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ASSISTED SUICIDE // WHEN THE HEART RULES

The nine justices of the U.S. Supreme Court this week will consider whether Americans facing painful and difficult deaths have a right to doctor-assisted suicide.

It may be the court's most significant case this year, touching every family, every person who will ever die within the nation's borders.

The question is simple: Should a terminally ill, mentally competent patient be allowed to ask a doctor to prescribe pills that could be used to commit suicide?

Suicide is no longer illegal in the United States, but helping someone to commit suicide is still a crime in most states. Florida has a 128-year-old law forbidding assisted suicide, which could be overturned by the court's ruling.

Florida's law is also being challenged by an AIDS patient in Citrus County who wants a doctor's prescription to help him die. That trial is to begin Monday in West Palm Beach.

Polls show overwhelming support for assisted suicide, and two lower courts have ruled that the U.S. Constitution provides a right to die. The Supreme Court is expected to issue its decision within six months.

The high court will focus on constitutional questions and legal precedent, not the human beings who may plead for help in dying _ or conversely _ may cherish every last moment.

Here are the stories of three people who have faced death and have given great thought to the meaning of life . . . at the end of life.

Their stories make clear what a slippery issue death can be. For one man, there is no question but that he will wait to die in God's time. For another, suicide may become the only rational option. And a third, oddly enough, says caring for her husband as he died turned out to be the best thing that ever happened to her.

James Carey was always strong and independent.

Now he's tethered to an oxygen machine and can't comb his hair without becoming short of breath. Brushing his teeth leaves him panting. Letting the dog outside exhausts him.

"It's a difficult way of life, but it's life," he said. He wouldn't dream of cutting it short with assisted suicide.

"Only God knows when I'm going," he said. "I'm just renting space here anyway. When my rental is up, I'll go."

Carey, 71, says his only problem is that he can't breathe. His bronchial tubes are constricted, a form of emphysema.

While Carey's wife, Chibi, is at work, he spends much of the day in a corner she prepared for him. It's a chair at the dinette, with space for Carey's newspaper and reading glasses, the portable phone and his medicine close at hand.

A clear, thin cord runs from Carey's face, down the hall to the oxygen machine in the bedroom.

Mickey, the Pomeranian poodle, sits in one of the other chairs at the table, adoring Carey and being adored.

Carey spent a career in radio and television and still has a broadcaster's smooth, deep voice. He lived in California then worked in Guam and Saipan, where he met Chibi, a Japanese-Filipino who now works in public relations at the Vinoy hotel.

They have an immaculate concrete-block house in St. Petersburg's Shore Acres, decorated with Chibi's needlepoint. Carey helps keep it tidy, but it takes him a day to do the laundry, and he can only vacuum a few feet at a time. He gasps for air if he bends over to put plates in the dishwasher.

His only outings are to see doctors or visit his 98-year-old mother in a nursing home. But Carey has goals. He would like to take a shower by himself. He would like to be well enough to sleep in the same bed with Chibi again instead of using the hospital bed in the corner of their bedroom.

Carey says he doesn't know how his disease will progress or how it will end, and he doesn't think much about the future. He has signed a living will so he won't have to die in the hospital hooked up to machines _ a question already settled by the U.S. Supreme Court. Patients have a right to refuse treatment, including respirators and feeding tubes that might keep them alive.

Carey says he was angry when he first learned he was terminally ill. He was angry that he could no longer be self-sufficient, and he felt guilty about burdening his wife.

But he said he has since learned to live with the limitations of his disease, and he believes everything happens for a purpose. Maybe this experience will help his wife become more independent, he said.

"Now I'm fine in terms of accepting it," Carey said. His blue eyes filled with tears.

Like Carey, most terminally ill people don't know how long they will live, how long they can remain productive or how bad their suffering might become.

The opponents of assisted suicide say no patient needs to suffer. Most dying patients could be kept free of pain, they say, if only their doctors knew more about pain management.

They also say the dying may need emotional or spiritual sustenance that would ease their fears.

But defining the quality of life is highly individual. Roy Witlin of Crystal Beach worries that he will lose the ability to read Shakespeare's sonnets or watch the hummingbirds outside.

Witlin is considering suicide.

Not now, not today, but someday _ if the pain gets too bad, if he begins to feel useless and a burden to his wife, if he can no longer enjoy life.

"I've cleaned the revolver and looked at the revolver and considered the revolver and put it back," Witlin said, his voice slow and rumbling.

He turned 74 on Thursday, in severe pain from the prostate cancer that has invaded his lymph nodes and lungs. If he is lucky, he says, his heart problems will bring a quicker end than the cancer.

Witlin is a retired clinical psychologist who specialized in treating depression. He finds it ludicrous that those who oppose assisted suicide _ and even many who support it _ believe the terminally ill should have to prove they're not depressed to get a doctor's help in committing suicide.

Any dying person will be depressed, he said.

When the lymph nodes in his neck were so swollen that he couldn't button a shirt or wear a seat belt, when his prostate problems kept him up all night going to the bathroom every half-hour, yes, he was depressed.

He also knows that prostate cancer typically settles in the bone and causes excruciating pain. But he hates morphine and other pain drugs and won't take them. It's like being a drunk, a child, he said.

"What price are you paying in mental sharpness? How much Mahler are you not hearing when you listen to Mahler?"

For the time being, Witlin said, he is living a day at a time, and he has plenty yet to do. He and his wife, Barbara, 56, have just moved into a brick house in Crystal Beach in North Pinellas, a block from the gulf in a neighborhood of sandy streets and Spanish moss. They still have packing boxes in the living room.

Both were psychologists and artists in Philadelphia. They first came to Pinellas to see a doctor who practices Chinese medicine, and they credit his herbs with bringing Witlin back from the brink of death six months ago.

Witlin is an atheist who believes that death is nothingness, oblivion, like being under general anesthetic.

People find meaning in life, he says, by treasuring something beyond themselves.

"I believe I have a soul sitting right there," he said, extending a hand across the room to Barbara. "Anything I can do to make our lives gentler and easier will justify any amount of pain I have to experience."

His wife, sitting in a big chair and hugging her knees to her chest, does not meet his loving gaze. Her deep brown eyes are pools of pain and concern.

Witlin continued: "If I become a burden to her or nonfunctional, then I would step out, with or without the assistance of a physician."

They have discussed this before. "If he took his life, it would be his choice," Barbara said. "I don't want him to suffer."

The Witlins studied art psychotherapy, and Barbara has a sketch book that serves as a journal of her husband's illness. Death is represented by an enormous, sleek bird with frightening talons. In some pictures, it has seized Witlin by the chest. In more recent sketches, the bird, still hovering, has let go.

Proposals for assisted suicide raise questions after questions. What constitutes terminal illness? After all, we're all going to die. If the terminally ill have a right to assisted suicide, what about everyone else?

And what if a patient can't ask for the pills himself? Should his family be allowed to ask on his behalf? A lethal injection from a doctor is considered euthanasia, which is still illegal and is not the issue before the Supreme Court.

But opponents of assisted suicide say that's where it all would end, with the poor and disabled at special risk of being helped to die whether they want it or not.

It might be easy to point to a dying patient and suggest that death would be a blessing. But an Oldsmar woman says her husband's final months were the most precious of their life together.

On the surface, you might think Cathy Orr's life had been hell the past year.

Her husband, Bob, was not yet 50 when he found out the prostate cancer he thought was under control had come roaring back, into his bones. Despite surgery, radiation and chemotherapy, he died in October, leaving Cathy a widow at 47.

And yet. . .

She speaks of that year as a transformation for both of them, as a journey of love with each other and with God. If Bob had been killed in a car accident or, for that matter, had committed suicide as his disease progressed, they would have missed those final months.

He never discussed suicide, despite pain that at times had him screaming.

"It is sad to me that it had to happen this way, but I'm so thankful for every moment," Cathy said at the hospice office in Palm Harbor, where she still has friends among those who helped her and her husband.

They were a glamorous couple, both so attractive, he a businessman, she an interior designer. They met while skiing in Switzerland and married in 1991. Cathy brought two sons and a golden retriever with her from Dallas.

She saw Bob as a good man, but she also knew he was angry _ about childhood, about Vietnam, she wasn't sure. She used to worry that a heart attack would kill him because of his anger.

He was the kind of man who thought he could solve his own problems. She asked for help from hospice behind his back, and he was furious when nurses and social workers showed up at the house.

"I imagine at that time Bob was very afraid, but he'd never use that word," Cathy said.

He gradually relented. He stopped responding to all information by saying, "I knew that." He learned to accept help.

Hospice got his pain under control with drugs. When Bob expressed interest in spiritual matters, hospice sent a Catholic chaplain _ Bob was angry at the church, too _ who told Bob the only important thing was his connection to God. Bob began to pray.

With help from a social worker, Bob and Cathy learned to talk to each other about the unknown, about death, she said.

"As he let down his guard, we became closer and more in love than I've ever been in my whole life. He helped me learn, and I helped him learn, what real love truly is. It was like he was this cocoon that eventually turned to a butterfly."

Bob died at home with Cathy talking to him long after he stopped breathing, just in case he could hear. As requested, he was cremated in a cherished T-shirt that read Peaceful Warrior, a souvenir from a men's movement Bob had been involved in.

Bob's unfolding came at the end of his life, Cathy said, but the experience transformed her, too, and she is still here.

She learned she is a natural caregiver and said she will find ways to help others. She discovered inner strength she didn't know she had and a capacity to love.

She's not afraid of growing old anymore, no longer thinking about a face lift someday.

"Life is so precious, so special," she said. "The older you get, the more you realize how important everybody is that you love and care about. You want to share and experience every single moment."

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