The twin issues of euthanasia and physician-assisted suicide have sparked intense debate over the years, from Jack Kevorkian, to the Terry Schiavo battle, and to the recent Supreme Court ruling on Oregon's Death With Dignity Act.

Proponents of euthanasia and physician-assisted suicide believe that it is the compassionate choice. They feel that terminally ill people should have the right to end their pain and suffering with a quick, dignified death.

Opponents of euthanasia and physician-assisted suicide worry about a "slippery slope" from euthanasia to murder. They value life at all stages and fear that legalizing euthanasia will unfairly target the poor and disabled.

Doctors, lawyers, philosophers, and religious leaders have been debating the euthanasia issue for over two millennia. The topics below are arranged to give readers an overview of the modern debate.

A second consequence of the common sense point concerns the acts of suicide and submission to euthanasia that would in fact occur as a result of legalization. One natural way to understand the thought that killing yourself is harder than having someone do it for you is that killing yourself requires firmer resolve. The element of passivity involved in your letting another perform the unpleasant task of putting you out of your misery means that your will is not as active as it would be if you performed the task yourself, and thus weakness or irresolution in the will is less likely to cause failure, less likely to cause an interruption in the lethal action.

Conversely, then, a completed act of suicide warrants more confidence in its having issued from a will that was strong or resolute than does a completed act of submission to euthanasia. Accordingly, though any act by which a person deliberately hastens his or her death raises concerns about its voluntariness, there is less reason to worry, other things being equal, about the voluntariness of suicide than about the voluntariness of submitting to euthanasia..."

In physician-assisted suicide the patient acts last ... whereas in euthanasia the physician acts last by performing the physical equivalent of pushing the button. In both cases, however, the choice rests fully with the patient. In both the patient acts last in the sense of retaining the right to change his or her mind until the point at which the lethal process becomes irreversible.

How could there be a substantial moral difference between the two based only on this small difference in the part played by the physician in the causal process resulting in death?"

I am told that this is nonsense in our age of highly advanced medical ethics. And American advocates of euthanasia often point to the Netherlands as a model -- a place where euthanasia is quasi-legal for patients who request it...

Yet the September 1991 official government Remmelink Report on euthanasia in the Netherlands revealed that at least 1,040 people die every year from involuntary euthanasia. Their physicians were so consumed with compassion that they decided not to disturb the patients by asking their opinion on the matter."

In the Netherlands we have a living laboratory in which the euthanasia experiment in being conducted, and it is claimed that active non-voluntary and involuntary euthanasia are openly practiced there, exactly as predicted by the slippery slope argument. But the claim of the open and common practice of involuntary euthanasia has been often repeated but has never been substantiated, and indeed has been repeatedly challenged."

It is worth noting that such nonreligious organizations as the American Medical Association, the American Geriatrics Society, the American Hospital Association, and the National Hospice and Palliative Care Organization are strongly opposed to legalization for reasons that are obviously medical and social."

Casey and Cruzan provide persuasive evidence that the Constitution encompasses a due process liberty interest in controlling the time and manner of one's death -- that there is, in short, a constitutionally recognized 'right to die.'"

So, for both patients and their loved ones, real decisions are demanded: When do we stop doing all that we can do? When do we withhold which therapies and allow nature to take its course? When are we, through our own indecision and fears of mortality, allowing wondrous medical methods to perversely prolong the dying rather than the living?

These intensely personal and socially expensive decisions should not be left to governments, judges or legislators better attuned to highway funding."

The evidence for the emotional impact of assisted dying on physicians shows that euthanasia and assisted suicide are a far cry from being 'easier options for the caregiver' than palliative care, as some critics of Dutch practice have suggested. We wish to take a strong stand against the separation and opposition between euthanasia and assisted suicide, on the one hand, and palliative care, on the other, that such critics have implied. There is no 'either-or' with respect to these options."

Sometimes, because of special features of the need, or because of the special relationship, or because of the uniqueness of the knowledge involved, a physician may have a professional obligation to assist in a suicide or perform euthanasia."

If this sounds farfetched, consider the following: While discussing the recently passed Oregon right-to-die law, a spokesperson for QualMed Oregon Health Plan confirmed that it would cover lethal medications 'as a prescription' while its 'value option' plan limits hospice care to $1,000...

Just think of all the money that could be saved by HMOs if they spared the expense of treating AIDS patients or the disabled, many of whom could easily be classified as terminally ill..."

Physician-assisted suicide is not likely to save substantial amounts of money in absolute or relative terms, either for particular institutions or for the nation as a whole."

Legalized medical killing is not a new human right, it's a new professional immunity. It would allow health professionals to decide which of us are 'eligible' for this service, and exempt them from accountability for their decisions. Killing is not just another medical treatment option, and it must not be made any part of routine health care. In these days of cost cutting and managed care, we don't trust the health care system, and neither should you."

Those who oppose a right to assisted suicide predict that a substantial number of people with disabilities would be killed against their will if assisted suicide were legalized. However, there is no evidence that this has happened to people on life-support systems, who have had the right to die at least since the Cruzan decision in 1990. We believe that abuses of assisted suicide, to the extent they are now occurring behind closed doors, are less likely to continue once assisted suicide is legalized and appropriately regulated."

The calls for legalizing physician-assisted suicide arise in a social system that is inattentive to the complex physical, emotional, and spiritual needs of people as they near the end of life. Additionally, abuse is a real risk, especially among those who are elderly..."