The communication between doctor and patient is key in right-to-die decisions, especially those in which the physician plays an active role, a Los Altos pastor told the Los Altos Senior Coordinating Council last week.
"There must be a relationship between patient and doctor in medical ethics," said John Dodson, senior pastor of the Los Altos United Methodist Church, who has studied medical ethics decisions since 1960.
"For me, personally when that happens, I will have a physician I know who will gradually ease me into a gentle and dignified end."
Dodson, addressing the question Feb. 25 of whether physician assisted suicides should be legal, said several factors have to be considered.
"How is it possible to define when a patient is terminally ill?" Dodson asked. "And, how will the move to health-maintenance organizations be accepted?
"A patient may not have that close relationship, and may not even know the doctor as well as he used to know his old personal doctor. The dialogue between a doctor and a dying patient can affect the final decision. Will some doctors be more willing to help than other doctors?"
Dodson said there were two ways to assist in suicide. One is where the doctor provides the materials and leaves the patient on his own such as Jack Kevorkian practices; or active euthanasia where another person assists in the injection.
"The Netherlands is the only country that practices euthanasia and their advice is, 'don't do it,' " Dodson said.
"Over there they have a doctor for life, and in our country with managed care, we don't know who our doctor is."
Dodson said every hospital has a medical ethics staff who make decisions, but the family and patient are still in charge, and everyone has a responsibility to discuss any such decision.
He said the Clinton administration, acting through the solicitor-general, has filed briefs with the Federal Supreme Court urging the justices not to find a constitutional right to die.
The case arose from decisions in two federal appeals courts overturning state bans on assisted suicide.
The cases cite many nursing homes around the country, "where the active hastening in the movement of death" is forbidden.
Life sustaining treatment may be withdrawn, but the Clinton administration viewed it this way: "There is an important distinction between withdrawing artificial supports so that a disease will progress to its inevitable end, or to provide chemicals to be used to assist suicide."
Dodson explained his principles of medical ethics.
"The first principle is veracity. It's truth telling, and we didn't always have that," he said. "Today, when you are a patient, you are entitled to know everything about your illness.
"There has to be a faithful contract in the team approach, and there has to be distributive justice. That's the need to look at a balance of what is right and wrong, and a decision made through a balanced input.
"Finally, there has to be respect for the patient, the physician and the family," Dodson said.
"We need to consider rules and regulations on life and take in consideration all medical ethical concerns."