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At a recent conference chaired by the Roman Catholic Archbishop of Westminster, Dr. W.F. Anderson of Glasgow University, a professor of geriatric medicine, called euthanasia "medicated manslaughter." Modern drugs, he argued, can keep a patient sufficiently pain-free to make mercy killing, in effect, obsolete. Perhaps. There is no doubt, however, that a panoply of new techniques and equipment can be and often are used to keep alive people who are both hopelessly ill and cruelly debilitated. Artificial respirators, blood-matching and transfusion systems, a variety of fluids that can safely be given intravenously to medicate, nourish and maintain electrolyte balance−these and many other lifesavers give doctors astonishing powers.
Until about 25 years ago, the alternatives facing a doctor treating a terminally ill patient were relatively clear. He could let nature take its sometimes harsh course, or he could administer a fatal dose of some normally beneficent drug. To resort to the drug would be to commit what is called active euthanasia. In virtually all Western countries, that act is still legally considered homicide (though juries rarely convict in such cases).
On the record, physicians are all but unanimous in insisting that they never perform active euthanasia, for to do so is a crime. Off the record, some will admit that they have sometimes hastened death by giving an overdose of the medicine they had been administering previously. How many such cases there are can never be known.
Now, with wondrous machines for prolonging a sort of life, there is another set of choices. Should the patient's heart or lung function be artificially sustained for weeks or months? Should he be kept technically alive by physicochemical legerdemain, even if he has become a mere collection of organs and tissues rather than a whole man? If a decision is made not to attempt extraordinary measures, or if, at some point, the life-preserving machinery is shut off, then a previously unknown act is being committed. It may properly be called passive euthanasia. The patient is allowed to die instead of being maintained as a laboratory specimen.
While legal purists complain that euthanasia and the right to die peacefully are separate issues, the fact is that they are converging. With the increasing use of extraordinary measures, the occasions for passive euthanasia are becoming more frequent. The question of whether terminal suffering can be shortened by active or passive means is often highly technical−depending on the type of ailment. Thus the distinctions are becoming blurred, particularly for laymen.
No dicta from ancient Greece can neatly fit the modern logistics of death. Until this century, death was a relatively common event in the household, particularly among farm families. Today more than 70% of deaths in American cities occur in hospitals or nursing homes. Both medical care and death have been institutionalized, made remote and impersonal. In major medical centers the family doctor is elbowed out by specialists and house physicians who have their elaborate and expensive gadgets. The tendency is to use them.