Medical concerns about physician-assisted suicide.

The November 8, 1994 passage of Oregon's Measure 16, which permits physicians to comply with the request of a competent adult patient with less than six months to live for a prescription for lethal drugs, has intensified the debate over the legalization of physicianassisted suicide following the defeats of similar initiatives in Washington' and California.2 Subsequent legal challenge to Measure 16 and the present preliminary injunction3 has shown that passage and popularity of a public initiative does not ensure its legality. The issue of physician-assisted suicide is most likely headed for the United States Supreme Court. This Article is intended, however, to review the medical concerns of the legalization of physician-assisted suicide and its potential impact on physicians and patients. The issue merits careful study not simply because of the unique concerns of legalized euthanasia, but also because of its critical relationship to physicians and their care of dying patients. First, some definitions. Euthanasia, or "good death," applies generally to decisions or actions that either hasten or cause the death of an individual. In the case of passive euthanasia, this usually applies to the withdrawal of life-support systems such as a ventilator, which allows the disease process to take its course and death to occur. At the other extreme lies active euthanasia, where one individual uses lethal means (such as an injection of a lethal dose of medication) to cause the death of another. Physician-assisted suicide refers to providing a prescription of medication and specific instructions to a patient, with the knowledge that these may be used to end his or her life. For many, physician-assisted suicide represents a type of active euthanasia.