Dr. Paul Stull

DATE April 16, 2002 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Peter Rasmussen discusses physician-assisted suicide
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

There is only one state in which physician-assisted suicide is legal: Oregon.
Its Death With Dignity Act enables physicians to prescribe a lethal dose of
drugs to certain patients who are terminally ill. The act was approved by
referendum in 1994 by a narrow margin. Three years later a larger majority
rejected a referendum to repeal the law.

Last fall Attorney General John Ashcroft issued a directive to strike down the
law, ruling that prescribing, dispensing or administering federally controlled
substances to assist suicide violates the Controlled Substances Act. The
state of Oregon and several dying patients filed suit against the federal
government. A stay is keeping the law in effect until a decision is handed
down by federal court. That decision may come down this week.

My guest, Dr. Peter Rasmussen, is an oncologist in Oregon. He's one of the
few doctors in America who has legally assisted terminally ill patients in
ending their lives. We asked him to talk with us about the process and his
experiences. I asked about his criteria for prescribing a lethal dose to a
patient. He told me the law has several requirements, and he has some of his
own.

Dr. PETER RASMUSSEN (Oncologist, Oregon): One is that I feel it's important
that I know the patient. I have to have met with that patient several times
so that I'm confident that the patient's request is consistent and so on. I
also require a trial of hospice care because it's not uncommon that somebody
who feels that there's no reason to continue living, once they get the good
multidisciplinary hospice care, care for themselves and their family, that
that takes care of some of the issues and concerns that were troubling them.
So I think a trial of hospice is a necessity.

The law does not require a psychiatric consultation, but with rare exceptions
I have asked patients if they would be seen by a psychiatrist just as a
safeguard, and they've always been willing to do that.

GROSS: Do you try to talk a patient out of it when they ask you to help them
kill themselves?

Dr. RASMUSSEN: Well, in a sense I do. I fundamentally believe that a
decision about how a person is going to die is, when possible, up to the
patient. I don't think that's something that the doctor should be deciding.
So in that sense I don't try to talk them out of it, but I explore all the
other options. I try to find out why they're thinking about suicide. And
there are some reasons that I feel are legitimate and others that are not.

For instance, there are some people who are just afraid that they'll suffer
terrible pain at the end of life, and I can assure them that with modern
medicine nobody has to suffer severe excruciating pain as they're dying. We
can prevent that. So often if I just address what their concerns are, their
interest in assisted suicide dissipates.

GROSS: What are the drugs that are actually being used?

Dr. RASMUSSEN: We started using a drug called secobarbital. It's kind of an
old-fashioned sleeping pill and tranquilizer, which is not used very much
anymore because of the overdose potential. It's been replaced by the
benzodiazepines like Valium. The drug we've been using, however, has become
unavailable. The manufacturer is no longer making it. So we're now using a
pentobarbital, a close relative which is designed to be administered
intravenously for anesthesia. What we do is we remove it from the bottles and
put it into a glass or a tumbler and have the patient drink that down.

GROSS: And what does it do to their body?

Dr. RASMUSSEN: It works very quickly. Typically within a minute or so, a
patient gets very sleepy and falls asleep, goes into a very deep sleep, then a
coma. And the patient then dies, typically a half an hour to a couple of
hours later.

GROSS: Now what's your role in actually giving out the drugs? You prescribe
the drug, but you're not allowed to actually administer the drug.

Dr. RASMUSSEN: That's right. One of the safeguards is that this has to be
ingested by the patient. The physician can help in preparing the drug. And
if the patient is very weak, we can even help bring it up to their lips or
something like that. But it has to be a voluntary act. And there's no
provision for lethal injection. That's strictly forbidden.

GROSS: Dr. Rasmussen, how many people have you prescribed lethal medication
for, and of those people how many of them actually used it?

Dr. RASMUSSEN: I've decided not to give absolute numbers, but I know that
approximately 60 or 70 patients have inquired about the process enough that
they have made a formal request and have completed their written request.

GROSS: In your practice.

Dr. RASMUSSEN: In my practice.

Now most of them, of course, do not end up using the law. One of the reasons
that people don't use the law is because many people wait too long, and
they're so ill by the time they make the request that they do not survive the
15-day waiting period.

GROSS: Right.

Dr. RASMUSSEN: There are other people who, once we start the process, make
sure they're on hospice, address all of their symptom concerns--many people no
longer want to continue the process.

GROSS: Can you give us a sense of what particular kinds of problems and
symptoms have led your patients to ask you to help them take their life with
lethal prescriptions?

Dr. RASMUSSEN: Yeah, I thought, and I think all of us thought, that the issue
was going to be pain...

GROSS: Mm-hmm.

Dr. RASMUSSEN: ...because pain is what kind of pops into everybody's head
when you think about dying of cancer.

GROSS: Absolutely.

Dr. RASMUSSEN: But the fact is we really can prevent severe, ongoing pain.
Sometimes to prevent that pain we have to give people such high doses of drugs
that they're sleepy all the time or kind of in a narcotic haze, and it turns
out that's the bigger concern. People's concern is mostly the quality of
their life, their ability to be awake and alert, continue to interact with
their family. It's those issues of control over their life which turns out to
be the primary impetus to the request.

GROSS: That life has ceased to have any point to them?

Dr. RASMUSSEN: The law is only available to people who are about to die
anyway, and so people are interested in minimizing what they consider to be an
inhumane and a pointless dying process. They would rather end their life on
their own terms in their own timing rather than become bed-bound, perhaps lose
control of their bowel movements and their bladder and require ongoing care
for that terminal period of time.

GROSS: Would it be possible to share with us the story of one of your
patients without violating their privacy in any way?

Dr. RASMUSSEN: Yes. I can think of one patient who was a retired teacher.
She had a big family. And she had had a stroke because of a brain cancer.
And as she got worse she requested the death with dignity. When I arrived at
her home on a Sunday afternoon, it turns out that her family, which had been
scattered all through the country, had come in over the previous Thursday and
Friday. And out in their front yard there were about 30 young people,
children, all dressed in--the girls were in dresses and the boys were in ties.
They had just come back from church. And they had been having a weekend-long
family reunion.

And then I talked with the patient again for a period of time before she took
the drug. And before she took it, each of the family members came in, kind of
one a time--one nuclear family at a time--to say goodbye to her. And it was
a very poignant situation. Then she took the medication and promptly fell
asleep.

GROSS: So this was the death she wanted. She wanted to time it so she could
the see the people who she cared most about and then end her life.

Dr. RASMUSSEN: Exactly.

GROSS: And that struck you as a legitimate amount of control to have, to kind
of like organize your death in a way like that?

Dr. RASMUSSEN: I think so. I've seen people die in a lot of different ways,
and some of them aren't pleasant and aren't very pretty. And to be able to do
it in this way I think is a reasonable thing for a terminally ill patient to
ask.

GROSS: Now how sick was this patient? Was she in a lot of pain? Had she
lost control of her bodily functions?

Dr. RASMUSSEN: She was becoming extraordinarily weak and fatigued. She also
was having increasing difficulty speaking. Her mind was sharp but her words
were very fuzzy, and it took a long time to communicate even between family
members. And because she was requiring more and more care, and she could see
that things were only going to continue to get worse, she decided that that
was the time to end her life.

GROSS: Would you tell us a story of another patient?

Dr. RASMUSSEN: Another patient would be a patient with amyotrophic lateral
sclerosis, who had had a relatively rapid onset in deterioration.

GROSS: You should explain what that is.

Dr. RASMUSSEN: That's a neurologic disease where people's brain function,
where people's mental function is perfectly normal, but they progressively
lose control of their body, typically starting down with the feet and then
rising higher and higher. And she had gotten to the point where she could
barely move her arms. She could not grasp a glass or a straw to drink from.
She required help eating. And yet her mind was perfectly normal.

And as she became increasingly dependent on people, she had decided that she
wanted to end her life. If she hadn't, what would have happened is eventually
the neurologic problem would have gotten to the level of her breathing and she
would have found it increasingly difficult to breathe. There would be periods
of gasping, swallowing saliva into the lungs, choking and dying in that way.

GROSS: So death with this disease is usually a very difficult process.

Dr. RASMUSSEN: It is.

GROSS: So did you try to talk her out of it and say wait a little longer?

Dr. RASMUSSEN: In fact, from the time she requested assisted suicide, I think
we put it off somewhere between four and six months. And that's not uncommon.
Once people know that they have this option, and they know that they have a
physician who is going to be available and is not going to abandon them, then
they try to put it off as long as they can because life is precious and we all
want to live. And it's not uncommon at all for people to put it off and put
it off and put it off. And some of those people end up losing their ability
to use the law. They become either mentally incapable of making that decision
or a disease sets in, like pneumonia, that takes its own course.

GROSS: My guest is Dr. Peter Rasmussen, an oncologist in Oregon. We'll talk
more after a break. This is FRESH AIR.

(Soundbite of music)

GROSS: My guest, Dr. Peter Rasmussen, is an oncologist in Oregon. He has
legally helped several terminally ill patients end their lives.

After you give the drugs, do you keep track of what happened?

Dr. RASMUSSEN: Well, one of the things I request of patients is that I be
present so that I can make sure that the process goes well. I can make sure
that on that final day the patient still has the mental capacity to make his
own decisions, has not become clinically depressed. I wait until the patient
becomes comatose, and I usually wait until the patient dies, spending some
time talking with the family.

GROSS: And you usually go to their home to do this?

Dr. RASMUSSEN: Yes. It's always been in the patient's home. I think three
times it's been in a nursing facility, and one time it was in a hospital.

GROSS: It must be a very--I don't know--awkward or difficult situation for
you, in part because you're not a member of the family and it's really a time
for family and friends to be there, and also, well, because you're presiding
over somebody's death.

Dr. RASMUSSEN: I've usually met most of at least the intimate family members
in the weeks before the patient ends his life. But you're right. It is a
very personal situation, and there are times when I fade into the shadows,
but I think many family members are reassured by the presence of a physician.

GROSS: When you've been present at the death, have you ever gotten a sense
that there's a loved one who is gathered around who is not at all happy with
this decision?

Dr. RASMUSSEN: There are times. There are some family members who disagree
with the decision of the patient, but I have never found a family member who
hasn't agreed that it was the patient's decision to do this. And even though
they disagree with it, they recognize his right to do it.

GROSS: And I'm wondering if it's ever been the other way around where you
have felt that the patient has felt pressured by family to end their life so
as to not be a burden, either a financial burden or a physical burden.

Dr. RASMUSSEN: No. I've never noticed anything like that, but I've certainly
noticed the opposite. Patients, as they're approaching the end of their life,
have a kind of a reordering of their priorities. You know, they're no longer
interested in making money and owning things. And what's really important
often is their family, their loved ones. And it's not at all uncommon for a
terminally ill patient to hope that his death and caring for him does not
impoverish the family. You know, some figures suggest that about a third of
patients who die of cancer in this country end up impoverishing their family
before they die. And there are a lot of patients who would rather keep some
of the family funds available for schooling of the children and so on. So
usually, it's the patient who is focused on the financial issues, and it's
usually the family saying, `No, Dad, it's very important that we be with you
and we want you to live as long as you can, and we'll be fine. We want you to
hold on.' So that's usually the discussion that takes place.

GROSS: You know, I think you've just hit on one of the real big fears
surrounding assisted suicide, which is if somebody does feel pressured, either
self-imposed pressure or pressure imposed by the family, to end their life
before it becomes too costly. What a kind of awful way to end your life, to
save money.

Dr. RASMUSSEN: It would be, wouldn't it? And I think that's one of the roles
of the physician, is to try to minimize that and we...

GROSS: How?

Dr. RASMUSSEN: Well, we always bring it up. It becomes a matter of
discussion, because I don't want to participate in a suicide where that is the
primary motive. And usually, we talk about it. And the family tries to
convince and often convinces the patient that they really will be OK. But
there's no denying the fact that the care required at the end of life is often
very expensive. And I think that's a legitimate concern for a patient to
have. If it's the only reason that they want a death with dignity, then I
would find that unacceptable.

GROSS: Were there times in the past, before the law, when you wished you
could help somebody or when you knew that they desperately wanted that kind of
help?

Dr. RASMUSSEN: Yes. But, you know, physicians tend to be very conservative,
careful people, and I count myself as one of those, and I've not been willing
to risk my license by doing that.

GROSS: I guess I'm wondering if there are things that you've seen, deaths and
end-of-life experiences that you've witnessed, that made you think
physician-assisted suicide can be a positive thing?

Dr. RASMUSSEN: Well, one example is people who commit suicide. I have had
patients who have committed suicide without my assistance, and it often
involves violence, like a gun, and that's very hard on the surviving family
members to encounter their loved one dead of a gunshot wound. Also, I've
heard stories of people who perhaps had a potentially curable cancer, but
early on, right after their diagnosis, they committed suicide before there was
even a chance for a doctor to talk with them about treatment options. And so
a suicide like that is very tragic, because it was based on ignorance and fear
rather than a thoughtful process.

GROSS: What was your biggest fear when you first started participating in
this process?

Dr. RASMUSSEN: Well, it was a totally new medical process for me. I had no
experience with it. I went with a group of others to the Netherlands to learn
about their experience. But any time a physician does a new medical
procedure, there's a certain amount of anxiety to make sure it's done
properly. That was probably my greatest concern. At the time we were having
the political discussion, the ballot measure, there was a lot of talk about
complicated suicides where people would terrible nausea and vomiting, where
they'd have seizures and it would be a miserable process. And although
everything I knew suggested that that was not the case, without actual
experience, I couldn't say that for sure. So it was just the unknown that
worried me the most.

GROSS: So experience put your mind at ease in that aspect of it.

Dr. RASMUSSEN: It has, yes.

GROSS: If this isn't too personal a question, I'm wondering if you practice
any religion and, if so, how those religious principles figure in your
decision to participate with the death with dignity, doctor-assisted suicide?

Dr. RASMUSSEN: I think it probably is too personal a question. I think that
my motivation is really that physician-assisted suicide is a personal liberty.
It's a right that people ought to have for themselves. It's not something
that a physician or a government should impose or restrict. And that's really
my philosophical foundation for believing that physician-assisted suicide is
legitimate. I really think it's up to the patient.

GROSS: Dr. Peter Rasmussen is an oncologist in Oregon. We'll talk more
about Oregon's Death With Dignity Act and the challenge against it in the
second half of the show. I'm Terry Gross and this is FRESH AIR.

(Soundbite of music; credits)

GROSS: Coming up, more on physician-assisted suicide in Oregon. We continue
our discussion with Dr. Peter Rasmussen. We talk with Dr. Paul Stull, who
opposes physician-assisted suicide. And we hear from a retired doctor who is
terminally ill and is getting a lethal dose of medication.

(Soundbite of music)

GROSS: This is FRESH AIR. I'm Terry Gross.

Oregon is the only state that legally allows physician-assisted suicide. A
doctor is allowed, under certain circumstances, to prescribe a lethal dose of
drugs to a terminally ill patient. The law has been challenged by Attorney
General John Ashcroft. The state sued the federal government; a federal court
may give its decision this week.

Let's get back to our interview with Dr. Peter Rasmussen, an oncologist in
Oregon who has prescribed lethal doses of drugs to several terminally ill
patients.

Do you ever feel that you're violating the Hippocratic oath which says,
`First, do no harm'?

Dr. RASMUSSEN: The Hippocratic oath does have a prescription against ending
a patient's life. I think that has to be taken in context of the Hippocratic
oath. You know, that goes back to some 300 or 400 years BC, when what was
called physicians were really--I don't know what we'd call them today;
faith-healers or--they certainly did not understand anything about anatomy or
physiology, and they had a bad reputation. If you read some accounts from
that time, physicians were known to occasionally work for a wealthy merchant
or a politician, but also take money from that person's enemy in exchange for
poisoning the patient, and it made it real hard for these physicians to get
work because nobody really trusted them.

And so the Hippocratic oath was an attempt to say, `You can really trust me.
I will work for you,' and it was the first written social contract, where
physicians made it clear that the people they were working for, the
instructions they were taking were from the patient, not from other people,
and that's why the Hippocratic oath is so important.

It's not particularly important, in my mind, about what it says they will do
and what they will not do. For instance, the Hippocratic oath says that they
will not do surgery because surgery, under those circumstances, of course, was
very dangerous and people routinely died. And the Hippocratic oath even says
that the medical secrets that physicians learn will only be passed on to the
son of another physician.

The `First, do no harm,' I think, really does not apply to modern medicine,
because there are many things that we do to harm patients. Every time you do
surgery, for instance, you drug a patient into unconsciousness, then you slice
open their body, and that certainly is not following `First, do no harm.'

GROSS: You could put chemotherapy in that category, too...

Dr. RASMUSSEN: ...and keep...

GROSS: ...because you're sickening them and...

Dr. RASMUSSEN: Exactly.

GROSS: ...weakening them.

Dr. RASMUSSEN: It's basically a poison, and radiation, likewise. So the
`First, do no harm' really needs to be replaced by `the greater good' concept.
There are times when people are willing to undergo some injury in order to
have a greater benefit.

GROSS: I wonder if doctors in Oregon are really divided over
physician-assisted suicide and if you have any close friends who are on the
other side.

Dr. RASMUSSEN: Yes, I do. The medical profession would very much like this
whole question to go away. The question of physician-assisted suicide did not
come from physicians. It came from patients. It came from people who thought
that medicine should be offering something other than what we were. It's
uncomfortable for us. This is not a type of medicine that we have been
trained to practice. It's something new. It's breaking new ground. And it
takes a lot of time to talk with these patients, to get to know them, to be
absolutely sure that they're making a well-thought-out, considered decision.
Takes a lot of time, and frankly, a lot of emotional effort as well. So there
are a lot of physicians who don't want to have anything to do with it, and
that's one of the reasons I've had patients referred to me who have
noncancerous diagnoses.

GROSS: Right. Do you ever have doubts about participating in suicide?

Dr. RASMUSSEN: I think I have a doubt every time I talk to a patient. I've
had many patients ask me for death with dignity who I have refused because I
thought they did not qualify for reasons of being emotionally unstable, acting
in a precipitous manner, that sort of thing. I've had patients who I thought
were depressed and, therefore, I've declined to participate. But even in
those where everything seems to be OK, it takes a lot of self-searching on my
part and in the part of many a physician to determine whether it's OK to go
ahead, but the primary safeguard in the law, frankly, is not the waiting
periods, and it's not the public reporting or anything. It's the fact that
there have to be two physicians who are willing to say this is OK. And that
is a heavy burden, and it worries me every time I do it.

GROSS: What will your reaction be if the Justice Department wins on this and
the Oregon state Death with Dignity Law is overturned?

Dr. RASMUSSEN: Well, on a real personal level, that would be frustrating for
me. But on the big-picture level, I think that would be OK because I really
believe that what we're talking about here is a citizen's right to an assisted
suicide, and that's a new right, and it's right that only exists in Oregon.
And anytime you're dealing with rights of citizens, it's a political question.
And I think it's very appropriate that this be dealt with in the news media.
I think there needs to be a lot of public discussion about the pros and cons.
And, ultimately, it has to be a legal decision ultimately decided by the
courts. I think that's the right process. I think it's the right way we
should be going about talking about end-of-life care.

GROSS: Dr. Peter Rasmussen is affiliated with Hematology/Oncology of Salem in
Salem, Oregon.

Coming up, Dr. Paul Stull, a pain management expert who opposes
doctor-assisted suicide. This is FRESH AIR.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Interview: Dr. Paul Stull discusses his opposing views to
physician-assisted suicide
TERRY GROSS, host:

We're talking about Oregon's Death with Dignity Act and the Justice
Department's attempt to overturn it. My guest, Dr. Paul Stull, practices in
Oregon and opposes physician-assisted suicide. He's hospice and pain
management consultant for Physicians for Compassionate Care, a group that
opposes the Death with Dignity Act. He served on the state task force on pain
and symptom management. He's a past president of the Oregon Hospice
Association and a former member of Oregon's Catholic Conference Board. I
asked him why he feels he could not prescribe a lethal dose of drugs for a
patient who asked for it.

Dr. PAUL STULL (Physicians for Compassionate Care): One, I think that it's
morally wrong and, two, that it has a great deal of social problems with it,
and, three, it's not a medical indication. When I took the Hippocratic oath,
it said--I took an oath that I would not give somebody a lethal dose of
medication, and I believe that we should keep our oaths.

GROSS: Have you ever been in a position where one of your terminally ill
patients asked you to help them die and said, `I can't face this life any
longer'?

Dr. STULL: Patients who have asked me to help to end their lives--and it
happens many times. There are many, many options. Even when the normal
medications and medical treatments to end someone's--I mean, to control
someone's pain, we have terminal or total sedation for those who reach or
exhaust all of their medical possibilities. So pain management is applicable
to handling this problem.

GROSS: How do you think the law in Oregon has functioned so far from the
anecdotes you've heard from patients and from doctors?

Dr. STULL: Well, it's really difficult because the people who are doing the
statistics is the Oregon Health Division, and that's like the fox guarding the
hen house--I mean, a chicken house--is that to really look at the statistics
this should be more of a bipartisan group. I think people on both sides
should have doctors and physicians and ethicists look at the statistics. But
if you look at it, it ranges from about six to about nine persons per 10,000
who are dying who utilize it. In other words, only 1/10th of 1 percent have
opted out for physician suicide, which tells you that most people in Oregon
dying do not use this function.

I think when it first started out in '98, there were only 25 requests, and
that's jumped up to about 48 in the last year, and only around less than 30
people have actually done this. Now you can say we have had an increased use
of morphine in this state, we have only 1/10th of 1 percent of patients
wanting physician-assisted suicide, but studies in our nursing homes
here--that almost 50 percent of our patients have pain, who are admitted and
six to nine months later those patients are still in pain. So we still have a
major pain management problem in this state.

GROSS: So that's one of your priorities?

Dr. STULL: So there's, really, a paradox. Yeah, it's a matter of priorities.
And I sympathize with people who have significant disease, you know,
significant dementia, neurological disorders. We can manage their physical
pain. I think we can manage their spiritual and psychological pain if we had
a different priority and different funding. And I'm saying how society uses
its resources is really the issue here. What are we going to be like as a
society? Because you can see only a relatively small amount of patients are
using it.

The Oregon law written is not a bad law if you believe in this. My question
is--I don't think it's right for a physician. Meanwhile, people always have
committed suicide, but we don't need doctors to do this. I'm a very competent
physician and have few peers in this. I would not want the power to do this
even in the best light. This is a very frightening thing to have in your
hands.

GROSS: You know, the argument on the other side is that when people do commit
suicide themselves, they often use more violent means: slitting their wrist,
shooting themselves. And it's a more violent way of ending your life and a
more frightening end for those who survive you.

Dr. STULL: I understand that, but does that make it right? Does it really
make it right? I mean, there are books on--you know what most patients do?
They high-grade their medications. There are a lot of ways of committing
suicide, and most of this is, you know, basically depression. You know, we
have to look at the big picture of: What are we teaching our children? How
to live, how to die.

GROSS: Do you have patients who have asked you what your stand is on this and
whether, if they wanted it down the line, you would help them die?

Dr. STULL: Mm-hmm. Yes, I do. I explain my position. I will help them die
in an appropriate fashion. I believe I help people die every day. If they
opt out for physician-assisted suicide, they can call the organizations in
this state, Death with Dignity, but I will not abandon the patient. Even a
patient or their family who opt out for this, I will still be there for them.
I will not attend that act, but I'm not going to abandon somebody because they
make those decisions. I will offer them counseling and pain management, and
I'll be there. That's my function as a doctor.

GROSS: You'd like to see our society pay more attention to palliative care...

Dr. STULL: That's correct.

GROSS: ...and take some of the resources that might be put into
physician-assisted suicide into palliative care. But sometimes, you know,
pain management or palliative care isn't the issue for the person. The issue
just might be the complete lack of pleasure that's left in life, the complete
despair brought on by losing control of one's body and one's bodily functions.

Dr. STULL: Well, see, what you're talking about is pain. And pain is not
just physical pain. There is psychological pain, what you're talking about;
spiritual pain, financial and social pain. Those are issues that we have not
really addressed as well as we could have.

As far as the relief of physical pain through palliative care and hospice
physicians, as myself, we're getting better and better at that. I think where
the real deficit is is: How do we take care of our social and psychological
needs? And I think that's where our emphasis--you know, it's the rights of
the one vs. the rights of all. You know, the needs of the one vs. the needs
of all. And that's my belief pattern, and it's my experience in dealing with
people. It's not just me. It's who is surviving me and my children.

GROSS: Is there an example you can remember where a patient came to you and
asked for your help in committing suicide or asked for your advice because
they wanted to take their own life, you advised them against it, they lived
and they were glad to live the remainder of their life, no matter how brief?

Dr. STULL: Oh, yes, absolutely. I mean, several instances where there was
healing in families, the person was thinking about--is they had some
significant family issues; children had not talked to each other or their
parents. It gave them another four or five months for that family to bring
together. And the wife and the children made peace and actually started a new
life together. It was beautiful, you know, and I was privileged to be part of
that. On the other hand, I told another patient--he went home and shot
himself, and the whole family was totally devastated. We win some, we lose
some, you know.

GROSS: After that patient of yours went home and shot himself, did it make
you secondguess yourself, like maybe a prescription legal dose would have been
a better way to end the life?

Dr. STULL: No, I didn't think that. Just that selfish act of dying that way,
without his wife and children there, was just terrible. I don't think it's
how you do it. Iit's just the act itself--because they needed time, because
in the discussion afterwards, in the family, there were many issues that had
never been solved and could have been solved, and the children would have been
better off.

GROSS: Do you have religious objections to physician-assisted suicide?

Dr. STULL: Do I think it's morally wrong? Yes. But I'm not a judge of the
person. I think the act is wrong.

GROSS: Dr. Paul Stull is hospice and pain management consultant for
Physicians for Compassionate Care in Oregon.

Coming up, we talk with a retired physician from Oregon who is terminally ill
and wants the option of ending his life. This is FRESH AIR.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Interview: Terminally ill patient discusses why he wants the
option of physician-assisted suicide
TERRY GROSS, host:

We're talking about Oregon's Death with Dignity Act that allows physicians to
prescribe a lethal dose of drugs to certain patients who are terminally ill.
The Justice Department is trying to overturn the law. A federal judge may
issue a decision this week. Earlier we heard from doctors on each side of the
issue. Our final guest is a retired physician in Oregon, who is terminally
ill and wants the option of ending his life. It's an option he was about to
get when we called him at his home this morning. We won't tell you his name
because he wishes to remain anonymous.

Now I understand you're getting your pills today. Do you intend to use them
in the near future?

Unidentified Man: I hope not.

GROSS: So you're getting them, but you hope not to use them at all?

Unidentified Man: Right. I hope they will be an insurance policy.

GROSS: What makes you think that you might want to use the lethal pills at
some point? What are your concerns? What kind of death do you want to spare
yourself from having?

Unidentified Man: A real loss of autonomy and pain.

GROSS: Now a lot of doctors say that pain isn't an issue anymore; that with
morphine and other pain drugs, that the pain can be alleviated. You're a
doctor yourself. Are you confident of that?

Unidentified Man: No, not at all.

GROSS: Did your doctor try to convince you that pain wouldn't be a problem?

Unidentified Man: Well, he felt that he could manage it.

GROSS: What are your sources of pain? What kind of cancer do you have?

Unidentified Man: I have prostate cancer. And this is bone pain.

GROSS: It spread to the bones?

Unidentified Man: Oh, yes.

GROSS: And is the pain severe already?

Unidentified Man: No. No, I really have no pain now.

GROSS: As a doctor, you've probably helped people through serious illness and
probably helped people who were facing death. Does being a doctor make it any
more difficult to face death, or does it give you, do you think, a different
perspective on death than other people might have?

Unidentified Man: I think we probably view death in a different way. Death
is the enemy in the chess game, but I think, rationally and scientifically, we
view it without the fear that the lay-public might.

GROSS: So you're saying you don't fear death, but yet you do fear the pain
and the loss of autonomy.

Unidentified Man: Right.

GROSS: What's been your family's reaction to your choice to have lethal
medication as an insurance policy in case you need it?

Unidentified Man: We have six grown children. All of them are supportive of
this decision.

GROSS: Some people have the fear that doctor-assisted suicide might open the
door for people to choose an early death so as not to be a financial burden on
their family. Are you worried about things like that, both in terms of like
your own motives and the motives of others?

Unidentified Man: Well, it hasn't occurred in Oregon in the four years of
experience so far. I have given it some consideration myself, thinking, you
know, why be an unnecessary financial burden to family when nothing is being
accomplished.

GROSS: That seems like such an awful reason to end one's life early.

Unidentified Man: Yes.

GROSS: Are you saying that it is figuring into your decision, though?

Unidentified Man: No, it's crossed my mind.

GROSS: I guess that's the fear, though, you know, that doctor-assisted
suicide opens the door for thoughts like that to cross your mind. You know,
that it's going to be expensive if you're alive.

Unidentified Man: Well, it is. Our circumstances are very fortunate, but in
many families, this would leave them with indebtedness that would persist for
many years. And I think any caring person would have that cross their mind.
What I am putting my family into hundreds of thousands of dollars of financial
burden?

GROSS: So you're saying you think it's a legitimate concern?

Unidentified Man: I do. I think my circumstances are better than most.

GROSS: If this isn't too personal, do you practice any religion, and if so,
how is that affecting your choice of how to face death?

Unidentified Man: Yes. I've been a Protestant all my life. And I don't
think it enters into the decision. I think that this is a different matter
entirely than a religious concern.

GROSS: Today you get your lethal dose. You don't plan on using it unless you
need to because of pain or...

Unidentified Man: I hope...

GROSS: Yeah.

Unidentified Man: ...and several experienced oncologists have told me that
the likelihood is that I would never use it; that more patients with terminal
cancer die of pneumonia, for example, that would ever be tempted to use the
medication.

GROSS: Why get it now? Why not wait until you do have pain or until, you
know, you felt like you might actually need it?

Unidentified Man: I think we're all concerned about what the judge's decision
over the next few days is going to be. If he makes his injunction permanent,
then I would have no reason to get the medication now. But if he, by any
chance, sides with the Justice Department, then all doors would be closed to
us at that point, both as far as physicians writing prescriptions and as far
as pharmacists filling prescriptions. So it's an insurance policy in that
sense that we want to circumvent, if you will, the judge's decision, or at
least anticipate the judge's decision as to whether we can get this medication
in the future.

GROSS: Can you tell me what you think it's going to do for you
psychologically to know that you have the option of ending your life if at any
point you want that option?

Unidentified Man: I think that the patients who have used it have expressed a
great sense of relief that they--or who have had it available, I should say,
have expressed a great sense of relief in knowing that they have this
insurance available to them.

GROSS: So do you feel that some of your fears about the dying process will be
alleviated once you get the prescription?

Unidentified Man: I do.

GROSS: And have you been very worried about--have those fears caused you a
lot of anguish?

Unidentified Man: Well, I've become weaker and you just wonder how far you go
with this weakness before life becomes untenable.

GROSS: And how is life now? I mean, there are still things that seem worth
living for, yes?

Unidentified Man: Oh, yes.

GROSS: Well, I hope that continues for a long time. And I hope that you
remain comfortable and in control.

Unidentified Man: Well, thank you very much.

GROSS: And I thank you very much for talking with us.

Unidentified Man: Thank you.

GROSS: Our interview was recorded this morning. At the doctor's request, we
will let him remain anonymous. A federal judge is expected to issue a
decision in the next few days on the Justice Department's challenge to
Oregon's Death with Dignity Act.

(Credits)

GROSS: I'm Terry Gross.
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