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Ludington has his own idea of a death with dignity. "I envision having a wonderful meal with friends. After they leave, I'll sit in front of the fire listening to Mozart, mix everything with brandy, sip it, and somebody will find me." He is an eloquent if unlikely spokesman for the allocation debate. "I feel that money belongs to a symphony," he says, "or for an impoverished museum to buy a painting that lasts. I won't last. I won't last. It's an unconscionable act to keep me going."
Purely economic arguments for euthanasia can sound brutally calculating. But as health-care costs rise annually at double and triple the rate of inflation, and as new technologies promise ever higher bills for ever older patients, the questions grow about how to ration medical care. In 1987 the Oregon legislature voted to deny organ transplants under its Medicaid program and to use that money instead for prenatal care. It is only a matter of time before the issue of continuing care for patients in a vegetative state comes under similar scrutiny.
Jurists and ethicists wrestle with the wider implications of measuring the value of life on a sliding scale. Once a society agrees that at some stage a life is no longer worth sustaining, patients are suddenly vulnerable. "We would begin with competent people making their own choice," warns Daniel Callahan, director of the Hastings Center and an authority on ethical issues in medicine, "but we would be too easily led into involuntary euthanasia -- either manipulating people into asking for suicide or actually doing it to them without their permission because they have become too burdensome or costly." The haunting precedent, of course, is the Nazi Holocaust, during which the chronically ill, then the socially unacceptable, and finally all non-Germans were viewed as expendable. In his stark essay "The Humane / Holocaust," Christian author Malcolm Muggeridge notes that "it took no more than three decades to transform a war crime into an act of compassion."
As the historic taboo about mercy killing gradually erodes, the courts and legislatures are struggling to be sure that the vulnerable are protected -- that, in the case of the severely disabled, the right to die not become a duty to die. They fear, for example, that medical care for newborn babies may come to depend on some cost-benefit analysis of their chance of living a "full healthy and active life." In the Baby Doe case in 1982, the Indiana courts allowed a couple to refuse surgery for their baby born with Down's syndrome and an incomplete esophagus; after six days, the baby starved to death. That emotional case raised the concern that some hospitals were not recommending even routine treatment for babies with Down's syndrome, spina bifida, cerebral palsy and other serious but treatable disabilities.