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SUICIDE: UTAH PHYSICIANS SAY PASSIVE EUTHANASIA IS DIFFERENT THAN ACTIVELY KILLING A PERSON, WHICH ETHICS PROHIBIT.

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Even those doctors who consider it ethical to participate in a passive form of euthanasia - the withholding of treatment - agree that helping in a suicide is a different matter.

"There is more than a fine line between withholding treatment and actually hastening the demise of a patient," Dr. John C. Nelson said in a Deseret News interview. "The ethic of the American Medical Association is that the physician will do nothing to hasten the demise of the patient."When Oregon Alzheimer's patient Janet Adkins pressed the button on a suicide machine owned by a Michigan doctor recently, she ignited national controversy over the ethics and legality of active euthanasia - which the American Medical Association has deemed morally inappropriate.

It was after reading of Dr. Jack Kevorkian's suicide device that the 54-year-old Adkins and her husband, Ron, flew from their home in Portland, Ore., to Michigan. Assisting someone's suicide is explicitly illegal in Oregon, but in Michigan the law is not so clear. Ditto in Utah.

Nonetheless, some local attorneys argue that someone who aids another in committing suicide could be prosecuted for homicide under the state's criminal code.

Living wills in Utah are, however, legal.

They allow a person, age 18 or older, to execute a directive not only to allow, but instructing doctors when to withhold and withdraw life-sustaining procedures.

The living will has been accepted, with few questions raised or accusations of suicide or assisted suicide.

In Michigan, Kevorkian believed he could go beyond that, and he hooked Adkins intravenously to the machine inside his van, parked in a suburban park. She hit the button, and coma-inducing thiopental and a lethal dose of potassium chloride dripped into her veins. Within six minutes she was dead.

Within hours the American public reacted. Some adamantly supported what had been done. Others expressed vehement opposition.

Nelson said the highly publicized event locally has caused significant concern in the medical community about "what this does to the public's image of physicians."

He believes doctors' Hippocratic Oath is clear and shouldn't be clouded by the incident.

"First of all, our job is to take care of patients. By and large that means taking care of people to make them better," Nelson said. "There certainly are circumstances that have come up where there's a question - a legitimate legal and moral question - about whether life support should be continued, even (among) the very, very sick, the terminally ill, the elderly, the very immature infants, for example."

Nelson stressed that in that context, decisions made to withhold treatment are made by the patient and/or the family. Such is the case with the living will.

"While withholding treatment certainly may be appropriate, facilitating the demise of the patient doesn't appear to be," he said. "It is no more right for a physician to make this decision independently than to say `we will do procedure A and not procedure B.' Those are societal-type decisions."

Nelson said if society were to make that decision, and it were lawful, then a doctor could choose to participate or not to participate.

But in Utah today, that's not the issue.

Even in a state where the death penalty is legal, doctors adhere to the American Medical Association statute that says a doctor can't actively participte in an execution of a convicted criminal.

"The physician would not give a dose of lethal medication to take a prisoner's life," Nelson said. "The physician may be there to pronounce a person dead, but would not actually perform the execution."

The Michigan drama, Nelson said, likely won't be played out in Utah for other reasons.

"I am not aware of any physician who has such a machine, nor am I familiar with any physicians who are members of the Hemlock Society" - which supports the option of suicide for the terminally ill. "Although there may be some," he said.