The Will to Live in Context:

How We Ourselves Have Come to Be at Risk from Euthanasia

By David N. O'Steen, Ph.D.
NRLC Executive Director

The fight over euthanasia has not been like the fight over abortion. Many members of the pro-life movement can recall exactly where they were and what they were doing when they heard about Roe v. Wade. In one calamitous stroke the Supreme Court swept away the laws of all 50 states, overnight instituting the regime of abortion on demand. The tragedy was overwhelming, but - - for that very reason - - unmistakable, and the grim event sparked the outrage of millions of Americans. Galvanized, we built a movement whose work has now built a powerful pro-life educational, legislative and political force throughout the nation.

But the progress of euthanasia has seen no such singular shattering event. Instead, the legalization and acceptance of euthanasia has proceeded slowly, step by step, in a sequence so gradual as almost to be imperceptible. Focused on the more visible horror of abortion, our movement's attention to the euthanasia fight has too often been spasmodic and even superficial. So it has come to pass that, as we look about us today, we find the final barriers toppling on every side.

We who in our fight for unborn children and in the earlier phases of the euthanasia struggle have taken pride in the altruism of our movement - - in our commitment to protect those who cannot speak for themselves - - now find that we ourselves are threatened. Our own families' lives - - our own parents and children - - are now directly and imminently at risk.

The point cannot be made too strongly. The trends in medical practice, in the courts, and in the legislatures, described elsewhere in this issue, are all too clear. The assumptions of 30 years ago, that the presumption is for life, has been virtually reversed in cases in which "quality of life" or degree of disability falls short of the medically approved or socially accepted norm. Denial of lifesaving medical treatment, and even food and fluids, to people who have never expressed any desire to reject them has become the norm. Their denial to people who say they want them is now increasingly practiced in hospitals all over America, and direct killing by lethal prescription is already legal in Oregon and is debated year after year in state after state.

How has it come to this? How has it seemingly snuck up on us?

The advocates of euthanasia began in the 1970s by building on an almost universally accepted premise: that, in the absence of truly exceptional circumstances, a competent adult may accept or reject any medical treatment. Rooted in the doctrine of informed consent and long accepted by common law, this principle became the starting point for a steady progression in two directions, along two axes.

On one axis (represented by the columns on the accompanying chart) is the degree of voluntariness. Euthanasia may be voluntary (meaning the patient, while competent, has requested it), non-voluntary (meaning the patient's wishes are unknown, and courts or a surrogate impose it), or involuntary (meaning that death is chosen for the patient against his or her explicit wishes).

On the other axis (represented by the rows) is the method by which death comes: moving progressively from deprival of lifesaving medical treatment, through starvation and dehydration by removal of food and fluids, to direct killing.

The chart shows mileposts in the progress along both axes, with the dates of leading court cases or other developments. The first step came in the movement from voluntary to non-voluntary deprival of lifesaving medical treatment. The 1976 Quinlan case inaugurated the doctrine of "substituted judgment," under which it was argued that an incompetent individual could not be deprived of the competent individual's right to reject medical treatment "merely" because she or he could not choose to do so. Rather, it was held that another party - - court, family member, or government bureaucrat - - could step in and exercise that right on the incompetent person's behalf. Ignored was the person's at least parallel right to choose to accept treatment - - to choose life.

The next steps were to move from rejection of medical treatment to rejection of food and water (at first, "artificially administered," but soon to include spoon feeding), initially for a competent adult (as in the Bouvia case) and then through "substituted judgment" for an incompetent person who had never expressed an opinion.

Direct killing was first legalized by a 1994 referendum in Oregon, whose assisting suicide law became effective, after withstanding court challenges, in 1997. While the Oregon law on its face legalizes only voluntary killing, both court precedents and the words of euthanasia advocates strongly suggest they will move to include nonvoluntary (surrogate authorized) killing once the first step gains a sufficient foothold. In the Netherlands, the first country in modern times to legalize assisting suicide, official government reports have found that over 1 out of 10 cases of active euthanasia occur without the consent of the person being killed.

Meanwhile, in 1992, Virginia passed a statute explicitly legalizing involuntary denial of treatment when a doctor thinks that following a patient's expressed desire for life would be "medically or ethically inappropriate." Fortunately, Virginia some years later amended the law to at least give patients a limited time to transfer to a more sympathetic health care provider before treatment is cut off. Again, the Netherlands points the way on direct killing: active euthanasia leader Dr. Pieter Admiraal openly predicts that in the future direct killing will be involuntary as well.

In this context, two things are evident necessities if we wish to save our own lives and those of our families. First, we must individually get all of our family members to sign Wills to Live to protect themselves and ourselves from the now commonplace non-voluntary denial of treatment food and fluids to those who have never made their preferences clear - - and very possibly from the non-voluntary lethal injections to come.

Second, we must collectively press, at the minimum, for legislation that will protect us from involuntary denial of treatment, food, and fluids despite our Wills to Live.