78-Year-Old’s Death Keeps Right-to-Die Issue Alive in Oregon : Doctor faces possible charge of active euthanasia in helping woman who suffered nearly always fatal condition die. The case has stirred discomfort across the ideological spectrum.

The proverbial slippery slope, so often invoked as abstract concept in right-to-die bioethics debates, has loomed large and quite tangible on the Oregon horizon these past months. What follows once you allow physician-assisted suicide? One possible answer, as played out last year in Corvallis’ Good Samaritan Hospital and examined last Thursday at a closed hearing in Portland, has provoked demonstrations, a state medical board complaint, possible criminal charges and--from across the ideological spectrum--considerable discomfort.

No wonder. Even right-to-die advocates concede that the details surrounding 78-year-old Clarietta Day’s death are, at the least, “highly unusual.”

As a family friend tells it, the elderly woman went to bed last March 21 feeling ill and tired from a trip. At 3 a.m., a blood vessel burst in her head. She called 911, then collapsed. Unresponsive upon admission at Good Samaritan Hospital, she ended up on a respirator. The diagnosis: subarachnoid hemorrhage, bleeding into the brain, an almost-always fatal condition.

Accounts of what followed next derive mainly from a formal complaint filed last summer by Oregon’s board of medical examiners. We know Day’s well-respected primary-care physician, Dr. James Gallant, 44, soon arrived at the hospital. There he talked with his patient’s daughter, Deborah Sorensen. A neurosurgeon advised them that surgery offered very little hope for recovery.

*

How to proceed? The patient, as often happens, had left tentative and contradictory instructions. In August 1995, Day had made notes on an unsigned advance directive indicating that should she be rendered unconscious, she didn’t want tube-feeding or life support. But she did wish that her life be “maintained and observed” for 48 hours before the medical staff determined a “course of care.”

Faced with this mix of desires, doctor and family apparently made a choice. According to the state complaint, Day was taken off the respirator. Morphine and Valium were ordered and administered intravenously, “anticipating a terminal course.”

That course, however, took its good time unfolding. Day kept breathing, her heart kept pumping. Over four hours, the state complaint observed, “there was no documentation at any time of any evidence of discomfort or agitation.” Midway through the morning, “a magnet was applied to the patient’s pacemaker in an effort to deactivate it.” With Day still breathing and pumping, Gallant at 11:15 a.m. “ordered the administration of 100 [milligrams] of succinylcholine, the effect of which is to paralyze the patient’s respiratory system.” That it did; Gallant finally declared Day dead at 11:30 a.m. The immediate cause of death, Gallant wrote on the death certificate, was “stroke due to subarachnoid hemorrhage.”

There have been, it must be said, some efforts to defend this sequence of events.

Sorensen, who reportedly remained at her mother’s side throughout that final morning, has declared through her attorney that she was “100% supportive of the decisions and the care provided by her mother’s physician.”

*

Gallant has told reporters: “I followed the wishes of the patient and the family. Out of respect for the family’s wishes to have this remain a private matter, I’m not able to say any more.”

Peter Hutton, a family friend and minister of visitation at Day’s church, has advised: “Whatever was done for her was best for her. The family also seemed to agree with that.”

Yet none of this has managed to quell the many voices raised in dismay. After all, shade, spin and explain as much as you please, what happened to Day--if the state’s allegations are true--constitutes active euthanasia. Which, in medical terms, means direct and intentional killing of a patient.

That’s precisely what Oregon’s board of medical examiners, voting 10 to 0, called Day’s death last July. Whether or not Thursday’s medical board hearing yields a final judgment in support of that charge--in which case Gallant could lose his medical license--the death of Day provides opponents of Oregon’s right-to-die movement with a powerful horse to ride.

Some context here.

Gallant’s case comes at a time when Oregon is leading the national debate on end-of-life health care. Voters in 1994 approved Measure 16, a physician-assisted suicide law that spells out precise conditions when doctors can help long-suffering terminal patients end their lives. Since then, a federal district court has blocked the law’s use, the U.S. 9th Circuit Court of Appeals has unblocked it, further appeals have been filed, legislative hearings have been held and seven bills have been proposed, among them plans to repeal, change, delay or send Measure 16 back to voters. One question among many regularly raised in this legal-bioethical melee: If doctors are allowed to help patients commit suicide, can mercy-killing be far behind?

The Gallant case provides the precise answer that some have been looking for and warning about.

Advocates for Life Ministries, a militant group in Portland, have taken to picketing outside both Good Samaritan Hospital and Gallant’s home, declaring the doctor “Kevorkian West.” Gayle Atteberry, executive director of Oregon Right to Life, has told reporters: “This re-emphasizes our fears that once Measure 16 becomes legal, the very next step is involuntary euthanasia. It’s a terribly downward spiral we’re on.” Dr. Thomas Reardon, vice chairman of the American Medical Assn., has said: “The question is, is this the slippery slope? You begin with medications and go on to lethal injection. It is fundamentally inappropriate to ask a physician to participate in either.”

In the face of all this, it’s no surprise that Measure 16 supporters have labored to avoid linkage with the Gallant case. Eli Stutsman, a Portland attorney representing Death With Dignity, sponsors of the initiative, wants it understood that “the issue [in the Gallant case] is active euthanasia. Measure 16 doesn’t go so far. In fact, Measure 16 prohibits active euthanasia.” Dr. Susan W. Tolle, director of the Center for Ethics in Health Care at Oregon Health Sciences University, adds: “Allegations in the Gallant case would not be allowed in Measure 16. It goes beyond anything in the Death with Dignity Act.”

*

It can’t be said just how much impact the Gallant case in the end will have on Oregon’s continuing right-to-die debate. Nor, for that matter, given their limited public comments, can it be said just what impulses governed Day’s family and personal physician as they made their unfortunate choices that final morning at Good Samaritan Hospital. It can be said that Day’s daughter is an intensive-care nurse in Portland, so perhaps understood more than most what lay ahead for her mother. It can also be said that Gallant until last year served as medical director of a Corvallis nursing home, so perhaps also saw the future all too keenly.

Something else can be said: The Gallant case, however objectionable, proves not the dangers of laws such as Measure 16, but the need for them. Clarifying the rules in an agonizingly murky area surely can only help doctors and families understand what they may and may not do to help fatally stricken loved ones. If Measure 16 had been in place, if a line had been clearly drawn, the Day family and Gallant at least would have known they were crossing it.