As voting day approaches for an aid-in-dying initiative in Washington state, the country faces the real possibility that a state will legalize active euthanasia.
Frustrated by medical technology and by a health care system that often seems more concerned with legal liability than with moral responsibility toward patients, many citizens are eager to take dramatic steps to regain some control over decisions affecting their own deaths. One result is evident in the recent news that Dr. Jack Kevorkian of "suicide machine" fame, has helped two more people to die in Michigan.
Another aspect-this one working within the legal system to change the law-can be seen in the bustling headquarters in Seattle where dozens of volunteers are waging the campaign to win approval of Initiative 119.
The grass roots support this measure has attracted is somewhat reminiscent of previous voter rebellions against taxes increases and, more recently, the drive in favor of clamping strict limits on the terms of officeholders. But of course the ethical implications of active euthanasia (allowing a dying patient to request a lethal injection or other means of death) are more far-reaching -- and more frightening -- than taxes and term limits.
The medical establishment and medical ethicists are now sounding the alarms, justifiably worried that the initiative will pass Nov. 5. But in large measure, this initiative reflects the deep alienation and resentment many people feel toward this country's health care system and the medical establishment.
Opponents of the initiative are warning about the effects of an aid-in-dying law on the poor and uninsured. Faced with a terminal disease and dismal prospects for receiving the kind of medical care they would need, wouldn't they be tempted to request active euthanasia? And wouldn't that be an unfair burden?
The answer? Yes in both cases. But think about it. In some cases, wouldn't active euthanasia be the kinder alternative? After all, people die every day because they haven't had access to medical care, and sometimes those deaths are preceded by excruciating pain.
Looked at from an uninsured person's point of view, Initiative 119 can easily be seen as a rational response to an irrational system.
Another argument often heard from doctors is that helping a patient to die violates the very nature of the patient-physician relationship. That, too, rings hollow, given the hasty, often impersonal nature of most encounters between patients and their doctors.
One physician who can speak authoritatively to this issue has found that his publicized involvement in a patient's death spurred the opposite reaction. In an article in the New England Journal of Medicine earlier this year, Dr. Timothy Quill, a physician in Rochester, N.Y., described how he prescribed lethal doses of barbiturates for a woman dying of cancer.
The story received national attention -- and a legal investigation. But Dr. Quill said he received "a tremendous outpouring of support" and found that his own patients were "remarkably positive" in their reactions.
There are strong ethical arguments against active euthanasia. But voters in Washington state are likely to send a message to the medical community that, from their point of view, those arguments pale in comparison to the ethical problems that pervade the medical care system in general and patient-physician relationships in particular.