THE nine justices of the U.S. Supreme Court gave a tremendous boost last week to pain control for terminally ill patients. They unqualifiedly endorsed a position long held by the Catholic Church that medication may be administered to relieve pain even at the risk of speeding death, so long as causing death is not the purpose. Decision on physician-
assisted suicideA series of such endorsements came from Chief Justice William Rehnquist, who wrote for the entire court, and then from several justices supplementing his views. Sandra Day O'Connor wrote with approval that in the two cases before the court, "There is no dispute that dying patients of Washington and New York can obtain palliative care, even when doing so would hasten their deaths."
Legally crucial to this is the intent to ease pain, not to cause death. Rehnquist reached out to a reference to General Eisenhower having the greater purpose of liberating Europe from the Nazis when he knew that he was sending many troops to certain death on the beaches of Normandy in 1944. The enemy on the battlefront of the terminally ill is pain.
Now lined up behind this pioneering position by the Catholics are the court, the American Medical Association and the American Cancer Society, among others. ACS was under the national chairmanship of Dr. Reginald C.S. Ho of Hawaii in 1993 when it declared that pain control is possible for just about every patient and should be provided. One of the Supreme Court concurring opinions noted that in those few cases where pain controls don't work the patient can be put into a coma.
In 1970, when it seemed far more radical than now, Sister Maureen Keleher, then head of Honolulu's St. Francis Hospital, enunciated to the Star-Bulletin the same pain control position repeated last week by Justice O'Connor. She did it as a contributor to a series of articles we were publishing on how badly death was being handled by our community. In 1977 she founded Hawaii's first hospice. We now have eight statewide, two on Oahu.
About one-sixth of all Hawaii deaths now are handled by hospices that understand pain control and provide counseling. Most hospice patients, by preference, die at home. An ideal number of hospice deaths could be about half -- or 3,600 of our 7,200 annual deaths instead of only 1,200.
Cancer was the early focus of hospices. They now reach out to patients with cardiac, renal and neurological diseases, Alzheimer's and AIDs. To qualify for hospice insurance patients must be deemed to have only a few months to live and be willing to give up acute-care life-saving efforts like surgery, chemotherapy and radiation.
Suppose your doctor says he can't control pain. Easy. Get another doctor. Some doctors still are too timid, though the Supreme Court decision ought to make them bolder. Others, I fear, just haven't been briefed well enough on pain control, which isn't terribly complicated.
In its rulings last Thursday the Supreme Court only skirted the "suffering" part of the "pain and suffering" equation. Non-pain suffering can be as real as pain and much harder to relieve. It can grow from the increasing debility, indignity and humiliation that can accompany loss of control over one's life and body functions. It can cause deep despair over one's situation and outlook.
RELIGION offers relief to some. Counseling can help even the non-religious. Hospices do their best to provide relief. But what about people who still hold a rational wish to die at a time of their own choosing?
Today no doctor can legally assist them. But the Supreme Court's quite compassionate main and concurring opinions left the door open to that being approved in some cases in the future. The justices spoke up for more national discourse, for using the laboratory of the states to work out future balances of competing interests, and expressed trust in the democratic process to do so.
I sit on Governor Cayetano's Blue Ribbon Panel on Living and Dying With Dignity. We will be grappling with these and many other questions as we try to formulate policy recommendations for Hawaii later this year.