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Doctors who work with AIDS patients in particular are aware of the underground system that provides the information and the means for suicide. "You have to understand what it is I see," says a Los Angeles doctor, who has prescribed medication that he knew would likely end up killing his patient. "I see people in agony. Most of my patients are pretty sophisticated. They know the exact dosage that will kill them. By God, if someone is dying, far be it from me to say 'Hey, tough it out.' "
But even physicians who spend all their days with the terminally ill are divided over Kevorkian's answer to the problem of pain. Some may respect the patients' decision to kill themselves but draw the line doing it for them. To withdraw treatment merely allows the disease to do the killing. A lethal injection is altogether different. "Medicine is a profession dedicated to healing," the American Medical Association has declared. "Its tools should not be used to kill people."
So far every effort to move the practice out of the legal half-light runs into practical and philosophical trouble. A good law is hard to write, harder still to enforce and easy to abuse. First in Washington and last year in California, voters turned down initiatives that would have legalized assisted suicide if a patient wrote out a "death directive" that was witnessed by at least two people who did not stand to benefit from the death. Doctors would need independent confirmation that a patient had six months or less left -- a judgment that is notoriously unreliable. "It's naive to believe it can be regulated," notes ethicist Daniel Callahan of the Hastings Center in Briarcliff Manor, New York. "There's basically no way you can regulate something that takes place in private."
As proof, ethicists point to the world's euthanasia laboratory, the Netherlands, where for almost 20 years the courts have not convicted doctors who assist in suicides at the explicit request of the patient. Last February, the Dutch parliament moved to give doctors the actual right to do so -- if they follow strict guidelines for second opinions. Yet a 1991 study found that in one year more than 1,000 Dutch patients who were not capable of giving consent died at their doctors' hands.
That finding fueled the fears of ethicists who believe that legal assisted suicide could become an instrument to meet social or economic goals, even "altruism." For example, people over 65 spend 3 1/2 times as much on health care as younger people. "It would be a terrible burden to put on the disabled, the dying and the weakened elderly, especially at a time when there is enormous pressure to cut medical costs," says Father Richard McCormick, professor of Christian ethics at the University of Notre Dame. "They would constantly ask themselves, 'Should I ask for it, is now the time?' "