FIRST AND LAST, DO NO HARM

By Charles Krauthammer

"DID YOU ASK FOR YOUR HEMLOCK?" THANKS TO APPEALS-court judges in New York and California, this question will now be in your future.

You will be old, infirm and, inevitably at some point, near death. You may or may not be in physical distress, but in an age of crushing health-care costs, you will be a burden to your loved ones, to say nothing of society. And thanks to courts that back in 1996 legalized doctor-assisted suicide for the first time in American history, all around you thousands of your aging contemporaries will be taking their life.

You may want to live those last few remaining weeks or months. You may have no intention of shortening your life. But now the question that before 1996 rarely arose--and when it did arise, only in the most hushed and guilty tones--will be raised routinely: Others are letting go; others are giving way; should not you too?

Of course, the judges who plumbed the depths of the Constitution to find the "right" to physician-assisted suicide--a right unfindable for 200 years--deny the possibility of such a nightmare scenario. Psychological pressure on the elderly and infirm to take drugs to hasten death? Why, "there should be none," breezily decrees the Second Circuit Court of Appeals.

King Canute had a better grip on reality. This nightmare scenario is not a hypothesis; it has been tested in Holland and proved a fact. Holland is the only jurisdiction in the Western world that heretofore permitted physician-assisted suicide. The practice is now widespread (perhaps 2,000 to 3,000 cases a year; the U.S. equivalent would be 40,000 to 60,000) and abused. Indeed, legalization has resulted in so much abuse--not just psychological pressure but a shocking number of cases of out-and-out involuntary euthanasia, inconvenient and defenseless patients simply put to death without their consent--that last year the Dutch government was forced to change its euthanasia laws.

Judge Roger Miner, writing for the Second Circuit, uncomprehendingly admits the reality of the nightmare: "It seems clear that some physicians [in the Netherlands] practice nonvoluntary euthanasia, although it is not legal to do so." Well, why would such things occur in the Netherlands? Are the people there morally inferior to Americans? Are the doctors somehow crueler and more uncaring?

Of course not. The obvious reason is that doctors there were relieved of the constraint of the law. The absolute ethical norm established since the time of Hippocrates--that doctors must not kill--was removed in the name of compassion, and the inevitable happened. Good, ordinary doctors, in their zeal to be ever more compassionate in terminating useless and suffering life, began killing people who did not even ask for it. Once given power heretofore reserved to God, some exceeded their narrow mandate and acted like God. Surprise.

In America the great moral barrier protecting us from such monstrous God-doctoring is the one separating passive from active euthanasia. Pulling the plug for the dying is permitted. Prescribing death-dealing drugs to those who are quite self-sustaining is not. It is this distinction that the judges are intent on destroying.

"Physicians do not fulfill the role of 'killer' by prescribing drugs to hasten death any more than they do by disconnecting life-support systems," writes Judge Miner. This is pernicious nonsense. There is a great difference between, say, not resuscitating a stopped heart--allowing nature to take its course--and actively killing someone. In the first case the person is dead. In the second he only wishes to be dead. And in the case of life sustained by artificial hydration or ventilation, pulling the plug simply prevents an artificial prolongation of the dying process. Prescribing hemlock initiates it.

The distinction is not just practical. It is also psychological. Killing is hard to do. The whole purpose of this case is to make it easier. How? By giving doctors who actively assist in suicide the blessing of the law and society.

After all, why did we need this ruling in the first place? In New York State, where this case was brought, not a single physician has been penalized for aiding a suicide since 1919. For 77 years, one can assume, some doctors have been quietly helping patients die. Why then the need for a legal ruling to make that official, a ruling that erases a fundamental ethical line and opens medical practice to unconscionable abuse?

The need comes from the modern craving for "authenticity." If you are going to do it, do it openly, proudly, unashamedly. But as a society, do we not want this most fearful act--killing--to be done fearfully? If it must be done at all--and in the most extreme and pitiable circumstances it will--let it be done with trembling, in shadow, in whispered acknowledgment that some fundamental norm is being violated, even if for the most compassionate of reasons.

No more. These judges have now liberated us from the hypocrisy of the unenforced law. Damn them. Lack of enforcement is an expression of compassion, but the law is the last barrier to arrogance. And God knows that in this age of all-powerful medicine, arrogance is the greater danger. Every grandparent will soon know that too.