The Magazine

Better OffDead?

Behind the opposition to the Pain Relief Promotion Act now before Congress lies the creepy ideology of the "rational suicide" movement

May 29, 2000, Vol. 5, No. 35 • By WESLEY J. SMITH
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WHEN OREGON legalized assisted suicide in 1994, Ron Wyden claimed to oppose allowing doctors to prescribe drugs for terminally ill patients to use in suicide. Now a Democratic senator from Oregon, Wyden has a chance to prove he meant what he said by supporting the Pain Relief Promotion Act, expected to come before the Senate any day. Instead, in his vocal and emotional opposition to the bill, Wyden may be showing his true colors.


The Pain Relief Promotion Act is intended to encourage the legitimate use of painkilling drugs -- and deter their use in suicide. The treatment of pain is an area of acute medical underachievement, partly, some say, because doctors fear prosecution under the Controlled Substances Act if they overprescribe narcotics. The Pain Relief Promotion Act states explicitly for the first time that alleviating pain is a legitimate use of controlled substances, even when it "may increase the risk of death." And the bill would provide funds to educate doctors in pain control.


But the legislation would do something else as well. It would restore the uniform application of the Controlled Substances Act, undoing the partial exemption attorney general Janet Reno extended to Oregon to accommodate its assisted suicide law. Doctors in Oregon, as in the other 49 states, who give patients controlled substances for the purpose of suicide could lose their federal license to prescribe such drugs or even suffer criminal sanctions. In effect, the Pain Relief Promotion Act would end Oregon's nullification of a federal statute.


It is on this ground that Ron Wyden vows a filibuster. He is outraged, he says, that the legislation would interfere with "states' rights" -- though he also maintains, bizarrely, that a bill intended to encourage pain relief would have a "chilling effect" on doctors' willingness to provide that very thing.


Senator Wyden doth protest too much. The Pain Relief Promotion Act would advance, not interfere with, the proper medical treatment of pain. That is why the American Medical Association, the National Hospice Organization, and many other medical groups enthusiastically support it. Experience in states like Rhode Island and Louisiana, moreover, shows that it is possible simultaneously to outlaw assisted suicide and promote aggressive pain control: After relevant laws went into effect in those states, doctors' use of morphine to treat pain skyrocketed. Nor does the federal bill impinge in the least on states' rights. As the (Portland) Oregonian editorialized, it is actually the Oregon law that "barges into an area of long-standing federal jurisdiction," and not the other way around.


Wyden's arguments, then, are off base, and his attempt to have it both ways with his constituents -- to oppose assisted suicide personally while supporting the state's right to legalize it -- looks like posturing. Sure enough, it turns out that one of Wyden's chief advisers in the fight against the Pain Relief Promotion Act is one James L. Werth, a Congressional Fellow working in Wyden's office. Werth, who has a Ph.D. in counseling psychology, is a national leader of the movement for "rational suicide."


Under the theory of rational suicide, mental health professionals do not have an unequivocal duty to prevent their patients from killing themselves. The only suicides they must stop are those that are impulsive or frivolous. If a mental health professional deems a patient to have a rational basis for wanting to die, the professional's primary duty shifts from preventing suicide to ensuring that the patient thinks through the decision carefully.


Here is how rational suicide would work. If a patient expressed a desire to die, his mental health worker would nonjudgmentally help him use proper decision-making techniques to sort out whether or not "to suicide." If the pros were perceived to substantially outweigh the cons, the mental health professional would stand back and refrain from impeding the patient's self-destruction (although some rational suicide advocates believe the better response would be to help the patient die).