Last rights

Several recent trends - demographic, social, and economic - are increasing the incidence and public support of deliberate death among the old and sick. The number of elderly people is at an all time high. Medical technology can prolong the lives of these men and women, but it cannot keep them independent, free of pain, or competent to manage their own affairs. Never before have so many been so sick for so long. Changes in the size and structure of the American family make long-term home care almost impossible, while exorbitant health costs and scarce resources limit the provision of highquality care by paid workers. Researcher Barbara J. Logue refers to any deliberate behavior that causes death as "death control" She points out that death control, like birth control, involves very serious and deeply personal decisions, choices that ought to be made on the basis of reliable information, with care and compassion, without coercion.^ She goes on to assert that like birth control, death control should be performed legally and with the help of the medical community. Without access to assisted deaths, many frail old people are left to endure wretched deaths. Some die slowly of neglect or malnutrition in nursing homes. Others take their own lives, sometimes by violent means, while they can still act independently because they are afraid that no one will help them if they wait until they are very sick. Some die alone, fearful of implicating friends or relatives in their "back alley" euthanasia. While some die too soon because they are poor, uneducated, or hard to manage, others are overtreated, and their deaths delayed, because doctors and hospitals want to increase their income or fear prosecution if they help a patient die. Barbara Logue describes these and many other hazards inherent in our present long-term care system, noting that all too often the system causes suffering instead of alleviating it.^ After assessing the alternatives, she urges that we must make compassionate death control as available as birth control. We must regulate and monitor it like any other medical procedure, taking steps to minimize the risks while maximizing the benefits.