License to kill.

We must all die. But prosperity, good food, and medical advances allow that day, at least in most advanced industrial countries, to be postponed far beyond any time dreamed of by our ancestors. The biblical golden age of threescore and ten has become commonplace. And where advanced old age is not reached, still many older people manage to live with ills that rapidly ended the lives of their parents or grandparents.

Because death has been staved off for so long for so many, achieving the end of life in a "good" death has actually become more ambiguous and more problematic. People linger in states of physical pain and spiritual or psychological suffering, sometimes attached to tubes and monitors, or sometimes abandoned in nursing homes, half-comatose and badly cared for. There is surely something paradoxical in living a life where death comes to seem a far preferable alternative, but which, nonetheless, stands just beyond the grasp of the suffering and dying.

Such are the scenarios that drive the movement for physician-assisted suicide. People who have watched parents, spouses, friends, even children dying so painfully, or who fear such an end for themselves, may become ready supporters of proposals that would allow physicians to legally prescribe lethal doses of drugs with which dying persons might kill themselves. It seems simple enough to execute. Furthermore, it plays into a well-honed American instinct - to be able to choose for oneself. Couching the proposed law within apparently strict limits, by restricting the practice to the competent and the conscious, allows voters to say to themselves, "I would never choose this myself, but who am I to keep others from choosing it?"

Something like this argument must be running through the minds of many Michigan voters, who will face "Proposition B" favoring physician-assisted suicide on the November 3 ballot. It is far from clear how the vote will turn out; those favoring Proposition B hold a slight lead in the polls.

Certainly the citizens of Michigan have had a long time to consider the matter. The state is the home of Dr. Jack Kevorkian, who has "suicided" 120 people since 1990. Strenuous efforts by state prosecutors to rein him in have been rejected by four juries who seem to have focused on the suffering of the victims rather than the guilt of their killer. At least some of those supporting Proposition B say they do so in the hope that it will put an end to Kevorkian's free-lance efforts; indeed, a good number of his victims would not qualify under Proposition B's provisions. But neither is it likely that Kevorkian would abide by those provisions should the referendum pass and become law.

The case against physician-assisted suicide, which is essentially a moral case (thou shalt not kill; thou shall not help others to kill themselves), is straightforward and clear. For centuries, it has been enshrined in medical ethics, the common law, and statutory law. But the effect of watching, or hearing about, needless pain and suffering at the end of life clearly has a powerful appeal to jurors, and voters. And for many the core belief that life is a gift of God has been replaced by the notion that life is an accident of nature.

As opponents to physician-assisted suicide discovered in their unsuccessful efforts to prevent a similar measure from becoming law in Oregon, mounting a convincing case is not easy, or necessarily straightforward. The moral case, particularly if it is advanced by religious groups, especially the Catholic church, can bring forth charges of violating the separation of church and state, and can unleash ugly anti-Catholic prejudices. In fact, some analysts believe the Oregon vote for physician-assisted suicide may have been tipped in its favor simply because of Catholic opposition to it.

But there are realistic, pragmatic, practical arguments that can help to unmask the notion that each of us is and ought to be the ultimate master or mistress of his or her own fate - and the parallel idea that legalizing assisted suicide is a way of expressing our mastery at end time. What might be termed a nation-sized pilot project conducted in Holland demonstrates that when physician-assisted suicide is permitted and becomes the social custom of the land, it will be gradually extended to persons who are not terminally ill, who are not competent, or who are not even conscious. When the arguments favoring assisted suicide are pursued to their logical conclusion, they lead inexorably to expansion of the categories of people who will be allowed to take their own lives or have their lives taken from them - quite possibly with the encouragement of others whose interests may be in conflict with the dying person's.

However pragmatic such arguments may be, they have substance. Opponents of referenda such as Michigan's Proposition B need to organize coalitions with sufficient resources to educate the public, and they need to offer political arguments in keeping with their own moral position. In Michigan, the coalition, "Citizens for Compassionate Care," has focused on such arguments and drawn attention to problematic aspects of the proposed law. The Michigan Catholic Conference is part of the coalition. At the same time, Michigan's Catholic bishops have developed their own parish-based program to remind Catholics of the basic theological and moral reasons for rejecting physician-assisted suicide.

This two-pronged strategy is important because in the first instance it may help defeat a bad law that would have the most serious consequences for individuals, families, and doctors. In the second instance it may help make people more astute and thoughtful about death and dying, about what kind of "choice" the voters of Michigan will be making.