The legalization of assisted suicide in Oregon has not made physicians' lives any easier. Many, in fact, remain uncertain, according to a new study published in today's issue of The Journal of the American Medical Association (JAMA). The Death with Dignity Act, passed in 1994 and enacted in 1997, lets doctors prescribe a lethal dose of medication for terminally ill patients who are mentally competent to choose to commmit suicide. The patients then administer the medication themselves.

But a survey of 2,641 doctors authorized to prescribe such medication revealed that many are grappling with both professional and ethical issues related to the new responsibility. Many reported referring more terminally ill patients to hospices; the number rose from 22 percent in 1994 to 30 percent. And among those willing to make life or death decisions, an alarming number were unsure of their own assessments: "Of the 73 physicians who were willing to write a lethal prescription and who had received a request from a patient, 20 (27 percent) were not confident they could determine when a patient had less than six months to live," the researchers write.

Seven percent of the survey participants also said that some clients became upset upon learning their physician's stance on assisted suicideand two percent had lost patients as a result. Of interest, more patients left their doctors because he or she opposed assisted suicide. "A large portion of physicians, despite not being morally opposed to assisted suicide, have practical concerns about participating in the Death with Dignity Act and only a minority are willing to provide a lethal prescription to a qualified patient," the authors conclude. "Some physicians who are willing to assist in legalized suicide may lack knowledge necessary to evaluate patients' eligibility."