DETROIT - Foot soldiers in the nation's right-to-die movement said they were glad to hear that Dr. Jack Kevorkian is getting paroled from prison next year but worried his presence might turn the national debate on end-of-life issues into a circus.

"There are so many good things going on right now in palliative and end-of-life care, I'd hate to see it get lost in his personality and sideshow," Dr. Timothy Quill, director of the Center for Ethics, Humanities and Palliative Care at the University of Rochester Medical Center in New York, said Wednesday.

Palliative care is the practice of easing patients' pain and suffering. Quill, an advocate of physician-assisted suicide and a national expert on right-to-die issues, wrote a 2004 article for the New England Journal of Medicine, describing how he used sedation to ease his father's suffering in his final days.

Nowadays, the movement is a far cry from Kevorkian's pointed denunciations of public policy and his flouting of Michigan law with news conferences and, in one case, a video showing an assisted suicide that ran on "60 Minutes."

Instead, the movement became mostly political, working through state legislatures, ballot initiatives and political action groups in its attempt to legalize assisted suicide and educate terminally ill patients and families about their options.

The results have been mostly unsuccessful, at least when it comes to changing public policy - though advocates say even getting the question before voters or legislatures, or educating people on their options, constitutes a success.

In 1998, Oregon enacted the Death With Dignity Act, giving that state's terminally ill patients the option of a legal overdose administered by a physician. But similar referendums in Michigan, Hawaii and Maine have failed. Right-to-die groups are still trying to get a law similar to Oregon's on the books in Washington state.

Few people have taken advantage of Oregon's law, according to the state's Department of Human Services. Since 2002, the number of Oregon's assisted suicides has remained stable at 30-40 a year.

The issue remains controversial, however. This year, the U.S. Supreme Court upheld Oregon's law when the Bush administration challenged it.

Although the right-to-die movement doesn't get the notoriety it did when Kevorkian was assisting suicides, advocates say that hundreds of people a year take their own lives with guidance from volunteers who instruct the terminally ill on how to overdose or end their own lives through starvation. Unlike Kevorkian, they don't administer the drugs or touch the patient and don't convene news conferences.

"They do nothing physical and therefore they don't break the law," said Derek Humphrey, founder of the defunct Hemlock Society, one of the original right-to-die groups.

"They do the opposite of Kevorkian," Humphrey added. "They do it and they just go away. We have found that as long as the person is terminally ill and as long as there is no publicity, law enforcement doesn't want to know."

In Michigan, authorities sat they see little if any evidence of assisted suicide anymore.

"If it's happening, it's being done very quietly and in a way that doesn't create any alarm for the public and authorities," said Dr. Daniel Spitz, medical examiner for Macomb and St. Clair counties.

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© 2006, Detroit Free Press.

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