PUBLIC FORUM : READERS AIR THEIR VIEWS ON DOCTOR-AIDED SUICIDE.

The attractiveness of physician-assisted suicide as a solution to the problem of the physical and emotional suffering of the terminally ill is related to the access to and quality of palliative care services - pain and symptom management - in the community. The less that physicians and other health-care professionals know about the care of the dying, the more people will prefer euthanasia or physician-assisted suicide.

In The Netherlands, euthanasia and assisted suicide by physicians have been essentially decriminalized and account for 3.3 percent of the deaths per year. An additional 2.9 percent of physicians increase narcotic medications, specifically intending to shorten life.

Until 1994, no hospice or palliative care consulting service was available for the entire country. In the last three years, Dr. Zbigniew Zylicz has run Hospice Rozenheuvel in Nijmegen serving about 200 of Holland's 30,000-plus terminally ill patients a year. About 50 percent of patients referred to Hospice Rozenheuvel have been seriously considering euthanasia after suffering for weeks or months with unrelieved pain and other symptoms.

Less than 2 percent of those patients referred to the hospice end up dying by euthanasia. If expert palliative care had been applied earlier in these patients, I expect that no one would have chosen euthanasia.

It is particularly sad that general practitioners with no specialty training in palliative care perform euthanasia in suffering patients whose only options are death or inadequate medical treatment.

At the Los Angeles County/USC Medical Center, I served as director of the pain and palliative care service for more than eight years and treated more than 2,000 terminally ill cancer and AIDS patients. Twelve of those patients asked me or someone else on the pain management team for physician-assisted suicide or euthanasia. Once we treated their pain and other symptoms, 10 of these patients changed their minds and chose not to shorten their lives.

Hopefully, the failure to repeal physician-assisted suicide in Oregon and the prospect of California getting a similar statute will serve as a wake-up call for the medical profession, the politicians and the public to demand the training not only of more palliative care specialists but also of all health care professionals in the modern approach to pain and symptom management. We will also need to restructure the perverse financial incentives that are impairing the advancement of this essential part of medical care.

- David Cundiff, M.D.

Long Beach

This is and always will be a touchy subject, but we should have a choice. Yes, I'd like to see California pass the doctor-assisted suicide law.

People should be educated about the durable power of attorney. It saves a lot of headaches later.

There are many people in convalescent homes just existing. Many are never visited.

There are many situations where people's lives have become intolerable. They should have a choice not to suffer!

The law will not change things for anyone who does not believe in the ``right to die,'' but it will give a choice to those who are crying for that option.

Yes, California should pass a doctor-assisted suicide law.

- Shirley Thielman

Reseda

On behalf of the California chapters of the National Multiple Sclerosis Society - and as a woman with MS - I want to say emphatically that California should not legalize doctor-assisted suicide

Contrary to popular impressions, legalizing doctor-assisted suicide involves much more than personal autonomy or morality. It's a matter of public policy, and it would have implications and ramifications that extend far beyond individual choice.

In fact, legalizing assisted suicide ultimately would turn the ``right to die'' into a ``duty to die,'' especially for people with disabilities and serious chronic illnesses like MS. It is clear from experience that there is a serious risk of abuse and that physicians and family members, rather than patients, are likely to be the real decision makers. But less well-recognized are the subtle and indirect ways in which legalization would affect health care for everyone.

In a world of legalized physician-assisted suicide, would a health plan pay $10,000 a year for me to take an MS medication that could prevent or slow progression of the disease, or would the plan simply exclude that treatment, wait until my condition worsened to a point that I found intolerable, and then ``compassionately'' cover the cost of my doctor-assisted suicide?

And with coverage of expensive new treatments curtailed or excluded, effectively destroying the market for any resulting product, why would anyone invest in research and development for new treatments?

Rather than legalizing doctor-assisted suicide, we should be improving the quality and availability of palliative care for terminally ill patients and of support services for family caregivers and for individuals with disabilities and serious chronic illnesses.

- Laura Remson Mitchell

Government issues coordinator

California Action Network

National Multiple Sclerosis Society

Winnetka

Hundreds of people, every day, approve the removal of life-support systems from their terminally ill loved ones, thereby hastening death.

Few of us are so callous or so uncaring that we could prolong the pain, fear, anxiety and torment of our terminally ill loved ones, knowing that life for them is no longer a reality.

If we're concerned that assisted suicide might be abused, we might well be concerned about our safety under any form of medical care. If we can't trust our physicians and medical institutions to honestly and legally administer the wishes of families and terminally ill patients, then how could we trust them as they administer surgery, medications and critical care?

- Fred W. Coble 

North Hills

Should California enact a law for doctor-assisted suicide? Of course it should. Everyone should have the right to decide, if possible, how he or she should leave this life.

Why should anyone who wakes each day to a nightmare of unbearable pain and misery be forced to go on living? The ailing who don't want doctor-assisted suicide are free to end their lives any way they choose. But why should they be telling others, ``My way is the only way.''

We all, as best we can, should determine our own destinies right up to the end.

- R.L. Hutton

Burbank

For 2,400 years, since Hippocrates' time, doctors have opposed physician-assisted suicide. As a family physician in practice for 36 years, I am convinced that a physician-assisted suicide law will always remain short of safeguards that prevent abuse.

My patients know that I have great compassion for their suffering, but I will not kill them. An occasional patient has stockpiled medicine that I've prescribed in good faith and has taken his or her own life. Many more have used my prescriptions to make themselves physically and emotionally comfortable to the moment of death, knowing that I'm there for them.

As physicians, our role is to relieve suffering in other ways than assisting suicide, and if we're not successful, refer the patient to a doctor who specializes in pain control.

Even better, all doctors should learn to handle pain and suffering control well.

Kill pain, not patients.

- Melvin H. Kirschner, M.D.

Van Nuys

Experts say increased suicides among the elderly are due to people living longer with chronic illness and the social isolation. Suicide took the lives of 30,484 Americans in 1992; 19 percent were over 65 years of age.

More people of all ages die from suicide each year than homicide; almost 2,000 people attempt suicide each day. Guns are the weapons of choice. Yet science continues to make longer life spans possible, while ignoring the quality of these lives.

With so many healthy people feeling death is preferable to life, why would those who are terminally ill - who have nothing to look forward to but pain, loss of quality of life and financial ruin - not want assisted suicide?

- Marilyn Dalrymple

Lancaster

If assisted suicide becomes law in California, there are foreboding implications for the poor and disadvantaged as well as the terminally ill. They will be the most vulnerable to being manipulated and victimized.

In the past 20 years, proponents of ``death with dignity'' have successfully convinced the public that medical care is being forced upon unwilling patients, causing them suffering and agony, and death is the only merciful way out. Patients have always had the right to refuse treatment.

California should not enact a law permitting doctor-assisted suicide. If the public understands its full implications, I believe they will reject it.

The following quote from Dr. Robert Jay Lifton's book, ``The Nazi Doctors,'' should serve as a warning to prevent history from repeating itself:

``There was at no point a sense of personal responsibility for, or even involvement in, the murder of another human being. Each participant could feel like no more than a small cog in a vast, officially sanctioned medical machine.''

- Sarah Jongepier

Lake View Terrace

I was told a long time ago that two things exist that cannot be stopped: homicide and suicide.

The real issue is not doctor-assisted suicide. It is government control. When will politicians focus on issues of real concern?

Politicians and politics are the cause of most of our problems. I remember when government operated on what was right, and always in alignment with the Constitution. Now it is all based on opinions and money; whoever has the most cash gets an opinion put into law.

Keep your nose out of the doctor-patient relationship. If the doctor feels that suicide is a humane option and has discussed it with the patient, let it go.

Stop trying to make an issue out of something that is not an issue. I have respect for others' opinions, but, I resent having those opinions forced on me. You do not need a doctor to assist, just a good gun.

It would be better if you had the right to discuss suicide with a doctor, but the government wants to eliminate another person's right and have more control over doctors.

- Leo Vaughn

Santa Clarita