for assisting a suicide. As amended on the House floor, the bill also requires the University of Kansas Medical Center to conduct seminars on pain management and care of the dying throughout the state [Topeka Capital-Journal, 2/17].

In Michigan, the House has begun to consider a statutory ban on assisted suicide (SB 200) that the Senate approved 28-to-7 in December. However, a House committee approved the bill with an amendment placing the issue on the state ballot, and approved another bill (HB 5474) that legalizes assisted suicide and places the issue on the ballot. "The House members should just do their job and ban assisted suicide," says the Detroit News [2/18]. The group "Merian's Friends" is also continuing its effort to collect enough signatures to place a legalization proposal on the state ballot.

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