Millions of Americans sighed and then sympathized last week when a retired doctor helped a 54-year-old woman losing her memory kill herself.

And millions were horrified.

American society is undergoing a profound change in its attitude about maintaining life at all costs. It is a change that could lead to a new and wrenching nationwide struggle like the battle over abortion.

Shifting public opinion is rapidly creating what some call a perilous pro-death juggernaut, and others call simply sensible.

The act of Jack Kevorkian, the doctor who built the suicide machine with the handy button that Janet Adkins pushed, was only one more step in what seems to be a steady march toward some new kind of bargain with the fate we call Death.

The evidence for this is overwhelming:

Lawmakers, economists, ethicists and theologians are actively debating both the logic and morality of spending millions of badly needed dollars keeping hopelessly unconscious or suffering patients alive.

Around the country, a legal consensus is developing that it is not only permissible but at times compulsory to withhold or halt life-extending treatment. Forty states and the District of Columbia have "living will" laws recognizing the right to say in advance that one does not want to be kept alive by artificial means when hope departs.

Last Friday in Las Vegas, a judge granted a man's petition to let his doctor give him a sedative and disconnect his respirator. The event would have been unremarkable in many hospitals.

ncreasingly, euthanasia -- "mercy killing" -- is becoming a respectable subject for debate. In several cases, district attorneys or juries have refused to prosecute or convict family members who have taken it on themselves to end a loved one's life.

"It is increasingly apparent that many people believe euthanasia to be morally licit and favor its legalization," Edmund Pellegrino, the physician who heads Georgetown University's Kennedy Institute of Ethics -- himself a foe of euthanasia -- wrote last year.

George P. Smith II, a Catholic University law professor, has written that since most states have decriminalized suicide and seldom enforce laws against assisting it, states should make it lawful for individuals -- including physicians -- to give a competent person "the means to commit suicide" so long as that person "takes the last definite step."

To the question, "Should a doctor be allowed to assist an ill person in taking his or her own life?" 53 percent of those surveyed in a New York Times/CBS News poll last week said "yes," 43 percent said "no."

And a growing number, albeit a minority, of doctors are questioning what they call an increasingly fine line between turning off life supports -- which most advocate in appropriate cases -- and actively administering a substance to cause death.

In the Netherlands, a country that many regard as enlightened, perhaps 10,000 people a year are now dying by euthanasia at the hands of cooperative physicians.

In the New England Journal of Medicine, the nation's leading medical journal, executive editor Marcia Angell wrote: "Many of us believe that euthanasia is appropriate under certain circumstances and that it should indeed be legalized, but that we should not perform it ourselves . . . Whatever their views . . . doctors should be prepared for its emergence as an important issue . . . and should be prepared to debate it."

Last year in the same journal, 12 prominent physicians -- assembled, it is true, by the Society for the Right to Die -- said "all but two of us believe that it is not immoral for a physician to assist in the rational suicide of a terminally ill patient."

In Internal Medicine News and associated publications in February, another distinguished physician, Robert Moser, former executive vice president of the American College of Physicians, wrote: "When quality of life becomes unbearable to an individual who is rational yet locked in the grip of relentless terminal suffering," despite relief of pain, "active euthanasia should not be dismissed arbitrarily. How much different is it to place a needle in a vein and pump in a lethal dose of morphine than to write a prescription of 50 secobarbitals when you are convinced of suicidal intent?"

There are many reasons to shudder at, or at least question, all this.

Many of us adhere to religions or ethical codes that sanctify life. Some people believe any attack on life is abhorrent, even though many condone one sort of killing but not another.

Many of us, including doctors, ask, "Can anyone trust doctors to help and protect us if we allow doctors to become killers?"

Or -- to quote three letter writers to the New England Journal -- "Although euthanasia may be limited at first to competent persons who request it, do we believe we can sharply limit such requests to the competent on a voluntary basis? The transitions from voluntary to involuntary euthanasia, and from competent to incompetent patients, are inevitable. In a society that is driven by a cost-benefit calculus and does not always value the frail elderly, the mentally ill, people with AIDS and other groups, we must guard against persons being seen as desirous of death or unworthy of life."

To some, this may be the crux of the argument.

Physicians and nurses deeply involved with the dying, such as those working in hospices, say that pain relief, caring and reassurance can alleviate suffering -- and any desire for suicide as a way out -- in virtually all cases. It is surely true that thousands of the dying do not get such care, and this should be one goal of any revamping of the American health system.

Still, some persons -- a few? many? -- may wish to hasten death.

Sigmund Freud, suffering from incurable cancer of the jaw, in 1939 asked his doctor to inject him with a lethal dose of morphine, saying, "Now it is nothing but torture." His doctor agreed.

Right or wrong? The debate -- I think a necessary one -- will go on.

How Area Doctors View the Issue

Last April, the National Capital Area Hemlock Society -- which defends the right of the hopelessly ill to end their lives -- asked 500 area doctors for their views on death and dying. Ninety-one, nearly 20 percent, answered, a respectable response for such a mailing.

Of the 91:

Fifty-one (56 percent) said they believe terminally ill patients "should have the option of requesting aid in dying, that is, assistance in suicide, to bring life to an end."

Forty (44 percent) felt that if such aid were decriminalized, physicians should be the ones to carry it out.

Forty-four (48 percent) said that if it were legal, they would help terminally ill, suffering patients who ask to die by providing a lethal dose of drugs.

Seventy-nine (86 percent) said they feel it's appropriate to prescribe a drug like morphine to relieve a dying person's pain, "even if the quantity hastens death."

Sixty-two (68 percent) said they would disconnect life supports at a terminally ill patient's request.

Three said they had at some time helped a patient die, either by providing or administering a lethal drug.

Do these numbers truly represent area doctors' views? Those conducting the survey said they picked 500 names from a directory of some 6,800 doctors by selecting those most likely to care for the gravely ill, then taking a name or two from each page.

This was hardly foolproof random selection. At the least, however, the 51 doctors who said they feel the terminally ill should be able to request aid in dying add up to 10.3 percent of those questioned.