Death is universal, but that doesn't necessarily make assisted suicide a universal right.

Dr. Jack Kevorkian, whose willingness to facilitate the death of terminally ill patients earned him admiration, condemnation and ultimately jail time, died today. He argued unrelentingly that consenting patients should be allowed to alleviate their suffering with the help of a physician, and dismissed his critics as being in thrall to superstition or religious dogma.

For some, Dr. Kevorkian was crusading for an inviolable civil right. For others, his work invited the insidious consequences of turning doctor-assisted suicide into a legally sanctioned medical treatment. A patient's right to refuse treatment is not in dispute. Rather, critics argue that making assisted suicide an option diminishes the patient's incentive to pursue other treatments and runs the risk of prematurely ending lives.

We should be fighting for the right to decent end of life care, said Herbert Hendin, a psychiatrist who has done extensive research on the issue. If you ask people if they want the right to die of course people want the right to die, but it's a spurious right. More important is the right to have the care that is necessary.

Hendin has studied assisted suicide both in the Netherlands, the first country to legalize the measure, and in Oregon, the first U.S. state to do so. He said that more emphasis should be placed on easing someone's last days through palliative or hospice care, adding that doctor support for assisted suicide is often born out of a desire to actively help and administer some form of treatment. He recounted a woman in the Netherlands whose wish to stay alive was overruled by well-intentioned doctors.

Why shouldn't she be able to end her life how she wants to? he asked. Pain was less important to her than her convictions but they justified it on the basis of compassion. That's not compassion, that's stupidity.

The Supreme Court has ruled that the issue should be left to the states. Currently, Oregon and Washington have laws allowing doctor assisted suicide if patients have a life expectancy of six months or less and express their consent three times: twice orally and once in writing. A Montana Supreme Court ruling safeguards the practice by allowing doctors to offer proof of a patient's consent as a defense against charges of murder (Kevorkian was found guilty of second degree murder for euthanizing a terminally ill man whose desire to die was emotionally recounted at the trial by family members).

But the measures in Oregon and Portland may not be enough, according to Rita Marker, executive director of the Patient's Rights Council. She noted that the law does not require witnesses to the euthanizing, so that unclear if patients choose deadly overdoses voluntarily. And there is a grim financial calculus at work, Marker said -- assisted suicide is less expensive than continued treatment and more likely to be covered by insurance providers.

We have to ask ourselves the question, do we really expect government bureaucrats or profit-driven insurance companies to do the right thing? Marker said. If we were in a philosophy class arguing about it that's one thing but we're talking about the real world and it's driven by costs.

For the Final Exit Network, the solution to this legal morass is to remove the doctors. People with irreversible illnesses who wish to die submit an essay and a copy of their medical records to the organization. If a team of doctors and psychologists determine that an applicant is rational and has a terminal disease, then the Final Exit Network provides that person with information on how to end his or her life, counseling and, if they wish, companionship in their waning hours.

We believe that mentally competent people who are suffering from an irreversible illness and have an unbearable pain have the right to end their life free of any restrictions, no matter how well intentioned they may be, said board member Frank Kavanaugh. He added that the group does not encourage people to end their lives or provide the means to do so. The group is currently arguing a case before the Supreme Court in Georgia over charges that they assisted an Atlanta man's suicide.

This model of people circumventing the legal and medical system and taking matters into their own hands is likely to gain wider use as assisted suicide becomes less stigmatized, said Jason Hannan, a scholar on the topic at Northwestern University. He said that the debate over assisted suicide reflects a broader moral shift, as a religiously informed belief in the absolute sanctity of life slowly gives way to an emphasis on individual liberty.

On the one hand as a culture we do want and advocate the rights of the individual, but there's something about the very idea of the right to die that seems to cross a moral barrier, Hannan said. What we're seeing now is this conflict between the new view, which is that we have complete and total sovereignty over our bodies, and this more traditional view that very strongly sees something wrong with suicide.

It's an issue that's not going to go away any time soon because death is not going to go away any time soon, Hannan added. What Kevorkian did is hammer this issue into the public consciousness and force us to take a stand.

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