The American culture of death changed radically in the 1970s. For terminal illnesses, hidden decisions made by physicians were rejected in favor of rational self-control by patients asserting their right to die - initially by refusing medical treatment and more recently by seeking physician-assisted suicide. This new approach rested on two seemingly irrefutable propositions - first, that death can be a positive outcome for individuals whose suffering has become intolerable; and second, that death is an inevitable and therefore morally neutral biological event.
In Death Is That Man Taking Names, Robert A. Burt suggests, however, that a contrary attitude persists in our culture - that death is inherently evil, not just in practical but also in moral terms. He maintains that the ethos of rational self-control cannot refute, but can only try unsuccessfully to suppress, this contrary attitude.
The inevitable failure of this suppressive effort provokes ambivalence and clouds rational judgment in many peoples minds, paradoxically leading to inflictions of terrible suffering on terminally ill people. In the 1970s, judicial reforms of capitol-punishment and abortion policy were driven by similarly high valuations of rationality and public decision making - rejecting physician control over abortion in favor of individual self-control by pregnant women, and subjecting jury decisions for capital punishment to rationally guided supervision by judges. These reforms, too, attempted to suppress persistently ambivalent attitudes toward death and therefore have been prone to inflicting unjustified suffering on pregnant women and death-sentenced prisoners.