In Washington earlier this month, prominent assisted-suicide activists held a briefing titled, "Jack Kevorkian and Physician Assisted Dying: Not One and the Same." Among the participants were doctors, nurses, attorneys and professors - all very prestigious. No one wore revolutionary-era judicial garb, as Kevorkian did at an earlier trial.

Speakers in business suits delivered a carefully crafted message that not everyone who supports physician-assisted suicide is an extremist. In a statement released just after the verdict, they stated: "The conviction of Dr. Kevorkian illustrates just how far outside the mainstream his actions in this case were, but should not be interpreted as rejection of physician-assisted dying."

Despite the finesse of the marketing effort, the message they are selling remains outrageous. Before we bring "medicide" into mainstream medical practice, consider what we know about mainstream practice today. We know that as many as 40 percent of patients needlessly die in pain. We know that people's preferences to avoid unwanted treatment in favor of a natural death are often ignored. We know that most Americans die in hospitals or nursing homes, despite an overwhelming majority wanting to live out their lives at home.

We also know that access to critical health care is limited. Congress determined that every Medicare recipient is entitled to at least six months of expert pain control and the comprehensive, supportive care that hospice represents.

In an era of budget cuts, managed care, hospital closures and curtailed health services for the poor, legalizing pre-emptive death feels too much like a way to bury our problems. Note that last year in Oregon, where physician-assisted suicide is legal, the state's budget-strapped health plan decided not to pay for certain pain medications. Yet it decided to pay for the full cost of lethal prescriptions. Is there a message there?

Searching for a middle road on the issue of legalization is probably folly. This fight will continue. But while it rages, opponents and proponents -- including those most ardently for and those most vehemently opposed to assisted suicide -- have a chance to improve end-of-life care dramatically.

Let's legislate a requirement that doctors must pass a test in pain management before getting -- or renewing -- a license to practice. Let's require medical and nursing students to learn as much about end-of-life care as they currently do about obstetrics. When erudite leaders of corporate and academic medicine complain that such laws would violate academic freedom and intrude on the sanctity of medical practice, let's ask whose side they're really on.

We focus the national spotlight on the Kevorkian trial. Perhaps now it's time to put medical school deans on trial for graduating doctors who can't treat people's pain. Why not charge executives of nursing home chains whose patients die in agony and alone? Their tolerance of the situation is tantamount to torture.

Ira Byock, M.D., is author of "Dying Well" (Riverhead/Putnam) and a founding member of Partnership for Caring, a consumer advocacy group working to improve end-of-life care. You can write to him in care of the Detroit Free Press Editorial Page, 600 W. Fort St., Detroit, Mich. 48226.