No verdict in assisted-suicide debate

With Jack Kevorkian facing what could be a lengthy prison term, euthanasia's crudest advocate appears to be out of action. Yet the debate he has come to symbolize rumbles on.

Perhaps more than anyone, the controversial doctor has pushed the United States to confront issues of death. There remains broad support for what Dr. Kevorkian represents - even if not for his attention-grabbing methods.

"People say, 'Maybe he's crazy, but we'll take it because the medical profession isn't helping us enough,' " says Joel Frader, an associate professor of medical ethics at Northwestern University in Evanston, Ill.

That feeling of isolation and helplessness among a growing number of people is causing the right-to-die debate to escalate on a number of fronts.

* It continues in the growth of groups that help ailing people decide if they want to commit suicide - and assist them if they do.

*It continues in medical schools, where more young doctors are trading some of their prolong-life-at-all-costs ethic for a newfound empathy for those facing death.

*It continues in state legislatures, where at least three states will take up bills to legalize assisted suicide this year.

Indeed, Kevorkian's six-year personal crusade ended Friday (at least temporarily) when a Michigan jury convicted him of second-degree murder. But many people feel society - and the medical profession especially - have a long way to go in caring for those diagnosed with life-threatening illnesses. It's perhaps not entirely a coincidence, for instance, that the number of hospices grew from 31 in 1984 to 2,274 in 1997.

The most dramatic assisted-suicide action is happening in the Northwest. Oregon is the only place in the country where assisted suicide is legal. Last year, 21 people - fewer than many critics expected - decided to exercise this option.

One group, Compassion in Dying, helps people in Oregon who have been diagnosed with terminal diseases weigh all their options - including suicide - or hastening death, as group members call it.

But the group is working outside Oregon, too. Its Washington chapter deals with between eight and 15 patients a month, only some of whom decide to commit suicide. Last year, two people did so. So far this year, four people have done so.

After years of reluctance, the Denver-based Hemlock Society recently began providing a similar service.

These groups distinguish themselves from Kevorkian. They stop working with patients, for instance, who the group believes might be clinically depressed. But they do tell patients which drugs they need to commit suicide. Patients must take the medication themselves, but case workers offer to be present when they do.

COMPARED with Kevorkian, "a lot more people believe in our way," says the Rev. Michael Bonacci, executive director of the Washington State chapter of Compassion in Dying. "We have a lot less theatrics."

Indeed, part of the lesson of Kevorkian's conviction, observers agree, is that he went too far by taunting prosecutors - and by carrying out a euthanasia himself, rather than assisting the patient. Groups like Compassion in Dying hope to be less dramatic.

But that's what critics say is so dangerous. "They're more subtle and less in-your-face," says Clarke Forsythe, president of the Chicago-based Americans United for Life. "But they have the same goals as Kevorkian."

There is, however, consensus among supporters and opponents of assisted suicide on one point: More must be done to help those who seem to be nearing death.

Witness the growth of hospices in the US. They work to ease patients' pain through spiritual and emotional counseling and support - as well as medication.

There's also new evidence of mainstream medicine confronting the issues Kevorkian raises. Doctors are getting training on being more compassionate - and not so coldly clinical - with those who have been diagnosed with a terminal illness.

And more medical students are taking classes on "spirituality" - which focus on helping patients with emotional and spiritual issues. In 1994, two medical schools had these classes. Today 62 of the nation's 126 schools have them. Most observers applaud these changes, although some conservatives worry that doctors will lose their traditional "sanctity of life" ethic.

Finally, there are the legislative battles. Connecticut, Massachusetts, and Arizona are expected to take up assisted-suicide bills this year. Next year Maine will likely tackle the issue in a ballot initiative.

On April 14 Kevorkian will be sentenced on the murder charge and a lesser charge of delivering a controlled substance. Even if he receives a life sentence, the debate he helped bring to the public forum rolls on.