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Battle is on to allow sufferers to end life

Despite new law, physicians balk

Stephen Wallace died of cancer in April. He was unable to find a doctor willing to use the state's new aid-in-dying law. Stephen Wallace died of cancer in April. He was unable to find a doctor willing to use the state's new aid-in-dying law. (Courtesy Wallace Family)
By Kim Murphy
Los Angeles Times / May 17, 2009
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KENNEWICK, Wash. - Stephen Wallace had watched his wife die of cancer 22 years ago, using up the morphine as fast as they could put it into her and begging for more. No, he said then. I won't let this happen to me.

So when he was diagnosed with advanced pancreatic cancer March 8 - given a few days to a few weeks to live - Wallace hoped to go quickly.

He told his doctor and family that he wanted to take advantage of Washington state's new law allowing physicians to prescribe a fatal dose of barbiturates to terminal patients. His five children agreed, but his doctor balked, citing moral reservations.

The family appealed to the hospital, got nowhere and called two others in nearby towns. No doctor was willing to give Wallace, 76, the pills for his deadly sleep.

Cancer of the pancreas has a cruel reputation, delivering what some say is the most intense pain humans can imagine. It killed Wallace on April 8.

"It was very hard to watch my father die that way," said Tricia Crnkovich, who took turns with her brothers and sisters in Wallace's small bedroom as he shrank from 250 pounds to just 60. "I'll tell you, if I ever get cancer," she said, "I don't want to put my kids through that."

On March 5, Washington became the second state to allow physicians to help hasten the death of terminal patients. Oregon legalized a nearly identical "death with dignity" statute in 1997, and the courts in Montana have ruled that the right to privacy extends to patients seeking a doctor's help in ending their lives.

But outside the population centers around Seattle, Tacoma, and Olympia, many physicians are unwilling. That leaves residents east of the Cascades who choose to use the statute with the same problem women seeking abortions in conservative rural communities have faced: It's legal, but health providers' moral qualms mean it's essentially unavailable.

"We knew that it would be harder to find attending and consulting physicians in more rural areas," said Robb Miller, executive director of the advocacy group Compassion & Choices of Washington. "It's going to take time to get people educated about the law . . . and build up trust and confidence among the physicians - many of whom support the law and want to use it but who might not be ready yet to make the leap."

From the moment he was diagnosed, the family said, Wallace refused even to go into hospice care. "When he retired in '94, he said, 'I bought this bed, and I will die in this bed,' " said his daughter-in-law, Ginny Wallace.

But Wallace's physician could not bring himself to assist, the family said. Dr. Idar Rommen, a family practitioner in Snohomish County - another rural Washington area where the majority of hospitals have refused to participate in the new law - understands why.

"To me, personally, giving a patient a suicide pill is like abdicating my role," Rommen said. "I'm here to heal and to make better. And the other just doesn't seem like that's what I went into medicine to do."

The extent of the hurdles patients face in the Kennewick area became clear during a recent physicians' briefing held by the Benton Franklin County Medical Society. The presentation on the new law - which allows a physician to prescribe a fatal dose of medication after a second qualified doctor has certified that the patient is terminal - was met with silence.

"There was no feedback," executive director Nicole Austin said. "It's their decision as physicians if they choose to participate. I sense that it will be a challenge in this community."

About one-third of Washington state hospitals have opted to allow their doctors to assist terminal patients. Austin said many doctors are especially uncomfortable with the requirement under the law that physicians list the cause of death as the terminal illness, not suicide.

Through 2008, 401 people in Oregon had opted for what Compassion & Choices prefers to call "death with dignity." So far, three Washington residents have obtained lethal prescriptions under the law.

Proponents characterize the laws as a means to allow the terminally ill to have some say over how and when they will die. Critics, including the American Medical Association, say the better response is to offer adequate pain medication and reassurance.

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