DEATH AND DYINGhumane death rather than being reduced at the
end of his existence to a childlike state of
helplessness—diapered, sedated, incompetent.The case was striking not only for its human
interest but also because it invoked the guarantee
of personal liberty in the Fourteenth Amendment
to the U.S. Constitution. Shortly thereafter a New
York statute was struck down by the U.S. Court of
Appeals for the Second Circuit (Quill 1996), which
had argued that if physicians were allowed to help
people die it would put society on a slippery slope
leading inevitably to abuse. The court pointed out,
however, that physicians are not killers if they
prescribe drugs to hasten death any more than
they are killers when they discontinue life supports.
As expected, both cases were sent to the U.S.
Supreme Court which has, at this writing, let stand
state laws that prohibit any form of physician-
assisted suicide. But the issue is far from settled.
The Court’s decision concluded with this surpris-
ing statement by Chief Justice Rehnquist:
Throughout the nation, Americans are engaged
in an earnest and profound debate about the
morality, legality and practicality of physician-
assisted suicide. Our holding permits this
debate to continue.This statement was all the more remarkable
since the chief justice, in his long opinion, rejected
both the ‘‘liberty’’ and ‘‘due process’’ constitution-
al arguments, but came far short of putting the
matter to rest. Indeed, continuing developments
indicate that the question of physician-assisted
suicide is not likely to go away soon. For example,
the State of Oregon has passed two voter referen-
da, the most recent in 1998 with a 60 percent
majority support which makes Oregon the only
state (as of 1998) to permit, under strict condi-
tions, physician-assisted suicide. The State of Michi-
gan has rejected an Oregon-type statute and has
finally convicted Dr. Kevorkian of second degree
murder. Several other states are reported to be
experimenting with alternatives that enhance the
‘‘right’’ of the individual to choose to die (for
details of these developments see The Hastings
Center reports). It may be that the law is overreaching
its capacity to deal with such a basic and philo-
sophical issue. The question is profound. Is there
any logical (or sociological) difference between
the right to refuse treatment designed to prolong
life and a parallel right to receive treatment de-
signed to hasten death? Sociologists would ask:
What is the distinction between the acceptance of
death and its acceleration? Is the question so ab-
stract that it defies empirical inquiry? Both the
medical and legal answers to the issue are ambigu-
ous and have been discussed in a book by a physi-
cian who publicly admitted helping a patient to
die. Dr. Timothy Quill not only was the main
plaintiff in the New York case, but he has become
the leading medical voice on issues of assisted
suicide. He writes with authority and sensitivity:
‘‘Death seems antithetical to modern medicine—
no longer a natural and inevitable part of the life
cycle, but a medical failure to be fought off, ig-
nored, and minimized. The dark side of this des-
perate battle has patients spending their last days
in the intensive care units of acute hospitals, tubes
inserted into every body part, vainly trying to
forestall death’s inevitability. No one wants to die,
but if we have to, there must be a better way’’ (for
an account of the issues see Quill 1996).The Quality of Dying. Sociological concern
with assisted suicide has been paralleled with con-
cern for how people die. It had been hoped that
the PSDA not only would make advance directives
more effective, but would also bring about better
communications between doctors and terminal
patients. The act, however, was deemed a failure
even before it was formally put in place. An im-
pressive experiment, of great sociological interest,
was designed to solve these basic issues. Funded
and launched by the Robert Wood Johnson Foun-
dation, it was the advance directive problem cast in
research terms. The ‘‘Study to Understand Prog-
noses and Preferences in Risks of Treatment’’
carried such an unwieldy title that it was quickly
shortened to the acronym SUPPORT (for a de-
tailed account see The Hastings Center special
supplement that carries the subtitle ‘‘The Lessons
of SUPPORT’’ 1995). Five teaching hospitals were
invited to participate in this multimillion dollar
project. Phase One called for baseline data on the
end-of-life experiences of some 9,000 dying pa-
tients. When the data were analyzed, the research-
ers were not surprised to find much to criticize in
various regimens of hospital care. Their main
finding, however, was that doctors and attending
nurses must attend not only to the physical com-
fort and pain management needs of patients but,
more importantly, to their psychosocial needs.