[If doctors are licensed to kill], imagine the scene: you are old, poor, in failing health, and alone in the world. You are brought to the city hospital with fractured ribs and pneumonia. The nurse or intern enters late at night with a syringe full of yellow stuff for your intravenous drip. How soundly will you sleep? It will not matter that your doctor has not yet put anyone to death; that he is legally entitled to do so will make a world of difference...

-Dr. Leon Kass, Professor for the College, University of Chicago, Commonweal, August 9, 1991

Margaret Mead, the wide-ranging anthropologist, considered it a matter of urgency to remind her readers-and her audience at lectures-that before the 5th century B.C., someone who was sick had ambivalent feelings when the doctor came through the door. The patient could not be sure whether he or she was about to be cared for or killed.

"Throughout the primitive world," she explained, "the doctor and the sorcerer tended to be the same person.... He who had the power to cure would necessarily be able to kill." The outcome of the case might depend on who paid the higher fee-the patient or an enemy.

But then came Hippocrates and the doctors he influenced through the centuries. As noted by Dr. Leon Kass, "The prohibition against killing patients ... sworn to in the Hippocratic Oath, stands as medicine's first and most abiding taboo:

 'I will neither give a deadly drug to anybody if asked for it, nor will I make suggestion to this effect."'

It was an extraordinarily important moment in the history of civilization. "For the first time in our tradition," Margaret Mead noted, "there was a complete separation between killing and curing.... With the Greeks, the distinction was made clear. One profession ... was to be dedicated completely to life under all circumstances, regardless of tank, age, or intellect....

"This is a priceless possession which we cannot afford to tarnish, but society always is attempting to make the physician into a killer-to kill a defective child at birth, to leave the sleeping pills beside the bed of the cancer patient.... It is the duty of society to protect the physicians from such requests."

More and more of us, however, are demanding that doctors actually be licensed to kill. On Sunday, November 3, the Boston Globe reported that a national opinion poll sponsored by the Globe and the Harvard School of Public Health revealed that "64 per cent of Americans, or nearly two out of three, favor physician-assisted suicide and euthanasia [killing by the doctor] for terminally ill patients who request it.

 It is the fear of the intensive-care unit, dominated by aggressive, noisily whirring machines and mysteriously. registering lights that never go off. And on many of the beds there are bodies hooked, beyond rescue, to those machines that seem to be devouring them. This is not death with dignity, but if euthanasia were legalized-so the dream goes-one could die with dignity before being fed to the machines.

Those who oppose "active euthanasia"-a euphemism for giving doctors the right to kill-are also afraid. They do not believe that it is possible to legalize this right to kill and keep it under control.

One of them is Yale Kamisar, a law professor at the University of Michigan, who was one of the first Americans to argue powerfully and continually against euthanasia. Reading his essays 30 years ago-and since-had a lot to do with making me aware of the horrors that can come from turning doctors into executioners. And, he warned way back then, there is no fundamental difference between ,.passive euthanasia" (removing a feeding tube) and "active euthanasia" (the doctor giving a lethal injection). Killing is killing.

"Euthanasia, once legalized, will not remain confined to those who freely and knowingly elect it," adds Leon Kass. "And the most energetic backers of euthanasia do not really want it thus restricted. Why? Because the vast majority of candidates who merit mercy-killing cannot request it for themselves: adults in a persistent vegetative state or severe depression or senility or aphasia or mental illness or Alzheimer's disease; infants who are deformed; and children who are retarded."

But since all are incapable of requesting death, will they be denied "our new, humane 'assistance-in-dying'?"

Kass continued: "But not to worry. The lawyers and the doctors (and the cost-containers) will soon rectify this injustice. The enactment of a law legalizing mercy killing (or assisted suicide) on voluntary request will certainly be challenged in the courts under the equal protection [of the laws] clause of the Fourteenth Amendment. Why, it wilt be argued, should the comatose or the demented be denied the right to such a 'dignified death'. . just because they cannot claim it for themselves....

"Clever doctors and relatives will not need to wait for such changes in the law. Who will be around to notice when the elderly, poor, crippled, weak, powerless, retarded, uneducated, demented, or gullible are mercifully released from the lives [which] their doctors, nurses, and next of kin deem no longer worth living?"

This was one of the arguments used by opponents of Initiative 119 in the State of Washington, which would have enabled doctors to kill so-called terminal patients who asked for the final exit.

Dr. Dorsett D. Smith wrote a broadside there for Physician Responsibility in which he recalled a very influential book, Consent to the Extermination of Life Unworthy To Be Lived, by a distinguished German psychiatrist (Alfred Hoche) and an equally distinguished jurist (Karl Binding). The book was published in Germany in 1920 and it greatly shaped the thinking of many German doctors, lawyers, and judges who were not Nazis but later found no difficulty in adjusting themselves to Hitler's fervent views on ridding the state of lives unworthy to be lived.

Seventy years later, In the State of Washington, Dr. Dorsett Smith warned of the history of intentionally lethal medicine repeating itself.

"Binding and Hoche began the German euthanasia movement by writing [this] small book calling for doctor assisted homicide of the terminally ill, which they also called Aid in Dying." (Exactly what Washington's 1991 killing act was called.) Binding and Hoche recommended strict guidelines to protect the public from the abuse of this new privilege by physicians.

"Over the next 15 years, the guidelines were gradually expanded until, by the mid-1930s, extermination of idiots, retarded, mentally ill, and later one-half Jews and other undesirables was willingly performed by the physicians without any unnecessary pressure from German authorities. In 1939, when Hitler introduced his master plan, physicians were more than willing co-conspirators."

It can't happen here?

As health costs continue to go up and health care is increasingly rationed, who will get the least care? The same people, as now, who are of least use to society. And when they're lugged into the emergency room, still struggling to stay alive, at what point will a harried doctor decide that this loser's quality of life isn't worth his or her time any more?

It can't happen here?

Surveys indicate that a majority of American doctors would like to see euthanasia legalized. I expect that most ' if not all, of them are decent people. But what would they be like with the power to kill?

As it is now, according to a physician quoted in an article by Paul Applebaum, a professor of psychiatry, and Joel Klein, a lawyer, in the April 1986 Commentary.

"The old, chronically ill, debilitated, or mentally impaired do not receive the same level of medical evaluation and treatment as do the young, acutely ill, and mentally normal. We do not discuss this reality or debate its ethics, but the fact remains that many patients are allowed to die by the withholding of 'all available care.' There seems to be, however, a general denial of this reality."

And this takes place now, without making euthanasia legal-yet.

But the denials and the euphemisms are becoming less necessary. Killing is not as unrespectable as it used to be.

The arch-strategist behind the attempts to get euthanasia initiatives approved by the electorate is Derek Humphry, founder and director of the Hemlock Society. He was a key force behind Initiative 119 in Washington and is now working on a revised initiative (with more  safeguards") to go before the voters in California. One of his allies in that state is the California branch of the National Organization for Women.

As Humphry's own organization puts it, Hemlock's "political arm in California, Americans Against Human Suffering, has started its campaign ... and the California chapter of NOW is 'laying the groundwork for their strong support and involvement in "aid-in dying ."

Indeed, at California NOW's April 1991 state convention, the delegates resolved "that California NOW recommends to National NOW that this issue be included as a priority feminist issue on its national ... agenda to gain equal opportunity for humane and dignified treatment for the terminally ill throughout all legal jurisdictions."

The same resolution calls for "a dignified dying, assisted by a caring physician."

California NOW still prefers euphemism, but it needn't be so diffident about using the word "killing." I met Derek Humphry a couple of years ago at a conference on euthanasia at Clark University in Worcester.

He told me that for some years, he'd had difficulty in getting his views on euthanasia across in this country. "But then," he said, "all the doors opened." I asked him what had made all the doors open. "Roe v. Wade," he said .

It makes sense. When over a million and a half developing human beings are killed each year, justifying other forms of killing for humane reasons is a less daunting task. And that's one of the reasons why, as we shall see, the defeat of Initiative 119 in Washington by no means indicates that doctors won't eventually have the legal right to kill.

How do you think the vote would go in this state?