U of Ideas of General Interest -- June 1998 University of Illinois at Urbana-Champaign
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Mark Reutter, Business & Law Editor
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MEDICAL ETHICS
Debate on doctor-aided suicide expected to boil over into state legislatures
CHAMPAIGN, Ill. -- The issue of physician-assisted suicide, long the shrouded preserve of activists like Dr. Jack Kevorkian, is about to go public with political battles expected in a number of state legislatures.
"The cliche that 'the devil is in the details' is nowhere more true than in the case of physician-assisted suicide -- or PAS," says Russell B. Korobkin, a University of Illinois law professor who specializes in the legal aspects of health care.
The debate over legalizing PAS was fundamentally altered when the U.S. Supreme Court declined last year to pass judgment on the legality of state laws regarding PAS, saying the matter did not raise constitutional issues. "The right to die, so said the high court, is something for the people and their legislatures, not the district attorneys and courts, to resolve," Korobkin said.
So far, only Oregon has legalized PAS, while a number of states criminalize the act of doctors aiding patients who commit suicide. "It is a fair prediction that Oregon will not stand alone for long and that legislation seeking to legalize PAS will be introduced and seriously considered in the next few years in virtually every state," Korobkin said.
In a paper recently published by the U. of I. Institute of Government and Public Affairs, Korobkin laid out questions that are certain to become central to the debate. Key among them is whether PAS should be extended to voluntary euthanasia or "mercy killing." The Oregon law requires the patient to self-administer the lethal dose of medication, but the question of allowing an incapacitated individual to direct a doctor to administer the lethal dose is bound to arise.
A second issue involves eligibility. In the Supreme Court cases, the plaintiffs seeking to die had been told by their doctors that they had only a short time to live. "In theory, PAS could be made available to all individuals who decide they would prefer death to life, or it could be offered to a broader class of individuals with an intractable and unbearable illness," Korobkin pointed out.
A broadened definition of PAS, however, runs the risk of creating a vague standard for determining which patients are eligible. Even the most ardent supporters of PAS agree that the option should not be available to people who are not mentally competent to choose it.
"But how should the law attempt to guarantee competence?" Korobkin asked. Leaving the determination of competence only to a family doctor "is unlikely to result in a coherent or consistent application of PAS legislation."
Korobkin suggested that second or even third medical opinions, written-consent provisions and prescribed waiting periods all offer important protections against any medical mistake or a patient who may make a rash decision because of a lack of information or extreme physical pain.
-mr-
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