The Supreme Court s decisions on physician-assisted suicide carry important implications for how medicine seeks to relieve dying patients of pain and suffering.

　　Although it ruled that there is no constitutional right to physician-assisted suicide, the Court in effect supported the medical principle of double effect , a centuries-old moral principle holding that an action having two effects a good one that is intended and a harmful one that is foreseen is permissible if the actor intends only the good effect.

　　Doctors have used that principle in recent years to justify using high doses of morphine to control terminally ill patients pain, even though increasing dosages will eventually kill the patient.

　　Nancy Dubler, director of Montefiore Medical Center, contends that the principle will shield doctors who until now have very, very strongly insisted that they could not give patients sufficient mediation to control their pain if that might hasten death.

　　George Annas, chair of the health law department at Boston University, maintains that, as long as a doctor prescribes a drug for a legitimate medical purpose, the doctor has done nothing illegal even if the patient uses the drug to hasten death. It s like surgery, he says. We don t call those deaths homicides because the doctors didn t intend to kill their patients, although they risked their death. If you re a physician, you can risk your patient s suicide as long as you don t intend their suicide.

　　On another level, many in the medical community acknowledge that the assisted-suicide debate has been fueled in part by the despair of patients for whom modern medicine has prolonged the physical agony of dying.

　　The Supreme Court s decisions on physician-assisted suicide carry important implications for how medicine seeks to relieve dying patients of pain and suffering.

　　Although it ruled that there is no constitutional right to physician-assisted suicide, the Court in effect supported the medical principle of double effect , a centuries-old moral principle holding that an action having two effects a good one that is intended and a harmful one that is foreseen is permissible if the actor intends only the good effect.

　　Doctors have used that principle in recent years to justify using high doses of morphine to control terminally ill patients pain, even though increasing dosages will eventually kill the patient.

　　Nancy Dubler, director of Montefiore Medical Center, contends that the principle will shield doctors who until now have very, very strongly insisted that they could not give patients sufficient mediation to control their pain if that might hasten death.

　　George Annas, chair of the health law department at Boston University, maintains that, as long as a doctor prescribes a drug for a legitimate medical purpose, the doctor has done nothing illegal even if the patient uses the drug to hasten death. It s like surgery, he says. We don t call those deaths homicides because the doctors didn t intend to kill their patients, although they risked their death. If you re a physician, you can risk your patient s suicide as long as you don t intend their suicide.

　　On another level, many in the medical community acknowledge that the assisted-suicide debate has been fueled in part by the despair of patients for whom modern medicine has prolonged the physical agony of dying.