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If doctors and nurses are uncomfortable about withholding food and water, they are profoundly uneasy about actively assisting a suicide. Yet a seemingly / inexorable logic enters the picture: once it is acceptable to stand by and allow a patient to die slowly, why is it not more merciful to end life swiftly by lethal injection? What was once taboo is now openly discussed in academic journals: last March the New England Journal of Medicine published an article by twelve prominent physicians called "The Physician's Responsibility Toward Hopelessly Ill Patients." "It is difficult to answer such questions," the doctors wrote, "but all but two of us believe that it is not immoral for a physician to assist in the rational suicide of a terminally ill patient."
While such articles challenge doctors to rethink their professional roles, there is no agreement among them on this issue. Some physicians and ethicists warn that active euthanasia, if commonly practiced, could undermine the whole ethos of healing and the doctors' role as care givers. "A patient could never be totally confident that the doctor was coming to help him and not kill him," argues George Annas, director of the Law, Medicine & Ethics Program at Boston University's Schools of Medicine and Public Health.
Even hospice workers, who are more concerned with controlling pain than delaying death, are firmly opposed to the idea of loading a syringe with an overdose of morphine and handing it over. And doctors who spend all their time treating the incurably ill may still stop short of sanctioning euthanasia. "I don't want that word and my name in the same sentence," says Jeffrey Buckner, medical director for the Jacob Perlow Hospice of Beth Israel Medical Center in New York City. "If you are a physician and that charge is made against you, it sticks."
One of his patients, a 66-year-old writer suffering from a gastrointestinal cancer, came seeking help in committing suicide. He said he had the pills: 60 capsules, 200 mg each, of Seconal. But surgery left him with trouble swallowing, and he wondered if there was a better way to go. In this case it was not so much the physical pain of the cancer that plagued him; it was the mental burden of a lingering illness. "This long farewell performance gets to be a drag on people," the patient said. "It's just not the way you want to see yourself behaving. There's less dignity. Christ, everybody dies. Why does that always have to be the topic of conversation?" Dr. Buckner refused to help with a suicide. "It is reasonable to want to protect yourself from a horrible death," he explains. "But if good medical care is provided, and | good pain relief, then those fears can be greatly alleviated."
For active help with a suicide, most patients will have to look elsewhere, well outside the realm of patient care. The spread of AIDS, for instance, has prompted some right-to-die activists to offer support and counseling about pills and occasionally lethal injections to people with the virus. Pierre Ludington, 44, executive director of the American Association of Physicians for Human Rights, has tested HIV-positive: he is stockpiling pills to use when he is ready to go. "I get angry that society wants me to suffer in a hospital," he says. "All I'm doing is feeding its coffers."