At first glance this would appear inevitable if most physicians refused to provide assistance to dying patients, and with the largest percentage of private hospitals being associated with the Catholic Church. Recent studies, however, show that up to 25 percent of physicians in some areas already admit having provided assistance, and the number may be much higher among practitioners treating cancer or AIDS. Further, these same studies have found as many as half of all physicians say they would be willing to provide aid-in-dying in certain cases if laws were changed.

At first glance this would appear inevitable if most physicians refused to provide assistance to dying patients, and with the largest percentage of private hospitals being associated with the Catholic Church. Recent studies, however, show that up to 25 percent of physicians in some areas already admit having provided assistance, and the number may be much higher among practitioners treating cancer or AIDS. Further, these same studies have found as many as half of all physicians say they would be willing to provide aid-in-dying in certain cases if laws were changed. Given these numbers, I doubt there would be a shortage of physicians who’d be willing to help their patients die. Unless confidentiality was guaranteed, however, strict reporting requirements might substantially reduce this number, as not all physicians might be willing to practice under close legal and public scrutiny.

This should not be a problem, however, if at-home hospice programs, critical care units in hospitals, and skilled nursing facilities agreed to provide aid-in-dying as an extraordinary option when their own efforts at pain control and palliative care failed to relieve suffering. Unlike outpatient abortion clinics I can’t envision outpatient “death clinics” that would meet requirements for involvement by primary care physicians and bioethics committees. Instead, I’d suspect that the dying would prefer the current model of privacy in regard to the practice of assisted death: if possible, dying at home while surrounded by loving partners, family members, or friends.

Nevertheless, for those without significant others or opportunities for round-the-clock care, I would encourage expansion of residential hospices as well as creation of centers for life and death that together might serve as feasible alternatives to current convalescent nursing facilities. Linking all such facilities to hospice services could ensure a range of options, starting with compassionate care, palliative efforts, pain control, emotional support for family members, and including the possibility of assisted death. If opponents of assisted point are correct in suggesting that public interest in legalized assisted death is rooted in fear of nursing homes, then such centers, instead of ghettoizing the aged and the dying, could have the additional benefit of serving as a viable alternative to the current model of convalescent care. They could even bring together volunteers from the larger community and multiple age groups in a fellowship of learning and sharing for both the dying and the living.