The challenge of definition

The Challenge of Definition As many of you know, I've always had a problem with the term "euthanasia" itself: "good death," "happy death." For one thing, the term seems to harbor an ambivalence about the absolute value of human life and the human experience in general. To me, any such ambivalence is inconsistent with the Judeo-Christian tradition within which I was raised, a tradition which, for me, places a consistent and primary emphasis on the supreme value of human life. It is also a tradition in which human life is valued not merely in the abstract realm of the intellect but also in the concrete world of social intercourse. There is, after all, implicit in the concept of euthanasia that death is the result of someone's conscious choice. It is, therefore, more than just an alleged "good death." It is a "good death" that is consciously, specifically brought about. ...So the element of choice has always been in the environment, but I don't think there's ever been any doubt, throughout the evolution of our Judeo-Christian heritage, as to the one who is to do the choosing. Each one of us must choose for himself or herself. And we're enjoined to choose life. Euthanasia, therefore, seems to directly challenge these two very fundamental aspects of our culture and heritage: First, that our basic framework of human values is indeed life-centered; and second, that each individual is personally responsible for being a life-centered member of the human community. Choosing life is not a responsibility that can be delegated, such as instructing the young or meting out justice. This one, each of us must do on our own. Thus, I question the legitimacy of the current debate over the difference between "active" and "passive" euthanasia. That is, the difference between someone playing an active role to bring about the alleged "good death" of another, as opposed to someone taking no action to prevent death from taking place. The most common illustration of this is the "case of the drowning man": . If a man leaps from a bridge into a raging current and to death, he commits suicide--literally, "self-death"--which many say is an immoral act, within the traditions of our social order. We know this is so because, if he tries to commit suicide but does not succeed, society will exact a price of some kind, a public rebuke at the very least. . On the other hand, if you take a man to the bridge and throw him over the railing to his death, you have killed him, you are guilty of that capital crime, and society will exact a price from you. . But what if you come upon the bridge just as the man stumbles and falls by accident over the railing, and you have some means at hand--a rope or a float of some kind--to save him? And what if you decide to do nothing...and the man dies? Again, society may hold you responsible for making a decision that defies our common, life-centered system of values, and society may exact a price from you in that instance as well. In other words, you cannot delegate the injunction to "choose life." ...I must reject the notion that medicine is somehow a special arena in which our life-centered values may be, of all things, reversed. And I do so because that, it seems to me, is the central lesson of Binding and Hoche. If we did not learn at least that from the Holocaust, then we learned little or nothing at all. Hence, regardless of when the term "euthanasia" was coined or by whom, I believe it lies outside the commonly held, life-centered values of the West and cannot be admitted without incurring great social and personal tragedy. And I must again emphasize the highly personal nature of the tragedy. For me, as both a practicing surgeon and, of late, as the Surgeon General, this issue has appeared more frequently in the real guise of an actual human being at risk, and less frequently as an intellectual conundrum. …