There are compelling reasons to oppose this bill, but at first glance it seems reasonable enough. As a hospice physician for over 20 years, I continue to believe that legalizing physician-assisted suicide is bad public policy and prescribing or administering lethal drugs is not legitimate medical practice.

The central fallacy of the Hyde-Nickles bill supersedes the letter of the proposed law; its flaw lies in locking us into the confrontational arena of social rights and legal wrongs. The Lethal Drug Prevention Act offers nothing to alleviate the suffering that fuels public support for legalizing physician-assisted suicide. At a time when consensus building and constructive legislation is urgently needed -- and would likely succeed -- the bill's backers have chosen instead to wag a moral finger at America. Sad, but not surprising. After all, the lobbying effort is financed and orchestrated by the same people who drew up the battle plan for the anti-abortion crusade. Undeterred by the havoc wrought, they appear eager to open a new theater of social warfare.

If this bill becomes law, count on a series of court challenges and legislative countermeasures. At best, this wrongheaded strategy squanders Congressional attention (a fleeting, precious commodity) and time while correctable deficiencies in training and practice persist. At worst, it pits Americans against one another in open confrontation. How long will it be before assisted suicide clinics are set up in Oregon employing carbon monoxide (Kevorkian's drug of choice) or other lethal chemicals not under DEA authority? How long before the angry pickets and demonstrations begin? How long before an anti-suicide extremist bombs a clinic or shoots at the people who work there?

Couldn't we learn from the abortion debacle and come to the peace table before waging another uncivil war? Faced with a true national crisis in end-of-life care, Congress has a number of steps it can take. It might begin by requiring medical and nursing schools to train students to treat symptoms effectively and to talk with and support patients as they confront dying. This is not optional material. Congress can require doctors to demonstrate competence in pain management prior to ever obtaining a DEA license. It can direct the Department of Health and Human Services to adopt comprehensive standards based on "best practices in hospice care" -- and require Medicare funded nursing homes, managed care organizations and home health agencies to comply with them. Within a few years, without any increase in total expenditures, people could be assured of dying unabandoned, comfortable, in a clean, dry bed.

Philosophers, ethicists and theologians will continue to debate assisted suicide and euthanasia for centuries to come. In the realm of public policy, success does not turn on whether these actions are legal or illegal, but on whether or not the public perceives them to be necessary. As the baby boomers assume increasing leadership within government and society, the real moral challenge facing America is whether, and how, we will care for the most frail, elderly and ill among us. This question may well become the ultimate test by which history will judge our generation. It is a test we cannot afford to fail.

Ira Byock, MD practices in Missoula, Montana. He is author of Dying Well (Riverhead/Putnam, 1997)

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