Lesson Four Die as You Choose
The need for laws on euthanasia cannot be dodged for much longer.
In one of the world's smaller countries， mercy-killing is accepted by the medical establishment and openly practiced a few thousand times each year.
In one of the world's biggest countries， euthanasia is condemned by the medical establishment， secretly practiced many times more often， and almost never comes to light.
Which of these countries has a mercy-killing doctor now languishing in its jails？
It is the small one， Holland， which has rules for euthanasia and so can police it effectively.
The Dutch doctor broke his country's rules.
There is a moral here for all the countries， and not just for the big death-forbidding country， America.
Right now it is going over the arguments about euthanasia once again.
In January the Journal of the American Medical Association published a bizarre letter， in which an anonymous doctor claimed to have killed a 20-year-old cancer patient at her own request.
This started a debate that will rumble on into the autumn， when Californians may vote on a proposed law legalizing euthanasia.
The letter was probably written for polemical impact. It is scarcely credible.
It's author claims that he met the cancer patient for the first time， heard five words from her – “Let's get this over with” – then killer her.
Even the most extreme proponents of euthanasia do not support such an action in those circumstances.
Yet medical monstrosities that are hardly any better undoubtedly continue， almost as a matter of macabre routine， in America， Britain and many other countries.
It is disturbingly easy to find doctors who will say， in private， that they sometimes kill patients on purpose.
Most say that know somebody else who does. But because they can rarely discuss euthanasia openly with patients – even when those patients beg them for it – doctors tend to kill only when the dying are too far gone to consent.
Thus， because voluntary euthanasia is taboo， a doctor makes the decision himself – and the patient is killed involuntarily in the night with a syringe.
That is one price of keeping euthanasia secret.
If all forms of mercy-killing are wrong， they should remain taboo.
But are they？
Because many people accept that it is sad， undignified and gruesome to prolong the throes of death will all the might of medical technology， passive euthanasia – letting patients die – is widely accepted.
Most American states have “living – will” legislation that protects doctors from prosecution if they do not try to save someone who has said he does not want life prolonged.
Active euthanasia – killing – remains controversial.
How long can the distinction between killing and letting die hold out？
Just as there can be culpable omissions， so too can there be blameless acts.
Suppose – to take an example from the moral philosophy books – that a man stands to gain from the death of a certain child. The child strikes his head in the bath and falls unconscious. The man sits down and watches him drown.
The fact that the man has performed no action does not excuse him.
Similarly， suppose that a doctor does no wrong by withholding some treatment in order that death should come sooner rather than later. Is he then necessarily wrong if he administers enough painkillers to kill？
Does the fact that the doctor performed an action， rather than an omission， condemn him？
Many doctors working on the battlefield of terminal suffering think that only squeamishness demands a firm difference between passive and active euthanasia on request.
Their argument for killing goes like this： one of a doctor's duties is to prevent suffering； sometimes that is all there is left for him to do， and killing is the only way to do it.
There is nothing new in this view. When Hippocrates formulated his oath for doctors， which explicitly rules out active killing， most other Greek doctors and thinkers disagreed with his ban.
Let the past be a guide.
Some people believe that the time of death is appointed by God and that no man should put the clock back on another. Yet if a patient's philosophical views embrace euthanasia， it is not clear why the religious objections of others should intrude on his death.
Another worry is that a legal framework for euthanasia， permitting a doctor to comply with a dying man's request in a prescribed set of circumstances， might pose dangers for society by setting a precedent for killing.
That depends on the society.
Holland， arguably， is ready for it.
It is probably no coincidence that it was Dutch doctors who most heroically resisted pressure to join in the Nazi medical atrocities that have given euthanasia its worst name.
The same tenacious respect for individual liberty that stopped them killing healthy people， who did not want to die， now lets them help dying people who do.
West Germany， by contrast， will not be able to legalize any form of euthanasia for a long time to come.
Opposition is too fierce， because of the shadow of the past. Countries with an uninterrupted recent libertarian tradition have less to fear from setting some limited rules for voluntary euthanasia.
By refusing to discuss it， they usher in something worse.