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The last major piece of President Barack Obama's health care law could raise costs for thrifty consumers as well as large corporations and union members when it takes effect in 2018. The so-called Cadillac tax was meant to discourage extravagant coverage. Critics say it's a tax on essentials, not luxuries. It's getting attention now because employers plan ahead for major costs like health care. (Alonso-Zaldivar, 9/1)

The financial condition of Connecticut’s hospitals, and how they’ve fared under the federal health law, has been a source of dispute among state lawmakers. Hospitals have faced repeated funding cuts and increased taxes in recent state budgets. Gov. Dannel P. Malloy’s administration has said hospitals are benefitting from Obamacare, since it has led to more patients with coverage – that is, more paying customers. But hospital officials say that, while they support the coverage expansion, it hasn’t led to a financial windfall, and that state funding cuts and tax hikes, along with cuts in Medicare payments in the health law, have added to the burden they face. (Levin Becker and Chang, 9/2)

Florida Healthy Kids Corporation is blaming President Obama's health care law after notifying parents that health insurance premiums will increase for thousands of kids starting next month, jumping from $140 to as high as $284. Healthy Kids, which offers insurance options where parents can pay full-price or get subsidized coverage depending on eligibility, said the increases will affect the families of nearly 34,749 children in the full-pay program. That's about 19 percent of the organization's 178,873 enrollees. (Kennedy, 9/1)

Tuesday marked the first day for thousands of newly eligible Alaskans to enroll in Medicaid after Gov. Bill Walker expanded the program, but it was a quiet afternoon at a state office in Anchorage that handles applications. ... When asked if anyone had come in to sign up for the newly broadened health care program, a woman who sat behind the front desk said, “I haven’t had anyone yet today.” By some estimates, expanding Medicaid could provide health care coverage for about 40,000 Alaskans. The state Department of Health and Social Services has said it expects 21,000 Alaskans to sign up in the first year. (Hanlon, 9/1)

The White House on Tuesday praised the decision by Alaska Gov. Bill Walker to expand Medicaid to thousands of residents over the wishes of the Republican-led Legislature, calling it the "right decision." Alaska on Tuesday became the 29th state to expand Medicaid, opening up health care through what it calls the Healthy Alaska Plan to an estimated 20,000 low-income residents. (Thiessen, 9/1)

Valerie Davidson has 50 people coming for dinner to her house in the remote western Alaska town of Bethel. She had planned to catch and cook enough salmon for the main course, but she’s hit a snag. Early in the morning, the state opened the Kuskokwim River to commercial fishing, which means subsistence fishermen can’t fish on it. So Davidson and I are ... stalking the free fish containers around town. That’s where state biologists deposit their test catches after they conduct their daily studies. We have been here for an hour, but Davidson is exceedingly patient and persistent. It’s a strategy she used as she worked to expand Medicaid in Alaska, as health commissioner. (Feidt, 9/2)

The state of Michigan submitted a waiver request to the federal government Tuesday in the hopes that it can continue health care coverage for nearly 600,000 low-income residents under its expanded Medicaid program. In April, state officials said they worried the Obama administration might not grant a waiver on the health care cost-sharing requirements in its Medicaid expansion law — called the Healthy Michigan Plan. The state has been talking with the Centers for Medicare and Medicaid Services about the request and expects to restart discussions “in earnest” in the next two weeks now that the waiver has been officially submitted, said Nick Lyon, director of the Michigan Department of Health and Human Services. (9/1)

The state of Michigan on Tuesday submitted its second waiver application to the U.S. Centers for Medicare and Medicaid Services, which would allow the state's Healthy Michigan program to continue. ... The first waiver Michigan needed, approved in 2013, allowed for some of Michigan's unique ideas like required co-pays and income-based premiums. The second waiver would allow for a soft cap included in Michigan's law that asks people between 100 and 133 percent of poverty level to pay higher premiums or seek coverage on the exchange after being on Healthy Michigan for 48 cumulative months. (Lawler, 9/1)

The Senate’s top Republican is conceding that his party will have to await the next president before it can cut off federal funds that go to Planned Parenthood, prompting heated rebuffs from conservatives. Senate Majority Leader Mitch McConnell, R-Ky., says Republicans lack the votes to halt the payments. He also says that standing in the GOP’s way is President Barack Obama, who doesn’t leave office until January 2017. (Fram, 9/1)

"We just don't have the votes to get the outcome that we'd like," McConnell said in an interview taped Monday with WYMT-TV, which serves eastern Kentucky. "I would remind all of your viewers, the way you make a law in this country, the Congress has to pass it, and the president has to sign it. The president's made it very clear he's not going to sign any bill that includes defunding of Planned Parenthood so that's another issue that awaits a new president hopefully with a different point of view." (DeBonis, 9/1)

Defunding Planned Parenthood has become a leading cause among some Republicans in the wake of controversial undercover videos showing Planned Parenthood officials discussing the price of fetal tissue for medical research. Planned Parenthood, while apologizing for the tone, denies any wrongdoing, saying officials are discussing legal compensation for expenses and pointing to an analysis that the videos are heavily edited. McConnell said that the Senate would vote again on defunding Planned Parenthood after a failed Senate vote last month, but he said that the votes are not there. (Sullivan, 9/1)

Republicans have threatened to push for cutting off the group's federal support, perhaps tying that demand to several must-pass tax-and-spending measures set to come before Congress after its August vacation. Lawmakers will return to Washington on Sept. 8. Left unresolved, failure to pass those bills could push them to the brink of shutdown by as early as Oct. 1 (Heavey, 9/1)

A government shutdown wouldn’t shut down Planned Parenthood. Instead, Planned Parenthood would continue to receive the majority of its federal funding — including all of its Medicaid payments — even if Congress cannot enact a new spending law on Oct. 1, according to a nonpartisan study by the Congressional Research Service, obtained by POLITICO. In addition to that federal funding, most of Planned Parenthood’s financial backing comes from outside the government, making it easier for the organization to weather a government shutdown. (Everett and Haberkorn, 9/1)

An anti-abortion group is releasing Web ads targeting four pivotal swing votes ahead of an expected Senate vote to ban abortion at 20 weeks of pregnancy. Susan B. Anthony List is running ads in Pennsylvania, Indiana, North Dakota and Alaska to target Democratic Sens. Bob Casey, Joe Donnelly and Heidi Heitkamp, and Republican Lisa Murkowski, respectively. (Haberkorn, 9/1)

Abortion opponents on Tuesday released their ninth Planned Parenthood sting video, this time capturing a tissue procurement company executive talking about rare circumstances in which an abortion has resulted in an intact fetus. The video from the Center for Medical Progress features Perrin Larton, procurement manager at Advanced BioScience Resources, which has worked with a Planned Parenthood clinic in California and provides fetal tissue to researchers with government funding. (9/1)

One month ago, six Planned Parenthood clinics allowed women to donate aborted fetus tissue for medical research. Now, there are just two that do — a sign that the future of the programs could be in serious jeopardy. Planned Parenthood has fiercely defended its fetal tissue donations in the face of attacks from an anti-abortion rights organization this summer. But the steady stream of undercover videos of the organization’s operations is taking a toll on its affiliates and partners. (Ferris, 9/2)

Your heart might be older than you are. A new government report suggests age is just a number — and perhaps not a very telling one when it comes to your risk of heart attack or stroke. The Centers for Disease Control and Prevention report takes a new approach to try to spur more Americans to take steps to prevent cardiovascular disease. CDC scientists estimated the average “heart age” of men and women in every state, based on risk factors like high blood pressure, obesity, and whether they smoke or have diabetes. Then it compared the numbers to average actual ages. (Stobbe, 9/1)

You may feel young at heart, but with apologies to Frank Sinatra, that’s probably a fairy tale. A new report from the Centers for Disease Control and Prevention says the average American man has a heart that’s 7.8 years “older” than his chronological age; for women, the comparable “heart age” is 5.4 years higher than her calendar age. If the idea of a heart age sounds like a gimmick, that’s because it is. The concept was developed by public health experts who work on the venerable Framingham Heart Study as a way to help regular folks understand their risk of having a heart attack, stroke, chest pain, peripheral artery disease or another heart-related condition, including death. And it works. (Kaplan, 9/1)

One more reason to watch the waistline: New research says people’s weight in middle age may influence not just whether they go on to develop Alzheimer’s disease, but when. Obesity in midlife has long been suspected of increasing the risk of Alzheimer’s. Researchers at the National Institutes of Health took a closer look and reported Tuesday that being overweight or obese at age 50 may affect the age, years later, when Alzheimer’s strikes. Among those who eventually got sick, more midlife pounds meant an earlier onset of disease. (Neergaard, 9/1)

Americans are getting older, and heavier—and both trends are trouble for the country's knees. The rate of total knee replacements almost doubled between 2000 and 2010 for Americans over 45, according to new data from the Centers for Disease Control, while the average age of patients decreased by more than two years, to 66.2. The elective surgeries, which replace worn-out cartilage and bone with metal and plastic mechanical joints, became the most common inpatient hospital procedure for people over 45 in 2008. Almost 700,000 were performed in 2010. (Tozzi, 9/2)

About 25 to 30 percent of people prescribed statins dump them within a year. I flunked Lipitor after a few wretched months. Statins are prescribed to lower cholesterol in people who show risk factors for cardiovascular disease or diabetes, or who already have them. Side effects can include muscle weakness, diabetes onset and, rarely, permanent muscle damage. ... Frustrated with trial and error, I was ready to swap some DNA for some personalized insight. (Wolfson, 9/1)

About 200 years ago a French physician rolled a sheet of paper into a cylinder and held it up to the chest of a patient. The creation was crude and simple, but it worked. Rene Laenneac could better hear his patient’s heartbeat, and the stethoscope was born. Today, the stethoscope remains a fixture in medicine, draped around the shoulders of doctors. It’s also overdo for a makeover. Now Eko Devices, a Silicon Valley start-up, has received FDA approval for its digital stethoscope, which brings the power of modern technology to an already essential device. (McFarland, 9/2)

A federal judge said Tuesday he has an “inclination” to deny Pfizer Inc.’s four-year-old request to throw out a Justice Department lawsuit accusing the drug maker’s Wyeth unit of overcharging government Medicaid health programs for the heartburn drug Protonix, according to a federal court website. (Loftus, 9/1)

The soaring costs of insuring the state’s poorest residents drove health care spending in Massachusetts up 4.8 percent last year, double the rate of growth in 2013, dealing a setback to the state’s efforts to contain medical costs. The increase far exceeds inflation, which was 1.6 percent last year, and blows past a state goal of holding health care spending growth to 3.6 percent annually, according to a report to be issued Wednesday by the state Center for Health Information and Analysis. (Dayal McCluskey, 9/1)

Massachusetts spent $632 million more on health care last year than it was supposed to, according to a report from the state’s Center for Health Information and Analysis. The goal, established via a 2012 law, is to keep health care spending in line with the rising costs of other goods and services. Every year the state sets a benchmark. In 2013 — the first year of accountability — Massachusetts stayed well under the cap. But last year, spending shot right past the 3.6 percent target and hit $54 billion, a 4.8 percent increase over the previous year. (Bebinger, 9/2)

The cost of health care soared nearly 5 percent in Massachusetts last year, despite efforts to hold costs down. The state Center for Health Information and Analysis said Tuesday that costs grew in 2014 at double the rate of 2013 and far higher than the inflation rate. (9/2)

A record number of Colorado residents now carry health insurance. Statewide, the uninsured rate plummeted from 14.3 percent in 2013 to 6.7 percent this year — the lowest ever, according to a report being released Tuesday. Nearly 5 million people are covered now. The increase is attributable to a dramatic growth in Medicaid enrollment following Colorado's decision to raise income eligibility limits and allow unmarried adults to qualify, an option available to states under the federal Affordable Care Act. (Olinger, 9/1)

The Wolf administration said Tuesday that it had completed the transfer of more than 1 million adult Medicaid enrollees into a single, new benefits package it had created as the program expands to record numbers under the 2010 federal health care law. The process that the Human Services Department finished included the dismantling of changes that Gov. Tom Wolf's predecessor had sought to make to Medicaid coverage as part of Pennsylvania's embrace of the Medicaid expansion. (Levy, 9/1)

During the first three months of the year, just 1 in 20 Americans said they did not get medical care they needed because they could not afford it, according to the U.S. Centers for Disease Control and Prevention. The findings, from the federal National Health Interview Survey, show that 4.4 percent of people interviewed from January through March said they had skipped medical care in the previous year because of its cost -- the lowest percentage in 16 years. The percent skipping care for cost reasons had reached nearly 7 percent in 2009 and 2010 and has been shrinking since then. (Goldstein, 9/1)

Twenty-seven million Americans were contacted by a collection agency about unpaid medical bills last year. A new Federal Communications Commission ruling makes it more difficult to track down those debtors on their cell phones, according to the collection industry. The new rule clarifies that collection agencies can "robo-call" someone on a cell, but only if that person consented to those calls for billing issues. (Gorenstein, 9/1)

A controversial bill to allow physician-assisted suicide for terminally ill patients in California passed a key legislative committee on Tuesday, after failing in the legislature earlier this summer amid opposition from the Catholic Church. The measure, which passed 10-3, next goes to the assembly finance committee. (Bernstein, 9/1)

In a room filled with the pleas of the dying, California lawmakers approved a bill that would allow doctors to prescribe lethal prescriptions to terminal patients wanting to hasten their own deaths. The controversial legislation passed 10-2 in an Assembly special session committee on health on Tuesday, nearly two months after the issue appeared done for the year. The bill now heads to a special session committee on finance. (Gutierrez, 9/1)

A bill allowing physicians in California to prescribe lethal doses of drugs to hasten the death of the terminally ill passed a key milestone Tuesday when it was approved by its first committee in the state Assembly. A similar bill had previously stalled during the regular session in the Assembly Health Committee, but the proposal was revived when Gov. Jerry Brown called a special session with a different committee membership that was supportive of the bill. (McGreevy, 9/1)

Abortion clinics in Cincinnati and Dayton sued Tuesday in federal court, claiming laws enacted in the last two state budgets unconstitutionally restrict access to abortion. The suit, filed in U.S. District Court in Cincinnati, targets changes in regulations that the clinics argue violate protected rights under the U.S. Constitution. Among those are a woman's right to pursue an abortion and the clinics' rights to due process under the 14th Amendment. (Higgs, 9/1)

The operators of two southwest Ohio abortion clinics asked a federal court on Tuesday to declare recently enacted state laws governing their operations unconstitutional. Planned Parenthood of Southwest Ohio and Women's Med Group sued in U.S. District Court, targeting several provisions tucked into the state's two most recent operating budgets, signed into law by Republican Gov. John Kasich this year and in 2013. (9/1)

The U.S. Justice Department told a federal judge that Gov. Bobby Jindal's decision to oust Planned Parenthood from Louisiana's Medicaid program appears to violate federal law by denying Medicaid patients the right to choose their health care providers. In a court filing, the agency said the Jindal administration hasn't offered "sufficient reasons" to keep Planned Parenthood Gulf Coast's clinics in New Orleans and Baton Rouge from receiving Medicaid payments. (9/1)

An advisory committee charged with helping state officials design a system for regulating the use of prescription mental health drugs for Medicaid patients met for the first time Tuesday. The nine-member committee spent nearly two hours discussing the pros and cons of “prior authorization” policies that would allow the three private insurance companies that manage KanCare, the state’s Medicaid program, to approve or disapprove mental health drug prescriptions. (Ranney, 9/1)

Ohio's Department of Medicaid must count live-in spouses as family members when determining whether Medicare beneficiaries qualify for financial assistance with their premiums, a federal appeals court ruled Tuesday. Family "does not mean whatever the State's officials want it to mean," wrote Circuit Judge Raymond Kethledge of the 6th U.S. Circuit Court of Appeals on behalf of a unanimous three-judge panel, ordering the state to reverse its current policy excluding spouses. (Pierson, 9/1)

In a decision that could have far-reaching effects, a federal appeals court ruled Tuesday that Ohio must count an applicant’s spouse as a member of his family when determining eligibility for financial assistance to pay Medicare bills. A three-judge panel of the Cincinnati-based U.S. 6th Circuit Court of Appeals told the state it can’t exclude a beneficiary’s spouse when it comes to income calculations simply because the federal law doesn’t define the word “family.” At issue is a program under Medicaid, the federal-state insurance program for the poor, that helps low-income Ohioans pay their premiums, co-payments, and deductibles under Medicare, the federal health insurance for senior citizens. (Provance, 9/1)

Several Democratic and Republican state senators want DFL Gov. Mark Dayton to delay implementation of 2016 Medicaid and MinnesotaCare contracts out of concern bidding may have been "flawed." At the center of those concerns is the decision by Dayton's Department of Health and Human Services to strip one major provider, UCare, of the vast majority of its customers. (Zdechlik, 9/1)

The chairwoman of a state program that provides health insurance to children of poor families is questioning whether Iowa has acted legally with efforts to privatize management of the system. At issue is a $111.3 million annual program known as hawk-i that provides health insurance for more than 37,000 children from low-income families in Iowa. The program's management will shift to private companies as part of Gov. Terry Branstad's effort to privatize oversight of the state’s annual $4.2 billion Medicaid budget. (Clayworth, 9/1)

Nonprofit insurer Blue Shield of California boosted executive compensation by $24 million in 2012 — a 64% jump over the previous year — according to a confidential state audit reviewed by The Times. The health insurance giant won't say who got the money or why. But Blue Shield's former public policy director, Michael Johnson, who left this year and is now a company critic, said senior officials at the insurer told him that former Chief Executive Bruce Bodaken received about $20 million as part of his 2012 retirement package, on top of his annual pay. (Terhune, 9/1)

A new state-run campaign will heavily push screening for hepatitis C among baby boomers and intravenous drug users. Set to launch in mid-October, the Delaware Division of Public Health program aims to reach out to health care providers, especially primary care doctors and substance abuse clinicians, to educate them on whom to screen and how the disease is transmitted. (Rini, 9/1)

Supporters of the legislation say it will ensure a fair outcome to talks in which the Rauner administration is trying to make sweeping changes, including a sharp increase in employee contributions to health benefits and no longer allowing union dues to be deducted from worker pay, said Roberta Lynch, executive director of Council 31. “They came in with most extreme demands we’ve ever seen,” she said. The governor says the bill will eventually put the labor contract in the hands of a union-friendly arbitrator and prevent Mr. Rauner from getting the best deal for the state. Such a result would increase salary and benefit costs and only exacerbate the state’s fiscal problems, administration officials said. (Peters, 9/1)

Medical giant Cedars-Sinai Health System said Tuesday it has acquired nearby Marina Del Rey Hospital, adding to a flurry of similar healthcare deals. Cedars-Sinai said it has purchased the 145-bed hospital and its neighboring medical office building. The price wasn't disclosed. (Terhune, 9/1)

The service at issue, known as extended, or complex, nursing care, involves a nurse providing services in a person’s home for more than two hours at a time. Clients must have their services reauthorized periodically to continue receiving them. Data from the state Department of Social Services shows the denial rate for requests for extended nursing services has risen sharply since the beginning of the year. (Levin Becker, 9/1)

It took nearly a decade, one false start and countless hours of negotiation and compromise. But the University of Arizona and partner Dignity Health realized a long-held dream last week with the opening of a $100 million cancer center at Fillmore and Sixth streets in downtown Phoenix. Now comes the hard part. (Alltucker, 9/1)

Sandra Shanahan offered a patient's family a ride home Tuesday after they walked there to be seen. "No, I'll take you," the nurse practitioner insisted to the Hispanic family. She's closing Shanahan Children's Clinic on Sept. 29 because she said she's getting too old to run it. The clinic opened 10 years ago. "I will miss nursing," the 73-year-old Edgewater resident said. "I feel guilty already." (Bottalico, 9/1)

With six weeks to go until a new state vaccine requirement kicks in, 95 percent of seniors at Lake Forest High School have submitted proof of being vaccinated against meningitis, said assistant principal Tom Meagher. For the first time, the state of Illinois is requiring that all sixth- and 12th-graders get a meningitis vaccine. Proof of vaccination is required by Oct. 15, according to the new state mandate. (Lawton, 9/1)

Maryland elected officials say the U.S. Department of Veterans Affairs is considering opening an outpatient clinic in Montgomery County. The announcement follows an outcry by elected officials in July over the planned closure of a VA outpatient clinic in Greenbelt in neighboring Prince George's County. (9/2)

Republican presidential candidates—and members of Congress—are proposing ways to replace or repair the Affordable Care Act. Undoing the damage of ObamaCare may finally become a realistic possibility. For now, Americans are experiencing the law’s natural consequences: rising health-insurance premiums and limitations on individuals’ choice of physicians and hospitals. Further consolidation in the insurance industry and among providers will likely drive health-care costs even higher. To reverse these trends, any replacement for ObamaCare should include two essential elements: high-deductible insurance coverage and health-savings accounts. (Scott W. Atlas and John F. Cogan, 9/1)

In a remarkably incoherent and injudicious opinion favoring the anti-abortion organization March for Life, U.S. District Judge Richard J. Leon of Washington, D.C., ruled Monday that the religious rights of employees of a secular anti-abortion organization are infringed because they're required to buy health insurance that covers contraception, even though nothing forces them to actually acquire contraceptives if they don't wish. (Michael Hiltzik, 9/1)

What’s so special about religion? When it comes to exemptions from general laws, whether regulating gay marriage or contraception, no question is more important -- or more complicated. The federal district court in Washington answered that question Monday by saying religion is nothing special. The court held that the Department of Health and Human Services is obligated to give the same exemption to a nonreligious group that has a principled reason to deny its employees contraceptive health-care coverage that the department already gave to religious groups with analogous views. This conclusion was almost certainly correct as a matter of moral logic. But it’s far from clear that it was correct as a matter of law. (Noah Feldman, 9/1)

The nation's healthcare system is endangering the elderly. But few outside the geriatric medical community seem to notice. I learned about this problem the hard way — when caring for an aging parent. My father, a highly regarded orthopedic surgeon, developed Alzheimer's when he turned 78. As his disease worsened, so did the stress of trying to navigate the healthcare system. (Marcy Cottrell Houle, 9/1)

New drugs to treat hepatitis C are tremendously effective — and tremendously costly — raising fears that the high prices might outstrip the ability of public and private insurers to pay. Fortunately, competitive market forces and hard-nosed bargaining by insurers for big discounts are going a long way toward resolving the problem. (9/2)

Along with the nation’s sharp jump in heroin overdoses has come a startling revelation, often called “the new face of heroin.” It is a white face, mostly middle-class and suburban, “far from the stereotype of the shivering urban junkie,” as the Christian Science Monitor put it this year. (Courtland Milloy, 9/1)

Montana's Medicaid expansion plan, the Health and Economic Livelihood Partnership Act, is a hard-won compromise that promises to offer coverage to as many as 70,000 Montanans. The state says it is on track to launch the program within a matter of months, and could begin providing coverage as soon as Jan. 1, 2016. But first, the plan requires federal approval -- and a waiver -- from the Centers for Medicare and Medicaid Services. And who knows how long that could take? Fortunately, Montanans have one week left to offer public comment telling the feds how important this program is -- and how important it is to get it up and running as soon as possible. (9/1)

In challenging the constitutionality of the hospital assessment paying for Arizona’s Medicaid expansion, it’s clear that the Goldwater Institute bet too much on the argument that the assessment is a tax. ... The Institute needs to retool the relative weight of its argument if it wants to have a chance on appeal. (Robert Robb, 9/1)

On June 1, 2015, the Centers for Medicare & Medicaid Services (CMS) proposed a long-overdue overhaul of Medicaid managed care that, among other provisions, will implement ACA requirements for states to collect a standard set of encounter data—detailed records of services delivered to beneficiaries—from Medicaid managed care organizations (MCOs). Encounter data are the only way to know whether the majority of Medicaid enrollees are receiving the care they need, that the care is of adequate quality, and that it is delivered at the lowest possible cost. ... Although the proposed rule could be finalized as early as 2016, many challenges remain for its implementation. States have been slow to adapt their data collection systems to the growth of managed care. (Philip Rocco, Walid F. Gellad and Julie M. Donohue, 8/31)

In January, Secretary Sylvia Burwell announced that the US Department of Health and Human Services will tie 90% of Medicare payments to quality or value by 2019. ... Paying for value will not work unless it can be measured. The ability to assess health care quality and health outcomes has significantly improved over the past several decades. ... At the same time, national improvement is not occurring fast enough given the resources expended on measurement and reporting. Too much care is of uncertain value, and many opportunities to deliver care of proven value are missed. There continue to be challenges in patient safety, ensuring that health care meets a person’s goals and needs, and providing reliable care that reflects the best evidence. (Christine K. Cassel and Richard Kronick, 9/1)

We are not “healers.” We almost never truly heal a patient of a serious disease, certainly not death. We are “treaters” who should try to help each individual patient deal with his or her problem to the best of our ability. Sometimes, for a dying patient, the option of an easy, assisted death is the most merciful, caring, and, I believe, ethical way to do that. I personally also believe that if a person knows he is dying, he should not be forced to wait until the unpleasantness actually begins. As in Oregon, he should be given the opportunity to die at his own time of choice. I personally choose to die before becoming bedridden or infection sets in, after I have tied up my loose ends and made the transition as easy as possible for my wife and family. (Dr. M. John Rowe III, 9/1)