DEATH WITH DIGNITY: Choices and Challenges.

• Author: GIRSH, FAYE

Terminally ill patients' right to refuse medical treatment has been established, but the issue of physician-assisted suicide remains a hotbed of controversy.

WHILE AMERICANS consider themselves free to live the lives they choose, most don't realize that this freedom ends when it comes to selecting a peaceful death over a life filled with unbearable pain and suffering. Euthanasia advocate Jack Kevorkian's conviction of second-degree murder for assisting in the nationally televised suicide of terminally ill Thomas Youk has shown that, despite achieving great legal successes over the last 25 years, Americans have a long way to go in securing the freedom to die with dignity when confronted by terminal illness.

Interest in the right-to-die issue has become increasingly important as people are now enjoying longer, healthier lives than at any time in history. Diseases that kill suddenly and prematurely have been virtually wiped out in developed countries. What are left are conditions that often result in lingering, agonizing declines--cancer, stroke, Parkinson's disease, and amyotrophic lateral sclerosis (Lou Gehrig's disease), to name a few. Ninety percent of the people who die each year are victims of prolonged illnesses or have experienced a predictable and steady decline due to heart disease, diabetes, or Alzheimer's disease.

Medicine can keep people alive with artificial organs, transplants, and machines--even artificial food and water--rather than allowing a terminally ill patient a quick death through pneumonia or organ failure. Modem medicine often does more than prolong living--it actually extends dying.

A study of dying patients in five major medical centers revealed that 59% would have preferred to receive just care to make them more comfortable, instead of the aggressive treatment they got. Another study surveyed Canadian patients who identified five areas of importance at the end of life: receiving adequate pain and symptom management; avoiding prolonged dying; achieving a sense of control; relieving the burden on loved ones; and strengthening relationships with people.

A big advancement in caring for terminally ill patients has come with the growth in hospice care, which started with one facility in 1974 and has grown to almost 3,000 nationwide, making it accessible to most Americans. Hospice care is designed to control pain and provide physical and spiritual comfort to those who are dying. It neither prolongs nor hastens death. While hospices have dramatically improved end-of-life care, there remains a serious gap between the choices people want at the end of their lives and what they are now permitted.

Patients' rights at the end of their lives take two forms--the right to refuse medical treatment when faced with inevitable death and the right to secure a doctor's help in ending suffering at the end of life. It took the deaths of two young women--Karen Ann Quinlan and Nancy Cruzan--to give every American the right to make medical decisions in advance. Both had gone into irreversible comas following accidents and, after lengthy legal battles, their parents received permission from the courts to disconnect their daughters' life support.

In Cruzan's case, which took place 14 years after Quinlan's, the Supreme Court ruled that every American has the right to refuse unwanted medical treatment for any reason, even if it leads to death. This includes the right to refuse food and fluids. Justice...