By Christine Blank

A majority of doctors approve of the practice of physician-assisted suicide, but most say they would not perform it themselves according to a University of Michigan study published in the New England Journal of Medicine.

The Michigan study also showed an unwillingness, both from doctors and the public, to support assisted suicide if those surveyed said they had strong religious beliefs. "Those who considered religion very important in their lives were much less likely both to support legalization and to consider personal involvement in assisted suicide," researchers said.

In addition, older physicians and consumers were less likely to support legalization or participate in assisted suicide.

According to the Michigan study, 56% of doctors approved of legalizing the procedure while 66% of citizens surveyed said they approved. Only one fifth of the doctors in the Michigan study said they support a ban on assisted suicide.

In Iowa, 49% of the doctors said they support physician-assisted suicide only under narrow conditions, according to a Des Moines Register survey. After the survey, Dr. Joseph Hall, president of the Iowa Medical Society, said many of the doctors who favor the idea would not do it themselves.

However, the American Medical Association, opposes the procedure.

"We believe the U.S. Supreme Court will recognize and honor our ethical code and refuse to declare a constitutional right to physician-assisted suicide," said Dr. Thomas Reardon, vice chair of the AMA. The organization's Council on Ethical and Judicial Affairs has consistently condemned the practice.

"Jack Kevorkian perverts the idea of the caring and committed physician, and weakens the public's trust in the medical profession," wrote Kirk Johnson, general counsel of the AMA, in a letter to Michigan Attorney General Frank Kelly. He applauded the attorney general for taking action against Kevorkian's license.

Instead, doctors should become more knowledgeable on pain management and suffering, and explain different therapies to help the patients improve, the AMA said. "If more patients were aware of the options available to them through hospice, advanced care planning and counseling, there would be virtually no need to resort to physician-assisted suicide," Dr. Reardon said.

The AMA is developing a program to educate doctors on several late-term therapies.

"There are serious gaps in doctors' knowledge," added Dr. Howard Brody, professor of family practice at Michigan State University. "We need to find ways to spread the word on up-to-date pain management techniques as well as the patient's right to refuse medical treatment."

Even when they support the option of assisted suicide, most doctors agree with the AMA when discussing the way Kevorkian has implemented the procedure. "Many of us have qualms because of the way he's selecting patients -- he's almost writing the law himself," said Dr. Edward Pierce, director of Merian's Friends in Ann Arbor, MI. The organization of doctors that is pushing for legalization of assisted suicide in the state is also calling for strict physical and mental evaluations of candidates for assisted suicide.

Physician-assisted suicide in general, and Kevorkian in particular, have proven to be difficult, controversial issues for physicians. On one hand, many are ethically opposed to the procedure, saying they should be able to heal the patients. On the other hand, physicians know there are extreme cases in which the patients never improve.

Legalization would actually force doctors to learn more about pain management, counseling and other alternatives to assisted suicide, that they would pass on to their patients. "I don't think physicians are going to want to do this (assisted suicide)-they will try every other possible avenue," Pierce said.

However, even Pierce's group that proposes legalization agrees to a certain extent with the AMA's opposition to physician-assisted suicide.

"This is only for the terminally ill and the mentally competent," Dr. Pierce said. Under the group's proposed protocol, which is still under development, two physicians would have to certify that the patient is dying and a psychiatrist would have to determine that the patient is not mentally ill.

In addition, the patient would have to wait at least seven days before doctors would assist in the suicide.

Many doctors think legislators should stay out of the legalization issue altogether. In the Michigan study, 37% of physicians said the issue should be decided between the doctor and the patient only, while 15% said the doctor should follow guidelines developed by the medical profession.

Still, even though 52% of the doctors in the Michigan study said they would not participate in assisted suicide themselves, many said they would refer patients to practitioners who would. "This parallels attitudes toward abortion in some respects," the researchers wrote. "Many physicians who oppose a medical action on moral grounds are nevertheless willing to make referrals..."

If physician-assisted suicide is legalized, Dr. Jerald Bachman, who headed up the University of Michigan study, believes that the state's lawmakers should entrust the responsibility to doctors.

"Physicians can assess a patient's medical and emotional status, and they know what pharmacological agents and modes of administration would meet the needs of particular patients," he said. In addition, he added, physicians are becoming better trained to provide palliative care, so they are ideally suited to show patients that there are acceptable alternatives to assisted suicide.

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