by Ann Hill
Is physician-assisted suicide a humane practice that allows patients to exercise their full rights, or is it murder?
According to Marjorie Shultz, professor of law and medicine at Boalt Hall and one of Northern California's leading experts in medical ethics, physician-assisted suicide is a natural outgrowth of the right-to-die movement.
"We are moving from withholding care and letting nature take its course to a consideration of an affirmative stance," she says. "The legal and moral question is, 'Is this nothing significant, or is it crossing a line into ethical damnation?'"
The debate will be brought to campus Saturday, Nov. 9, from 1 to 5 p.m., when Shultz and a panel of experts representing a variety of disciplines and points of view will take part in a discussion on "Physician-Assisted Suicide: Respect for a Right to Die or Murder?"
Some issues in the debate touch on centuries-old traditions.
A doctor, for example, who takes the Hippocratic oath, by contract, law and ethics, is obligated to help heal a patient. From a legal point of view, a doctor's omission to treat or help a patient is an actionable, ethical lapse, Shultz says.
Shultz's role will be to discuss the recent legalization of physician-assisted suicide in the states of Washington and New York, the upcoming review of those decisions by the United States Supreme Court and other legal ethical questions pertaining to physician-assisted suicide.
Other issues stem from very recent changes. According to Shultz, California's move during the last decade from a fee-for-service to a managed health care state now gives many physicians an incentive to stop using treatments that needlessly prolong their patients' lives.
Shultz, who says she favors physician-assisted suicide if it has adequate safeguards and guidelines, thinks many doctors don't understand how strongly their patients want more control over their own medical care.
"Most patients want to have the right of informed consent. They are frustrated about the lack of control and the lack of information they have about their medical care. They want more autonomy."
Shultz pointed out that The Netherlands allows physicians to assist in suicide, if the doctor follows certain guidelines. Some of the safeguards she favors include informed voluntariness, adequate access to health care and restraint on the abuse of power.
She says that restraining the abuse of health care providers' power is a key safeguard and very difficult to institute. "How do you make sure that the assister's motives are rooted in understanding and feeling what patients really want?" she asks. "This is very important to making sure that power isn't abused."
Giving everyone equal access to adequate health care is also important.
"Sometimes those without adequate care just decide to give up, even though their condition may not be terminal," she points out. "You don't want a situation where patients consider suicide as a way out of poor health care."
Shultz is a member of the Advisory Committee of the Office of Women's Health Research of the National Institutes of Health and serves on the Alta Bates Hospital Ethics Committee.
The program at Alumni House is cosponsored by UC Berkeley Extension, the schools of Public Health and Social Welfare, the Center on Aging and the Townsend Center for the Humanities. Admission is $15. Call 642-4111 for information.