I read with interest the article by Sulmasy,1 entitled "Managed Care and Managed Death," in the January 23, 1995, issue of the Archives. Unfortunately, its tone, especially in the "Plausible Scenario" section, and its blurring of important distinctions between the proponents of assisted suicide (Quill2 and Kevorkian) lead me to think that Sulmasy's "view" of the dying process is one from "high up and far away." When one is on the "peaks," elevated above an object or an event, distinctions tend to blur. What looks similar from a distance looks entirely different close-up. Quill2 has argued for easing the prohibitions against assisted suicide and for providing safeguards against Kevorkian-like activities. To lump Kevorkian and Quill together is a distortion.
Sulmasy believes that by "managing death" (ie, by assisting suicide), health maintenance organizations, physicians, and the nation will lower health care costs and that each group will profit