The article by Quill and Cassel [1] admirably stresses some of the lost concepts of medical practice, including a focus on human relationships and the role of "caring for the patient." Interestingly, however, without ever using the dreaded word, we are encouraged throughout the article to consider active euthanasia. The argument is persuasive when we are told of a patient, Cynthia, who probably has a different philosophy of life from our own (she is a Buddhist) and who might well have desired more active participation on the part of her physician in terms of the timing of her death to limit her suffering. The authors urge us in the name of nonabandonment to "take some risks on behalf of the patient." Although in the same breath we learn that "nonabandonment does not mean that physicians should violate their own moral values," we certainly should challenge these "limitations" in our own value system.

This article uses the concept of nonabandonment to maximize our uncertainty about the ethical boundaries between easing suffering and actively causing death. These ethical distinctions are said to "lose their sharpness in the context of such relationships."

I know of no way to keep the ethical boundaries in the discussion of euthanasia clearly in focus without acknowledging the principle of the sanctity of life. If one's world view does not embrace this historical value and emphasizes humans as the measure of all things, then one will take risks and push the envelope of conventional ethics. If, however, humans have the image and likeness of their Creator, then our intent can never be to assume the role of life-taker, even if the ends seem to justify the means.