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CORVALLIS, Ore. - A new survey has found that more than half of Oregon's 64 hospice programs had zero or limited participation in Oregon's landmark "Death with Dignity" Act, citing both legal and moral justification.

The survey was conducted by researchers at Oregon State University and published in The Hastings Center Report.

Such limited participation is significant because hospices are considered important for "assuring that physician-assisted death is carried out responsibly," write authors Courtney Campbell and Jessica Cox of OSU.

"Most patients in Oregon who choose physician-assisted death are enrolled in hospice care," said Campbell, the Hundere Professor of Religion and Culture and a professor in the Department of Philosophy at OSU. "But the role of hospices in Oregon is largely confined to providing information about the law in a neutral manner.

"Patients must work on their own to find physicians who are willing to help them die," he added.

Campbell said Oregon's Death with Dignity Act specifies that aiding ailing patients in dying may only be done by a physician. Thus a hospice staff member who offers assistance - even at the request of the patient - risks violating laws against assisted suicide, mercy killing, active euthanasia, and even homicide.

Some hospices cite organizational or personal values that preclude staff members from participating more fully in physician-assisted death, according to Cox, who is a second-year graduate student at OSU working with the Hundere Program.

"Core values (such as commitments not to abandon patients and to neither hasten nor postpone death) are necessarily in tension and do not lend themselves to a clear consensual conclusion for hospice providers," the authors write in the Hastings Report.

The survey was based on responses from 55 hospice programs, or 86 percent of those operating in Oregon. The authors compared policy statements, program guidelines and educational materials relating to Oregon's Death with Dignity Act, which was passed in 1995. The Oregon law allows physicians to prescribe a fatal dose of medication to a terminally ill patient who requests such treatment - as long as several specific conditions are met.

Campbell and Cox conclude that hospices can navigate the legal and moral obstacles through a stance of "studied neutrality," which recognizes that there are a diversity of viewpoints about physician-assisted death - among both providers and patients - and one role of hospices is to encourage open discussion.

Write the authors: "This approach can bring much-needed dialogue and transparency to a process that is unnecessarily opaque, permit hospice programs to acknowledge tensions in the core values, and promote efforts to assure congruence among values, policies and procedures."

The Hastings Center, located in Garrison, N.Y., is a non-partisan research center focused on bioethics. The Hastings Center Report, published six times a year, explores ethical, legal and social issues in medicine, health and life sciences.