Hawaii’s World

By A.A. Smyser

Thursday, November 13, 1997

Death With Dignity

YOU haven't yet heard of DADD for Doctor-Assisted Death With Dignity. It hasn't been formed yet. But the editor of Hawaii Medical Journal, Dr. Norman Goldstein, may suggest it as an umbrella name for diverse national organizations advocating exactly that. He believes the DADD acronym could bring the movement recognition and success like that achieved by MADD for Mothers Against Drunk Driving.

Goldstein won praise both nationally and locally for devoting the last December and March issues of the Hawaii Medical Journal to doctor-assisted death -- probably the only medical journal in America to give it such intense attention. Copies went to medical libraries throughout the U.S.

One local doctor's letter to the editor reminded Goldstein that most of organized medicine is opposed to doctor-assisted suicide yet most of HMJ's articles were in favor. She still thanked him for providing the leadership and devoting the time and effort to publish the journal. It digs into many other topics, ophthalmology most recently. Two issues on pain control lie ahead.

Copies of the journal's reports, mostly written by physicians, became a part of the information-gathering process for the Governor's Blue Ribbon Panel on Living and Dying With Dignity. Goldstein is a panel member, as am I, also a DADD advocate, but other members have positions in opposition, which Governor Cayetano knew when he appointed us.

One of HMJ's subject areas was the Swiss organization known as EXIT, which helps people to die after they pass intense screening as to suitability. None of its practitioners has been prosecuted.

Goldstein has updated data from EXIT showing it approved fatal potions for 210 people in 1996 yet only 110 used them. He believes that in Hawaii, too, the availability of such assistance could become a security blanket ailing persons would welcome but not use.

HMJ also dealt with the Hippocratic oath, often cited against doctor-assisted death. It is a 2,400-year-old-pledge, Goldstein points out, that if literally followed would prevent modern surgery. Hippocrates swore by Apollo and other Greek gods and goddesses that, among other things, "I will not use the knife." The oath has been modified for today's medical students.

Goldstein thinks the basic caring sense expressed by Hippocrates can be interpreted today to give compassionate release from suffering for our loved ones just as we already offer it for our pets.

He says "slippery slope" concerns about abuse to cause deaths for the convenience of others can be met by strict guidelines on voluntariness that will reassure both patients and doctors.

AS a dermatologist he does not deal with dying patients. If he were an internist, he says, he would even now provide help if the patient wanted it, he knew the patient well, and no other relief from suffering was available. This already occurs in Hawaii, he says, but cannot be publicly reported.

Goldstein was recruited into the Hemlock Society by Dr. John Spangler, outgoing president of the Hawaii Medical Association. Out of 2,000 physicians in Hawaii, 1,200 are HMA members.

Spangler testified before a hearing of the Governor's Panel on Living and Dying With Dignity that the American Medical Association opposes doctor-assisted death but the American Medical Students Association supports it.

Hemlock is the oldest of an expanding group of national organizations lobbying for doctor-assisted death, the ones Goldstein thinks could be more effective if they united under a DADD banner.

A.A. Smyser is the contributing editor
and former editor of the the Star-Bulletin
His column runs Tuesday and Thursday.

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