America and death: reflections on euthanasia.

The contribution of Smith and associates in this issue, "A good death: is euthanasia the answer?," calls for more attention to research in palliative care, and argues against the assumption that active, direct, and voluntary (ADV) euthanasia is necessary. I agree with the authors' basic lines of argument against ADV euthanasia, and the following comments are intended to explain in part why the cultural pressure for ADV euthanasia is so powerful in America.