Debate on patients' right to medical aid with suicide picks up momentum.

The controversy over whether terminally ill patients have the right to get help from physicians in hastening death has heated up in recent months. Seattle lawyer Kathryn Tucker and New York lawyer Carla Kerr filed suit in New York federal court to overturn an 1881 state statute forbidding physician-assisted suicide. (Quill v. Koppell, No. 94 Civ. 5321 (S.D.N.Y. filed July 20, 1994).) The action followed hard on the heels of Tucker's victory in a similar suit in Washington. (Compassion in Dying v. Washington, 850 F. Supp. 1454 (W.D. Wash. 1994), appeal docketed, No. 94-35534 (9th Cir. June 10, 1994).)

The New York suit was filed on behalf of three doctors who treat the terminally ill and three dying patients. The lead plaintiff, Dr. Timothy Quill of Rochester, New york, published an article in the New England Journal of Medicine in 1991 on how he had helped a terminal patient commit suicide. This led to a criminal investigation, though no charges were ever filed.

In the Seattle case, Judge Barbara Rothstein struck down the state criminal law prohibiting doctors from helping patients commit suicide on the ground that the law impermissibly burdens liberty interests of the terminally ill. Rothstein ruled that the Due Process Clause of the Fourteenth Amendment protects rational adults' interest in getting help when they need to hasten death. Since the state constitution permits dying patients to refuse life-support treatment, she reasoned, the bar also violates the Equal Protection Clause.

"There is no more profoundly personal decision, nor one that is closer to the heart of personal liberty, than the choice that a terminally ill person makes to end suffering and hasten an inevitable death," Rothstein wrote. "From a constitutional perspective, the court does not believe that a distinction can be drawn between refusing life-sustaining medical treatment and physician-assisted suicide by an uncoerced, mentally competent, terminally ill adult."

The decision acknowledged the state's interest in deterring suicide by healthy people or those being influenced to do so, but said this interest does not apply to the competent terminally ill.

The spring of 1994 saw a number of landmark events in the controversy.

* The Seattle ruling came a day after a jury in Detroit acquitted Dr. Jack Kevorkian of breaking the Michigan ban on assisting suicide. (People v. Kevorkian, No. 93-10158 (Mich., Detroit Recorder's Ct. May 2, 1994).)

A week later, the appellate court reinstated two earlier murder charges against Kevorkian, but on technical grounds it struck down the state law that forbade assisted suicide and established the Michigan Commission on Death and Dying. (People v. Kevorkian, No. 154740 (Mich. Ct. App. May 10, 1994), leave to appeal granted, No. 99674 (Mich. June 6, 1994); Hobbins v. Attorney General, No. 164963 (Mich. Ct. App. May 10, 1994), leave to appeal granted, Nos. 99752 & 99758 (Mich. June 6, 1994).)

In granting leave to appeal, the state supreme court reinstituted the law on a temporary basis so the commission could issue a long-awaited report and recommendations on assisted suicide. Case hearings were set for October 4. (Top Michigan Court Reinstates Assisted-Suicide Ban, for Now, N.Y. Times, June 8, 1994, at A21.)

* The New York State Task Force on Life and the Law, an influential advisory panel, recommended in May that the legislature not legalize assisted suicide for the terminally ill. The panel said legalization might influence some doctors to prescribe deadly drugs for those who are dying, in severe pain, or badly depressed, instead of trying to relieve their pain and improve their care. (Elisabeth Rosenthal, Panel Tells Albany to Resist Legalizing Assisted Suicide, N.Y. Times, May 26, 1994, at Al.)

Tucker said this report was one factor in the decision to file Quill v. Koppell. "The report sets back the prospects for legislative reform. There's still a possibility, but this is a terribly sensitive issue politically. A judicial determination as to constitutionality will be a cleaner and speedier way to protect patients' Fourteenth Amendment right to access this essential medical service."