(2 of 10)
Right-to-life advocates denounce what they call the "pro-death juggernaut," a shifting of public opinion on death and dying that is affecting not only private decisions but also public policy. Forty states and the District of Columbia have living-will laws (see box) that allow people to specify in advance what treatments they would find acceptable in their final days. In January, a New York State Supreme Court justice ruled that a family did not have to pay about two years' worth of $172-a-day fees for tending a comatose patient after they asked to have a feeding tube removed. That same month the Brooklyn district attorney decided not to press any charges against three grown children who had turned off their father's respirator, on the grounds that he was already brain dead.
Though statutes and court rulings may codify what is legal, they cannot ease the acute personal dilemmas of those who must deal directly with right-to-die situations. The issues that patients and families face are not only ethical but also medical, financial, legal and theological. In the last days of a ravaging disease, when the very technology that can save lives is merely prolonging death, how is a family to decide whether to stop the treatment? By adopting the abstract reasoning of jurists and ethicists weighing legal arguments about privacy and moral arguments about mercy? Through some private intuition about how much sorrow they can bear and how much courage they can summon? Or by some blunt utilitarian calculation about whether it is more important to keep Grandmother alive than to send Junior to college? In the end, individuals are left with an intricate puzzle about what is legal -- and what is right -- in making a decision.
It is not only families that must decide. Doctors are wondering when, in an era of untamed technology, they should stand back and let their patients die -- or even help death along. Economists are calculating a sort of social triage: at a time when infant mortality is scandalously high and public health - care is a shambles, does it make sense for taxpayers to spend tens of thousands of dollars a year to keep each unconscious patient alive? Lawmakers are struggling with how to draft laws carefully enough to protect life while respecting individual choice. Theologians are debating how sacred life can be if we take it upon ourselves to end it.
It is not surprising that physicians are on the front lines of the euthanasia debate, since they are the only participants for whom life-and- death decisions are as common as they are complex. They are most acutely conscious of the allocation of scarce resources -- time, money and their own energy -- among patients who might be cured and those who can only be sustained. And it is they who must offer explanations to the anxious families of patients whose lives are lost but not yet gone.
It is a basic premise of medicine that doctors should be healers and care givers; that they must work for their patients' well-being; that if they cannot cure, they should at least do no harm. When they took their Hippocratic oath, they promised, "I will give no deadly medicine to anyone if asked, nor suggest any such counsel . . ." But the plight of the incurably ill has challenged all these premises and left doctors and nurses deeply divided over their duties to the dying.