A doctor attending a conference on physician-assisted suicide Friday said that in four recent cases he knew about, the morphine drip rate was increased for dying patients - both to help control pain and to "speed things up."
The occasion was a conference at LDS Hospital, Eighth Avenue and C Street, held to discuss legal, ethical and medical issues surrounding the controversy over physicians helping terminal patients die. Among those attending were a number of young doctors in residence.Dr. Jeffrey R. Botkin, a member of the hospital's Division of Medical Ethics, said in some circumstances there's no question that helping people to overcome their pain with medication is acceptable, even in cases where that could hasten their death.
One doctor asked what if the patient were unconscious but the medication was increased because of the way the patient was breathing. Botkin replied that was a touchy situation, and the important factor is the doctor's intentions. Traditionally, the intention that was accepted was to help with the pain, not to hasten death, he said.
If the courts establish that a terminally ill person has a right to assistance in ending his life, what are the rights of a person who is not dying but sick of living? "It's a so-called slippery slope," Botkin said.
Leslie P. Francis, a lawyer in the Division of Medical Ethics and on the staff of the University of Utah School of Medicine, said the legality of physician-assisted suicide is under study by the U.S. Supreme Court. The court accepted appeals on the issue from New York and Oregon and is expected to rule by next summer, she said.
"I think there are three different moral views that are on the table right now," she said. They are:
- The notion that suicide is wrong, period.
- The idea that even if a right to suicide is established, health-care providers shouldn't participate in that practice, as their role is to heal.
- The idea that under certain circumstances, "where we've got a clearly autonomous patient, with understanding, the suicide itself is permissible and assisting it is permissible."
In Utah, lawmakers have written no exception to the homicide law to protect doctors who help patients end their lives, according to Francis. However, "I couldn't predict whether a physician who knowingly wrote a (sleeping pill) prescription could ever be prosecuted" for helping a patient die.
Careful patients who wanted a doctor's help could always dance around the subject by "saying they're having trouble sleeping," she said.
Utah physicians should be prepared for the Supreme Court's decision, she said. The justices could rule that patients have a right to die, that states can set their own standards, or that physician-assisted suicide should be illegal, she said. The court may take the last option if it is worried about misdiagnoses that cause suicide.
"My own best guess is you're going to get the federalist" option - that is, a ruling that states can set their own standards, Francis said.