For as long as people have been dying, societies have held opinions as to the value of their deaths: whether they are noble and transformational, or cowardly and sinful, even treasonous. Over the centuries, these judgments have shifted along with the ethical values of the age. No kind of death has elicited such dramatically changing convictions as death by suicide and assisted suicide.

The first evidence of a tolerance for suicide and voluntary euthanasia comes from ancient Greece. This era held some taboos about taking life: Aristotle said, "To kill oneself to escape from love or poverty or anything else that is distressing is not courageous" ( The Ethics of Aristotle). But for the Greeks, there was nothing blameworthy about choosing to stop suffering at the end of life; sometimes, they believed, it was a worthy and sensible choice. The writer Plutarch said that in Sparta, infanticide was practiced on children who lacked "health and vigor." And Soc rates, according to Plato, announced that painful disease and suffering were perfectly acceptable reasons to choose to end one's life: "Eu" (good) and "thanatos" (death)--the words that have given us "euthanasia"--was the desired end to a life well lived.

The Stoics, also, approved of suicide when it was used to end a life that had fallen out of harmony with nature. The best known of the Stoics, Seneca, who praised suicide as the last act of a free man, wrote prolifically about death in Epistulae Morales.

It makes a great deal of difference whether a man is lengthening his life or his death. But if the body is useless for service, why should one not free the struggling soul? Perhaps one ought to do this a little before the debt is due, lest, when it falls due, he may be unable to perform the act.

In time, attitudes would change dramatically. With the rise of the Judeo-Christian religions in the second and third centuries, euthanasia came to be seen as either suicide or murder--both of which were morally abhorrent and sinful. Christianity, Judaism, and Islam all condemned euthanasia and held that human life was sacred. Christians in particular warned of the toll such a death would take on the immortal soul, and those who committed suicide were denied a Christian burial. In the thirteenth century, St. Thomas Aquinas pronounced suicide to be the most dangerous of all sins because it violated the sixth commandment, and allowed the dying person no time for true repentance.

But the dawn of the Renaissance in the fourteenth century brought yet another change of view. With their admiration of classical Greco-Roman values, people reevaluated suicide as a reasonable option. In 1516, in Utopia, his depiction of an idealized world, Sir Thomas More wrote:

Since your life's a misery to you, why hesitate to die? You're imprisoned in a torture chamber--why don't you break out and escape to a better world.... We'll arrange for your release.... If the patient finds these arrangement convincing, he either starves himself to death, or is given a soporific and put painlessly out of his misery. But his is strictly voluntary.

This tolerance of suicide, and the respect for the right of individuals to choose how they died, lasted through the eighteenth century. Essayists and philosophers wrote longingly of death. John Donne, in his celebrated muse, Biothanatos, argued for the right to suicide as a form of voluntary euthanasia.

By the end of the nineteenth century, and into the twentieth, professionals and intellectuals (including Karl Marx) began serious study of the issues involved in euthanasia. In Britain, attempts were made to advocate its legalization. The Voluntary Euthanasia Society, formed in 1935, was the first organization of its kind in the world. Early members included the novelist H. G. Wells and Lord Listowel, an aristocrat and activist who remained a member of the society for 51 years, until he resigned in 1996. In 1936, the first of 3 attempts was made to introduce a law endorsing voluntary euthanasia in the British Parliament. It failed by a margin of 35 to 14. One of the Royal Physicians, Lord Dawson of Penn, argued that legalizing the practice wasn't necessary as good physicians already helped their patients to die. History has shown that the physician was speaking from personal experience: Earlier that year, he had hastened the death of King George V with a combination of morphine and cocaine.

The darkest time in the history of euthanasia was undoubtedly the German eugenics program of the 1920s and 1930s. With government approval, the new Social Democratic party elected euthanasia committees and began a program of annihilating those with "Lebensunwerte Leben"--lives unworthy of living. Those deemed to be unworthy of life included anyone who was found to be a burden on the state: the physically handicapped, the mentally retarded, people too weak to care for themselves.

The Germans coined another term for them, "unnutze Esser"-useless eater. Within a 2-year period, between 1939 and 1941, the authorities had killed 100,000 of their own citizens. They were Aryan Germans--none of them even Jewish.

The true facts of the German eugenics program only came to light after the war was over, at the 1946 Nuremberg War Crimes Trials. And more is coming to light, even to this day. As recently as 1996, evidence was emerging of the role that Austrian physicians had played in selecting children for scientific experiments. Like their German neighbors, uncounted hundreds were put to death in the name of science. Four hundred brains of children and teenagers, carefully labeled and preserved in formaldehyde, still survive in one of the country's leading psychiatric clinics, Am Steinhof, in Vienna.

The horror of the Nazi acts has cast a long pall over the rest of this century, and for many years after World War II, almost no one dared to advance the idea of euthanasia. As Humphry and Wickett suggest in The Right to Die, the Germans tarnished the meaning of "euthanasia" as "the good death"--perhaps forever.

The desire for assisted dying, however, did not diminish. In fact, it increased sharply as medical technology grew more sophisticated, through the 1960s and 1970s. Although it is hard to pinpoint the exact start of a social movement, the date generally cited for the birth of the modern right-to-die movement is March 31, 1976, the day when the New Jersey Supreme Court allowed the parents of a comatose young woman to take her off a life-support machine.

That young woman, Karen Ann Quinlan, quickly became a symbol of the new crusade. Because of her heartbreaking physical state and the measures taken to keep her alive, Quinlan's case jolted people into rethinking the so-called miracles that modern medicine was providing. As the American people were fed minute details of the Quinlan family's legal fight, they found themselves considering the circumstances for themselves. What would they want for their own daughter if she lay comatose in a hospital, kept alive by a machine? And if they'd want the machine switched off, how could they avoid going through the torturous legal process that the Quinlans endured to guarantee that they'd get their wish?

Karen Ann Quinlan was just 21 years old when she collapsed at a party and was taken to St. Clair's Hospital in Denville, New Jersey. No one is sure exactly what happened to her, but it is thought that a combination of Valium and alcohol depressed her metabolism and caused her breathing to stop twice--for 15 minutes or longer at a time. By the time paramedics brought her to the hospital, she was found to be in a persistent vegetative state, beyond hope of recovery.

Quinlan was kept alive for a few months by means of a respirator and a food tube into her stomach. After consulting a Catholic priest, her devoutly religious parents decided they wanted no more "extraordinary measures" taken to keep their daughter alive. They asked the hospital to pull the plug on her respirator. But the hospital refused, citing the "do no harm" stricture of the Hippocratic oath, and most of Quinlan's nurses, who were Catholic themselves, also refused to cooperate. The Quinlans took their case to court.

In court, the judged sided with the parents and ordered the hospital to unhook Quinlan's breathing apparatus. Yet because the nurses had carefully weaned her off it in anticipation of the judge's decision, Quinlan managed to breathe on her own. She survived another 9 years, kept alive through a nutrition and hydration tube, never regaining consciousness. By the time she died, in June 1985, she weighed 65 pounds and had spent the last years of her life curled in a fetal position. She finally succumbed to acute pneumonia, which, according to the wishes of her family, was left untreated. . .

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