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"For the first time in history, physicians have the ability, know-how and sophisticated technology to sustain the physical life of patients beyond any reasonable quality of life which they might went to endure."

What does that mean?

For the first time in history, doctors can keep patients alive for a very long time, even though the quality of that life is much, much less than what that patient would want to live.

What does that mean for our society?

Who would have imagined a hundred years ago that humans would be faced with a question like this? Until quite recently, illness, accidents, disease, and age were a constant threat to human life. Physicians often could do no more than stand by their dying patients, unable to help a child suffering from pneumonia, a middle-aged man experiencing a heart attack, or an old woman slowly slipping away into unconsciousness, a coma, and slow death.

Today, modern medicine has many technologies to keep people alive. For example, a variety of drugs and vaccines are available to prevent disease, cure infection, treat heart attacks, and control many other medical problems. Only a few medical problems--many of them genetic in origin--are totally beyond the ability of medical science to treat. Artificial respiration and heart function are also available. At one time, a person was said to be "dead" if he or she had no respiration or pulse. One of the earliest signs of death, in fact, was the patient's inability to fog a mirror with his or her breath. Today, machines exist that will indefinitely maintain a person's blood flow and breathing. Therefore, pulse and respiration can no longer be taken as signs of life and death.

Kidney dialysis machines provide yet another means of survival. Until the invention of these machines, kidney failure meant certain and painful death in a short time. Today, kidney dialysis machines keep alive thousands of patients who, a hundred years ago, would have died much sooner.

Finally, even the most basic needs of food and water can be provided artificially. Patients who are unable to take these nutrients on their own can be fed intravenously for indefinite periods of time.

So medical technology now keeps humans alive in many instances for weeks, months, and even years beyond the point at which they would have died "naturally" in the past. For many people, this extra span of life is a blessing of immeasurable significance. They are able to live happy, productive lives because of advances in medical technology. But the same technology has also created difficult new ethical questions about those who are seriously ill.

One of those questions is how to decide when a person has died. Traditional criteria which were based on pulse or respiration are no longer very useful. Instead, medical authorities today are more likely to base life-and-death decisions on the basis of a patient's brain activity. When brain activity ceases, the patient can be said to have died, according to most medical authorities. In fact, in 49 states, the legal definition of death is the absence of brain activity.

That definition does not always make life-and-death decisions easier, however. In many cases, the brain does not stop functioning all at once. In some kinds of injuries, for example, the front part of the brain which controls thought, feeling, and emotion may be damaged beyond repair. But the back part--the part controlling automatic functions such as respiration--may still be functioning normally. The person may be legally alive, but without any hope of ever regaining consciousness or behaving in any "human" way again. Physicians call this condition a persistent vegetative state (PVS)

The problem of defining death may present a physician with other difficult choices. For example, the physician may know of other patients who are waiting for organ transplants that can save their lives. At what point can a terminally ill patient be regarded as "dead enough" to allow removal and transplantation of his or her organs? Some critics worry that a physician may become too eager to take an organ and declare a patient to be dead before all hope is truly gone.

Deciding when to pronounce a person legally dead is also, of course, a critical issue for the person's family and friends. Some people believe that matters of life and death are beyond the power of human actions. Only God can and should decide when a person's life should end, these people feel. Thus, the Roman Catholic Church and Right-to-Life groups, for example, tend to oppose human choices and decisions as to when a person has died. The medical profession has an absolute responsibility, such groups believe, to use every kind of technology available to keep every human alive. This position is a complex one, however, since these same groups may not be willing (for example) to "let nature (or God) take its course" in case of infections, but would support the use of antibiotics to prevent a person's death.

For many people, the issue of maintaining life is a question of what kind of life the patient will have. Some people on life-support systems manage to live relatively satisfying, happy lives. Others might know nothing about their own existence.

Most people on life-support systems probably are between these two extremes. In any case, the patient (where possible), family, friends, and medical staff often have to decide when the maintenance of life is no longer worth the pain, inconvenience, and expense needed to provide that quality of life. At that point, the decision may be made to "let the patient go."

Allowing a seriously ill patient to die is called passive euthanasia. Those people who are opposed to passive euthanasia are concerned that this practice may lead to a greater acceptance of active euthanasia the active participation of humans in helping another person to die. Their argument is as follows:

If a person is considered too ill to be allowed to live, then perhaps you might accept that passive euthanasia is justified. The next step may be to ask, "Well, why not speed up that person's death by active human intervention, that is, by active euthanasia?" If we believe that some humans are expendable, that is, not worth trying to save, then what is to prevent doctors or the government from perhaps extending that decision to people who are not yet critically or terminally ill? Those people who oppose passive euthanasia, that is, allowing people to die, want to know what standards can be used to limit other decisions about those who should live and those who should be "let go" or assisted in dying.

While euthanasia involves letting a patient die (passive euthanasia) or even killing a patient (active euthanasia), assisted suicide is another issue to consider. Assisted suicide involves helping a very ill person kill himself or herself. Assisted suicide is currently legal only in one state in the United States, Oregon. There are many disagreements about assisted suicide in Oregon--some people call it "murder" and other people call it "death with dignity." It is a very controversial topic.