Federal ruling on assisted suicide sparks debate. (Law Upheld, Ashcroft Rebuked).

A federal court's denial of the Bush administration's attempt to nullify Oregon's assisted suicide law has rekindled debate over the issues of assisted suicide and federal intervention into physicians' practices.

In his April 17 ruling, U.S. District Court Judge RobertJones found in Portland that Attorney General John Ashcroft did not have the legal authority to decide that doctors acting in compliance with an Oregon law allowing physician-assisted suicides were in violation of the federal Controlled Substances Act. The decision in Oregon v. Ashcroft did not deal with the constitutionality of the Oregon law, but Judge Jones was quite critical of Mr. Ashcroft and his handling of the situation.

Judge Jones said in his ruling that the attorney general had attempted to "stifle an ongoing, earnest, and profound debate in the various states concerning physician-assisted suicide. The citizens of Oregon, through their democratic initiative process, have chosen to resolve the moral, legal, and ethical debate on physician-assisted suicide for themselves by voting--not once, but twice--in favor of the Oregon act."

Voters approved the Oregon Death With Dignity Act in 1994 and again in 1997. The law allows terminally ill patients with fewer than 6 months to live to request a lethal dose of drugs, but only after two doctors confirm the diagnosis and declare the patient mentally competent to make the request. But on Nov. 6, Mr. Ashcroft fulfilled one of President Bush's campaign promises by declaring that any physician prescribing a lethal dose of pain medicine was in violation of federal law because such a prescription was not a "legitimate medical purpose."

The Ashcroft directive suited Dr. N. Gregory Hamilton just fine, and he was highly critical of Judge Jones' decision in the case. "The message to the patient is that your life is no longer worth living," said Dr. Hamilton, a Portland psychiatrist and the spokesman for Physicians for Compassionate Care, the Oregon organization leading the charge against assisted suicide. "What we need to do is to treat suicidal tendencies in the gravely ill just like we do with anyone else."

But surveys suggest that Dr. Hamilton might not hold the majority opinion among psychiatrists, either in Oregon or nationally. In a 1994 survey of 322 Oregon psychiatrists, 68% felt that physician-assisted suicide should be permitted; 59% said it can be morally acceptable. A 1997 national survey of 292 forensic psychiatrists found that 66% believed the practice was ethical in certain circumstances; 63% thought it should be legalized in certain cases.

Dr. Linda Ganzini, professor of psychiatry at Oregon Health Sciences University, Portland, conducted both surveys. She said her research found that although many terminally ill patients consider ending their own lives under Oregon's law, very few actually go through with it. Studies conducted before the law was passed showed that between 10% and 26% of eligible patients "showed a strong interest" in assisted suicide, she said, but since the act went into effect in 1998, the rate of deaths from assisted suicide in Oregon has been 9 per 10,000 deaths in the general population.

Some in the psychiatric academic community say this debate is healthy, Oregon's approach is reasonable, and Mr. Ashcroft is just plain out of line.

"This does something very important for Oregon and for the rest of us," said Dr. Lawrence Hartmann of Harvard Medical School, Boston, a past president of the American Psychiatric Association. "It gets these complicated issues out in the open, and it can affect the issue of good end-of-life care. Is there a population out there who, even with good end-of-life care, still wants to opt for this? I think there is, and we can't even have a discussion about it unless there are places like Oregon and the Netherlands," which last month also enacted a law allowing assisted suicide.

As for Mr. Ashcroft, "he is being monumentally hypocritical," said Dr. Hartmann, who stressed he was speaking solely for himself on this issue and not for the APA. "Medicine in general should oppose the political dictating of medical treatment."

"This represents a consensus of the citizens, there is a pathway and a process to guard against abuse, and it's recognized that a lot of people who think about it don't really do it or want to do it," said Dr. Norman A. Clemens, a psychiatrist at Case Western Reserve University, Cleveland.

Dr. Clemens said it was good that the Oregon assisted suicide law did not make psychiatrists gatekeepers for this process--as they were for abortions before that procedure was legalized.

"There are situations where this is not a psychiatric issue or a matter of depression, but rather a matter of a person with a horrible and intolerable situation," he said.

He was similarly critical of Mr. Ashcroft. "I think he's out of bounds," Dr. Clemens said. "He was trying to impose his personal moral views through the use of laws, and it was an abuse of power."

Dr. Jerry M. Wiener, who disagrees with the concept of assisted suicide, agrees that the voters of Oregon were perfectly within their rights to vote as they did. Mr. Ashcroft, on the other hand, was not at all within his rights, said Dr. Wiener, emeritus professor in residence of psychiatry and pediatrics at the George Washington University in Washington.

"I disagree both with the voters of Oregon and with the attorney general," he said.

A spokesman for the attorney general did not return calls for comment. But Assistant Attorney General Robert McCallum released a statement saying, "A just and caring society should do its best to assist in coping with the problems that afflict the terminally ill. It should not abandon or assist in killing them. Doctors should not use controlled substances to assist suicide. Instead, they should be encouraged to use them for pain control, which is one of the most important positive alternatives to suicide."

Mr. McCallum said the Justice Department was still deciding whether to appeal Judge Jones' ruling.