May 21, 2005 - Choices, fear weigh in right-to-die fight

By HANH KIM QUACH
The Orange County Register

It was Polly Crouch's doctor who flinched when he delivered the prognosis: Crouch had lung cancer and had six months to live.

" 'Oh,' " said the Laguna Woods grandmother, who had already been treated for breast and skin cancer. "What else would I say?''

With about two months left, death doesn't scare her. What does frighten her is losing mental clarity and ultimately dropping into a vegetative state. Crouch wishes she had more options.

A bill in the state Legislature would give her what she wants: the right to physician-assisted suicide.

But what seems like an option to Crouch, 78, looks more like an affront – even an assault – to others, who fear the option would be abused by a cost-conscious health- care industry.

Assembly members Patty Berg, D-Humboldt, and Lloyd Levine, D-Van Nuys, have modeled their bill after Oregon's Death with Dignity law, enacted seven years ago. More than 200 terminally ill patients have ended their lives under the auspices of that law.

Advocates for people with disabilities say facilitating suicide for people whose illnesses are just beginning to cripple them minimizes the difficulties that physically disabled people have had to endure for years.

"People actually already can commit suicide if they want to. It's against the law, but people do it every day. To be having the state sanction the ability for people to commit suicide goes against everything we stand for," said Rick Franz, an advocate for the disabled at the Dale McIntosh Center in Garden Grove.

When Franz was 9 months old, he contracted polio. He believes that if physician-assisted death were accepted 47 years ago, he would not have survived.

The debate around death was reinvigorated recently when Congress intervened in the case of Terri Schiavo, a severely brain-damaged Florida woman whose last days were played out before the nation as her family fought over whether to restore her feeding tube.

A physician-assisted suicide law would not have affected Schiavo, because patients would have to be alert in order to make the decision to die.

Compassion and Choices, an Oregon group that supports the California measure for physician-assisted suicide, said it received 26,000 telephone calls in the wake of the Schiavo case.

"People who had never given much thought to their mortality and what it would mean to have someone else make your end-of-life decisions for you started asking, 'If I were in that position, this is the choice I'd want to make, rather than continue in that permanent unconscious state,' " said Barbara Coombs Lee, the organization's president.

Those who consider assisted suicide may not ultimately follow that path, a study in Oregon found. One in five people who are dying consider assisted suicide, but only one in 1,000 follow through with it, according to a study by the Oregon Health and Science University.

In the seven years since the law was passed, 326 people in Oregon have obtained the lethal medication, and 208 used it. For many, it's mainly a safety cushion.

"They're not making a request to die. They don't want to die. But since they are dying, they want to have their 'insurance' policy. They want there to be a way to escape intolerable suffering," Lee said.

Advocates argue that safeguards in the law ensure that people who don't want to deliberately end their liveswon't have to.

But opponents call that view naïve.

Many advocates for people with disabilities fear that some patients may feel tacitly pressured to die - either by health organizations that deny expensive treatments, or because they don't want to burden their family members.

"Naivete is the kindest word I can use to describe support for assisted suicide. The people proposing it are privileged, affluent white people," said Paul Longmore, history professor at San Francisco State University and longtime advocate for the disabled. The Oregon study found fewer ethnic minorities consider hastening their death than whites.

Critics fear that health maintenance organizations would encourage physician- assisted suicide to save money. The California bill, AB654, explicitly prohibits that, but Longmore said insurance companies could still covertly deny expensive treatments.

"By denying access to end-of-life care, they effectively put pressure on people to choose to end their lives," he said.

Crouch believes the choice should be hers.

Her cancer is getting worse. Her feet feel like they're on fire. The burning has spread to her lips and mouth.

"My mind doesn't work well these days, and that scares the dickens out of me. It's far worse than death," said Crouch, who watched her father and father-in-law slowly die of terminal illnesses.

She's making the best of her life now, swimming and reading and spending time with family and talking through the issue.

"Death has been such a closed topic in our society," Crouch said. "From when I was very young, death was just terrible. I don't know why we give that impression to our children, since we're all going to die. We should be telling our children that death is a part of life.''

But for many people with disabilities, the concept of physician-assisted suicide is insulting.

Some of the "worst nightmares" of terminal illness are the very challenges people with disabilities face daily.

"If you require physical assistance with basic tasks, like bathing, using the toilet or eating, you're very stigmatized," Longmore said. "To me, it seems pretty dangerous and objectionable to authorize people committing suicide because they're reacting to social prejudice.''