The Miami Herald, Inc.; Monday, 21 July 1997.
Mark Silva; Capital Bureau Chief

The 5-1 ruling echoes a recent decision by the U.S. Supreme Court that states can outlaw physician-assisted suicide if they choose. And it may lay to rest a debate over assisted suicide in Florida, where lawmakers are loath to tamper with a century-old law forbidding it.

For Charles Hall, 35, dying of complications from AIDS, the ruling ends a long quest to let Jupiter physician Cecil McIver assist him in ending his life when his pain becomes unbearable. A Palm Beach County judge said he could, but the state appealed.

"He's experiencing right now what he fought against. He's right on the verge of terminal sedation," Hall's attorney, Robert Rivas, said Thursday. "He said he didn't want to be a zombie, but that's what's happening. The pain is so great, he doesn't have any alternative to taking the morphine."

For opponents of assisted suicide, the dual rulings from Tallahassee and Washington should avert "a wildfire" of Dr. Jack Kevorkian-styled deaths in a state with the nation's highest proportion of people over 80.

"We feel there isn't any constitutional right to die, and had either court said there was, it would have spread like a wildfire throughout the state," said Jim Towey, director of the Florida Commission on Aging with Dignity.

The Legislature could enact a law allowing assisted suicide if it chose, the court said, but the governor-appointed justices had no interest in doing so.

"The state has an unqualified interest in the preservation of life," wrote Justice Stephen Grimes, who will retire from the court this fall at 70.

The ruling drew a scolding from Chief Justice Gerald Kogan, the lone dissenter, accusing his colleagues of overlooking "a chasm of ambiguities" in modern life and death, essentially holding Florida in the "Dark Ages."

"What possible interest does society have in saving life when there is nothing of life to save but a final convulsion of agony?" Kogan wrote.

Medical integrity

One of the court's interests is "maintaining the integrity of the medical profession," the majority's ruling says. And Dr. Cecil Wilson, president of the Florida Medical Association and a Winter Park internist, welcomes it.

"We think it addresses the principle that the role of physician is to heal, to help save lives, to help cure people and help relieve suffering," he said. "To change that role to a position where physicians would be actively involved in doing things to end life strikes at the heart of the profession."

At the same time, Towey, Wilson and physicians in South Florida say, the ruling begs a new look at how Florida helps its terminally ill.

This could be Hall's legacy: The case has ignited conversation in the medical community about how doctors can better quiet patients' pain.

"The problem is not really death but pain, and what we have to do is learn how to deal with pain better so that the patients don't have to suffer as much at the end of life," said Coconut Grove neurosurgeon Miguel Machado, president of the Dade County Medical Association.

Quality of death

Towey's commission has urged the state to relax rules on pain-killers, enabling physicians to offer extraordinary medicine for dying people. It has called on churches and others to pay more attention to people dying alone.

The court has recognized rights of dying Floridians to refuse medical treatment. But assisted suicide is different, the court says.

"The assistance sought here is not treatment in the traditional sense of that term," Grimes wrote. "It is an affirmative act designed to cause death -- no matter how well-grounded the reasoning behind it."

The court has upheld an 1868-vintage state law against anyone assisting another person in suicide, deeming it manslaughter.

Rivas contended that Florida's 1980 privacy amendment to its state Constitution overrides the old law, allowing people to choose for themselves.

But the court says the state's interest in preserving life is even greater.

"I recognize the emotional appeal of allowing a patient such as Mr. Hall, who is overcome with a debilitating and dehumanizing disease, to have assistance in ending his suffering," Justice Major Harding wrote. "But a constitutional right must be based on more than emotional appeal."

Law a possibility

The court's ruling does not prevent the Legislature from enacting a law allowing doctors to assist ailing patients who wish to die. In fact, the court says, this is the way it should be done, if that's what lawmakers want.

Justice Ben Overton wrote that "a carefully crafted statute" could be written, "ensuring . . . assisted suicide would truly be used to assist only those individuals who suffer unbearable pain in the face of certain death."

Perhaps, one ethicist suggests, asking the court to decide wasn't such a good idea. Better that the Legislature, after robust public discussion, decide the issue, says Kenneth Goodman, director of the University of Miami's Forum for Bioethics and Philosophy:

"To have a nervous court interpret murky laws on an issue of inherent ethical and social controversy -- that's no way to identify rights."

But legislative leaders aren't interested in that debate.

Not a priority

This simply isn't one of Senate President Toni Jennings' priorities, an aide says. House Speaker Dan Webster, R-Orlando, sees little interest on his side: "I believe the will of the House is that the current law is good."

Dr. Panagiota Coralis, chairwoman of Jackson Memorial Hospital's ethics committee and chief of general medicine at the Veterans Administration Medical Center in Miami, believes this is the court's message: "They're having as much trouble with these kinds of issues as the rest of us are, and it's probably more appropriate as an issue of public discussion."

Hall, who lives in Beverly Hills, a small town about 100 miles north of Tampa, couldn't stay awake long enough to discuss the court's ruling Thursday, his attorneys said.

Hall was one of three terminally ill patients who sued the state for the right to physician-assisted suicide. The other two have died.

"Why not just let me die in peace?" he said in May after listening to attorneys' arguments in his wheelchair in the state Supreme Court chamber.

Attorney Florence Rivas, finding "comfort" in Chief Justice Kogan's dissent, said: "In our lifetime, that's where the law is going to end up. . . . In the meantime, Charles Hall will die a miserable, degrading death."

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Herald staff writers Lori Rozsa and Stephen Smith contributed to this report.

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