Important note: Information in this article was accurate in 1997. The state of the art may have changed since the publication date.
San Francisco Chronicle - The Voice of the West, 901 Mission Street, San Francisco, CA 94119 - Thursday, February 6, 1997 - Page A1
Sabin Russell, Chronicle Staff Writer
The results of the San Francisco study were published in today's New England Journal of Medicine. Researchers polled members of Community Consortium, a 228- member group of Bay Area physicians who treat patients infected by the AIDS virus.
Of the 118 doctors who responded anonymously to the survey, 53 percent acknowledged that they have prescribed a fatal dose of opiates at least once, although the study did not determine whether the patients ever carried out their plans. Nevertheless, the poll appears to show the highest rate of physician participation in assisted suicide ever documented. Earlier studies, including one published in the New England Journal of Medicine last year, had found that between 7 percent and 9 percent of doctors had helped terminally ill patients die.
"I think there is great value in this study," said Dr. Marcus Conant, a prominent San Francisco AIDS physician. "It takes it out of the realm of speculation and shows just how widespread it is, so it can be discussed and debated."
Although most doctors admitted assisting the suicides of only one or two of their patients, the study found at least one doctor who estimated prescribing deadly doses of drugs to 100 patients -- far more than the 45 deaths attributed to Michigan "suicide doctor" Jack Kevorkian.
REFLECTION OF REALITY
"The results show that physician-assisted suicide is clearly a reality. It reflects what physicians are really doing," said Lee Slome, a San Francisco psychologist and lead author of the study, which was carried out with researchers at San Francisco General Hospital.
Physician-assisted suicide is a felony in California, although the legal status of such actions is under review before the U.S. Supreme Court, which is expected to rule this summer on the issue.
Slome said she was not surprised by the findings, given the popular understanding in the gay community that assisted suicide has occurred frequently since the beginning of the epidemic. "On the other hand," she added, "it is surprising that this large a proportion of physicians is willing to admit to doing it at least one time."
The study also indicates that physician attitudes toward assisted suicide are changing, with more doctors willing to consider it. In a second part of the survey, 48 percent of doctors polled said they would likely grant a request to help a hypothetical AIDS patient commit suicide, compared to 28 percent when members of the consortium were asked an identical question in 1990.
Peter DiGiulio, a 43-year-old San Francisco man with AIDS, has considered the possibility of assisted suicide in the future and believes doctors who help patients die are usually doing the right thing. "There are other terminal diseases out there," he said. "The focus should not be just on AIDS. Society as a whole has to grapple with this, one way or another."
THE PROTEASE FACTOR
DiGiulio is one of thousands of AIDS patients whose conditions have improved dramatically with the approval of so-called protease drugs, which, taken in combination with other pills, have helped some patients keep the virus in check.
As a result, he said, many patients who may have considered suicide now have a reason for hope. Dr. Donald Abrams, a San Francisco General Hospital AIDS physician and director of Community Consortium, noted that the latest survey was taken between November 1994 and January 1995, before the protease drugs began to show their promise.
"The survey is a snapshot of what doctors in the community were doing," he said. "The question is, will it change when we look at this again in the future?"
Abrams said the high percentage of doctors embracing assisted suicide in the survey is not surprising given San Francisco's reputation as a proving ground for liberal social ideals. "We voted 78 percent in favor of medical marijuana," he noted.
The study showed that gay and lesbian doctors, and those who treated the most AIDS patients, were most likely to favor assisted suicide. These same doctors are also most likely to empathize with their patients, said Abrams.
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