This makes it difficult for people to use PAS on a whim. 9 Recent improvements in palliative care in Oregon 13 may have allowed some people to die in relative comfort without having to hasten their death. Oregon has one of the highest rates of hospice admission and morphine usage per capita in the United States. The Veterans Affairs system, the Indian Health Services system and a major Catholic healthcare system do not allow PAS in their facilities. Some physicians willing to prescribe the medication have had difficulty finding a second physician to confirm the prognosis or a pharmacist willing to fill the prescription.
Some physicians fear being penalised if they prescribe a lethal medication.
In November 1997 Thomas Constantine, head of the US Drug Enforcement Administration, stated that if physicians prescribed a lethal medication to end a person's life it would be a violation of federal law. Then, in June 1998, United States Attorney General Janet Reno ruled that physicians in Oregon could legally write such a prescription. However, the US Congress is now considering a bill that would make it illegal for physicians to prescribe a controlled substance to end a person's life. Consequently, some physicians may consider it risky to write such a prescription, particularly as to do so remains against professional guidelines. Physicians who do not have a large population base from which to draw patients may fear that if they participate in assisted suicide they could be the target of demonstrations outside their homes and offices, similar to those directed at physicians who perform abortions.