Lonny Shavelson
Berkeley, California
    When the United States Court of Appeals for the Ninth Circuit ruled on Wednesday that terminally ill, mentally competent patients have a constitutional right to physician-assisted suicide, advocates of the right to die movement hailed it as a civil rights triumph. That is true, but the celebration must be tempered with respect, caution and careful planning.
    Judge Stephen Reinhardt, in his majority opinion overruling a Washington State law forbidding physician-assisted suicide, launched a new era of civil liberties for the dying: “A competent, terminally ill adult, having lived nearly the full measure of his life, has a strong liberty interest in choosing a dignified and humane death.” Thus in California and the eight other states under the court’s jurisdiction, physicians have suddenly gained the right to prescribe lethal doses of medication for those who are suffering greatly.
    The decision will likely be appealed to the Supreme Court. However, if this decision stands, it alone will not substantially improve overall medical care for the terminally ill. That’s because the “civil right” long sought by those with terminal illnesses is not merely the right to a deadly dose, it is the right to a dignified death.
    But that idea has been lost in the recent hullabaloo around the latest trial of Dr. Jack Kevorkian. Public attention has focused more on assisted suicide than on the dignity that dying patients truly desire.
    If we really want to make sure that patients have the right to a dignified death, shouldn’t we see that they have the right to hospice care, home nurses, pain relief medication and even such mundane things as care for bed sores and some good company during their final days?
    It is, of course, not in the realm of the courts to grant such “privileges.”  Giving patients a dignified death is up to hospitals, doctors, nurses, medical ethicists, medical boards, insurance companies and government, which now must begin to create a system to comply with the court’s ruling to allow lethal prescriptions.
    As a start, insurers, health maintenance organizations and Medicare should encourage and pay for the terminally ill to use hospices, which are the most effective and least expensive route to a dignified death. Tragically, a mere 10 percent of terminally ill Americans are even offered hospice care.
    The American Medical Association and the National Hospice Organization, which oppose physician-assisted suicide, should acknowledge that for the few patients who cannot be made comfortable by hospice care, physician-assisted suicide is an alternative.
    The Hemlock Society and other right-to-die groups must make greater efforts to help patients find, hospices and not just provide information on how to end one’s life.
    Medical schools and professional organizations should see that doctors get adequate training in caring for the terminally ill. A large majority of physicians have little knowledge of pain control and comfort care.
    Insurance companies, physicians and right-to-die advocates should make sure that a prescription for an overdose is always preceded by a consultation from a hospice team.  This would insure that the fewest patients possible ever reach the point of desperation. 
   The courts have wisely granted patients a new civil right.  Now society and health care professionals must set standards guaranteeing that Americans have gained more than the mere access to a stash of deadly pills.

    Lonny Shavelson, a physician, is the author of “A Chosen Death: The Dying Confront Assisted Suicide.”