No questions inspire public passion — with usually divisive effects — more than those concerning the beginning and ending of life.

Abortion has long ranked atop the list of issues that polarize American society, but in more recent years that debate has been joined by the furor over the "death with dignity" movement. Between the two camps lie ideas that both sides could support as humane improvements, but such hopes have been lost in the fray.

Under the most optimistic scenario, the recent Supreme Court ruling upholding Oregon's physician-assisted suicide might be seen as a settlement that would move the political dispute off the front burner so that more attention could focus on the general need for end-of-life care.

Unfortunately, there's little cause for optimism here.

The ruling was a victory for proponents of the Oregon law, but a narrow one. The majority opinion, written by Justice Anthony M. Kennedy, was less an endorsement of physicians who help dying patients end their lives than a declaration that federal authorities have no power to interfere with a state's regulation of medicine.

So the law's opponents in Congress surely will try to give the feds that authority.

And while that's happening, doctors who care for the dying will continue to feel constrained. A climate of fear will persist, one that can inhibit the appropriate prescription of drugs for relief of pain.

This is the most tragic outcome of all, as many who have watched a loved one near death can testify.

Now that the Supreme Court has ruled, our lawmakers might wish to test the waters for the reintroduction of a "death-with-dignity" bill, one modeled after the Oregon statute, which severely restricts the way lethal drugs can be prescribed.

But in doing so, they shouldn't lose sight of an even more achievable goal: encouraging more services that offer "palliative care" — comfort to the dying.

Hawai'i already has well-established hospice services as well as more recent initiatives, such as the Kaiser Permanente "palliative care team" that assists members caring for a dying loved one at home. Such programs require an investment in staff positions, but the investment pays off in lower hospitalization costs as well as a more humane experience for patients and families.

There should be some strictly regulated provision for those in the final stages of a terminal disease who can find no other way to have dignity in dying. But even if they fall short of that breakthrough, lawmakers should seek ways to support care of the dying as a normal part of healthcare, available to everyone.