The good fight: on euthanasia proposals.

Before joining Commonweal, I worked for a number of years on the staff of a nursing care facility for terminal cancer patients. Saint Rose's Home overlooks the East River on Jackson Street in Lower Manhattan. It was rounded in the late 1890s by Rose Hawthorne Lathrop, the daughter of Nathaniel Hawthorne, and it continues today thanks to the efforts of the Hawthorne Dominican Sisters and their co-workers.

During my time at Saint Rose's, death was no stranger. I saw hundreds of people die, victims of every variety of cancer in every conceivable and disastrous manifestation. Not all died the death Catholics traditionally pray for: a graceful or happy death. That is, after all, largely a psychospiritual gift that cannot be leveraged, even by one's certifiable merits. Yet with very few exceptions, each of these men, women, and children died a good death: relatively comfortable and pain-free, if not always at the expected or desired moment. Even in a hospice setting, death has the final word and arrives sometimes as a thief.

It is death's habit of arriving stealthily, unpredictably--like the phantom caller in Muriel Spark's Momento Mori---coupled with our fear of pain, loss of bodily integrity, and the unknown, that, in part, lends strength to the present movement for legalized euthanasia in the United States. That's why such referenda are not going to disappear any time soon.

Just two days after the defeat of California's euthanasia Proposition 161 on November 3, the New England Journal of Medicine published two opinion pieces by respected doctors at prestigious medical schools advocating physician-assisted suicide. And next year alone, there will be legislative efforts to iegalize euthanasia in a number of states, including New Hampshire, Maine, and Michigan. In each, the stakes are very high. "If one state legalizes these practices [medically assisted suicide], we will see other states adopting similar legislation in a relatively short time," predicts Ron P. HameI, a senior associate at the Park Ridge Center for the Study of Health, Faith, and Ethics (see the center's newsletter, The CenterLine, Fall 1992).

Fortunately, when it comes to euthanasia, American voters seem to be more than simple pragmatists looking for an allpurpose silver bullet. We may have justifiable fears about prolonged, painful, and seemingly purposeless suffering at life's end, but we also have realistic doubts about the final exit enthusiasts. And that's why--at least until now--physician-assisted suicide legislation has failed, even though in poll after poll over the past forty years, a majority of Americans have said they favor such legalization.

In the past two years, major euthanasia propositions--in the generally liberal states of Washington and California--although initially heavily favored to win, both met defeat. In September 1992, a Los Angeles Times poll on California Proposition 161, for instance, found that over 60 percent of those queried favored physician-assisted suicide. Yet by October 27, one week before the election, the Times reported that those in favor had seen their margin shrink to only 49 to 45 percent. And when the actual votes were finally counted, it was Proposition 161 that was declared dead on arrival, losing soundly, 54 to 46 percent. Why this shift?

I imagine that given time, people began pondering not only the imponderables, but the practical ramifications of Proposition 161. They began to comprehend the utter finality of what 161 was proposing. They, especially the older voters and minorities, started to think about the real potential for abuse. (A postelection poll conducted by the Tarrance Group indicated that voters sixty-five and older opposed the initiative by 64 to 36 percent.) Then, I think, people started considering the revolutionary transformation 161 would mean for the reshaping of medicine, shifting it from a sometime art of healing to a licensed dispatching service. This rethinking was further spurred when cancer survivors staffed showing up on anti-161 TV ads: people who could have been from one's own family and who testified that life is worth fighting for. Finally, there were the professionals who argued formidably that in almost all cases pain can be controlled; and that laws already on the books provide adequate protection from unwanted, prolonged, or burdensome treatment.

These pragmatic arguments may not be the most basic reasons for opposing euthanasia, but they provide the best grounds on which to fight next year's legislative battles. To most people, they are the strongest and most convincing. And those who have experienced, or worked in, hospice care ought to be given special voice. They know from experience that it is possible to meet the needs of the dying practically, compassionately, and routinely. Hospice personnel know how to handle pain, and, when the time comes, how to accept death. They have seen patients' desire for suicide diminished as pain has been brought under control. And they know at what point treatment is no longer justified--morally, medically, or legally.

Earlier this year, the American Bar Association's Commission on Legal Problems of the Elderly unanimously opposed Proposition 161. It did so for a number of reasons, but one was most telling. In the present health-care climate, it said, stateauthorized euthanasia would not long remain voluntary, and in terms of social equality, the commission argued, access to adequate health care "ought to be a much higher priority than access to death." We can do something about the former; the latter arrives inevitably.

At Saint Rose's, I remember a variety of people as they set off into that final expanse. Like birth, the voyage wasn't always easy, on time, or without blood. But given a chance, it had its own integrity. I'm afraid at this point the euthanists have yet to discover that. PATRICK JORDAN