The Will to Live in Context: How We Ourselves Have Come to Be at Risk from Euthanasia.

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), nonvoluntary (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).