In Hawaii last month, two perfectly healthy people killed themselves after a television station broadcast Derek Humphrey's unique "self-help" video on how to commit suicide. Dr. Kanthi von Guenther told the Honolulu Star-Bulletin News that she had never before seen two suicides using the same method on the same weekend: "I don't think this was coincidence," she said.

Derek Humphrey expressed not the slightest dismay: "If these people are intent on suicide, and released themselves in a nonviolent way from their troubles, then I can live with that," he told the paper.

Derek Humphrey, a man who helped kill one terminally ill wife and abandoned another wife when she developed cancer, can live with that. Can we_

Maybe not, if the person is healthy. But what if the person is disabled or sick_ Then, to many of us, suicide seems only "natural," even a "blessing." We feel such personal revulsion contemplating a life bound by physical dependence that we cannot muster much outrage at the Derek Humphreys of the world.

In a study of the Netherlands, in almost one out of five such legal assisted-suicide cases, the suicides did not work as planned. In such cases doctors did not do what they ordinarily do when suicides go awry -- rejoice and help the patient recover. Instead they took the next step and killed their patients directly. Physician-assisted suicide leads to doctors who kill, just as night follows twilight.

In the New England Journal of Medicine, Dr. Sherwin Nuland has no trouble, like Derek Humphrey, taking that next step: "Patients who wish to receive help in dying face a small but nevertheless worrisome possibility that some untoward event will prevent the smooth accomplishment of their wish."

Doctors, he says, must be thoroughly trained in how to kill their patients efficiently in such cases. The Hippocratic Oath_ Sacrificed to the new god of efficiency.

Nuland tries to convince us that the debate is over; it's "only a matter of time before organized medicine recognizes the pragmatic necessity to support physicians who feel they have a moral obligation to provide such assistance."

Given the trends in organized medicine, he may be right. What managed-care bureaucrat could fail to notice how much cheaper it is to kill patients requiring expensive care_ As Derek Humphrey wrote in a 1998 book, "Economics, not the quest for broadened individual liberties ... will drive assisted suicide to the plateau of acceptable practice."

But why put doctors in this uncomfortable position_ Why not just have roving death squads put depressed, sick, old people down when they ask_ Why not hand the geezers a semi-automatic and be done with it_

Gee, that wouldn't feel much like medicine, would it_ It would at least be more honest than the elaborate word games we play with ourselves to disguise the horror of what we contemplate.

Since Oregon legalized suicide, the number of people asking to kill themselves almost doubled, from 16 in 1998 to 27 in 1999. They were not, for the most part, tormented by pain, but by fears about the future: About two-thirds cited "concern about loss of control of bodily functions" and "loss of autonomy."

Another survey in Oregon found that when those who request death are instead offered alternatives, such as pain control, hospice care or treatment for depression, almost half changed their minds, compared to 15 percent of patients who did not receive extra care.

In the old and the sick, just as in the young and healthy, a suicide threat is a cry for help. Will we, the able-bodied, instead confirm the worst fears of the sick: They are indeed just a burden on the rest of us, an example of a life not worthy of living_

To care or to kill, that is the question: Just what kind of people are we going to be_