The debate over physician-assisted suicide sometimes has been confused with a debate over whether doctors and other caregivers will be allowed to hasten a terminally ill patient’s death. It iractice of helping the terminally ill die already occurs. The question is whether to set standards for this practice and make it available to all who desire it and meet the standards.

This question has passed from state legislature to state legislature. Maine will take it up early next year through a bill, LD 916, sponsored by Rep. Joe Brooks of Winterport. The bill requires that two physicians confirm in writing that a mentally competent but terminally ill patient has made a sound voluntary decision to end his or her life. A psychiatrist must determine that the patient is not suffering form a psychologicial disorder. A patient must repeatedly request, orally and in writing, medication to die and wait at least 15 days for a prescription to be written.

None of these conditions must be met currently for a caregiver to help a patient die. The decision now is made quietly and is dependent on the level of care that a patient has access to and the predilictions of the attending doctors. That is, doctors currently decide these cases based on personal and professional judgment, not state standards. Indeed, in the Supreme Court’s recent ruling that there is no constitutional right to die with the help of another person, Justice Stephen Breyer noted that the ruling does “not prohibit doctors from providing patients with drugs sufficient to control pain despite the risk that those drugs themselves will kill.”

The Maine Medical Association opposes LD 916, with its executive vice president, Gordon Smith, observing that, “There is a lot more that ought to be done in dialogue before settling for suicide.” But not since the distillation of morphine has an issue brought on more dialogue about pain management. The very fact that assisted suicide may be codified has drawn an enormous amount of attention to what can be done to avoid having patients use this option. It is fair to guess that passing an assisted-suicide bill would further intensify this discussion.

To oppose LD 916 is to argue that the current unregulated method of assisted suicide is better than a regulated method. For the people dispensing the pain killers, it may be. But it difficult to see how this improves the end of patients’ lives.