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Quietly, Doctors Already Help Terminal Patients Die : Ethics: A Westside physician tells of two 'caring acts.' Prop. 161, to legalize such aid, divides the medical field.


As a doctor his primary goal is to prolong lives.

But twice in the 30 years since he took the Hippocratic Oath and added MD to his name, he has written prescriptions for drugs requested by terminally ill patients so they could end their lives.

And in one case two decades ago, the doctor administered the poison himself to a pain-racked patient. In that instance, he botched the job.

"I still agonize over the first one," he said. "If I were going to do it, why didn't I do it better?" Then he added wryly: "I'm a failed murderer."

A soft-spoken middle-aged practitioner on the Westside of Los Angeles, the doctor agreed to discuss his experiences with a reporter as California voters prepare to take sides on the emotional issue of doctor-assisted death.

If Proposition 161 on the Nov. 3 ballot passes, California would become the first state in the nation--and apparently the first government in the world--to put a law on the books authorizing doctors to help patients die.

The initiative would allow physicians to administer fatal doses of drugs to terminally ill patients who request euthanasia, or provide the dying patients with chemicals needed to take their own lives.

The Westside physician is prominent in the Southern California medical community. He agreed to be interviewed after being assured that his name would not be divulged. Knowingly providing the means for suicide is a crime in California, and mercy killing can be prosecuted as murder.

The doctor, who said he has rejected more than 30 other requests for help in dying, supports Proposition 161 to remove the legal threat from doctors who comply with their patients' wishes--"something that I consider a very compassionate and caring act," the physician said.

Clearly, not all physicians feel the same way. The measure has become the subject of a fierce debate among doctors and religious groups, hospitals and lawyers, ethicists and patients.

Proposition 161, written by Southern California attorneys Robert Risley and Michael H. White, follows the failure last year of a similar proposal in Washington state.

Proposition 161 is backed by a diverse list of groups, including the American Civil Liberties Union, the Gray Panthers and the Hemlock Society, a group that advocates a dying patient's right to suicide. Among the supporters is Dr. Warren Bostick, the former president of the California Medical Assn.

But the California Medical Assn. itself opposes the measure, along with the California Nurses Assn. and religious organizations. Most of the money raised to fight the initiative has come from the Roman Catholic Church and Catholic hospitals. Catholic bishops took the unusual step of calling for volunteers and political donations in a plea read from pulpits statewide.

Supporters say Proposition 161 protects patients from a rash decision to die by requiring that two doctors certify that the illness is likely to cause death within six months. Under the measure, the patient must sign a witnessed directive, which can be revoked at any time.

Opponents argue that the safeguards are not sufficient to protect patients who may request to die while influenced by extreme pain, depression or drugs. Some opponents go even further and say that doctors should avoid any role in their patients' deaths.

"Most of us believe that a suicide wish is a result of fear and depression and not because it is truly the answer people are looking for, but because it seems the only way out," said Dr. Michael-Anne Browne, who chairs the California Medical Assn.'s medical ethics committee.

Physicians opposed to Proposition 161 say that in recent years practitioners have been freed to give large enough doses of medications to deal with pain in all but rare instances.

California was the first state to put into law the right of patients and their families to refuse life-extending treatment through "living wills."

As for the next step--actually assisting in suicide--there is wide agreement in the medical field that it already occurs illicitly in that anguished, private world occupied by dying patients, their families and closest friends, and their doctors and nurses.

"I can tell you that many doctors do that," said the Westside physician. "It's part of the practice of medicine. We don't like doing it but we do."

Those few cases in which he intervened to help cut short a life still cause him stress: "They're uncommon, but you remember every one of them."

The first time he attempted to help a patient die was more than 20 years ago, not long after he began private practice. A man in his 20s came to the hospital complaining of bruises. Tests revealed extensive cancer.

"The diagnosis was made in hours and he never left the hospital," the doctor recalled. "He failed chemotherapy and it was a downhill course."

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