The odyssey of Dr. Jack Kevorkian continues. The 'suicide doctor' remains under indictment, in and out of jail. Already a modern American folk hero, at times he seems determined to become a martyr for the right to die. The attention of the press and the public is captured by the deaths of those who have briefly been his 'patients.'

But while the nation watches to see whether he will win or lose the latest round in his struggle with the Michigan legal system, the major impact of this one man's actions goes essentially unnoticed. Jack Kevorkian has single-handedly defined and dangerously narrowed the discussion of end-of-life issues in America. Having identified the right problem, Kevorkian has drawn the wrong conclusions. His actions may be well-intended, but they have the potential for making a very bad situation even worse.

The problem is that of unmet suffering - indeed, unaddressed suffering - among many of the terminally ill in this country. Kevorkian deserves credit for loudly calling attention to this situation in a manner that the public - and the medical profession - finally can no longer avoid.

Although I am a physician, I cannot apologize for the medical profession in this matter. The regrettable frequency of uncontrolled symptoms exists because of a critical deficiency of medical education as well as a lack of commitment on the part of established medicine to do whatever is necessary to alleviate the distress of the dying. The requisite knowledge, medicines, techniques and technology exist; they are simply not being applied. Physicians who do not aggressively respond to anguish among their dying patients deserve the sternest professional sanctions.

As a doctor who has been involved in hospice care for more than 14 years, I can state without equivocation that the physical sources of suffering associated with dying all can be controlled. Most often, such symptoms as pain, shortness of breath and nausea, yield to routine evaluation and straightforward interventions. Even the pain of end-stage cancer commonly can be managed with oral medications. In a small percentage of cases, pain or other bothersome symptoms do require advanced interventions. Rarely, sedation is required to effectively alleviate pain, breathlessness or terminal agitation.

Symptom management is not always easy. Effective therapy may require the efforts of a physician with special interest in palliative medicine and a team of hospice-trained nurses, consultant pharmacists and others. Yet I want to state again clearly that in all cases the physical distress of the dying can be controlled.

Symptoms are not the only cause of misery. Financial suffering among the terminally ill is pervasive in contemporary America. Today, our non-system of health care routinely pauperizes people in their dying. It is a national disgrace, and it is unnecessary. Hundreds of millions of dollars could be saved annually by making hospice care universally available to Americans. The situation is particularly severe among the poor - those with the twin diagnoses of terminal illness and medical indigence.

Most major urban medical centers charged with care of the socially disadvantaged have not developed specialized hospice or palliative care teams. While hospice care is substantially less expensive than hospitalization and continued, futile curative measures, it will always be more expensive than preemptive death.

What happens if assisted suicide and euthanasia become legal in today's environment? I submit that in the absence of adequately funded palliative care programs and residential hospice settings, it will become our responsibility to recommend assisted suicide to those who lack basic financial or family resources. What a horrific way for society to respond to the needs of the destitute and dying.

My strongest objection to the vision for the dying that Jack Kevorkian has given to America concerns not suffering but missed opportunity. The transition from life can be every bit as profound, intimate and precious as the miracle of birth. The surprising fact is that in the midst of their dying, many people are able to experience not merely comfort but an increased sense of well-being, which often includes a deep sense of connectedness to others and the world. This is not some religious tract or wistful, new-age thinking. It is the direct experience of clinicians who are privileged to care for the dying in modern hospice-like settings.

These words will sound odd to many modern American ears. Stories of wondrous dyings have infrequently been told and do not lend themselves to sound bites or headlines. Yet in recent years, it has become common for hospice clinicians to hear people - some of whom had previously considered suicide - reflect that their dying has been among their most meaningful life experiences.

Truly excellent care embodies goals that extend beyond relief of suffering and seeks to preserve the potential for people and their families to grow, inwardly and together. Assisted suicide and euthanasia reflect a world view in which dying is equated with suffering and the only hope is its avoidance. It represents an ominous contraction of the human condition. As a nation, we can financially afford to provide comprehensive, enlightened care for all our dying. As a people, we cannot afford to sanction the killing of the most frail and needy among us.

The writer is a practicing hospice physician in Missoula, Montana, and ethics chairman of the Academy of Hospice Physicians.

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