Two years ago, voters in Washington state turned down an initiative that would have legalized the participation of a physician in the suicide of a terminally ill patient. At the time, some supporters of the proposal laid some of the blame for the defeat on Dr. Jack Kevorkian, whose highly publicized participation in several suicides may have helped "put a face on the fears" that surround this controversial issue. Dr. Kevorkian is still thwarting authorities in Michigan, his home state, but some physicians, nurses and clergy in Washington state have decided that the field shouldn't be left to one maverick zealot.
A group calling itself Compassion in Dying has set up shop in Seattle, offering assistance to terminally ill people in great pain who wish to end their lives rather than letting their illness play itself out.
Like Dr. Kevorkian, the group will take advantage of ambiguity in the law. But unlike Michigan, Washington state does outlaw suicide assistance. However, the scope of its 1975 law is open to interpretation, since it does not clearly define key terms like "promoting" suicide or "causing or aiding" another person to attempt suicide.
The organization is a vast improvement over Dr. Kevorkian's approach. It will not provide people with the means to commit suicide -- they are expected to obtain lethal doses of drugs from other sources -- but it does promise counseling and a comforting presence at the time of death. Deaths would take place at a client's home, but the organization would not reveal names or the time and place of death.
One other difference: the organization will require the judgment of two physicians, at least one of whom is not affiliated with the group, that the person has six months or less to live, is in pain and is mentally competent to make such a decision.
Even so, the new group is entering a risky business. Compared to Dr. Kevorkian's Lone Ranger approach, its safeguards are admirable. But they are not foolproof. Medical records and a few counseling sessions cannot substitute for the kind of long-time, established physician-patient relationships that are required in the Netherlands, where euthanasia is not prosecuted when cases meet certain strict standards. Moreover, determining life expectancy is a famously inexact science.
But perhaps the most troubling aspect of any effort to lend assistance to people who want to end their lives is the inescapable fact that, under current circumstances, any such decision is made in the context of a health care system riddled with inequities. Until this country comes up with a way to provide all its citizens with reasonable access to medical care, it will be impossible to ensure that grave decisions about life and death are fully insulated from worldly worries about dollars and cents.