sonal service support for home care in preference to impersonal hospital or nursing home settings.

If, one way or another, Oregon proceeds, the committee believes that its implementation of legal physician-assisted suicide should be carefully and intensively monitored. One key objective would be to learn whether legal safeguards are truly effective. A second objective would be to determine whether general deficiencies in the care of dying people influence individual choices for physician-assisted suicide and whether legalization stimulates correction of deficiencies. If the Oregon law is implemented, advantage should be taken of the opportunity to develop a more adequate factual basis for evaluating the competing claims for and against legal recognition of physician-assisted suicide.

Individual committee members had varied views about the morality, legality, and administrability of assisted suicide. The group fully agreed, however, that the current deficiencies in the provision of care for dying people are so extensive that they may provide inappropriate incentives for people to choose hastened death if that option is made available to them without accompanying remedial measures to improve their care. The nation should not need the prod of assisted suicide to drive it to act in behalf of the dying, although this committee, realistically, believes that media coverage of the assisted suicide cases has put the issues before the public and the professions in a very attention-getting fashion.

Conclusion

Reliable, excellent care at the end of life is an objective that should be supported, not impeded, by public policy. Unfortunately, some laws, regulations, and policies of public/private regulatory bodies may obstruct good care, either by their specific provisions or by the fear and misunderstanding they create. Drug-prescribing laws stand out in this regard and, in the view of the committee, warrant revisions to minimize discouragement of effective pain management. Other laws and regulations reflect an overly optimistic view of the effectiveness of laws and legal documents in clarifying how people wish to be treated when dying. Legal documents have a role to play but should not deflect attention from the more significant and complex process of advance care planning as considered in Chapter 3.

Deficiencies in care of the dying were recognized well before recent assisted suicide referenda, legislative activities, and court challenges. Nonetheless, much of the recent attention to deficiencies in end-of-life care arose only when the issue of assisted suicide came before the Supreme Court. Even if assisted suicide becomes legal, both society and the professions should feel confident that no one who chooses suicide does so because care systems are deficient in meeting their needs.



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