Federal Pain Relief Act Advances

A federal Pain Relief Promotion Act (H.R. 2260, S. 1272) has begun to advance in Congress. The bill promotes use of federally regulated drugs for pain relief, while reaffirming that they are not authorized for use in assisted suicide.

The bill was introduced in June by Reps. Henry Hyde (R-IL) and Bart Stupak (D-MI) and Senator Don Nickles (R-OK) [see June Life at Risk, p. 1]. By August the House bill had collected 154 sponsors, including 23 Democrats; its Senate counterpart had 26 sponsors, including Democrats Joe Lieberman and Chris Dodd of Connecticut and Evan Bayh of Indiana.

The bill also continues to collect organizational support. The Catholic Health Association, the American College of Osteopathic Family Physicians, and the disability rights group Not Dead Yet endorsed the legislation in July, joining the American Medical Association, National Hospice Organization and other supporters [see June Life at Risk, p. 4].

Opposition to the bill has also become more visible. The Oregon Hospice Association and Oregon Medical Association have broken ranks with their national organizations to defend Oregon's authority to decide whether assisted suicide is "good medical care" [The Oregonian, 8/4/99; Seattle Times, 8/8]. This is not a new situation for OMA, which was "neutral" on Oregon's proposal to legalize assisted suicide in 1994 when the American Medical Association was working to defeat it. However, Oregon's own policy has also collected more visible opposition within the state. In July, the state legislature approved a state budget that forbids state funding of assisted suicide and abortion for the first time; but Governor John Kitzhaber vetoed the budget, forcing the restoration of $2.8 million for those procedures [AP, 7/21; Catholic Sentinel, 8/6].

In Congress, H.R. 2260 was marked up in the House Judiciary Subcommittee on the Constitution on July 20. Democrats opposing the bill found themselves in the unaccusatomed role of "states' rights" advocates, with Barney Frank of Massachusetts claiming the bill "over-federalizes" assisted suicide. Fellow Democrat Mel Watt of North Carolina offered an amendment that he said would leave in place a federal "bias" against use of federally regulated drugs to cause patients' deaths, while allowing a state to follow the opposite policy if it wishes. Chief sponsor Henry Hyde, chairman of the Judiciary Committee, said this would allow an individual state to "trump" federal law on an important matter of national policy. After the Watt amendment was defeated by voice vote, apparently along party lines, the unamended bill was also approved by voice vote -- but here Democrat Jerrold Nadler of New York joined all present Republican members to approve the bill 8-to-2. Rep. Nadler praised the bill's active support for pain control and said he does not oppose its policy on assisted suicide, but has reservations about the means chosen to deal with Oregon's law.

Full House Judiciary Committee consideration of the bill was tentatively scheduled for August 3, but did not occur then due to lengthy debate on another bill. Markup and approval of the bill are now expected in full committee on September 9.

The Pain Relief Promotion Act still faces a number of hurdles before it can be approved by Congress in the final weeks of this session. It must also be marked up by the House Commerce Committee, and the Senate Health, Education, Labor and Pensions Committee. However, co-sponsors of the bill include many key members of these committees -- including House Commerce Committee chairman Thomas Bliley; Sherrod Brown, ranking Democrat on the relevant Commerce subcommittee; and Chris Dodd, second-ranking Democrat on the Senate Health committee.

News Briefs

Kevorkian's Ongoing Troubles

The prospect of a prison sentence for second-degree murder is not Jack Kevorkian's only recent setback.

On July 15 Judge Jessica Cooper denied Kevorkian's request for a new trial, observing that he willingly and repeatedly waived his right to counsel during the trial that led to his conviction. Kevorkian had claimed that he received incompetent advice from former legal advisor David Gorosh during the trial. Gorosh praised Cooper's decision, calling Kevorkian's bid "an underhanded attempt by Dr. Kevorkian's new counsel to get Dr. Kevorkian out of jail, which he apparently isn't liking too much." Kevorkian will appeal to the state Court of Appeals [Detroit Free Press, 7/16/99].

On August 9, the Michigan Court of Appeals dismissed a defamation suit that Kevorkian filed in 1996 against the American Medical Association and Michigan State Medical Society. He had sued them for libel for calling him a "killer." But the court ruled 2-to-1 that such suits should be dismissed "where an allegedly libelous statement cannot realistically cause impairment of reputation because the person's reputation is already so low... We find that, as to the issue of assisted suicide, plaintiff is virtually 'libel proof'" [AP, 8/9].

Finally, in accord with a settlement reached August 23, Kevorkian will have to pay rent for his prison cell. Under a Michigan law allowing the government to charge inmates for the cost of their imprisonment, Kevorkian must pay the state a lump sum of over $28,000 from his bank account and $364.50 a month from his pension to defray costs. He may keep his paintings, and a legal defense fund containing over $77,000 [Detroit Free Press, 8/24].

Kevorkian's only consolation is that he has been moved from the maximum-security Oaks Correctional Facility to the medium-security Kinross Correctional Facility in Michigan's upper peninsula. A corrections official said the move is being made because "the prisoner has made a successful transition to confinement" [Detroit Free Press, 8/28].


Dutch Bill Includes Euthanasia for Kids

The Dutch government has unveiled a proposal to legalize euthanasia and assisted suicide in the Netherlands. The bill would formalize guidelines from court rulings that have allowed Dutch physicians to avoid prosecution for causing patients' deaths for decades.

Receiving much attention is the bill's proposal to allow minors to request death. Children aged 16 and over will make their own euthanasia decisions as adults; even those aged 12 to 16 could do so, and have their wishes prevail over parents' objections, if a doctor consents. Dr. Ben Crul, chief editor of the journal of the Royal Dutch Medical Association, supports this aspect of the bill, saying that children with terminal illnesses are "a lot more grown-up than many adults." The Dutch Voluntary Euthanasia Society also has no problem with this provision, and a Justice Ministry official says it is consistent with other Dutch laws allowing teenagers to make medical decisions and receive birth control pills without parental consent. The legalization bill is expected to win approval from the Dutch Parliament next year, though it is possible the provision on minors will be modified [Chicago Tribune, 8/26].


Alaska Assisted Suicide Suit Goes to Court

On Aguust 9 an Alaska Superior Court judge heard oral arguments in Sampson v. Alaska, in which the suicide advocacy group Compassion in Dying has filed suit to establish a "right" to assisted suicide for terminally ill patients under Alaska's state constitution [see May Life at Risk, p.3.]. The judge promised a decision soon, but predicted that any ruling will be appealed to the Alaska Supreme Court and the stae supreme courts of Michigan and Florida [Catholic News Service, 8/23].

"Mercy Killing" Cases Confront Legal System

Cases of assisted suicide or "mercy killing " continue to test the American legal system, with mixed results:

In New York, a grand jury has decided not to indict a veterinarian who admitted aiding the suicide of his receptionist who was dying of cancer. Marco Zancope, 44, was arrested in October 1998 and charged with second-degree manslaughter for supplying an overdose of barbiturates and other drugs to Cara Beigel, 33. Beigel's father supported Zancope, saying: "I don't know why the police arrested him. What difference does it make that she died on one day or the next?" [Newsday, 7/17/99].

Also in New York, however, a 75-year-old man has been charged with manslaughter for allegedly hanging a noose from a ceiling beam and leaving his sick wife alone to commit suicide. Peter Florio has pleaded innocent in the death of his 70-year-old wife Ann, who had Parkinson's disease and heart problems [AP, 8/7].

In Nebraska, a 77-year-old man was sentenced to two to five years in prison for shooting his ailing wife to death in a local hospital. Vernal "Bob" Ohlrich pleaded no contest in February to a manslaughter charge in the death of his wife Phyllis, 74. He had fatally wounded her with a .22-caliber pistol when he found her writhing in pain in her hospital bed. Mrs. Ohlrich had been treated for cancer and was thought to still have the disease; however, an autopsy revealed no cancer [DeathNet (www.rights.org/~deathnet/open.html), 7/2].

In Indiana, a nurse suspected of killing as many as 100 people is on trial, charged in the deaths of seven elderly patients. Orville Lynn Majors Jr., 38, began serving as a licensed practical nurse in a Clinton, Indiana hospital in 1993; months later, other nurses observed an abnormally high death rate in the hospital's intensive care unit whenever Majors was on duty. On one occasion Majors was found, syringe in hand, at the bedside of a woman who had died unexpectedly; the patient had been scheduled for discharge the next day, and an autopsy suggested that an injection of potassium caused her death. Autopsies on other patients uncovered enough evidence to go to trial in seven cases. A statistical study showed there was a patient death in the ICU every 23 hours when Majors was on duty, but every 552 hours when he was not; however, statistical evidence was barred from the trial. Reportedly Majors had also told others that he thinks elderly people are "a waste" [New York Times, 8/31].

In Washington, D.C., police are pondering the motives behind a Michigan woman's apparent decision to kill her father and then herself. Beth Lois Katz of East Lansing, Michigan, 54, was in town to visit her 84-year-old father, Robert O. Shaw, who was living with another daughter. Shaw had Alzheimer's disease, and the family was debating future placement in a nursing home. But on the night of September 1, Katz apparently shot her father twice in the head and then shot herself; both bodies were found in Katz's station wagon in front of the Washington Hilton Hotel. "From what we are able to figure out, she felt that this was the most humane option for him," said Katz's former husband. An Alzheimer's Association official in Maryland said she was "horrified by the tragedy of it," and regretted that "the family apparently didn't know about the sources of help that are available" [Washington Post and Washington Times, 9/4].

In New Mexico, Jack Kevorkian's friend and colleague Georges Reding, a retired psychiatrist, has been charged with first-degree murder for his apparent role in the death of 54-year-old Donna Brennan of Rio Rancho. Brennan died in 1998 from a lethal dose of barbiturates; after her family requested an investigation, police found phone and credit card records and a witness that place Reding at her home around the time of her death. Reding failed to show up for his arraignment on September 3, prompting issuance of a warrant for his arrest. Reding is thought to have helped Kevorkian in several assisted suicides, and some looked to him as Kevorkian's successor [AP, 8/20; Washington Post, 9/3].

Background: Terminally Ill Patients' Will to Live

In the September 4 issue of the British. medical journal The Lancet, Canadian researchers report on how dying patients' "will to live" is likely to show "substantial fluctuation" due to changes in both physical and mental factors.

Dr. Harvey Chochinov of the University of Manitoba and his colleagues assessed the "will to live" twice daily in 168 mentally competent cancer patients admitted to palliative care, and correlated this with a variety of other factors. The patients ranged in age from 31 to 89 years old; they survived an average of 18 days, though one woman lived more than 150 days.

The factors with the most impact on the will to live were "depression, anxiety, shortness of breath, and sense of well-being." Which factor was most important varied with the stage of illness. During the earlier course of a patient's illness, anxiety was the dominant factor; depression became more important later, and shortness of breath was the chief factor suppressing a will to live when death became imminent. The study confirmed that, at least during much of a terminal illness's course, psychological factors weigh more heavily in a desire for death than factors such as physical pain.

The study's finding that the will to live is "highly unstable" among terminally ill patients should not be surprising, say the researchers. After all, "only 10-14% of individuals who survive a suicide attempt commit suicide during the next 10 years, which suggests that a desire to die is inherently changeable." Dr. Chochinov added in an interview with the New York Times that physicians who want to be responsive to their patients should be knowledgeable in "how to go about managing reversible distress at the end of life," which can greatly affect a patient's interest in living.

Also interviewed by the Times was Dr. Gregory Hamilton of Physicians for Compassionate Care, which promotes improved care of the dying and opposes assisted suicide. "This study demonstrates numerically that feelings of suicidal ideation or suicidal despair can be influenced through treatment and should not be taken at face value as some kind of abstract philosophical right," he said. But George Eighmey of Compassion in Dying, which supports assisted suicide, also claimed that the study "in a sense confirms what we have found to be the case... The overwhelming majority of our patients who have a sustained desire and will to end their life do so because of fear of loss of autonomy, and of the indignities associated with losing control over bodily function."

On this point the Lancet article itself observes: "For jurisdictions considering legislation enabling physician-assisted suicide or euthanasia, the likely transience of a request to die is one of the most important considerations."

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