A subtle shift in habits of thought and language has infiltrated discussions of euthanasia and related issues. The prevalent understanding of euthanasia as an action or an omission of treatment motivated by mercy has been joined to - and sometimes replaced by - a conception of euthanasia as an economically motivated denial of medical treatment.
Not surprisingly, this shift occurs at a time when economic considerations are playing an increasing role in public policy discussions of the morality and legality of euthanasia. Economic arguments have long been employed both to support and to oppose public sanction of euthanasia. What has changed is that, in some instances, economic considerations have become part of the definition of euthanasia.
A clear example of this shift occurs in a New York Times op-ed piece addressing the congressional debate over Medicare reform. Burke J. Balch, a representative of the National Right to Life Committee, worries that private managed-care plans will lead to the rationing of life-sustaining medical treatments. In opposing such rationing, he claims that "denial of lifesaving medical treatment against the patient's will amounts to involuntary euthanasia."
His fears should be taken seriously. The argument that supports his view, however, relies on an unacknowledged replacement of the generally accepted meaning of euthanasia with an understanding of euthanasia as the product of a cost-benefit assessment.
Those who debated the morality of euthanasia in the 1970s and 1980s generally agreed that euthanasia was characterized by a merciful desire to relieve another's suffering or end mere existence in a hopeless condition. A deliberate action or an omission of treatment that led to a person's death was termed euthanasia only if its intent was beneficent - if it sought the patient's good - and was motivated by compassion. This understanding is still widely shared, even among opponents of euthanasia.
In the National Right to Life Committee's grim depiction of managed Medicare, however, the real force behind "euthanasia" is the overriding drive to save money. Beneficence is barely in view, and compassion is nowhere to be seen.
If this definitional shift appeared only in one special-interest group's polemic, it might merit little attention, but similar deviations have also appeared in the writings of philosophers and bioethicists - those who might be expected to act as guardians of moral discourse.
Some of these authors seem unaware of the shift they make. Philosopher Larry Churchill observes that opponents of a proposal to ration medical treatment on the basis of age are wrong to characterize the proposal as "advocating passive euthanasia for the elderly on utilitarian grounds." Yet Churchill overlooks the most crucial point. Such opponents of age-rationing not on allege that "passive euthanasia" has a utilitarian justification; they also redefine "passive euthanasia" as an economically based denial of treatment. They then feel free to charge that "euthanasia" is the intent of the proposed rationing of care. By failing to note the redefinition, Churchill is drawn into the new use and appears to concede its legitimacy.
Other writers are more deliberate about shifting the definition. Bioethicist Margaret Pabst Battin observes that society is "coming to use the term euthanasia not just for pain-sparing deaths but for resource-conserving deaths as well." She comments that euthanasia's Greek root meaning good death," a death that is good for the patient, is thereby compromised, and she decries the change: "Our very language invites us to overlook distinctions that we ought to make. …