As physician-assisted suicide reaches the level of Supreme Court review, the debate is escalating on many fronts. From the religious perspective, one opposes doctors' right to "play God". From a medical viewpoint lies the Hippocratic Oath and the commitment to promote health, not death. Moral and legal concerns focus on the "slippery slope" and the fear that people will be coerced to chose death when their lingering life becomes expensive and burdensome. And societal arguments pose that we should not hasten death in a context in which all citizens do not even have access to health care. Yet, no single argument encompasses the complexity of the issue; each can be refuted within the context of the system - medical, legal and social - that we have created and that we continue to accept.

Technology has evolved to the extent that doctors do or are expected to play God. We demand perfection of them and we punish their errors. If our heart or liver fails, we get a transplant. If our lungs or kidneys fail we are hooked to a machine that takes over for the malfunctioning system. In terminal illness, we are sustained long beyond the point at which God would have intervened, if unassisted. (Is not all of medicine an interference with nature; with bacteria and viruses, diseases of aging and heredity, and therefore, an act of God?) While physicians provide comfort care, studies show that the majority of patients do not receive adequate pain management because of reluctance to over-prescribe narcotics, the fear of addiction, etc. Yet fear of intolerable pain is a major concern among terminally-ill patients.

If we were to truly value life, we would demand adequate and reasonable (not heroic) medical care for all. The fact is, we do not, and this lack of concern may translate to an acceptance of hastening death for those in whom it is imminent. The potential for misuse of physician-assisted suicide cannot be ignored, and its legalization would certainly need to include checks and balances to control the practice. Unfortunately, one cannot expect to find the perfect answer in the face of a far-less-than perfect medical and legal system, and it is doubtful that an equitable system will be in place in this writer's lifetime. Until it is, perhaps personal choice is a reasonable option. After all, the choice to live or die is one that we already make, every day.