Did you ever wonder how involuntary euthanasia took root in the Netherlands and spun out of control? Many of the elderly in Dutch retirement homes have learned to dread going into the hospital, fearing that their lives may be terminated.  How did a casual attitude toward medical killing become entrenched in a nation's medical system?  Could this happen in the United States of America?  Would American doctors ever acquiesce to such a system?
There are several steps along the way before Netherlands—type medical killing could occur in the U.S, but we may be farther along that path than commonly appreciated. If involuntary euthanasia is to take hold here, first the moral and ethical foundations of valuing life within the medical professions must de undermined.
A major step has already taken place, almost unnoticed by the general public. The tepid modern alternatives to the Hippocratic Oath, such the World Medical Association's Declaration of Geneva, came into widespread use in America after World War II. The now—unused original Hippocratic Oath was a covenant between the physician and patient. In addition to swearing to uphold patient confidentiality, and prohibiting sexual relations between physician and patient, the Oath specifically prohibited medical killing. Both abortion and physician—assisted suicide were violations of the Oath American physicians once affirmed. Unbeknownst to most Americans, U.S. physicians have not had to swear off medical killing for decades.
To enable medical killing, second, pro—life forces within the medical profession must be extinguished or made impotent. This is fairly close to happening already. Currently, medical elites are almost universally pro—abortion, adopting a secular and utilitarian mindset, largely cut loose from Judeo—Christian roots. It is increasingly difficult to obtain or maintain faculty positions in medical schools in the U.S., if one does not adopt the pro—choice line.  There is pressure to perform abortions in medical training programs. The New England Journal of Medicine has published editorials promoting euthanasia, as well as surveys indicating that many physicians have surreptitiously practiced it.
As in so many other elites, the beliefs of those attracted to the medical profession do not closely resemble those of the public they serve. Even if a portion of medical students start out as evangelical Christians, observant Catholics, Orthodox Jews, Muslims, or secular pro—life, their beliefs and religious practices undergo constant challenge and ridicule, often succumbing to the dominant mindset in which human life is at times deemed expendable.
A third condition that might allow involuntary euthanasia to take place in the U.S. would be to forbid pro—life physicians from entering the health system. This happens more easily in the state—controlled medical systems of Europe, such as the Netherlands or Sweden, where currently there are no gynecologists who do not perform abortions. They are not admitted to training programs and hospitals will not hire them. In many European nations, laws do not exist protecting religious liberty to the same degree as the U.S., preventing observant Catholics, Christians, Orthodox Jews, or Muslims, whose faiths prohibit all or most abortions, from the practice of gynecology in those nations in which there is minimal or no private practice of medicine. Systems in which private medical care is extinguished, such as the Canadian system or the ill—fated proposal by Hillary Clinton, are especially inflexible of physicians' conscientious objection. Doctors who protest or refuse to go along with the desired practices are simply thrown out.
A fourth condition for a Netherlands scenario in the U.S. is rationing of medical care. With rising costs, de facto rationing of health care in the U.S, especially at the end of life, is already taking place by insurance companies and managed care systems. The right of health care consumers to have medical care they desire at the end of life is already under assault.
A family of a disabled person may desire for that person to have life—sustaining treatments that are costly. However, these therapies may be denied by insurance companies, on the basis that such care is 'inappropriate.' Hospital committees all over the U.S. are increasingly putting into place 'futile care' protocols, in which treatment can be denied to patients even if they desire it. In some HMOs, physicians directly benefit financially from denying medical care to their patients. Wesley J. Smith speaks eloquently about these frightening trends in his book, Culture of Death.   Health care consumers' worries about endless and painful prolonging of life are misplaced in the current environment of cost—containment.
Finally, even if physician—assisted suicide is not legalized in states beyond Oregon, currently unique in this regard, withholding nutrition and hydration has now become a common practice for ending the lives of the cognitively disabled and dying elderly. Eliminating pro—life voices from medicine will accelerate the ethical slide, from denial of care, to expanding current legal practices of withholding nutrition and hydration, and possibly to physician support of direct medical killing, especially as it becomes apparent that more people as patients suffer from starvation and dehydration.  If the voices of physicians who strongly object to these practices are weakened, or not even in the medical system to begin with, patients will be even more unprotected from the culture of death in medicine, which is growing stronger.  Americans do not realize that major elements of four out of five conditions for the Netherlands scenario already exist.
In the U.S., we inched closer to entrenching the culture of death in American medicine when Wisconsin Governor Jim Doyle vetoed AB 67, a bill that would have increased legal protection to workers who do not want to take part in procedures they find morally objectionable. Current Wisconsin law protects health care workers who do not want to participate in abortion or sterilization. The new law would have expanded legal immunity to procedures such as euthanasia, physician assisted suicide, withdrawal of end—of—life—nutrition, and research involving embryos and fetal tissue.