c. 1996 Religion News Service

WASHINGTON (RNS)-For many Americans, doctor-assisted suicide for terminally ill patients has only begun to emerge as a high-profile public issue, on a par with abortion and capital punishment.

But after two major legal developments this week upholding the”right-to-die,”professional ethicists are concerned that assisted suicide may soon become the law of the land before Americans have a chance to fully weigh its moral, ethical and medical implications.

On Wednesday (March 6), an appeals court sanctioned doctor-assisted suicide for terminally ill adults in nine western states. On Friday, Dr. Jack Kevorkian was acquitted of assisted suicide for helping two ailing patients kill themselves by breathing carbon monoxide.”I’m concerned that we’re rushing to premature closure on an issue that needs to be discussed far more extensively,”said Laurence O’Connell, president of the Park Ridge Center for the Study of Health, Faith and Ethics, an ecumenical Chicago-based think tank.

O’Connell is a cautious supporter of assisted suicide as”a reasonable moral choice”in some circumstances. But he suggests that not enough work has been done yet in exploring other options, including so-called palliative care-medical care that seeks to lessen a terminally ill patient’s pain and suffering while allowing the disease to take its course.”Many physicians don’t know how to give palliative care. It’s a whole area that needs more development,”said O’Connell, adding that if pain could be reduced, the suicide option would be less attractive.

Wednesday’s ruling, which is being compared in magnitude to the 1973 Supreme Court abortion decision in Roe vs. Wade, gave a major boost to the right-to-die movement. The 8-3 decision in the 9th Circuit Court of Appeals in San Francisco threw out Washington state’s ban on doctor-assisted suicide, effectively legalizing some forms of euthanasia in California, Washington, Oregon, Idaho, Montana, Nevada, Arizona, Alaska, and Hawaii.

Washington state officials said they are considering whether to appeal the ruling to the U.S. Supreme Court.

Written by Judge Stephen Reinhardt, the opinion for the first time in U.S. history said a terminally ill adult has a constitutional right to a doctor-assisted suicide.”A competent, terminally ill adult, having lived nearly the full measure of his life, has a strong liberty interest in choosing a dignified and humane death rather than being reduced at the end of his existence to a childlike state of helplessness, diapered, sedated, incompetent,”Reinhardt wrote.”When patients are no longer able to pursue liberty or happiness and do not wish to pursue life, the state’s interest in forcing them to remain alive is clearly less compelling.” Not all clergy and ethicists reacted negatively to the ruling.

The Rev. Julian Rush, a United Methodist minister who directs the Colorado AIDS Project, said the decision provides support for people with AIDS who choose what he called”self-deliverance.””My main thrust is that people have the right to have the information”about medical options, including doctor-assisted suicide, he said.”If somebody makes the choice to self-deliver (commit suicide), they should be free to do so, with or without a doctor’s assistance.”For me, the major ethical issue is that people are already making this decision, sometimes privately, sometimes with friends and support groups. The fact that in 1996 they have to do this underground, in dark rooms with dim lights, is ridiculous.” But among religious thinkers, Rush appears to be in the minority.

Cardinal Bernard Law of Boston, chairman of the National Conference of Catholic Bishops’ Committee for Pro-Life Activities, said the ruling sends a”chilling”message to the nation’s elderly and seriously ill people.”It tells them that their lives are relatively worthless under the founding charter (Constitution) of our nation-that a state is not even allowed to protect them as it would protect the young and able-bodied who may be tempted to suicide,”Law said in a statement.

He said the ruling”threatens the same large-scale assault on the lives of the elderly that Roe (the Supreme Court’s abortion ruling) unleashed on the unborn.” The assisted suicide ruling highlights a growing public debate over death and dying prompted in part by striking advances in medical technology, which can keep patients alive long after they might have died a generation ago. Also fueling the debate over euthanasia are new diseases such as AIDS, in which the dying process can be long and painful.”The way we die has changed,”said Mark Hanson, associate for religious ethics at the Hastings Center, a medical ethics think tank in Hastings-on-Hudson, N.Y.”New technologies that prolong life have brought a potential loss of control (for patients) but also introduced many more decision points”for making health-care decisions, including that of ending life, he said.”We have a difficult time in our culture dealing with death,”Hanson said.”That’s one of the reasons people are finding these (right-to-die) initiatives so appealing.” O’Connell agreed.”With the dawn of technological medicine, we are extending quantitative biological life but not necessarily qualitative life,”he said.”That heightens the anxiety of the individual and the society at large.” Still, O’Connell said, the ruling failed to address a number of issues. He singled out possible shifts in the patient-doctor relationship in which a doctor may be perceived as both a protector and taker of life.

O’Connell also said the ruling fails to address adequately the”morally important difference”between refusing treatment to those who are gravely ill and taking steps to actively bring about death.

Orthodox Rabbi Moshe Tendler, an ethicist and chairman of the department of biology at Yeshiva University in New York, said he opposed the ruling because”suicide in biblical ethics is murder.” Tendler’s interpretation of scripture was far different from Judge Reinhardt’s, however.”The stories of four suicides are noted in the Old Testament-Samson, Saul, Abimelech and Ahithophel-and none is treated as an act worthy of censure,” Reinhardt wrote in his majority opinion. “In the New Testament, the suicide of Judas Iscariot is not treated as a further sin, rather as an act of repentance.”

Like O’Connell, Tendler cited the medical community for turning too quickly to euthanasia when a disease is incurable and not doing enough to practice palliative care.”The major driving force for the permission of ending a life of short duration is unendurable pain,”he said.”Doctors have become so focused on cure or not cure that they’ve forgotten about care.” Tendler said developments in pharmacology and surgery mean”there is no reason for people to suffer the kind of pain they do.” The Hastings Center’s Hanson said under the present U.S. health care system, the ruling could induce patients to choose death over expensive long-term care.

Some patients, he said,”may think they have an obligation to commit suicide”so as not to be a financial burden on their families or society.

MJP END ANDERSON