In 1920, a prominent German jurist, Professor Karl Binding, alongside a well-known German psychiatrist, Dr. Alfred Hoche, advanced the destruction of what they dubbed “life unworthy of life.” They explained each killing as “purely a healing treatment” and as a “healing work”[1].
Less than a century later, Dr. Else Borst-Eilers, former politician in the Netherlands and chair of the Dutch Health Council, has declared that “there are situations in which the best way to heal the patient is to help him die peacefully and the doctor who in such a situation grants the patient’s request acts as the healer par excellence”[2].
The eerie similarity of such a statement to the kinds of statements put forth by Binding and Hoche in Nazi Germany should be enough to send chills down one’s spine. Argue, if you must, in favor of killing terminally ill persons; but at least have the decency not to pretend that it is some kind of praiseworthy “healing”[3].
I have previously discussed the question of physician-assisted suicide in relation to its discrimination against the elderly, but here I would like to discuss it as it relates (or does not relate, as the case seems to be) to the role of medicine. In order to determine the rightness or wrongness of a physician committing a certain action (namely, helping someone take his own life), it seems we first have to ask something like, “What is it that a physician is supposed to do?”
This question is weighty, but not complex. Put simply, a physician is supposed to heal. Of course, there may be situations when he is unable to do so, but his singular and noble goal remains to heal the sick. He does this by serving them and caring for them, largely in their physical needs, but often in their mental and emotional needs as well. In the words of Leon R. Kass, “The physician as physician serves only the sick. [He] does not serve the relatives or the hospital or the national debt inflated due to Medicare costs. Thus the true physician will never sacrifice the well-being of the sick to the convenience or pocketbook or feelings of the relatives or society”[4]. In this light, the “physician-euthanizer” clearly becomes a paradox as absurd as “healer-destroyer”. The physician’s aim is to heal; our focus should remain on this aim, not his potential power over life and death.
It is not only unjust, but also illogical, to eliminate suffering by eliminating the sufferer. The logic fails in this way: “it is in fact impossible to compare the goodness or badness of one’s existence with the goodness or badness of one’s ‘nonexistence’, because it nonsensically requires treating ‘nonexistence’ as a condition one is able to experience and enjoy”[5]. In other words, the intent to relieve the suffering of a living patient only makes sense insofar as there is a living patient left to be relieved. As Kass puts it, “[There can be] no benefit without a beneficiary”[6].
I feel at this point that a crucial distinction should be made. I am not suggesting that one ought not cease painful treatment (like intensive chemotherapy) or withhold additional doses of life-sustaining medication if such therapies are not serving the comfort and happiness of the suffering patient in his last days. Indeed, we are finite beings and eventually each of us must embrace our own death. But allowing death is far different from causing death. While a doctor may be perfectly right in letting his patient pass free from tubes and contraptions, he is never right in killing her through any means, however seemingly peaceful. The first and most steadfast promise a physician swears to in the Hippocratic Oath remains medicine’s basic proscription: “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect… In purity and holiness I will guard my life and my art.” In foreswearing to never administer poison, a doctor relinquishes any trace of godlike power that he might contribute to himself in governing life and death, recognizing that “drugs can both cure and kill”[7] and understanding the mass of his responsibility.
Should doctors throw in the towel, should U.S. legislation permit them to stoop to killer rather than healer, Americans will be abandoning their loved ones in their hour of need, rejecting their duty to care for them, and subjecting them to poison by a stranger. The last days of a person’s life ought to be filled with love and encouragement; for reasons perhaps beyond our understanding, they are sometimes also filled with pain and suffering. Nonetheless, the doctor’s task remains to heal and comfort his patient as much as possible and then allow nature to take its course—whatever that course may be. For surely, “physicians cannot be serving their art or helping their patients… by making them disappear”[8].
[1] R. J. Lifton, “The Nazi Doctors: Medical Killing and the Psychology of Genocide” (32-48).
[2] Quoted in A.M. Capron, “Euthanasia in the Netherlands: American Observations” (30-33).
[3] Leon R. Kass, “’I Will Give No Deadly Drug’: Why Doctors Must Not Kill.”
[4] Ibid.
[5] Ibid.
[6] Ibid.
[7] Ibid.
[8] Ibid.
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