Physicians split on suicide issue.

CORRECTION (ran 12/19/01): Dr. Rick Kincade is a Eugene family physician who opposes Oregon's doctor-assisted suicide law. His first name was incorrect in a story in Tuesday's newspaper.

Oregon's 4-year-old physician-assisted suicide law continues to divide the state's doctors.

Some physicians, such as Dr. Peter Patricelli of Springfield, argue the law helps ease the minds of terminally ill patients by giving them control over how they die.

Others, such as Dr. Rick Kincade of Eugene, contend doctors should provide comfort and support for dying patients, not a lethal dose of drugs.

About 100 physicians around the state have either written lethal prescriptions for dying patients or provided a second opinion, as the law requires, according to Compassion in Dying of Oregon, a group that supports doctors and patients who participate in the law.

An additional 200 agreed to participate but never got to the point of writing a prescription, the group said.

Still, about one in four patients turn to Compassion in Dying for help because their regular physician won't participate, said George Eighmey, the group's executive director.

That's how Patricelli, a Springfield family doctor, gets involved with dying patients.

He's written prescriptions for eight people - six of whom then committed suicide - and believes he's doing the right thing.

"The frequent medical decision to stop treatment, of any type, and let someone go to the natural conclusion of their disease is always emotionally moving, if not often perfectly, clearly, the right thing to do," he said. "To me this is no different."

There is, however, a difference to Kincade, a family doctor and former president of the Oregon Medical Association. Kincade said he won't help a dying patient commit suicide.

"It's much easier to prescribe medication than to deal with the long-term complications and long-term suffering. As a physician I can't do that," he said. "My role is comforter, to try to be with people at the end of life."

Perhaps a half dozen patients have asked him about physician-assisted suicide, he said. He tells them he won't do it.

"My role is to be with them should they need care and attention at that time," he said. "I do everything within my ability to ease their suffering. Just being able to talk to patients about their fears is comforting."

He acknowledges a point made by Patricelli, that having the suicide option may help ease the anxiety of dying patients.

"But if they know a physician is there to give medication to keep them comfortable and alert, there's comfort in that, too," he said.

He said his position on doctor-assisted suicide is informed by his religious faith.

"I do place tremendous value on each human life, no matter what end of the life spectrum," he said. "As such I will always be committed to making the most of lives, accepting death as a natural event, and directing my energies toward comfort, not toward suicide."

Patricelli and Kincade are in agreement in their condemnation of U.S. Attorney General John Ashcroft's efforts to cripple Oregon's law by authorizing federal drug agents to investigate doctors who prescribe life-ending drugs. "They will bring the DEA back into physician's offices to see if medications were used to hasten death or ease pain," Kincade said. "That's a medical decision, not a legal decision."

Patricelli called Ashcroft's directive "irrational and schizophrenic."

It presumes that it's OK for a doctor to prescribe enough painkillers to ease a patient's suffering and perhaps hasten death without the patient's consent.

But it's not OK for patients to consent to medication that will hasten death, he said. Regardless of a physician's personal beliefs about the law, his or her response to a patient query about assisted suicide should be the same, said Dr. Susan Tolle, director of the Center for Ethics in Health Care at Oregon Health & Science University in Portland.

"The initial response is to probe the meaning behind the request," she said. "My belief is, the first thing you should do is explore the meaning behind the question, no matter what your values are."

Doctors should ask patients about their concerns and fears.

Their answers may raise issues, such as depression or fear of pain, that doctors can address short of assisting suicide, she said.

About one in 10 patients who make a request follow through, she said.

Studies show Oregon doctors' attitudes toward the law have changed and that more are willing to participate.

A study published in the New England Journal of Medicine in February 1996, before the law took effect, found 46 percent of doctors said they "might be willing" to write a lethal prescription in some cases.

A majority of doctors at that time were unwilling: 31 percent were morally opposed, 21 percent were unwilling for other reasons.

A subsequent study published in February 2000 found most Oregon doctors said they support the law, and a slight majority said they would be willing to help patients kill themselves.

The study, which surveyed 2,649 Oregon physicians, found about 54 percent supported or strongly supported the law, 28 percent opposed or strongly opposed it and 17 percent said they were neutral.

When asked if they would be willing to prescribe lethal medication to a dying patient, 51 percent said they would, 37 percent said they would not and 12 percent were uncertain.

- Tim Christie