[00:03.85]2002 Text4

[00:07.78]The Supreme Court's decisions on physician-assisted

[00:10.92]suicide carry important implications

[00:13.64]for how medicine seeks to relieve dying patients of

[00:16.66]pain and suffering.

[00:19.18]Although it ruled that there is no constitutional

[00:21.70]right to physician-assisted suicide,

[00:24.29]the Court in effect supported the medical principle

[00:27.29]of "double effect,"

[00:28.99]a centuries-old moral principle holding

[00:31.93]that an action having two effects

[00:34.64]--a good one that is intended

[00:36.18]and a harmful one that is foreseen

[00:39.00]--is permissible if the actor intends

[00:41.28]only the good effect.

[00:43.80]Doctors have used that principle in recent years

[00:46.91]to justify using high doses of morphine

[00:50.14]to control terminally ill patients' pain,

[00:53.06]even though increasing dosages

[00:55.08]will eventually kill the patient.

[00:58.21]Nancy Dubler, director of Montefiore Medical Center,

[01:01.95]contends that the principle will shield doctors

[01:04.86]who "until now have very,very strongly

[01:08.08]insisted that they could not

[01:09.78]give patients sufficient medication to control

[01:12.10]their pain if that might hasten death."

[01:16.43]George Annas, chair of the health law department

[01:19.26]at Boston University,

[01:21.18]maintains that, as long as a doctor

[01:23.29]prescribes a drug for a legitimate medical purpose,

[01:26.83]the doctor has done nothing illegal even if

[01:29.85]the patient uses the drug to hasten death.

[01:32.77]"It's like surgery," he says.

[01:35.29]"We don't call those deaths homicides

[01:37.41]because the doctors didn't intend to

[01:39.18]kill their patients,

[01:40.55]although they risked their death.

[01:42.83]If you're a physician,

[01:44.39]you can risk your patient's suicide as long as

[01:47.42]you don't intend their suicide."

[01:50.74]On another level,

[01:52.16]many in the medical community acknowledge

[01:54.48]that the assisted-suicide debate has been fueled

[01:57.31]in part by the despair of patients

[01:59.72]for whom modern medicine

[02:01.23]has prolonged the physical agony of dying.

[02:04.86]Just three weeks before the Court's ruling on

[02:07.48]physician-assisted suicide,

[02:09.60]the National Academy of Science (NAS)

[02:12.82]released a two-volume report,

[02:15.24]Approaching Death: Improving Care at the End of Life.

[02:19.79]It identifies the undertreatment of pain

[02:22.21]and the aggressive use of "ineffectual

[02:24.83]and forced medical procedures

[02:26.95]that may prolong and even dishonor

[02:29.36]the period of dying"

[02:30.63]as the twin problems of end-of-life care.

[02:34.74]The profession is taking steps to require

[02:37.27]young doctors to train in hospices,

[02:40.70]to test knowledge of aggressive pain management therapies,

[02:44.42]to develop a Medicare billing code for hospital-based care,

[02:48.25]and to develop new standards for assessing

[02:50.98]and treating pain at the end of life.

[02:54.00]Annas says lawyers can play a key role in insisting

[02:57.83]that these well-meaning medical initiatives

[03:00.35]translate into better care.

[03:02.97]"Large numbers of physicians seem unconcerned with

[03:06.00]the pain their patients are needlessly and predictably suffering,"

[03:10.22]to the extent that it constitutes "systematic patient abuse."

[03:14.66]He says medical licensing boards

[03:17.01]"must make it clear...

[03:18.29]that painful deaths are presumptively ones

[03:21.01]that are incompetently managed

[03:22.33]and should result in license suspension."