20 Week Euthanasia Essay

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A Humane Necessity


IT SEEMS inconceivable that in a happier world of the future no provision should be made for putting out of their misery persons suffering from an excessively painful and incurable disease. We shall have to find some legal way to accord to human beings the relief we accord to animals.

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Euthanasia—or “mercy killing”—can be practiced by commission, which is illegal, or by omission, which is not. A doctor cannot he punished for intentionally neglecting to administer some remedy or stimulant which might prolong life, although he may be accused of incompetence and malpractice. I shall consider here only euthanasia by commission.

The present situation is utterly unfair to the individual physician who believes that the relief of suffering is one of his principal duties. Many medical practitioners undoubtedly resort to euthanasia, but since they do so secretly it is impossible to say how many. They feel compelled to commit a technical “murder” even though they must bear the whole responsibility. That is the unfair part. Situations like the recent one in New Hampshire must arise frequently, and why in that case the doctor reported his act is difficult to understand. (Why, too, did he inject air instead of merely giving an overdose of morphine?) Bigots and sticklers for legal technicalities will always try to prevent or punish humanitarian action by an individual physician. Since the decision rests with him alone, the doctor will rarely ask for the consent of either the patient or the relatives. The mercy killing is therefore done furtively, when it should be done candidly, serenely, and lawfully.

None of the various arguments against euthanasia have ever shaken my belief in its truly humane purpose. In the space at my disposal I can refer only to a few. One of the most frequently heard but also most superficial objections is that the Nazis practiced euthanasia. What loose thinking! The Nazis never asked the consent of patients or relatives. There was no mercy in their killings, only expediency.

The contention that a seemingly incurable condition might some day be cured by a new medical discovery hardly holds water. How can the hopeless cancer victim or the imbecile child of today benefit by a discovery of tomorrow? The laws regulating euthanasia must of course be flexible, and requirements based on present knowledge may be changed in the future.

Another objection to euthanasia stems from the possibility of fraud and abuse. But if the decision on “merciful release” is left to a government-appointed board of at least three persons—for instance, two medical men and one lawyer, who must be unanimous in its favor—this seems a weak argument. Surely legal experts can devise adequate safeguards.

There will always remain the opposition of those who ding to sentimental superstitions about the sacredness of life. Such an emotional attitude cannot be changed by any reasoning. But let me give an example of the “sacredness of life.”

A friend of mine, a professional man in his late sixties, suffered from an inoperable cancer of the liver which caused great accumulation of water in the abdominal cavity. At least once a week his abdomen had to be tapped to relieve the pressure. He suffered also from a chronic inflammation of the heart muscle, and the resulting circulatory weakness added to the complete hopelessness of the case. Bedridden in a hospital, he was kept alive by medical skill and expert nursing. Physicians and nurses did their duty. Sedatives were used, but in small doses they were often ineffective, and large doses were deemed contra-indicated.

My friend was not a man of means but had managed to save a few thousand dollars for his wife and for a handicapped child. His savings dwindled from week to week. The hospital expenses were high. The bill for oxygen alone, which he required frequently, was more than $20 a week. He was anxious to die to end his suffering and to preserve at least part of his savings. But he was a religious man and rejected any idea of suicide. He did not approve of euthanasia. He could only pray that death might come soon. When he was down to his last few dollars and had to worry how he would pay his next hospital bill and how his wife would pay the next month’s rent, then and only then did death come. There was not enough money left to bury him.

In this case even legalized euthanasia would have been out of the question since the religious convictions of the patient himself, and probably also of his wife, would have prevented him from making the application or giving his consent. But in innumerable cases such religious convictions do not exist.

I could have made this story a more effective argument for euthanasia by having the patient beg in vain for release, but I wanted to report a true experience. It is easy for the reader to visualize the increased suffering and the heightened tragedy when euthanasia is desired and unmercifully denied by society.

Euthanasia has been called “pagan” and “indecent.” One may well ask, which is better—pagan mercifulness, indecent compassion, or devout inhumanity?

A False Mercy


EUTHANASIA is humane and merciful as an idea. It might be inhumane and dangerous as a practice. A progressive society should limit its power over human beings instead of expanding it. Strangely enough, many people who denounce capital punishment are in favor of euthanasia.

Legalizing euthanasia would be a disservice to the medical profession in that it would expand the power and responsibility of physicians, which are already almost unbearably great. The legal conditions proposed—consent of the patient or his family, decision by a state commission—would create psychological and technical situations beyond human endurance.

Millions of people today live a hopeless and painful, even a socially useless, life without the benefit of an incurable disease. Should they be permitted to be candidates for euthanasia? Suffering is more easily accepted by the patient who really has a painful disease than by the neurotic person who produces his misery and pain by emotional processes. Even the incapacitated, agonized patient, in despair most of the time, may still get some joy from existence. His mood will change between longing for death and fear of death. Who would want to decide what should be done on such unsafe ground?

Last summer in Germany I witnessed a number of so-called euthanasia trials. The Nazis and their medical hangmen had murdered many thousands of mental patients, epileptics, feeble-minded, physically handicapped, “asocial” persons. Of course these crimes had no resemblance to the euthanasia some people want legalized. There was no consent, no indication—in most cases—of unbearable suffering. However, the mass murder was justified as “euthanasia,” and one cannot help being deeply disturbed by the attitude of apparently honest physicians toward the orders of a perverted government and by the potential dangers of euthanasia as an instrument of public health.

“Hopeless” or “incurable” disease is an outmoded medical concept. We have seen in our lifetime a great number of incurable diseases become curable. Cancer may be curable the day after our application for euthanasia is signed.

It is also possible that undue influence would be exercised by the patient’s family. Suffering may seem more unbearable to the sensitive onlooker than to the sufferer himself. Chronic disease is always a social catastrophe whether death is imminent or not. Families are disrupted; their economic security is destroyed. But it is a sinister thought that economic considerations might influence the decision as to life or death. Death; in our society, has already too much taken on the character of an important financial transaction; a physician must frequently deal with patients who insist that they can afford death because of their insurance provisions, but not life with an incapacitating incurable disease. It seems clear to me that a public health insurance system should lessen the risk and the tragedy of chronic disease, but euthanasia is not a tolerable substitute for social and medical assistance.

The weapons of medicine for fighting pain and alleviating unbearable suffering have increased beyond any expectation. There is, indeed, no place for unbearable pain in modern medicine. If people die in torment it is because qualified medical or nursing care is unavailable. I have often been appalled by the undignified and careless way in which people are forced to die. Help in making birth easier is today a matter of routine, and almost no child comes into the world without expert assistance. Dying is often very difficult. It seems to me there ought to be well-trained death helpers among doctors and nurses just as there are birth helpers. But what is needed is wise guidance in the tremendous human experience of death, not the fulfillment of a more or less self-imposed death sentence by euthanasia.

Much can be done to integrate death into everybody’s existence, to make our departure from human society as natural an event as our entrance. But I greatly doubt that legalized euthanasia is the best means. As a physician, I feel I would have to reject the power and responsibility of the ultimate decision.

In the Netherlands, euthanasia is legal for patients older than 16 who request it.

"The question under consideration now is whether deliberate life-ending procedures are also acceptable for newborns and infants, despite the fact that these patients cannot express their own will," the authors wrote. "Or must infants with disorders associated with severe and sustained suffering be kept alive when their suffering cannot be adequately reduced?"

The doctors divided the newborns who might be considered for end-of-life decisions into three groups. The first is made up of infants "with no chance of survival" because of severe underlying diseases. Babies in the second group have "a very poor prognosis and are dependent on intensive care." Although intensive treatment might help them to survive, "they have an extremely poor prognosis and a poor quality of life." The third group has a "hopeless prognosis" and experience "what parents and medical experts deem to be unbearable suffering," whether or not they need intensive medical care. Within this group, the doctors include "a child with the most serious form of spina bifida," a condition in which the spinal column does not close completely.

According to the doctors, in the Netherlands there are 15 to 20 cases of euthanasia each year in newborns who fall into the third group. Two cases reviewed by the authors resulted in court cases in the mid-1990's, and in each case, the Dutch courts "approved the procedures as meeting requirements for good medical practice." The authors also examined 22 cases of euthanasia of newborns with severe cases of spina bifida that have been reported to district attorneys' offices since 1997. None of those doctors were prosecuted.

Publishing the Groningen guidelines "is not about our preparedness or joy in ending life," Dr. Verhagen said. "It's another phase, the phase that comes afterward. If you end the life of children, are you prepared to be accountable for it?"

Douglas J. Sorocco, a lawyer in Oklahoma City who has spina bifida, said that doctors might be quick to classify a baby as a hopeless case who might, with the right medical care, lead a happy and productive life. He said he might be classified as having "the most serious form" of the condition, since he was born with an open spine.

"People with spina bifida are having families, and making a contribution to their communities," said Mr. Sorocco, who is chairman of the board of directors of the Spina Bifida Association of America. "I would say I have a life worth living. My wife would say I have a life worth living. My family would say I have a life worth living."

Dr. Verhagen said that he did not question the quality of life of people like Mr. Sorocco, but argued that there was no comparison between those healthy people and the developmentally devastated newborns described in his paper.

Arthur Caplan, a professor of bioethics at the University of Pennsylvania, said he could not imagine such guidelines and practices becoming the norm in the United States. "It's not acceptable to the culture," he said.

The doctors in the Netherlands appeared to agree. "This approach suits our legal and social culture," they wrote, "but it is unclear to what extent it would be transferable to other countries."

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