The scene is a darkened hospital ward. An intern stands over Debbie, a young woman with terminal cancer. Her breathing is labored as she struggles for oxygen. She weighs 80 pounds. She is in horrible pain.

The doctor has never seen Debbie before, but a glance at her chart confirms she is not responding to treatment. He leans down to hear her whisper, “Let’s get this over with.”

Most doctors would have hurried to give relief against the pain, or tried to offer some solace to the anguished relative standing near the bed. But this intern measured out 20 milligrams of morphine into a syringe—enough, he wrote later, “to do the job”—and injected it. Four minutes later, Debbie was dead. The doctor’s only comment: “It’s over, Debbie.”

Stories like this, publicized a few months back, are shocking but should not surprise us. While no one likes to admit it, active euthanasia is not uncommon. It has been closeted in hospital ethics committees, cloaked in euphemisms spoken to grieving relatives. It is the unnamed shadow on an unknown number of death certificates—of handicapped newborns; sickly, aged parents; the terminally ill in critical pain.

No, Debbie’s case is something new only because of the public nature of both its telling and the debate that has followed.

This story was first written, anonymously but without apology, by the intern himself, and published in the Journal of the American Medical Association (JAMA)—one of the most respected medical journals in the world.

Following the article’s publication, the commentary came fast and furious. Some experts dismissed the incident as fictional. Others believed it, but focused their criticism on the young doctor’s lack of familiarity with Debbie’s medical history.

But the article’s greatest effect was to yank euthanasia out of the closet and thrust it into the arena of national debate. On the surface that might seem healthy, getting the whole ugly issue into the open. But there’s a subtle danger here: The JAMA article and the impassioned discussion it provoked offer a case study of a recurring process in American life by which the unthinkable in short order becomes the unquestionable.

Usually it works like this: Some practice so offensive that it could scarcely be discussed in public is suddenly advocated by a respected expert in a respected forum. The public is shocked, then outraged. The very fact that such a thing could be publicly debated becomes the focus of debate.

But in the process, the sheer repetition of the shocking gradually dulls its shock effect. No longer outraged, people begin to argue for positions to moderate the extreme; or they accept the premise, challenging instead the means to achieve it. (Note that in Debbie’s debate, many challenged not the killing, but the intern’s failure to check more carefully into the case.)

And gradually, though no one remembers quite how it all happened, the once unspeakable becomes tolerable and, in time, acceptable.

An example of how this process works is the case of homosexuality. Not long ago it was widely regarded, even in secular society, as a perversion. The gay-rights movement’s first pronouncements were received with shock; then, in the process of debate, the public gradually lost its sense of outrage. Homosexuality became a cause—and what was once deviant is today, in many jurisdictions, a legally protected right. All this in little more than a decade.

Debbie’s story appears to have initiated this process for euthanasia. Columnist Ellen Goodman welcomed the case as “a debate that should be taking place.”

So what was once a crime becomes a debate. And, if history holds true, that debate will usher the once unmentionable into common practice.

Already the stage is set. In a 1983 poll, 63 percent of Americans approved of mercy killing in certain cases. In a 1988 poll, more than 50 percent of lawyers favored legal euthanasia. The Hemlock Society is working to put the issue on the ballot in several states.

I don’t intend to sound alarmist; legal euthanasia in this country is still more a threat than a reality. But 20 years ago, who would have thought abortion would one day be a constitutional right, or that infanticide would be given legal protection?

The path from the unmentionable to the commonplace is being traveled with increasing speed in medical ethics. Without some concerted resistance, euthanasia is likely to be the next to make the trip. As Ellen Goodman concluded her column, “The Debbie story is not over yet, not by a long shot.”


Novelist Walker Percy, in The Thanatos Syndrome, offers one vision of where such compromising debates on the value of life might take us.

The time is the 1990s. Qualitarian Life Centers have sprung up across the country after the landmark case of Doe v. Dade “which decreed, with solid scientific evidence, that the human infant does not achieve personhood until 18 months.” At these centers one can conveniently dispose of unwanted young and old alike.

An old priest, Father Smith, confronts the narrator, a psychiatrist, in this exchange:

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“You are an able psychiatrist. On the whole a decent, generous humanitarian person in the abstract sense of the word. You know what is going to happen to you.”


“You are a member of the first generation of doctors in the history of medicine to turn their backs on the oath of Hippocrates and kill millions of old, useless people, unborn children, born malformed children, for the good of mankind—and to do so without a single murmur from one of you. Not a single letter of protest in the august New England Journal of Medicine. And do you know what you are going to end up doing?”

“No,” I say …

The priest aims his azimuth squarely at me and then appears to lose his train of thought.…

“What is going to happen to me, Father?” I ask before he gets away altogether.

“Oh,” he says absently, appearing to be thinking of something else, “you’re going to end up killing Jews.”

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