Virtual Mentor. January 2002, Volume 4, Number 1.
Cases in Law and Ethics
Oregon v. Ashcroft: Physician Assisted Suicide with Federally Controlled Substances
A case that describes a terminally ill patient's request for a prescription for barbiturates to end her life and the legal and ethical implications the request has for the prescribing doctor under Oregon's Death with Dignity Act.
Amber Orr, JD, MPH
A friend and colleague Dr. Barber was recently diagnosed with colon cancer and urgently moved from your medical center in Portland to Houston for treatment and the support of her family. Upon hearing the sad news you volunteer to help in any way and agree to accept several of her patients. Dr. Barber calls you about one of the patients you have accepted. EH, is a 46-year-old woman with liver cancer who has enjoyed a long, trusting relationship with Dr. Barber. Dr. Barber has been a strong advocate for EH and also expresses her great confidence in your professional skills and ethical wisdom. She asks you in a serious tone to complete a task that she was unable to complete before her retirement. She tells you this is very important to her, and its completion will finally allow her to focus on her family and provide significant closure to her medical career.
She asks you to write a prescription for secobarbitol for EH so that EH can make a decision about her own death. Three physicians have certified in writing that EH is within 6 months of death. She has been found to be mentally competent by your former psychiatry instructor, Dr. Redman. Also in her file is a long, compelling letter written by EH detailing why she wants access to barbiturates to end her life, how she has researched her options for 3 years, and how she willingly asked Dr. Barber for a prescription.
The following Tuesday at hospital grand rounds you learn that US Attorney General John Ashcroft has issued a letter encouraging the Drug Enforcement Agency (DEA) to take action against any physician who assists in a suicide. You have taken a significant amount of time in your decision about EH and have determined that EH meets all the eligibility criteria for assistance under the Oregon Death with Dignity Act . You also are now aware that you will be required to record your participation and the prescription of the lethal dosage of barbiturates (a federally regulated substance) with the Oregon Department of Health. Drs. Barber and Redman both remind you that your duty is to EH and that Oregon voters approved the law by 60 percent. Your trusted friends and colleagues insist that EH has the right to make difficult choices about her death, and they suggest that any alternative could be equated with abandonment of EH in her time of need.
Convinced that terminally ill adults have a right to death with dignity, yet fearful that you may lose your license to prescribe federally regulated substances, you think about the harm that such a loss would cause to you as a professional and to your patients for whom you could no longer prescribe.
Questions for Discussion
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