Hawaii’s World

By A.A. Smyser

Thursday, February 18, 1999

The case for physician-
assisted suicide

IN our institutions and homes on any day must be many dozens of people who would welcome death to end their suffering. Quite a few actively request it, and are denied.

Governor Cayetano's Blue Ribbon Panel on Living and Dying with Dignity, on which I served, is unanimous that these people ought to be offered spiritual counseling, adequate pain control (now often undersupplied), hospice care (still underused), and be able to help control their destiny with living wills to give direction as to what to do when they no longer can speak for themselves.

A majority of our panel would supplement these alternatives with the options of physician-assisted suicide (PAS) or physician-assisted death (PAD) under conditions highly controlled to prevent abuse.

PAS would provide the patient with a life-ending potion to be self-administered. PAD would involve a physician giving an injection to cause death to someone wanting to die but unable to self-administer a potion, for example, a stroke victim. This would be voluntary euthanasia, meaning "gentle death."

Participation by all parties would be voluntary only. The governor's panel is unanimously against involuntary euthanasia.

We recognize and respect strong feelings in opposition to PAS and PAD, but believe the option of choice should be available to those who do not share those feelings.

We, too, are moral and extremely respectful of life. Our numbers include a Buddhist bishop and a rabbi. Our proposal would put severe restrictions on PAS and PAD. After a patient's request for either, we propose the involvement of a second physician, psychological consultation, and a social worker to make the patient aware of available alternatives and to confirm that the request, if still maintained, is voluntary and reasonable.

We also would require that the patient be terminally ill or facing intractable suffering that can neither be cured nor palliated. This determination would be made during two weeks before PAS or PAD could be authorized.

Opponents of what we propose frequently cite the Netherlands. So do supporters. The Netherlands story has two sides. It maintains 70 to 80 percent public support there. The Dutch Supreme Court guidelines are somewhat like those we recommend.

Early experience in Oregon, where PAS has been legal for over a year, suggests requests will be in very small numbers. In part, this may be because the Oregon debate has significantly advanced the use of pain control and hospice care, which both sides agree on.

We hope for similar progress in Hawaii. Today, however, these are terribly underused. Adequate pain control may be refused. Relatively few people have living wills. Even these few may be ignored or remarkably hard to enforce. I will have a further story on this next Tuesday.

THUS many people still suffer unnecessarily. They will not live long enough to experience the hoped-for improvements, which may take years to achieve. The inertia of the status quo is very strong.

Our hearings show that many people who may never request PAS or PAD will be comforted if they exist as options. They also make us sure the vigorous opposition groups will be vigilant against "slippery slope" abuse if PAS and PAD are legalized.

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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