Physician-assisted suicide in the United States: confronting legal and medical reasoning--Part two.

In the United States, judicial rulings that unrealistically addressed the complexity of cases and demonstrated limited understanding of principles, helped to create a legal quagmire which legislatures had to confront. Moreover, the legislative response was often slow and inadequate in terms of both the scope and clarity of the laws. However, since the 1970s, progress has been made on many fronts, particularly in regard to advance directives dealing with end-of-life decisions. The debate over physician-assisted suicide has spawned a repetition of moral and legal arguments. Those against legalization have failed to make a realistic appraisal of the dilemmas facing patients and their families in an age of technological medicine delivered in the context of the marketplace. The underlying problem is a system in dire need of reform that will no longer treat health care as a commodity of the marketplace and provide universal health care. Terminal care as an integral part of health care will substantially benefit from such reforms because a major obstacle to comprehensive palliative care is the condition of the present system.