Since active euthanasia is illegal and not widely practiced in this country, most doctors are not faced with the dilemma of deciding whether or not to put someone out of his misery. Most of the controversy in this area currently centers around the question of whether or not the practice should be legalized.

Despite popular support, however, the issues and questions surrounding passive euthanasia have become far more acute and complicated for physicians, as a result of the tremendous gains in medical science's ability to significantly prolong the lives of many "terminal" patients. Today, more and more doctors must decide when it is no longer worthwhile to attempt to keep a patient alive by further treatment or heroic measures.

Most of the doctors attribute the fact that my grandmother is still alive today to her intense desire to survive. Had her will to live and endure the suffering been any less intense she might have convinced the doctors that further treatment was not worth the agony of prolonging her life by a month or two. But in each case over the last five years, the doctors' assessments that she could only live a short time longer with treatments has proven wrong.

Because pain and suffering are subjective elements, the question arises of who should say the patient is in too much agony to continue treatment. In how many cases, where a decision to withhold lifesaving treatments is based on the patient's assessment of pain, would the patient have been able to make an unpredicted recovery with treatment--regardless of the small odds given by doctors?

A doctor must decide in which cases he is willing to play the odds and in which he should do everything within reason to beat those odds. And he must further decide whether the patient has the right or the proper outlook to demand an end to his suffering. In some cases the agony is so severe and the prognosis so hopeless that there is little question that heroic measures to prolong the patient's life should not be employed. But many times the line between hope and hopelessness is a fuzzy one, and the problems of who is to draw it and on what basis remain unresolved.

THESE AND OTHER moral, judgmental and legal problems raised by passive euthanasia have concerned increasing numbers of medical and legal experts in the past few years.

Most of these experts do not think that these doubts should mean that no doctor may dare let a patient die without first doing everything humanly possible to prolong even the most hopeless cases. Instead they say that advisory groups and some general guidelines for doctors should be considered.

As a result of the famous case several years ago where a mongoloid child with an intestinal obstruction was allowed to dehydrate and die instead of being operated on, Johns Hopkins University Hospital in Baltimore, Md., established a review board to advise its medical staff. The board, which meets regularly to attempt to develop ethical guidelines, consists of a surgeon, a psychiatrist, a clergyman and a lawyer.

Dr. Alejandro Rodriguez, director of child psychiatry at Johns Hopkins and a member of the board, said that board members' expectations of outlining definite policy were too premature. "We just didn't know enough about so many questions," Rodriguez said. "We're trying to put together meaningful answers to ethical problems on which we can base some sort of guidelines for the handling of [passive] euthanasia." He added that until more thought goes into the matter, he is "terrified at the thought of individual doctors being faced with life and death situations and decisions."

THE JOSEPH P. KENNEDY Jr. Foundation in Washington sponsored a symposium on ethical problems of medicine in October 1971 which was attended by legal and medical experts from all over the country. The foundation has funded programs in medical ethics at several institutions, including Harvard's Interfaculty Program in Medical Ethics. Harvard's program is designed to examine the ethical behavior of physicians "at a time when reappraisal of the moral basis for the medical acts of society and physicians is occurring in a wide variety of issues," according to the foundation.

William J. Curran, Lee Professor of Legal Medicine at the School of Public Health and one of the joint directors of the program, said last month that the interfaculty group has already initiated several programs and courses in medical ethics, including one of the only undergraduate courses in medical ethics in the country, History of Science 141: "Problems in Medical Ethics."

Curran said that the whole question of euthanasia raises the basic "question of the quality of life." The undergraduate medical ethics program was created because the moral and legal problems of the question must be encountered before the student begins his internship and active involvement in the medical field, Curran says, adding: "There is a very, very strong drive to help patients on the part of most of those who intend to practice medicine, but they must develop moral and ethical standards early in their training."

Sissela Bok, who teaches History of Science 141 with Stanley J. Reiser, assistant professor of the History of Medicine, said recently that the medical ethics course deals with euthanasia and other similar problems by "examining cases which pose questions about the ethics of the subject and discussing the difficulties encountered by physicians and patients." She said that the improvements in medical techniques over the last few decades have been a problem to doctors who know that their patients are terminally ill.

"Something that laymen don't consider is the enormous pressure that the doctor is under," she said. Many doctors have done everything in their power to prolong a hopeless patient's life, she continued, because they are afraid of being accused of negligence in not trying everything possible to save someone's life. Bok added that this trend is becoming less of a problem as more and more patients opt against extraordinary means of prolonging life.

Still, each individual doctor who is faced with the problems of seriously ill or injured patients bears enormous burdens and the decisions to which he must come may have serious consequences. Recently, many doctors have suggested that national guidelines concerning the ethical extremes of euthanasia should be outlined. "The problem is a legal one as much as a medical one," says Dr. Irwin Kopin, chief of the Laboratory of Clinical Science at the National Institute of Health in Bethesda, Md. "And the ethical and legal elements simply haven't been explored enough."