The Pacific Northwest, which has spawned consumer revolutions from personal computers to gourmet coffee, has become home to the latest upheaval in individual rights: a terminally ill person’s right to “hasten death” with a fatal dose of medication.
While maverick Michigan pathologist Jack Kevorkian has made headlines for helping dozens of patients die, a small group of activists in Washington and Oregon have moved quietly - and, so far, successfully - to make the practice legal.
In March, the Seattle-based group Compassion in Dying won a landmark federal appeals court ruling that declared “a mentally competent, terminally ill adult” has a right to obtain medical help to end his or her life.
That means people like Alice Hagli, a 70-year-old widow whose lung cancer has spread to her breast and throat. Five years ago she cared for her husband as he died of cancer, an ordeal that convinced her she does not want to linger for agonizing weeks.
“I want to live,” she says. “Who doesn’t? But I don’t want to live in agony and pain. What’s the point?”
This week, the U.S. Supreme Court will consider an appeal of the right-to-die ruling filed by Washington’s attorney general. If the justices reject the appeal, assisted suicide will be legal in nine Western states.
More likely, the high court will hear the case and use it to set a national precedent on the right to die.
Meanwhile in Oregon, another small group of retirees, AIDS activists and physicians won a state ballot initiative that permits dying patients to obtain medicine to end their lives. A federal judge in Eugene has blocked the law from taking effect, but the same U.S. appeals court that ruled in the Seattle case is expected to overturn his order.
If it does, Oregon will become the first state where assisted suicide is legal.
The battle, however, may be just beginning.
“This is the abortion issue of the 1990s,” says Susan Dunshee, who heads both the Seattle AIDS Support Group and Compassion in Dying.
She and other advocates call it a matter of personal choice, the right of dying persons to control their final days.
Under its guidelines, Compassion in Dying and its volunteers work only with patients who are likely to die within six months. The patients must request help to end their lives on at least three occasions, and their close relatives must agree with the decision.
Even then, the group neither provides lethal medication nor administers it. Instead, it informs patients about how to get a physician to prescribe medicine that can be fatal in large doses.
Opponents condemn assisted suicide as violating two fundamental principles of civilized society - that doctors should not kill their patients and that government should not sanction the practice.
Leaders of the Catholic church and the American Medical Association say they fear the nation is about to start down a road that will inevitably lead to putting to death the old, sick, disabled and unwanted.
“It is a very dangerous proposition when society begins to decide which lives are worth living,” says Richard Doerflinger of the National Conference of Catholic Bishops.
The AMA says the “physician’s role as healer” would be fundamentally jeopardized if the law permitted doctors to end the lives of some patients.
Despite the AMA leadership, many doctors apparently support assisted suicide. A confidential survey of more than 2,700 Oregon physicians found that 60 percent believed it should be legal to help some terminally ill patients die.
“A lot of docs are closet supporters” of the right to die, says Dr. Thomas A. Preston, chief of cardiology at Seattle’s Pacific Medical Center. “They certainly want this choice for themselves, but they don’t want to say it publicly.”
If many Americans have become less afraid of dying than of living too long, it is because of medical technology’s growing capacity to prolong life. Doctors can “keep a human body alive for longer than any reasonable person would want to inhabit it,” as Justice Antonin Scalia once put it in concurring with a Supreme Court opinion that actually limited the right to die.
More than that, cost concerns have forced many people to abandon their family doctors in favor of health maintenance organizations and other large medical institutions.
“They’re afraid of dying a miserable death, in pain, surrounded by technology that keeps them alive and makes them uncomfortable, at huge cost, delivered by strangers in a lonely ugly environment,” says Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania.
When he asks people whether they would rather spend a year in a medium security prison or a nursing home, he says the response is 80 percent to 20 percent in favor of prison.
In the Pacific Northwest, the right-to-die movement has succeeded in the face of political leaders’ silence or outright opposition. In Washington and Oregon, the governors and state legislatures refused to get involved in the issue, and most of the leading newspapers, church figures and medical leaders spoke against the idea.
Support came from the grass roots, from people such as Don and Sheila Cook, who both watched their mothers die slow deaths.
“Once you see a loved one dying, it can change your view forever,” says Sheila Cook, 65. “My mother spent nine years in a nursing home with Alzheimer’s. By the end, they were forcing food down her throat.”
In 1991, the Cooks and other volunteers put on the Washington state ballot a measure to authorize euthanasia. While early polls showed strong support, the tide turned when ads raised the specter that doctors would simply kill their unwitting patients.
The initiative was defeated, 54 percent to 46 percent, leaving it illegal for doctors to assist suicides under all circumstances.
Neighboring Oregon has its own grass-roots activists, notably Al Sinnard, a lively 79-year-old who built a series of wholesale tire stores in the Portland area. In 1989 his wife, Sara, was suffering from a rare and painful heart defect. No one could cure the disease or even alleviate the pain.
“Finally, she said to me one day, ‘Al, I want out. I’m alive, but I’m not living,”’ he says. In the weeks afterward, she told her children and her close friends of her decision.
She also insisted that her husband not be present when she carried out the act because Oregon’s law makes it a crime for any person to take part in a suicide. One day, Al returned home to find his wife’s lifeless body in bed with a plastic bag over the head.
“I swore right then I was going to change that law,” he says. “It was absolutely wrong for the law to say I couldn’t be there, that she had to die alone.”
Sinnard and Oregon’s other right-to-die activists were unable to prevail upon the state Legislature to change the law. So they gathered signatures and put the issue on the ballot in 1994.
Learning from Washington’s experience, the Oregonians wrote detailed guidelines to make clear that the scope of assisted suicide would be carefully limited and that the patient, not the doctor, would be in control at all times.
Two doctors, according to the Oregon law, must certify a patient is likely to die within six months. That means the initiative will not aid those with an incurable illness that does not threaten imminent death, nor will it help Alzheimer’s patients who cannot express their wishes.
Doctors who choose to participate may prescribe death-inducing medication, but can’t administer it. The law “does not authorize mercy killing, lethal injection or active euthanasia,” according to the guidelines.
Voters supported the Oregon Death With Dignity Act by 51 percent to 49 percent.
The outcomes of both the Washington and the Oregon ballot initiatives were appealed to federal courts. They overturned the votes in both cases: a peculiar result in which federal judges declared unconstitutional the Washington law that forbids assisted suicide and the Oregon law that allows it.