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For many, the inevitability of dying is too painful to contemplate. Our society is marked by a consummate denial of death; most of us prefer to pretend it doesn't exist. We shy away from making our wills and leaving instructions about the kind of end-of-life care we want. We fight the forces of nature to stay youthful, healthy, and, to the greatest degree possible, immortal. Our crusaders, the physicians, arm themselves with shiny modern machinery and powerful drugs to repel the enemy for as long as possible. Meanwhile, we remove the dying from the flow of everyday life and confine them to institutions. As recently as 50 years ago, the majority of people died at home. Today, 80 percent end their lives in hospitals and clinical care settings. And according to an important 1997 study on death and dying led by Dr. Joanne Lynn, director of the Center to Improve Care of the Dying at George Washington University School of Medicine in Washington, D.C., (published in Annals of Internal Medicine, January 1997), most of those people end their days in pain, breathlessness, depression, and confusion. Many patients are subjected to at least one form of "heroic" treatment before they die--cardiopulmonary resuscitation, or attachment to a respirator or a feeding tube--even though fully 59 percent of the patients in the study said they wanted comfort care rather than aggressive treatment in their final days of life.

As the first study to have been carried out on dying hospital patients in almost a century, Lynn's important research highlights two critical factors. First, we as a society have turned our back on death for too long. "Our cultural inclination," Lynn says, "is to disavow dying." Second, the study illuminates how stubborn physicians are in their determination to keep death at bay--even when the patients themselves make it clear that they don't want life-prolonging procedures.

Consequently, it is not surprising that so many of us fear being rushed into an intensive care ward, placed on life-support equipment, and made to linger in a state of semiexistence against our will. This particular fear seems to have grown in direct proportion to our physicians' abilities to perform these life-prolonging feats. The very measures that we once viewed as miracles of modern medicine can now be seen in a more critical light: Now we know that machines designed to prolong life can sometimes do nothing more than prolong the dying process. Many who once considered death too unpalatable to contemplate are beginning to realize that living can be worse than dying. As a result, more and more suffering people are asking their physicians to help them die, not keep them alive.

For these reasons, the right-to-die movement has emerged as an urgent social concern for the next century. It is the last frontier for personal choice or, as some regard it, the ultimate human rights crusade. The implementation of this "right" would cause a profound social revolution for the medical profession, the religious community, bioethicists, lawyers, philosophers, and, of course, for us, the patients and future patients, who would be able to invoke that "right" for ourselves. According to the proponents of assisted dying, now is the time for that revolution. As one advocate put it: "We urgently need a modern set of ethics for a modern state of medicine."

The supporters of the right-to-die revolution are a variegated bunch: a loose coalition of physicians, lawyers, ethicists, and ordinary men and women, most of whom are united by their experiences with painful, protracted death. Their desire for a "good death"--a "death with dignity," as their inspirational mantra has it--is not simply an abstract concept or a worthy social principle. At the heart of almost every person's wish to take charge of his or her own death lies the story of a terrible end-of-life struggle of someone dear to them. Those who have witnessed a loved one lingering on to a desperate end, physically unable to let go of life--either because of medical intervention or the lack of it--have a particular determination not to meet the same fate themselves. That is why they joined one of the many right-to-die organizations such as the Hemlock Society, or Compassion in Dying, or are fighting to get the laws changed in their particular state. It is also why, as the movement has gained in momentum and respectability, they remain such dogged campaigners: As they say, the price of the status quo is just too high to pay. Pitted against these campaigners are people who are just as fervent in their opposition: For them too, the stakes are high. Wresting control of death, they counter, represents metaphysical trespassing into God's domain, and it would seriously violate the integrity of the medical profession and its age-old oath to "do no harm." An increasingly vociferous group of opponents even fears that legalizing physician-assisted death could mark the beginning of society's moral descent toward a new kind of national eugenics program, in which the mentally and physically disabled would find themselves unwilling victims.

Are any of these fears justified? There is nothing new about people--with or without the involvement of their physicians-helping one another to end their lives when they are suffering without hope of relief. For centuries, these acts of mercy were carried out in the shadows, heavily guarded secrets kept locked within family or medical lore. No one knows how many people have died with another's help, or how many physicians have offered their patients this kind of assistance. But legal history is dotted with court cases involving physicians and loving family members who were tried and sometimes found guilty of charges from assisting death to murder. Most have been acquitted on compassionate grounds, but not all. As a result, families in search of physician assistance once had to turn to a kind of "underground railroad"--a network of people who contacted each other through coded messages, worked together secretly to perform what was necessary, and then never met or spoke of their actions again.

The new right-to-die movement has changed all of these rules. Finally, after decades of secrets and silence, both the dying and those who have helped the dying have started speaking out about meticulous plans, about stock-piling drugs, suffocating loved ones with pillows and plastic bags, administering carbon monoxide or increased doses of morphine. People have decided to tell their stories in the hope of shaking up what they see as archaic medical ethics, challenging religious doctrine, and changing outdated laws. In a remarkably short time, they have had great success around the world. At the time of this writing, physician-assisted dying has become legal in Colombia, was briefly legal in Western Australia (where supporters are fighting to reinstate it), and is widely practiced in certain parts of Europe, most notably the Netherlands. In the United States, proponents have managed to propel their cause onto the ballots and before the legislatures of several states. In October 1997, Oregon became the first U.S. state to make physician-assisted dying legal. Supporters have also tried to get assisted dying recognized as a constitutional right in two parts of the country--on the West Coast and in the Northeast--and in 1997, managed to gain a hearing before the Supreme Court. Although the Court refused to recognize the constitutionality of assisted dying, the judges readily acknowledged that the legal debate is in its infancy: There will undoubtedly be much more ahead. . .

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