Decisions to die for.

• Author: Griffin, Denise
• Position: Assisted suicide

Courts, legislatures, medical groups and religious leaders are struggling with the complex question of death by choice.

March 6, 1996 - The U.S. Ninth Circuit Court of Appeals finds Washington state's ban on assisted suicide unconstitutional. The ruling affects nine states.

* March 8, 1996 - Dr. Jack Kevorkian, prosecuted under a now-expired Michigan law, is acquitted of criminal activity for assisting in the suicides of two patients.

* April 2, 1996 - The U.S. Second Circuit Court of Appeals rules New York's assisted suicide ban unconstitutional. Three states are affected.

* May 14, 1996 - Kevorkian is again acquitted of any crime for assisting in two patient suicides, this time under Michigan common law.

Two major court rulings in less than a month and a second and third acquittal for Kevorkian in two years represent unprecedented activity on the issue of assisted suicide. March also marked the 20th anniversary of the Karen Ann Quinlan case that first raised the national consciousness about the right to die. In a landmark ruling, the New Jersey Supreme Court found that the right to privacy included the right to refuse life-sustaining treatment. Twenty years later, the quickening debate over the right to die - whether by active intervention or treatment withheld - has developed a notable shift.

With a rapidly aging population and shrinking health care funds, the economics of end-of-life medical care come up as often as the issue of bioethics. The statistics are staggering. The 1995 White House Conference on Aging reports that the nation's elderly population, now 33 million, is expected to reach 77 million by 2030; one in five U.S. citizens will then be over 65. The fastest growing segment of the population is over age 85 and will number nearly 9 million by 2030, according to the U.S. Census Bureau. The federal government currently spends nearly 10 times as much on every person over 65 as it spends on those under age 18.

"I'm scared of the whole medical system in terms of economics," says Rashi Fein, who teaches the economics of medicine at Harvard Medical School. "This is an area where there is tremendous economic advantage to not getting involved with keeping people going. But I come down grudgingly on the side that regulation can come much closer to keeping us honest than the unregulated, underground system we have now." Fein says he is "increasingly troubled" about doctors participating in assisted suicide and that this role may in the...