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Nevertheless, one would expect that a physician who was so inclined -- who wanted, for example, to give a terminally ill patient a prescription for a painless and peaceful death -- could readily use the modern pharmacopeia to bring a swift, sure end to life. But recent evidence suggests that attempts at physician-assisted suicide often meet with unexpected complications. What's more, almost no one in the medical community is doing anything about it.

"If we're going to do this, we should do it right," says Dr. Sherwin Nuland, a surgeon at Yale Medical School.

A study published in the New England Journal of Medicine suggests that things can, and do, go wrong in physician-assisted suicide.

In 7 percent of 114 cases analyzed, patients suffered complications such as regurgitating a would-be lethal dose of drugs. In 16 percent of cases, death did not happen as expected: It took longer, or patients slipped into a protracted coma, or didn't go into a coma, or even woke entirely after metabolizing the drugs. The study was done in the Netherlands, where physician-assisted suicide is closely monitored by the government.

No one knows how often complications occur in the United States. A threatening legal environment, widespread social controversy and an element of medical machismo that equates death with failure conspire to drive physician-assisted suicide underground. But anonymous surveys over the past decade make one thing clear: Although they often don't discuss the matter with colleagues, it is not uncommon for U.S. doctors to help bring death to terminally ill patients.

There is no reason to believe that assisted suicide attempts run into fewer complications in this country. In fact, it seems logical to assume that the more open practice in the Netherlands would lead to a greater sharing of information and fewer complications there. The Dutch data raise a haunting question: How often do brutally sick patients who try to end their lives painlessly wind up suffering ugly, violent deaths?

In an editorial that accompanied the Dutch study, Nuland argued that organized medicine should attend to physician-assisted death "with the attention to detail that all aspects of medical practice demand. Better sooner than later."

Within the U.S. medical establishment, however, Nuland's is a rare voice. Even in Oregon, the only state where physician-assisted suicide is legal, doctors don't much discuss the how-to's or anything else about the practice.

"Many physicians are very happy to participate on an individual basis, but they remain concerned for their public reputations," says Barbara Coombs Lee, executive director of the Oregon advocacy group Compassion in Dying. "The opponents of this practice can be brash and harsh and vitriolic, and physicians are not eager to expose themselves to that. And the universities and professional societies that sponsor continuing education have not been ready to address the clinical practice of physician-assisted dying."

Next page | Drugging a patient into unconsciousness and keeping him there until he dies