Still Closer To A Beginning Than An End

This time the words seem almost understated.

“Groundbreaking” and “landmark” barely describe how much the topography has now changed, how deeply the American landscape of dying is being re-contoured.

In Oregon, the people have taken death into their own hands. For the second time in three years, they have voted in favor of legalizing doctor-assisted suicide for terminally ill patients.

Just three years ago, a controversial referendum passed by a slim margin of 2 percent. But this year, a heavily financed attempt to repeal that law was defeated by a huge margin of 20 percent.

The voters meant what they said. And what they said - again - means that once the postelection confusion clears, Oregon is slated to become the proving ground for doctor-assisted suicide. For the first time, doctors will legally provide a proscribed group of dying patients with lethal drugs. A theoretical debate between ethicists, doctors, lawyers and citizens will become a reality.

Last June, when the Supreme Court ruled that there was no constitutional right to die, Justice Rehnquist wrote that “throughout the nation, Americans are engaged in an earnest and profound debate about the morality, legality and practicality of physician-assisted suicide. Our holding permits this debate to continue as it should in a democratic society.”

Oregon has been a virtual debating society on compassion and dying, on high-tech and hospice, on pain and palliative care.

But what is remarkable about this evolving argument is not the hostility among its leading combatants. That we have come to expect. It’s the gradual tilling of public common ground.

“People of good will now understand that America has made a hash of dying,” says ethicist Art Caplan from the University of Pennsylvania. “It’s terrifying to think we might have to endure a technological death. What Oregon did was cry out and say, ‘something has to be done.”’

Virtually no one defends the status quo anymore. Even in this campaign, political opponents chose to argue against the efficacy of the law as much as its morality. The most controversial attack warned that the drugs would not work. This time, the scare was that instead of “death with dignity” a patient would “choke on his own vomit.”

At the same time, those who favor legalizing doctor aid-in-dying no longer describe it as the alternative but rather as the last resort. Barbara Coombs Lee, the nurse, lawyer and driving force behind this campaign, says that the “wide benefit of the law is from the knowledge that it is there. … If they find themselves in their worst nightmare, there is a way out.”

Indeed, her side points with pride to the hospice movement that has burgeoned in the wake of attention to dying. On the morning after victory, Lee added, “We have much common ground that we share with our opponents. We and they can work together to improve the end of life care. … We only differ about what we have to offer patients for whom palliative care fails.”

Oregon’s law may well be the country’s first draft, not the last word, on assisted suicide. Others may refine this law - and the guidelines that allow only oral drugs and may not be cautious enough about screening for depression. There is, moreover, much common ground left uncharted.

An assisted suicide law that affects only the competent ill does not begin to address the deepest of our terrors - to be left so demented or so disabled that we can’t ask to be released.

Nor does this doctor’s permission slip relieve the other set of terrors, about a too-cheap solution in an era of managed care and ill-managed chronic care.

As Art Caplan says, “Passing laws is very dramatic. But putting them into practice is where the action is.” Will we develop new ceremonies for this new way of dying, he asks? New businesses? Will we have a new set of expectations for a pastor, a new set of emotions for a daughter?

The people of Oregon have now become the first to vote mercifully and overwhelmingly to provide the terminally ill with what many call “a parachute.” Step by careful step, the rest of us have begun to follow the Oregon Trail.

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