Eugenics to Euthanasia

Archbishop of Philadelphia Charles J. Chaput, O.F.M. CAP.

See if this story sounds familiar: A happily married couple — she is a pianist; he a rising scientist — have their love suddenly tested by a decline in the wife's health. Diagnosed with multiple sclerosis, she falls victim to a steady loss of muscle control and paralysis. The desperate husband uses all his professional skills to save her. But ultimately he must watch her deteriorate in hideous pain. The wife worries that she will soon no longer be a person anymore — just a lump of flesh — and a torture for her husband. She begs her husband to kill her before that happens. And eventually, worn down, the reluctant husband releases his wife from her misery with poison.

The husband is indicted for murder. But the understanding judge and jury soon agree that, given the circumstances, the husband is not a killer, and the law needs to be reformed. Meanwhile, in impassioned public comments, the husband attacks the proponents of outmoded beliefs and antiquated laws who inflict unnecessary anguish on the terminally ill, who suffer without hope and whose death would be deliverance for them.

The story fits comfortably with today's medical headlines. It could easily be a 20/20 segment or a page from Jack Kevorkian's latest trial. But it comes from another era. Produced in 1941, it's the plot line of I Accuse, one of the Third Reich's most effective propaganda films. I Accuse was created for one reason only: to advance the Nazi campaign of euthanasia for the mentally and physically handicapped, antisocial elements, and the terminally ill. And it worked. It was a big box-office success. It's also the classic example of how compassion can be manipulated to justify mass killing — first in the name of mercy, then in the name of cost and utility.

Obviously, America in 1997 is not Germany in 1941. Americans have a practical sense of justice that favors the weak and the little guy. But if we want to keep it that way, we shouldn't assume that merely knowing about a past tragedy prevents us from repeating it. We need to learn from history. And in reflecting on physician-assisted suicide, the first lesson for our lawmakers is that any killing motivated by a distorted sense of mercy — no matter how many reasonable and honeyed words endorse it — leads to killing that has nothing at all to do with the best interests of those killed.

Let's examine a few simple facts

First, every one of us fears the image of a dying patient stripped of dignity and trapped in a suffering body. But today, no one needs to suffer excruciating pain in a terminal illness. Modern pain-suppression drugs can ensure the comfort of persons even in the final stages of dying. Hospice care, focused on ensuring a natural death with comfort and dignity, is increasingly available. It's true that some doctors underprescribe pain medication or seek to artificially prolong life beyond reasonable hope of recovery. But that is an issue of training. Patients have the right to decline extraordinary means of treatment. They also have a right to be free of mind-numbing pain. Both these goals can be accomplished without killing them.

Second, terminally ill persons seeking doctor-assisted suicide usually struggle with depression, guilt, anger, and a loss of meaning. They need to be reassured that their lives and their suffering have purpose. They don't need to be helped toward the exit. We should also remember that in helping the terminally ill to kill themselves, we're colluding not only in their dehumanization, but our own. Moreover, the notion that suffering is always evil and should be avoided at all costs is a very peculiar idea. Six thousand years of Judeo-Christian wisdom show that suffering can be — and often is — redemptive, both for the person who suffers and for the family and friends of the one in need. In any case, it is very odd to try to eliminate suffering by killing those who suffer.

Third, the Hippocratic Oath has very good reasons for binding physicians to do no harm. Doctors wield enormous power over their patients. And that power quickly corrupts the profession unless it is rigorously held in check. That is one of the reasons the American Medical Association has rightly, and so strongly, opposed physician-assisted suicide.

The alternative is immensely dangerous. The doctors who killed their patients in Nazi Germany may be written off as the product of a special and terrible time. But what about the doctors in the Netherlands — right now, today — who admit to killing patients without their approval? Physician-assisted suicide among the Dutch has been quietly tolerated for some time. But no one was prepared for the number of Dutch doctors who have taken it beyond that, proactively dispatching the terminally ill without their knowledge. The point is: The logic behind doctor-assisted suicide naturally expands. Can anyone honestly argue that physician-assisted suicide will limit itself to voluntary candidates in an era of ruthless medical cost-efficiency? And do we really want a society where patients aren't sure they can trust their physicians?

One final point: While the Supreme Court upheld state bans against physician-assisted suicide in Washington and New York earlier last summer, the debate is far from over. Missing from too much of today's discussion of doctor-assisted suicide is the presence of God. Yet God, in the view of the great majority of Americans, is the author of life and its only true owner. Life is God's gift, and he alone is its Lord. However wounded or attenuated it may seem, life is precious. Every life is sacred, from conception to natural death. We rarely understand life. We certainly don't own it. But if this sad century has taught us anything, it's that we have no right to dispose of it — however good the alibi.