The MacNeil/Lehrer NewsHour

MR. MacNeil: Good evening. Leading the news this Wednesday, progress was reported in talks on a hostage swap, but a quick release was called unlikely. We'll have details in our News Summary in a moment. Roger Mudd's in Washington tonight. Roger.

MR. MUDD: After the News Summary, doctors and ethicists debate a new best selling book on how to commit suicide. Charlayne Hunter- Gault has the second in our series of conversations on the snarled finances of the Bank of Credit & Commerce International, and essayist Jack Perkins observes the 75th anniversary of the National Park Service. NEWS SUMMARY

MR. MacNeil: UN Secretary General Javier Perez DeCuellar and Israeli negotiators reported progress today in their talks on ending the hostage crisis. But they said any resolution was unlikely in the next few days. They were reported to be working towards a broad-based prisoner swap involving the Western hostages held in Lebanon. Libby Wiener of Independent Television News reports on the meeting.

MS. WIENER: The United Nations Secretary General, Mr. Perez DeCuellar, was enjoying a rare moment of relaxation on the terrace of his Geneva hotel this afternoon before his second critical meeting with the Israelis. Earlier, he'd suggested that one possible obstacle to a deal, the issue of convicted Arab terrorists such as the Hamadi brothers in Europe, was not on the agenda.

SEC. GEN. JAVIER PEREZ DE CUELLAR: That is a different problem. I am now referring to the hostages and the Hamadi brothers are not hostages as far as I know.

MS. WIENER: The plane carrying the Israeli delegation touched down shortly after 1 o'clock. The chief negotiator, Uri Lubrani, emerged in shirt sleeves accompanied by a top Tel Aviv lawyer and another foreign ministry official. Arriving at the hotel, he appeared as hopeful as the Secretary General.

MR. LUBRANI: I'm always optimistic. I'm always optimistic.

MS. WIENER: What will you be saying to the Secretary General?

MR. LUBRANI: I won't say to you now before I say to him.

MS. WIENER: But you're hopeful that a deal might be possible now?

MR. LUBRANI: I'm always hopeful.

MS. WIENER: But after an hour and a half of negotiations, it became clear that the question of the missing seven Israeli servicemen in Lebanon still has to be resolved.

SPOKESMAN: What I can tell you is that we've had a very fruitful, very friendly, very, very good conservation with the Secretary General of the United Nations. We conveyed to him the position of the government of Israel versus the problem of releasing the hostages and prisoners of war. The Secretary General is now aware of Israel's position.

SEC. GEN. JAVIER PEREZ DE CUELLAR: Well, I think what I have heard from the Israeli side has been extremely helpful to me, and that now with their encouragement and with the encouragement of the captors and with the support of the Iranian government, I will continue my efforts.

MR. MacNeil: Israeli media reported the country's negotiators had a proposal for a two stage swap of its Lebanese prisoners for Western hostages in Lebanon. As a condition of the swap, Israel wants information on its seven soldiers missing in Lebanon. Deputy Foreign Minister Benjamin Netanyahu said if this country gets that information, then it is ready to make a deal for releases. Roger.

MR. MUDD: President Bush seemed cautious today about the prospects of any further hostage releases. The President interrupted his vacation to address a police convention in Pittsburgh. He said it was a very difficult time, especially for the hostage families.

PRES. BUSH: For years they've endured the cruel water of that cruel water torture, you might say, of occasional vague promises followed by crushing disappointment and they've seen their loved ones used as political puppets. But they haven't been able to identify the puppeteers. And we cannot tell -- I wish I could tell you -- but we cannot tell what lies ahead. But this administration will never rest until every hostage is free to rejoin his loved ones and return to the America that loves them. [applause]

MR. MUDD: Former hostage Edward Tracy is back in the United States. He arrived at an Air Force base in Massachusetts this afternoon accompanied by his two daughters. Tracy will undergo treatment in Boston at the Veterans Hospitals which specializes in post traumatic stress disorder. He'd been held captive in Lebanon for the last five years. There was news of the Italian hostage Alberto Molinari today. The Reuters News Agency quoted Lebanese security sources as saying he was killed shortly after his capture six years ago. The sources said the killing had been a mistake. Beirut's police chief, however, said he had no information to confirm the report. He said Molinari was still considered missing and presumed kidnapped. The Syrian born Molinari had lived in West Beirut for more than 30 years. No group has ever claimed responsibility for his kidnapping.

MR. MacNeil: The Commerce Department had some good inflation news today. It said the Consumer Price Index rose just 2/10 of a percent last month, reflecting sharply lower food and gasoline prices. Inflation has been running at an annual rate of 2.7 percent so far this year, well below last year's rate of 6.1 percent.

MR. MUDD: The governor of Vermont, Richard Snelling, was found dead this morning at his home in Shelborn, Vermont. The governor was home alone. Officials said he had apparently died last night after cleaning his swimming pool. The cause of his death has not been announced. The 64 year old Republican was governor from 1977 to 1985 and last year was elected to his fifth term. Vermont's Democratic Lt. Governor, Howard Dean, was sworn in this afternoon. Television journalist Douglas Kiker died last night in his sleep, apparently from a heart attack. The 61 year old Kiker who left the old New York Herald Tribune to join NBC News in 1966 had been vacationing at his summer home on Cape Cod. That's it for our News Summary. Just ahead on the NewsHour, debating a "how to" book on suicide, the former Customs Commissioner talks about his investigation of BCCI, and an essay on national parks. FOCUS - SUICIDE - FINAL EXIT

MR. MacNeil: Suicide is our lead focus tonight. This week a different kind of "how to" book soared suddenly to the top of the New York Times best seller list. It is a book advising terminally ill people how to kill themselves. Its popularity has renewed a growing national debate over making suicide an easier and more acceptable choice for patients who want to avoid prolonged painful deaths. We start with a background report by Elizabeth Brackett.

MS. BRACKETT: The dog days of August are not the best time for book sales but one book, "Final Exit," has been moving rather briskly. In fact, it's sold out at just about every bookstore here in Chicago.

SUE BUCKMAN, Bookstore Clerk: I heard about it before I saw it and I did take a look at it when it first came in. I didn't get a chance to read it because it went out the door as fast as it came in.

MS. BRACKETT: The book isn't your typical summer pot boiler, but one that deals with the serious subject of how to kill yourself, a subject that brought Henry Dasko to the bookstore.

HENRY DASKO: In my opinion, it's a gigantic step in our civilization to bring out a vehicle that specifically addresses a very unique need that one might have the need to terminate one's own life.

MS. BRACKETT: And would you ever consider that yourself?

MR. DASKO: I don't know. Certainly not at this point, no, not today.

MS. BRACKETT: The book is published by the Hemlock Society, a group committed to advising terminally ill patients on ways to end their own lives. Just this year, using a technique similar to the one described in the book, author Jersey Kucinski killed himself. Deaths like Kucinski's who had not been diagnosed as terminally ill worry opponents of the book. They fear it could be used by those suffering from depression, not terminal illness. Last summer, when Janet Adkins was looking for a way to end her life after being diagnosed with Alzheimer's Disease, she turned to Dr. Jack Kevorkian, a Michigan pathologist who had built a device that could give patients fatal injections. The device quickly did its job, but many ethical questions were raised. After all, Ms. Adkins was only in the initial stages of Alzheimer's and would likely have lived years longer, though certainly with a declining quality of life. But Dr. Kevorkian had no second thoughts.

DR. JACK KEVORKIAN: [June 6, 1990] It's up to a physician with his medical expertise combined with logic and common sense and a totally free mind to evaluate whether this person's desire and wish is medically justifiable. And if it is, then I think it's a physician's duty to offer that option to the patient.

MS. BRACKETT: Homicide charges were brought against Kevorkian but later dismissed. Different ethical issues were raised this spring in an article in the New England Journal of Medicine. The article by Dr. Timothy Quill, a doctor from Rochester, New York, told of his decision to prescribe barbiturates to one of his terminally ill patients. He also instructed her on how many pills to take to kill herself. After her death from a barbiturate overdose, Dr. Quill continued to be haunted by his course of action. In the article he wrote, "I wonder whether Diane struggled in that last hour and whether the Hemlock Society's way of death by suicide is the most benign. I wonder why Diane who gave so much to so many of us had to be alone for that last hour of her life." Shortly after the article appeared, charges were brought against Dr. Quill but dismissed by a grand jury. With the publication of "Final Exit," patients and anyone else, for that matter, are no longer dependent on suicide machines or a doctor willing to write a prescription. For the price of the book, anyone can now be an instant expert in the art and science of suicide.

MR. MacNeil: We turn to four different views on the ethics of helping people commit suicide and what role, if any, doctors should play. Betty Rollin wrote the introduction to the book "Final Exit." Her own book, "Last Wish," relates how she helped her own mother to die in the face of ovarian cancer. She's a correspondent for NBC News and joins us from Boston. Dr. Lonnie Bristow is a practicing physician in Oakland, California, and a trustee of the American Medical Association, which opposes medically assisted suicide. Dr. Bristow joins us from San Francisco. Dr. Leon Kass is a professor at the College on Social Thought at the University of Chicago. Dr. Kass served as a professional witness for the prosecution in the trial of Dr. Kevorkian. He's the author of a collection of essays entitled "Toward a More Natural Science: Biology and Human Affairs." Dr. Kass is in Chicago. And Ruth Macklin is a professor of bioethics at the Albert Einstein Medical Center in New York City. She's the author of a book called "Mortal Choices." Dr. Macklin, how do you explain the popularity of the Hemlock Society book?

DR. MACKLIN: Well, one obvious explanation is probably curiosity. People hear about this -- after all, the front page of the New York Times and the news media have been describing the book and people might want to see what it's all about. More importantly, I think is the desire for people for some form of self-determination. There are many people in our country who have seen their loved ones suffer, people who have been dying of cancer, perhaps the ravages of chemotherapy, and a prolonged dying process. For these people, they may want to take matters into their own hands at some future time and I think this provides a little insurance in that direction.

MR. MacNeil: Dr. Bristow, why do you think the book is so popular?

DR. BRISTOW: Well, I suspect it's a combination of many factors. But probably one of the most dominant factors is the fact that most people are probably unaware of the fact that they do have the ability to control those final days of their existence, if they were to use a mechanism such as a durable power of attorney for health care or the living will, which is available in any community in this country. Also, it's because the book starts out --

MR. MacNeil: Which permit -- enable doctors, if they will obey it, to withdraw or withhold treatment that is prolonging a life.

DR. BRISTOW: That is correct.

MR. MacNeil: They don't instruct a doctor to terminate a life, those living wills, isn't that correct?

DR. BRISTOW: No. That's correct. And also, as I said, the book starts out with a premise which in my view is really false, and that is that Americans are experiencing a great deal of what the book calls unbearable suffering. There's no need for patients in America today to experience unbearable suffering. We have much better mechanisms for adjusting those needs in a very humane, compassionate fashion.

MR. MacNeil: Dr. Bristow, how do you explain the popularity of the book?

DR. KASS: You mean Dr. Kass?

MR. MacNeil: Dr. Kass, I beg your pardon. Dr. Kass, I'm sorry.

DR. KASS: Thank you. I think it's very hard to explain why people buy this book or any other book. I think Dr. Macklin is certainly right in thinking that for some people there is a fear about self- determination, although I would add in many cases it's not only a concern for self-determination but a concern for maybe assisting the suffering of others who may or may not choose such an outcome. But I also think that Dr. Bristow is right in saying that there's a great deal of ignorance about available alternatives that would make the end of life much less scary, and I think also that there's a great deal of morbid curiosity when a topic once taboo becomes chatted about as we are doing right now. I think there are all kinds of reasons and one would need a very careful study before one could determine it.

MR. MacNeil: Betty Rollin, you were impressed enough to write an introduction for this book. How do you explain its appeal?

MS. ROLLIN: Well, Dr. Macklin used the word "insurance" and I think that's right. I think there are people who are desperate to die and since I wrote "Last Wish" I've heard from many of them, but many more people are afraid of being desperate to die. I think the book gives people the assurance that if they're trapped in life they will know how to get out. I saw what this did for my mother, who felt that was her way of describing it, that she was trapped in a room and she didn't know where the key was, and for many people, this book provides the key, not that they will use it. I think by far the extreme majority of people, no matter what their condition, will not opt to die, but to know that they can die, that they will -- that there is a way for them to escape. I think that's why people want to buy the book. Of course, if we had a law that allowed physicians to help desperate people, then such a book wouldn't be so popular.

MR. MacNeil: Well, we'll come to that question in a moment. I just want to ask you -- you heard what Doctors Bristow and Kass said --

MS. ROLLIN: Yes.

MR. MacNeil: -- that in a sense suicide is unnecessary --

MS. ROLLIN: Yes.

MR. MacNeil: -- because there are humane ways, but your introduction and your experience with your mother suggest you think that modern medicine is failing the terminally ill.

MS. ROLLIN: Yes, I do. I think that when the doctor says that there should be no reason for people to want to take their life because they should be -- there's a way that they can be medicated so that they don't feel the pain, well, in a perfect world that is, is the case, but this is not a perfect world and many people do suffer. And all of the people I hear from with suffering parents and spouses are not making this up and the fact is that medication is not perfect and it's much better than it used to be, but many people still suffer. And, by the way, some people who are, are asleep 18 hours a day, they take the kind of pain medication that puts them to sleep 18 hours a day, many of those people or some of those people, as my mother did, don't -- they don't feel that that's the kind of life that -- that is the kind of life they want to live. So they want to die because they think being, you know, that being asleep all the time and being in pain the rest of the time is not, is not life worth living. And the important thing is what the individual wants. As I say, I think most people want to live no matter what. But there are people who see nothing ahead of them but, but pain and suffering and they see no reason, as my mother did, to -- not to rationally say, hey, this has been a wonderful life and now it's time for me to go and I want help to do that safely, because many people try to die and take the wrong kind of medication and wind up suffering more. And that's the value of the book.

MR. MacNeil: Dr. Bristow, you heard what Betty Rollin just said. There are a lot of people suffering still and would love a way, an assured way to end that. How do you respond to that?

DR. BRISTOW: Well, I would respond to that with understanding, that there are individuals who believe that that's the case. But I would remind you, your audience, that one of the most famous cases this country has ever heard of, of an individual desiring euthanasia, was a young lady in Southern California, Evelyn Bouvier, who about 10 years ago went to court trying to force her physicians to end her life. Now fortunately, she was unsuccessful in the courts, her physicians did not carry out her wish and a year later, she had changed her mind. Now that was about 10 years ago. She's still alive and apparently no longer wishes to end her life. And so if you have the sort of mechanism that this book calls for, you're going to lose the opportunity for people to change their minds.

MR. MacNeil: How do you respond to that, Betty Rollin?

MS. ROLLIN: Well, no, no system is perfect and I think that the doctor has a point and I think that if the law is changed so that physicians can aid people who beg them to die, there have to be safeguards and it has to be ascertained that the person truly wants to die over a period of time. I mean, they have these safeguards in place in Holland, and the system works. And by the way, in Holland, not many people do ask to die. But the ones who do want it and they have every right, I think, to have their wish.

MR. MacNeil: Let's just make clear -- it is not a crime in this country now to commit suicide.

MS. ROLLIN: Right.

MR. MacNeil: It is a crime to help somebody to commit suicide.

MS. ROLLIN: Right. But many people who are so ill that they want to die can't do it themselves.

MR. MacNeil: Right.

MS. ROLLIN: They need help. Some of them can't swallow so they really do need a physician. The ones who can swallow and get prescription drugs can now refer to "Final Exit."

MR. MacNeil: Dr. Kass, how do you respond to Betty Rollin's point that medicine is actually failing many people who continue to suffer and would like an assured way out?

DR. KASS: Well, I think there are enough such cases to make the point intelligible and forceful, but I think a number of things have to be said in response. First, we've learned tremendous things from the hospice movement so that I think Dr. Bristow is right, that the number of people for whom pain is an incurable problem today are really vanishingly small, providing that physicians and patients are willing to use the requisite doses of medicine on a proper schedule. I don't think pain is really the problem.

MS. ROLLIN: That's a big "provided."

DR. KASS: Well, but --

MS. ROLLIN: That's a big "provided" --

DR. KASS: Yes --

MS. ROLLIN: -- in many hospitals and there are pieces about this all the time.

DR. KASS: I understand.

MS. ROLLIN: Very few people are medicated properly.

DR. KASS: Yeah, but --

MS. ROLLIN: That's the real world.

DR. KASS: But I think --

DR. BRISTOW: You don't handle that problem by saying let's find a mechanism to dispatch people because you have a problem which is an educational one that --

DR. KASS: Exactly.

MR. MacNeil: But in the medical culture, Dr. Kass, are people now, are doctors and nurses giving people adequate medication to relieve their pain in their terminal things, oris there still a suffering problem?

DR. KASS: No, I think -- I mean, I think we've made great strides and I think that there is very, very much progress on this score. I think the problem is much less pain than it is fear of debility, fear of dependence, dehumanization, and things of that sort. And many of the people who fear those things are, in fact, not yet suffering but are anticipating future suffering, or who can't bear the sight of the suffering of the loved one or the -- let's say can't bear to see their loved ones in reduced conditions for which, they, the relatives are suffering. And I think we have to be very careful before we allow steps to be taken that will allow some people to choose the death for other people because they can't stand the sight of them and of this reduced condition.

MR. MacNeil: Dr. Macklin, what do you think of the pain issue? Is -- has the medical professional adequately solved that problem for terminally ill people, or is, as Betty Rollin said, is it still a problem real enough that many people fear it?

DR. MACKLIN: Well, I think Betty's right and to add -- emphasize her point, it's not just the provision of pain medication, but for patients who are truly in great pain, the amount of pain medication they may need is so great that the quality of their life and the debility from the medication, itself, as Betty Rollin put it, they're either sleeping, or to use another term, they're zonked. Now that's not a quality of life which anyone would choose to have. So it's partly the physician's inability -- not doctors' inability, but, indeed, the limits of medication. Medication can either relieve pain or put people to sleep. And there may not be anything in-between.

MR. MacNeil: Let's move on to the central message of this book, which is here's how to do it, it tells you what kind of medication is lethal and how to take it, and how to assist it in other ways. What do you think as an ethicist, yourself, of providing that kind of information to the public?

DR. MACKLIN: Well, I'd like to hear what arguments there are against it. One would have to --

MR. MacNeil: In other words, you don't have any yourself?

DR. MACKLIN: No, I don't. One would have to endorse either self- censorship of authors who want to print things in a country that believes in freedom of the press and freedom of speech, or another form of censorship that would clamp down on people who want to provide this sort of information. The book is addressed to suffering, terminally ill patients. The book is very responsible in what -- in its "dos" and "don'ts," what it's suggesting people do and do not do and says over and over again that the audience it's addressing are people who are capable of making this decision so I think some of the comments that Dr. Bristow and Dr. Kass made about dispatching people or others choosing are not to the point of this book at least. This book presumes that people are voluntarily able to read, to follow directions, and to carry out in times of their own terminal illness and suffering the recipes in the book.

MR. MacNeil: And you think it's a humane and social service to provide those recipes?

DR. MACKLIN: I do think so and I think the worry about abuses, that it will fall into the hands of "the wrong people," who are the wrong people? After all, when people are terribly depressed, clinically depressed, they find a way. Most people who are experts in suicide are quick to say that patients who truly want to commit suicide will do it and they find a way. They don't need this book.

MR. MacNeil: Dr. Bristow, how do you respond to that -- the central message of this book and whether it is a humane and useful service to this society to have the information presented this way?

DR. BRISTOW: Well, it's one of the two main problems that I have with the book. Apparently, many people are unaware of the fact that in this nation every year approximately 50,000 adolescents between the ages of 10 and 19 attempt suicide every year. Of that number, only 10 percent are successful. The other 90 percent fail largely through ineptitude. This book provides a mechanism to reduce those percentages of failure considerably so that we may find many children dying because of access to a book which is sold in the "how to do it" section of bookstores. Now I would submit to you that the death of even one child who's despondent over a failed history examination is, is not worth the price of having this information available under the freedom of information approach or the First Amendment considerations.

MR. MacNeil: Betty Rollin.

MS. ROLLIN: Well, for the most part, the book recommends prescription drugs which children would be unable to get. And, umm, you know, to say a book is dangerous because this might happen, well, I mean, one hardly knows how to answer that. Of course, it would be terrible if a depressed adolescent got the book and, and somehow managed to get the prescription drugs and, and died. But, umm --

DR. BRISTOW: May I insert that every household in this nation has a medicine cabinet, most of which have prescription drugs in them, and many of which --

MS. ROLLIN: Not that kind --

DR. BRISTOW: -- are the sort of drugs --

MS. ROLLIN: -- not enough, not what you need.

DR. BRISTOW: That's not true.

MS. ROLLIN: Well, I don't know what kind of medicine cabinets you have --

DR. BRISTOW: What I'm saying is that --

MS. ROLLIN: -- but most medicine cabinets don't have the kind of dosage and the kind of medicine. It takes a lot to die. It takes a lot of medication. If you saw the letters I get from people who've tried to die and failed, grisly, grim stories.

DR. BRISTOW: Through ineptitude, through not knowing how to do it. This book removes that problem.

MS. ROLLIN: It takes a lot of medication.

MR. MacNeil: Let's bring Dr. Kass in. What do you think on the scale of whether this book is more dangerous or more humane and useful to society to have precise information on how many pills of which particular brands it would take to kill someone?

DR. KASS: Well, I lean on the side of more dangerous and I think there is something naive about saying that because the author intends this book only for a selection portion of the population that it will only be read and used by those people. Second, I think it's -- it's a very dangerous thing to send out a message to people that this is "the" technical fix for their troubles when for many of them there are existing alternatives which they will not explore and which they will be denied, because, once again, we opt for the quick and neat and short and irreversible solution.

MR. MacNeil: By the alternatives, you're talking about death in a hospice with adequate medication --

DR. KASS: Well, no, but I think -- I think, as I learned in the Kevorkian trial, people wrote to Dr. Kevorkian with unbearable pain and he wrote back saying, I'm sorry, I can't help you now, I will do so later. It turns out one of these patients had chronic migraine, but for which she became desperate. Now it seems to me the medical profession society owes people every exploration of possible hope and human company and not just simply a technical alternative dispensed through bookstores to do it by yourself.

MR. MacNeil: Let's go to the other point finally that the book raises. It suggests that people look for a sympathetic doctor. Dr. Macklin, in your experience, are more American doctors now sympathetic in an informal way to this kind of solicitation, and do you think they should be, and are we moving towards a time and should we be moving towards a time when doctors will consider it ethical to help people die who want to die?

DR. MACKLIN: One thing is that physicians are quite reluctant to express their sympathy for fear that they will be stigmatized as a "Dr. Death" perhaps. Most doctors do not -- and it's part of their medical training -- do not express an eagerness to help patients by providing pills or certainly by providing lethal injections. Indeed, one of the reasons why we hear in the medical center why there is so much suffering from cancer patients is that doctors are reluctant to give an adequate dose for fear that the morphine will suppress respiration and, therefore, the patient will die as a result of the pain medication rather than as a result of the disease. So I think doctors want to relieve suffering, but they do not want to be the agent of death. There are occasional very compassionate, very courageous doctors like Dr. Quill, whom we saw on the earlier segment, who, indeed, felt compassion for a patient he knew, he knew for a long time, he knew her medical condition, and knew that her wish was sustained and voluntary. I think doctors like Dr. Quill are still rare, but in particular is to be commended both for his action and I think the way in which he did it.

MR. MacNeil: Dr. Kass, is Dr. Quill, and people like him, are they to be commended?

DR. KASS: Umm, I would rather not point a finger or cast blame on individual physicians. But on the whole, I would say that they are not to be commended. I mean, precisely as Dr. Macklin suggests, because there may not be an adequate number of caring and sensitive physicians, the last thing one wants to do is erode the venerable, age old prohibition that doctors must not be dispensers of death. The hippocratic oath's first taboo is I will give no deadly drug if asked, nor will I even make a suggestion to this effect. And this kind of self-imposed restraint of physicians on themselves is really necessary in order to protect them against their weaknesses if they really are fully and adequately to care for those patients that are hard to cure and that frustrate every effort to help them. I think there might be some cases where we would want to excuse, but I think medicine and all of us would be in terrible trouble if, if it abandoned its adherence to this, to this age old and I think strictly rational taboo.

MR. MacNeil: Betty Rollin, do you think we should be moving -- American medicine should be moving toward a more, whatever the word is, liberal, relaxed, tolerant attitude to physician-assisted suicide?

MS. ROLLIN: Well, I don't think relaxed is the word but I do think we must move in a more compassionate way. The technology has gone far beyond the place where it was when the Hippocratic oath was written and we do have technology now that prolongs life sometimes madly. And I think as a society we have to find some humane way to deal with a patient who looks up at his or her doctor and begs to die and who can't, himself, get out of life. I think we have to help these people and I think there are physicians who would, if it were legal to assist such a person, would with great joy in the heart give such a patient a lethal shot, as Dr. Quill did.

MR. MacNeil: Dr. Bristow, in a word, is the American medical profession moving any closer to the attitude we've just heard expressed?

DR. BRISTOW: No, I don't believe so, and I certainly hope it will not in the future. It's important to understand that most doctors have had a similar experience at some point in their careers. When I was an intern, I'd been out of medical school only a month when I had a patient come to me who had to be admitted to the hospital who had terminal cancer of the gall bladder. She was there only three or four days and it appeared as though she was going to die shortly. Her daughter came to me and said, can't you please help mother end this tonight? I had every sympathy in the world for that. I identified with the daughter and her mother. And at 3 o'clock in the morning, however, I was able to call my senior resident and explain to him, Al, this is the situation, this is what my heart tells me maybe I should do. He was kind enough to take the time at 3 o'clock in the morning, to sit there and explain to me what it is that we do as physicians, why we do it, and what we don't do. I was able to go back to that family and say, I will be as close a friend to your mother as I can, I will sit and monitor her medicine personally, I will rub her back, hold her hand, but I will not do something that would make all of us ashamed a week or two from now.

MR. MacNeil: Well, Dr. Bristow, I'm sorry to interrupt but we have really run out of time. Thank you very much. Thank you, Betty Rollin, Dr. Kass, and Dr. Macklin.

MR. MUDD: Still ahead on the NewsHour, the BCCI scandal and a Jack Perkins essay on the National Park Service. SERIES - TANGLED WEB

MR. MUDD: Tonight the second in our series of conversations on the BCCI bank scandal. While the scale of the bank's illegal activities are thought to be global, the initials BCCI meant little to most Americans until recently. So this series of conversations is meant to spell out the story of the scandal from those who were trying to put the BCCI puzzle together. Tonight we hear from the former U.S. Customs Commissioner, William Von Raab, who tracked BCCI's activities to the bank's first criminal indictment in the United States. The first public notice of misdeeds at the bank came in 1988 in Tampa, Florida. Five BCCI officials, including one who was Manuel Noriega's banker, were arrested in a sting operation and charged with money laundering. Two years later, a plea bargain, a $15 million fine, and a commitment to clean up its act left BCCI's Tampa operation open for business. Not until last month did banking regulators from seven countries shut down most of the bank's offices around the world, a network that by then reached about 70 countries. The regulators acted amid charges of massive fraud and a global criminal enterprise that earned BCCI the nickname "Bank of Crooks and Criminals." The bank is said to have funneled billions of dollars in deposits from honest customers and from big time criminals to a small circle of corrupt insiders. By cultivating the rich, powerful and prominent, BCCI tried to keep banking regulators off its back. And finally, in Time Magazine came the most explosive allegation of all, that a secret bank within the bank ran a full service spy ring with terrorism and drug running to order. It was four years ago as Commissioner of U.S. Customs that William Von Raab first came across clues that BCCI was flaunting the law. He claims that the pressure he applied to his superiors at the Treasury Department to investigate led to his forced resignation. He talked yesterday with Charlayne Hunter- Gault.

MS. HUNTER-GAULT: Mr. Von Raab, why should anybody care about this case?

MR. VON RAAB: Well, there are two reasons to care about this case. One, it's a banking case. Banking means money, international transactions of money. Major criminal activities, whether it be drug trafficking or arms trafficking cannot take place without transfers of money. Money is the lubricant for international crime. It's a sine quinone. The banking system is the engine that drives that. That's the main reason. Secondly, I think the question has to be asked as to how the entire federal government could have been asleep at the switch when something of this magnitude took place.

MS. HUNTER-GAULT: Now as I understand it, the Customs agency got involved in this case through a sting operation in 1987.

MR. VON RAAB: That's right. Customs on a regular basis tried to get ahold and arrest drug traffickers by offering to launder their money. We were laundering some money for some major drug traffickers and were using BCCI as the government through which to launder it.

MS. HUNTER-GAULT: Why?

MR. VON RAAB: We had to use a bank. It could have been Citibank. It could have been any bank. But the important thing is that when we went to BCCI, they said, we know what you're doing, and we're going to be really good at it and we're going to give you even better ways to do it. So they came back to us and they offered to join our conspiracy. So what ended up were Customs agents undercover, drug traffickers, and BCCI involved in a conspiracy to launder money.

MS. HUNTER-GAULT: And at that point, the BCCI weren't cooperating with law enforcement officials, they were cooperating with the undercover agents they believed to be crooks?

MR. VON RAAB: BCCI thought the Customs agents were bad guys and they liked it.

MS. HUNTER-GAULT: Now tell me about the sting, how it unfolded, and what it produced.

MR. VON RAAB: Well, we had, in fact, we married drug traffickers and the bank and in marrying drug traffickers and the bank, we also married the Customs agents who were undercover, because in order to cause all of the bad guys, the traffickers and the bank officials to come to the United States, we engineered a wedding between the two undercover Customs agents so they all came together in Tampa, we arrested them for conspiring to launder money, conspiring to import narcotics, and at the same time, we almost married the two Customs agents. Unfortunately, they are already married to different people and we arrested everybody at the bachelor's party so we never did get to the wedding. There was an amazing story. When one of the drug dealers was arrested, in this case by a couple of female agents, and the handcuffs were put on him, he was read his Miranda rights and told that he was under arrest and being brought off and he was being brought off into a holding room, he turned and said, boy, this is some party, this is the kinkiest party I've ever been at.

MS. HUNTER-GAULT: And when did it really turn serious?

MR. VON RAAB: The most important first event obviously were the arrest of some of the low level traffickers not only in Tampa, by the way, but in London and in Paris, and from that point on, a very, very important continuing investigation took place on an open basis.

MS. HUNTER-GAULT: Now at what point during the sting operation did it become clear to you just how big this case really was?

MR. VON RAAB: As the sting operation was going on andthe Customs agents would occasionally come up to Washington and give me a firsthand readout on what was going on, and it became clear to me, as it was to them at that point that BCCI was an incredibly diverse criminal enterprise with connections not only to Noriega but with a willingness to do illicit criminal activity all over the world.

MS. HUNTER-GAULT: So what did you then do?

MR. VON RAAB: I tried to make this case as high profile a case as I could. I tried to encourage the agents and the Justice Department to bring the strongest charges against the bank, so that it would be set up as an example of what international banking organizations should not do. So what Customs did was basically put as much energy as it could behind the case so that when the case was announced, it would make the biggest hit possible.

MS. HUNTER-GAULT: And it did.

MR. VON RAAB: It certainly made a big hit on the media and there was a lot of coverage. For some reason it didn't make much of a hit on the Justice Department or on the Treasury Department.

MS. HUNTER-GAULT: Well, did you talk to them about it at this - - at this point? I mean, at what point did you start to talk to other agencies and say, hey, look, this is really bigger than us?

MR. VON RAAB: Customs has been working very closely with the IRS, which is in the Treasury Department, from the beginning, and of course, as soon as the Justice Department was brought in and accepted the case, which is the way it worked, I mean, Customs went to the local U.S. Attorney and said, will you prosecute this case, the Justice Department was pulled in. And the Treasury Department was briefed on a regular basis because they were given all the information that I had and others had and it was passed over to them on a daily or a weekly basis.

MS. HUNTER-GAULT: So what was disappointing to you in the response of the agencies -- you say the media responded well -- what was wrong with the response from the government agencies?

MR. VON RAAB: One, the Treasury Department really didn't seem to care. I mean, they didn't really respond at all. They didn't even say good job to the Customs Service. It sort of went on its merry way, which is understandable I suppose. I suppose they had other things to do. Justice's response was more concerning, and that is they didn't support Customs' desire to indict higher level officials and to bring a strong charge against the bank, itself, for money laundering. They came up with all sorts of maybe legitimate but certainly disappointing technical arguments against indicting higher level officials or indicting the bank, and I thought that it was very important both as a practical matter in terms of punishing people who deserve to be punished and also as sort of setting an example.

MS. HUNTER-GAULT: What would it have done to have indicted the bank at that point and higher level officials?

MR. VON RAAB: If we had indicted the bank at that point, it would have resulted in the Customs and IRS investigators actually beginning to investigate some of the corporate activities of the bank, rather than merely chasing around the personal and criminal activities of some of the mid-level managers. It would have made a huge difference. It would have sent a signal to the agents on the case that they were free, in effect, to go after the bank as an entity and all of its activities. That's a big difference.

MS. HUNTER-GAULT: How did you happen to begin questioning the CIA?

MR. VON RAAB: I called the CIA at the time of the Tampa arrests, or just slightly before that, which was in October 1988. I wasn't completely happy with what I knew about the corporate side of the bank, and so I called the CIA. In this case, I called up Bob Gates, who is the deputy director. And I asked him if he had any information on BCCI, because I said although I knew a lot about their money laundering activities in Tampa and we had a sense, a very good sense, that they were a far flung criminal enterprise, I didn't know how they were founded, I didn't know a lot of other things, I didn't know about other criminal activities, and I wanted some help from him. And he then sent me a memorandum which was a sort of file memorandum that the CIA maintained on BCCI which talked about its origins, its ownership, in general terms about some of its criminal activity and its modus operandi.

MS. HUNTER-GAULT: At any point, did you suspect the CIA or other intelligence agencies were involved?

MR. VON RAAB: No, I didn't. I mean, I didn't ask and I wouldn't have necessarily expected to have been told, but the conservation didn't lead me to believe that -- that BCCI was anything other than one of the many criminal enterprises about which the CIA knew something.

MS. HUNTER-GAULT: Gates said it was called the "Bank of Crooks and Criminals."

MR. VON RAAB: That's right. He was the first man to coin that phrase, "Bank of Crooks and Criminals."

MS. HUNTER-GAULT: What happened next?

MR. VON RAAB: We then started to develop some information, for example, about some of the bank's connections with big league international crooks like Manuel Noriega. At that point, the Justice Department began to be very interested in the case. Unfortunately, they weren't interested in the case in terms of prosecuting BCCI. But they became interested in the case as a source of evidence against Manuel Noriega. So, in effect, that was almost worse for the case because they looked to milk the case for evidence. This ultimately led then to the plea agreement in which, among other things, in return for cooperation from BCCI in providing some evidence against Noriega, they basically took a very, very low and meaningless plea. The other thing that happened at the same time was that the Treasury Department became very concerned about my continued highly public prosecution in the case, my discussions of it in public, and they became very very fearful that somehow I was taking the case out of control, and what they did was they took me off the case.

MS. HUNTER-GAULT: And you said --

MR. VON RAAB: And I said, I can't believe this, it's the most unbelievable thing I've ever heard, but at this point in fairness to the Treasury Department, I was having a pretty good round with them over what I thought was their meager commitment to criminal enforcement, particularly drug enforcement. And so I'd had go-arounds with them over the degree to which the Secretary had shown an interest or his activities and this just sort of fitted into a general bad feeling that had existed with Treasury and that I felt they were lackadaisical and disinterested; they felt I was overly zealous.

MS. HUNTER-GAULT: But at no time during this period did you feel that you were being taken out because you were -- because there was any kind of government collusion with BCCI?

MR. VON RAAB: No. I didn't feel it was government collusion. I felt that somehow the Treasury Department had gotten the impression that I was being unfair to BCCI, that I was harassing them, that I was beating on them, and that, that somehow they had to get rid of this, this rogue who kept talking in these bad terms about BCCI. That's what it seemed to be.

MS. HUNTER-GAULT: But there are those who are arguing these days about this case that it was influence peddlers and others who were able to talk the Justice Department out of rigorous prosecution. Does that make any sense to you?

MR. VON RAAB: Well, let's just look at the record. I'm not sure they talked the Justice Department out of the prosecution, but let's look at the record. There were arrests early in October of 1988. On October 14, 1988, Hill & Knowlton signed a $45,000 a month contract to represent BCCI for among other things political purposes in Washington. I mean, if that isn't influence peddling, nothing is. All sorts of men started to appear representing BCCI. Former assistant U.S. attorneys were representing them in Florida, which you can say is legitimate, but the range of these people is enormous. I mean, it's a collection of all of the big names of influence peddling in Washington. They don't necessarily go to Richard Thornburgh or Nick Brady and say, oh, pal, you know, back off. What they're doing is they just put the word out that they are assisting BCCI, they're trying to improve the environment in which it operates, and people get the -- you get the picture very quickly that they want some help for BCCI. And in this case it worked.

MS. HUNTER-GAULT: But I guess Justice could argue that even with Customs out and everything else, they got the arrests, they got the indictments.

MR. VON RAAB: Well, they didn't get the arrests and they didn't get the indictments of the higher level officials or of the bank, actions which Morgenthau recently did take.

MS. HUNTER-GAULT: In 1991.

MR. VON RAAB: Exactly. So something went wrong for over two years. And I think what went wrongly simply was they didn't have the stomach for it. They didn't have the enthusiasm for it. And I think to some degree that was caused by their obsession with Noriega and their need to get good evidence for that and operating in an environment in which the influence peddlers had basically successfully characterized BCCI as not as bad as everyone says it is.

MS. HUNTER-GAULT: But the Justice Department argues that, in fact, the BCCI Tampa case was the biggest money laundering case that had ever been prosecuted.

MR. VON RAAB: That's absolutely right. It was the biggest money laundering case that had ever been prosecuted. But the punishment that was meted out was ludicrous. There was a fine of some 14 to 15 million dollars, which was less than the money that the bank had made off of its illegal activity. No significant higher level official was even indicted, and the bank, itself, wasn't charged with any significant crime. So it is true that it was the biggest case, it had the biggest potential, but Justice failed to realize on that potential. That's the problem.

MS. HUNTER-GAULT: It was just ignorance on their part, is that what you're saying?

MR. VON RAAB: I don't know why the Justice Department dropped the ball here. Justice in Washington is basically a huge bureaucracy. If you don't have some guts at the local level, you're certainly not going to obtain it from Washington. So the system collapsed in that sense. There was no leadership locally and there was no leadership from Washington, because they didn't know or care about the case.

MS. HUNTER-GAULT: Do you believe that this case says anything about the administration's or the nation's commitment to the drug "war?"

MR. VON RAAB: When I was resigned from the Treasury Department, I was very hard on the Treasury Department for its lack of commitment to the drug war and its lack of putting drugs at a sufficiently high priority. Unfortunately, the failure to prosecute and investigate the BCCI case is first class evidence of a lack of commitment to the war on drugs because it was originally a drug case, and the lack of interest in criminal prosecution. One of the issues that our government is going to have to look at if they want to prevent future BCCI's from taking place is to somehow set up an international scheme, whether it's regulatory or whether it's investigatory, to avoid the use by these criminal banking operations from operating in one country safely and then conducting satellite operations of a criminal nature in other countries.

MS. HUNTER-GAULT: What else do you think has to happen so that this -- I mean, is it possible [a] that justice is ever going to be served in this case, and what has to happen to make it so?

MR. VON RAAB: I think to clean up the BCCI mess the administration is going to have to identify someone whom they will anoint to take care of this matter.

MS. HUNTER-GAULT: Like a special prosecutor?

MR. VON RAAB: Or maybe a special prosecutor. I don't think until it reaches that level of commitment that we're really going to see the thing straightened out. It goes to many places. It goes to the Federal Reserve Board in terms of their information. It goes to state regulatory committees. It goes into the FBI, Customs, IRS, someone that's got to have the stature and the authority to bring together a lot of those organizations and pool their resources and pool their information as well as to go abroad and to collect and work with some of the foreign regulatory and enforcement organizations who are trying to do this as well.

MS. HUNTER-GAULT: Well, William Von Raab, thank you.

MR. VON RAAB: Thank you. ESSAY - NATIONAL TREASURES

MR. MUDD: This year marks the 75th anniversary of the National Park Service. We mark the event with an essay from Jack Perkins.

MR. PERKINS: It is not the easiest trail, precipitous -- it's called Precipice Trail. At time it offers only grab irons in the granite.

TOURIST: Oh, my goodness, we lost a rung there.

MR. PERKINS: Not easy but given the challenge and the view, it is one of the most popular trails in Acadia National Park, which makes what's been happening here even more impressive. Peregrine Falcons used to live on these cliffs until mankind's DDT almost wiped out the species. They haven't nested here for 35 years. But this spring, a couple of birds were spotted and park rangers, not knowing if they were a pair or wanted to nest, just in case closed the Precipice Trail -- for several months at the busiest time closed one of the most popular trails in one of the most heavily used national parks. It is a way of asserting that humans don't always need to assume primacy. That's a very good reason for national parks. This is the 75th anniversary of the national park system and I think we should realize how lucky we are. If we did not already have our national parks, we never would. Most of them just couldn't happen today. The lands would be no longer available, or the plans for them far too costly, or politically incorrect. Think of Mount Rushmore, the national memorial observing its own 50th anniversary this summer. Even if there were people today of Gutzon Borglum's vision to conceive carving Presidents from the hard carny granite, OSHA work rules would never permit the risks his crews took. The cost would be staggering billions today -- plus which can you imagine any political body today agreeing on which four Presidents to put there? It couldn't happen. Or another example of vision -- John D. Rockefeller, Jr., must have foreseen what automobiles might one day mean to parks. For at Maine's Acadia National Park he personally created a refuge. Rockefeller purchased land, designed, and at his own expense had constructed a 50 mile network of carriage roads, graceful carriage roads on which no motorized vehicles would ever be permitted. In perpetuity, these roads are for horses, hikers, bikers -- in winter, skiers -- but never cars, trucks, or motor homes. To carry the roads and adorn them, Mr. Rockefeller had craftsmen work 30 years constructing 16 magnificent granite bridges and when he had done all this, he gave all of it to the nation, to the national park. It is the sort of benefaction seen no longer, perhaps possible no longer. Had it not been done then, it wouldn't be. Had the National Park Service not been born 75 years ago, the crown that is the American landscape would have no jewels. By the way, here at the Precipice Trail, this is the news -- the peregrines this year were a pair, did nest, and rangers and strangers from a discreet distance through binoculars can see brand new peregrine falcon chicks. Welcome to your national park. I'm Jack Perkins. RECAP

MR. MacNeil: Again the main story of this Wednesday, the United Nations Secretary General and Israeli negotiators reported progress in talks on a prisoner swap involving the Western hostages, but they said an end to the crisis was unlikely in the next few days. Good night, Roger.

MR. MUDD: Good night, Robin. That's the NewsHour for Wednesday. We'll be back tomorrow night with another conversation about the BCCI scandal. I'm Roger Mudd. Thank you and good night.