Nine-year-old Mikey came to see me today. His parents wanted a second opinion about the tumor that is growing out of control a hair's breadth from that part of his brain that tells his lungs to breathe, his heart to beat. Mikey sat in a wheelchair during our visit, his eyes closed against the light, ears plugged to mute the ambient noise. This helps his headache.

"What do you want, Mikey?" his mother asked, softly.

"I want to live," Mikey said.

Mikey is not afraid of death itself. He knows Jesus, and the two of them have discussed this matter thoroughly. His oncologist gave him only four more days to live, but Mikey and Jesus don't agree. That was weeks ago. Like most dying children, Mikey will make a fool out of any doctor who pretends to be a prophet.

The team at the hospital who treated Mikey had their own nurses to follow terminally ill children through to the end at home. But managed care has changed all that. The family's insurance offers hospice services, but only through a provider of the company's choice. The first day the "hospice" nurse came to Mikey's home, she criticized the oncologist's prescriptions.

"We need to get him off Decadron," she said to his mother, about the steroid used to reduce the swelling in his brain.

"But it helps with his headaches," his mother pointed out.

"We'll use morphine for that," the nurse informed.

"But Decadron has helped the headaches before, and it doesn't depress his breathing," his mother responded (correctly).

"Decadron will only prolong things," said the nurse of the child who does not yet intend to die.

Even before the Supreme Court has spoken its piece on physician-assisted suicide (PAS), the merchants of managed death are recasting the name hospice into their own cost-effective, ...