Cross Purposes

[January 25th, 2006] It's a small act of rebellion that nobody at Providence hospitals wants to talk about: At least three physicians employed by Providence have defied the spirit, if not the letter, of their employer's ban on assisted suicide, according to Compassion & Choices of Oregon.

The physicians have helped at least three patients get life-ending drugs by writing prescriptions and consulting with terminally ill patients outside the property of Providence Health Systems, says George Eighmey, the Oregon director of the assisted-suicide advocacy group.

Providence, a Catholic institution and the state's largest health-care provider with seven hospitals in Oregon, declined to comment about its policy on assisted suicide. Spokesman Gary Walker said Providence has a policy against talking with Willamette Week.

The U.S. Supreme Court voted 6-3 last week to protect Oregon's unique assisted-suicide law from the Bush administration. From 1998 through 2004, 208 terminally ill Oregon patients chose to end their lives.

Providence ethicist Father John Tuohy expressed initial interest in talking about the Catholic view of assisted suicide, but said he had been told to remain silent.

"I have no idea what's behind it, but I was asked to pass on the interview," Tuohy said.

Eighmey described Providence's assisted-suicide stance as a "don't ask, don't tell" policy, meaning that the hospital has not conducted any "witch hunts" for physicians violating the rule.

By comparison, Legacy Emanuel, a Lutheran hospital system, bars its doctors from prescribing the drugs for assisted suicide but will let them act as one of two consulting physicians required to approve a patient's request. State law requires consulting physicians to agree that a patient has less than six months to live and is of sound mind. Doctors at Oregon Health & Science University and Kaiser fully participate, Eighmey says.

The Providence doctors chose to help dying patients off property in order to be protected by a 1999 legislative amendment to Oregon's voter-approved Death with Dignity Act. The amendment states that hospitals can only fire doctors or cancel their privileges if their actions occur within the physical perimeter of a health-care provider that has a policy against assisted suicide.

Eighmey says the Providence doctors aren't risking their jobs.

"I make sure that they're following the statute," Eighmey says. "They get the file at home and they write the prescription at home.... If the person talks to their physician and their physician says "no" at Providence, then we will help them locate someone who will [write a prescription]."

At the same time, Providence doctors are fearful of discussing the "don't ask, don't tell" policy. Eighmey approached several who have helped patients considering assisted suicide. All turned down the opportunity to talk with a reporter, even with the option of omitting their names.

Dr. Peter Goodwin, a retired OHSU physician and assisted-suicide advocate, says the ban imposed by Catholic hospitals squelches doctor-patient communication, even if it isn't actively enforced. "There is such a shadow over this issue," Goodwin says, calling it a "pity" that there's now an inhibition against discussing issues that were openly addressed before Oregon voters approved assisted suicide.

The fact that terminally ill patients may confront roadblocks from the Catholic Church shows how much Vatican policy affects U.S. health care. The United States Conference of Catholic Bishops issues a set of ethical and religious directives for Catholic hospitals on everything from abortion to last rites. Its end-of-life directives specifically forbid assisted suicide.

Eighmey says he respects the circumstances of Catholic hospitals with moral and religious oppositions to assisted suicide, but adds, "I wish they would be more open about publicizing what they do not cover."

"I think everyone who enters into a facility should be aware up front that [the hospital] will not provide the following services," Eighmey says. "And then I have to make a decision whether I want to be there or not."