ROYAL OAK, Mich. — He earned notoriety as the nation’s foremost advocate of assisted suicide, helping at least 100 patients kill themselves, and today Dr. Jack Kevorkian met an old friend at a Michigan hospital.

Dr. Kevorkian, 83, died of undisclosed causes at William Beaumont Hospital in Royal Oak, Mich. He reportedly struggled with respiratory and kidney problems. A spokesman did not address the extent of his physical suffering during his final days, but the occasion of his death was marked by broad acknowledgement of his impact on the nation’s shifting view of assisted suicide and legislative efforts to legalize this practice.

“Dr. Kevorkian’s death marks the end of an era,” said a statement issued by Barbara Coombs Lee, president of Compassion & Choices, formerly the Hemlock Society. “In today’s America, a substantial majority believe in autonomy and choice for people facing the end of life. Physician aid in dying is on its way to becoming an accepted part of the standard of care for terminally ill patients.”

Coombs Lee said Dr. Kevorkian “recognized the need for a public discussion of compassionate options at the end of life. He drew the national and international spotlight to the desperation of patients whose current legal choices are inadequate. His actions raised public awareness and highlighted major public policy problems. As in every movement for social change, there are provocateurs and persuaders.”

Marie Hilliard, director of bioethics and public policy at the National Catholic Bioethics Center, said, “The death of Dr. Kevorkian is no less sad than the death of any human being. We only can hope he experienced the wonderful benefits of palliative care that should be available to all persons as they approach the end of life.”

Hilliard added, “Dr. Kevorkian justified his assisting others to end their lives as necessary to end their suffering. Assisted suicide represents a failure of the health-care system to provide the comfort and solace of palliative care and, in some ways, denies those who were assisted to die the beauty and dignity of such a natural death.”

Rapid medical advances that have made it possible to prolong dying have stirred public fears that patients have little control over end-of-life medical decisions. Film and television continue to explore the suffering and despair of terminally ill patients.

Meanwhile, physicians have been under pressure to modify their understanding of the Hippocratic Oath and its requirement that doctors do no “harm.”

“Kevorkian, with the assistance of the media, was able to drive the issue of assisted suicide into mainstream American conversation. To date, his crusade has had little effect. But if Kevorkian is ultimately successful in coarsening our culture so that it accepts assisted suicide as a response to sickness and suffering and enlists the medical profession in killing people, then his impact will be distinctively harmful,” said John Brehany, executive director of the Catholic Medical Association.

Last week, Gallup released its 2011 “Values and Beliefs” survey, and its researchers concluded that “doctor-assisted suicide emerges as the most controversial cultural issue … with Americans divided 45% vs. 48% over whether it is morally acceptable or morally wrong. Having a baby out of wedlock and abortion also closely divide Americans. However, stronger public consensus exists on 14 other issues tested.”

An aggressive and confrontational proponent of assisted suicide, Kevorkian earned jail time for acting on his view that terminally ill patients should be able to hasten their deaths.  He played a pivotal role in the national debate, producing countless articles outlining his position.

“He touched a nerve of people who are afraid of suffering and death and have no moral grounding. Partly based on his encouragement, two or three states have moved to legalize assisted suicide. It’s a sad and dark legacy,” said David Prentice, senior fellow for life sciences at Family Research Council.

Some commentators have suggested that Kevorkian’s willingness to address end-of-life issues paved the way for the hospice movement, which focuses on the needs of dying patients, including aggressive pain management.

But Prentice disagreed. “I don’t think he had anything to do with promoting hospice or even the idea of ‘death with dignity.’ He sought to hasten death to escape life, rather than promoting any kind of good life or a good death.”

Prentice also noted that a reassessment of state suicide laws is already under way, with some legislators looking to impose limits on the practice. “The hope is that every state that has approved assisted suicide will ultimately renounce it,” he said.

The Disabled

Disabled Americans strongly opposed Kevorkian’s argument.

“The people most opposed to his message were the disabled. He saw them as less than human,” Prentice said. “He didn’t value their life.”

Kevorkian participated in his first assisted suicide in 1990.

During the U.S. bishops’ upcoming meeting in Seattle, the bishops will review and vote on their first conference-wide statement dealing with assisted suicide, “To Live Each Day With Dignity.”

“Why are the suicides of some considered acceptable while others are not? The bishops’ anticipated statement on assisted suicide addresses this discrimination and calls for policies to help all people live out their days according to their God-given dignity,” said Deirdre McQuade, assistant director for policy and communications at the bishops’ conference’s Secretariat for Pro-life Activities in an email message following Kevorkian’s death.

Before Kevorkian’s death, Cardinal Daniel DiNardo of Galveston-Houston, chairman of the USCCB Committee on Pro-Life Activities, issued a statement that marked a “resurgence” of legislative efforts to legalize assisted suicide.

“This renewed effort has led to the passage of an Oregon-style law in Washington by popular referendum in November 2008, a state Supreme Court decision essentially declaring that assisted suicide is not against public policy in Montana, and concerted efforts to pass legislation in several New England states,” Cardinal DiNardo reported in a prepared statement.

According to a published summary, the draft statement “speaks of the hardships and fears of patients facing terminal illness and the importance of life-affirming palliative care. It cites the Church’s concern for those who are tempted to commit suicide, its opposition to physician-assisted suicide, and the consistency of this stance with the principle of equal and inherent human rights and the ethical principles of the medical profession.”

Register senior editor Joan Frawley Desmond writes from Chevy Chase, Maryland.