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By Rosalynn Carter

The Washington Post

The Supreme Court's refusal to grant physician-assisted suicide as a constitutional right for all Americans obviously is a crucial decision that will affect thousands of people in this country. But the court's decision must be viewed separately from an equally important question: What will we as a society demand as a standard for good care at the end of life? Properly given, such care might substantially reduce the number of patients considering physician-assisted suicide.

The overwhelming evidence from the largest clinical study ever conducted with dying people shows that Americans too often face death in pain and attached to machines. That study, published in the Journal of the American Medical Association in 1995, was a wake-up call to many who are concerned about improving care at the end of life. This goal is attainable and should be a much higher priority for medical schools, hospitals, insurance companies, the clergy and other groups. And if these professionals are to help us, as a society and as individuals, we must overcome our fears about discussing death.

I helped care for my father and grandfather, who, like many people, died from prolonged illnesses. My experiences taught me that the unpleasant prospect of our deaths does not preclude meaningful experiences at the end of our lives. Although some people may be sad and physically compromised during their last months and years, these days also can be an opportunity to appreciate life's last chapter and to reach out again to loved ones.

We must focus not on whether we have the right to ask a doctor to end our lives prematurely, but on the changes that need to take place to ensure that systems exist to help us die with dignity.

Doctors should be encouraged to devote at least part of their training to nursing homes and hospices as well as hospital emergency rooms.

Insurance companies, managed-care organizations and the federal government should be obliged to pay for long-term care that supports people's emotional needs as well as their physical ones.

Clergy and others who address spiritual needs could collaborate more with medical-service providers to address health needs of patients that cannot be addressed by tests or surgeries.

Hospitals and lawyers can stop being fearful of lawsuits, and let doctors prescribe the dosages that are required for pain relief.

Jimmy and I have written living wills, but legal documents to express our wishes are not enough to prepare us for our final days. We must talk honestly with our loved ones, our clergy, and our doctors and nurses about the choices we would make if confronted with a chronic or terminal illness.

The old cliche is true: Dying is part of living. Any definition of "dying well" must include respecting patient's wishes reducing pain, involving care givers throughout the process, minimizing financial burden and encouraging spiritual growth until the very moment of death.

The writer is a former First Lady and honorary chair of Last Acts, a national coalition to improve care at the end of life.