A Merciful End: The Euthanasia Movement in Modern America
Oxford University Press, 2003
272 pp., 99.00
Merciful Release: A History of the British Euthenasia Movement
Manchester University Press, 2002
288 pp., 33.95
by Richard Weikart
Killing Them Kindly
Decades ago a prominent euthanasia proponent stated that "there is a place in humanity for murder, that is to say by killing the unfit." Another commanded, "Chloroform unfit children. Show them the same mercy that is shown beasts that are no longer fit to live." One might be forgiven for thinking that these were rantings of a Nazi leader, for they do reflect the ideology underlying the Nazi euthanasia program, during which about 100,000 handicapped Germans were murdered by physicians under government direction. But alas, these statements came from prominent British and American progressives—the former from the British physician Havelock Ellis, and the latter from the controversial American lawyer Clarence Darrow.
These statements illustrate two important points stressed by Ian Dowbiggin and Nick Kemp in their recent books on the euthanasia movement in the United States and Britain, respectively. First, despite efforts by Anglo-American euthanasia advocates to distance themselves from the horrors of the Nazi euthanasia program, the euthanasia movement was not as far removed from Nazi ideology as it wanted outsiders to believe. Second, statements supporting involuntary euthanasia for the mentally handicapped were rather common in the euthanasia movement, providing ammunition for euthanasia opponents. Critics of legislation to permit voluntary euthanasia continually protested that this would begin a rapid descent down a slippery slope.
Kemp points out that the slippery slope argument is not all that rigorous philosophically. The euthanasia movement has often capitalized on this by insisting that it only supports voluntary euthanasia (i.e., assisted suicide) for terminally ill patients enduring intense suffering. To emphasize that it only promoted voluntary measures, the British organization for euthanasia dubbed itself the Voluntary Euthanasia Legalization Society when it was founded in 1936, and after several name changes in between, adopted the name Voluntary Euthanasia Society in 1982.
Even so, the euthanasia movement's attempts to introduce legislation permitting voluntary euthanasia have been dogged by the criticism that this will start a dangerous descent into barbarism. Whether the slippery slope argument has logical rigor or not, the historical perspective sketched in Kemp's and Dowbiggin's books provides plenty of grist for the mill of those suspecting that the slope is slippery nonetheless.
The parallels between the euthanasia movement in the United States and Britain are striking. Both books demonstrate that the euthanasia debate emerged in response to ideological currents gaining ascendancy in the late 19th and early 20th centuries. Dowbiggin argues, in fact, that support for euthanasia was always driven more by the prevailing intellectual climate than by medical advances.
The first public debates over euthanasia occurred in the late 19th century, and both authors stress the importance of Darwinism in the advent of the euthanasia movement. Dowbiggin writes, "The most pivotal turning point in the early history of the euthanasia movement was the coming of Darwinism to America." Kemp thoroughly agrees: "While we should be wary of depicting Darwin as the man responsible for ushering in a secular age we should be similarly cautious of underestimating the importance of evolutionary thought in relation to the questioning of the sanctity of human life." This confirms my own findings about the connections between Darwinism and euthanasia on the German scene.
Of course, Darwinism was only one manifestation of a wider intellectual shift that gave birth and succor to euthanasia. Dowbiggin is especially good at tracing the connections between euthanasia and the larger intellectual picture in vignettes of many leading figures in the euthanasia movement. Most early leaders were either secular progressives or Unitarians. Charles Francis Potter, who organized the Euthanasia Society of America (ESA) in 1938, was a former Unitarian minister who after leaving Unitarianism founded the Humanist Society of New York. In addition to the many humanists and Unitarians supporting the ESA, Potter gained the endorsement of a few prominent liberal religious leaders, including Harry Emerson Fosdick and Rabbi Sidney Goldstein.
For these progressives, the euthanasia movement was part of a larger campaign to replace traditional Judeo-Christian morality. Along with euthanasia, most of them also promoted birth control, abortion, and eugenics. Dowbiggin points out that their concern for individual freedoms (some were ACLU members, for example) was often vitiated by the paternalism inherent in their technocratic ideals. Thus many euthanasia advocates affirmed the propriety of involuntary euthanasia for those whose lives were deemed not worth living, not only for the sake of the suffering individual, but also because these "defectives" were perceived as a burden to society. Crass economic arguments for ending human lives that consumed precious resources without contributing anything to society were not at all uncommon in euthanasia literature. 1
The backlash against the Nazi euthanasia program together with the conservative political and moral atmosphere in the 1950s caused the euthanasia movement to flounder in both the United States and Britain, but it revived with the advent of Sixties-style liberalism. In the 1950s the Anglican minister Joseph Fletcher, famous for promoting situation ethics, heralded a new approach to euthanasia that would become prominent in the 1960s and thereafter. He abandoned eugenics considerations and stressed personal autonomy. Individual choice would not only become the slogan of abortion advocates, but would also dominate pro-euthanasia literature.
Of course, medical advances have also played a significant role in the vicissitudes of the euthanasia movement. Improvements in health and hygiene have extended life expectancy but have also thereby increased the numbers of people dying of protracted, painful terminal illnesses, such as cancer. However, the argument that compassion for these suffering individuals requires the legalization of voluntary euthanasia was partly undercut by advances in palliative medicine. Even the Catholic Church, the staunchest foe of euthanasia, accepted the doctrine of "double effect," which acknowledges that it is permissible for physicians to administer pain-killers, even if this unintentionally speeds the death of the patient.
By the 1960s, life-support systems that kept people's bodies functioning even without brain function led many to conclude that individuals needed protection against a too-vigorous medical establishment, leading to the popularization of the Living Will, an advance directive to terminate life-support systems in cases where recovery seems hopeless. The euthanasia movement preyed on these fears, and most Americans and Britons came to accept the necessity of passive euthanasia, i.e., withdrawing life support from patients without prospect of recovery. Nevertheless, most remained either opposed to or at least uneasy about legalizing active euthanasia.
Despite increasing sympathy for euthanasia since the Sixties, the prospect of legalizing assisted suicide in Britain and most states of the United States is rather remote. Though Oregon passed an assisted suicide measure in 1994, both Michigan and Maine rejected similar laws since then. Dowbiggin does not think the gridlock over euthanasia in the United States will be broken very soon, since only about a third of Americans support the legalization of euthanasia, about a third oppose it, and about a third support it only in restricted cases. Kemp predicts that formal legalization in Britain is remote, too, since many people are convinced that legalization would lead to abuses, and the legal system is not vigorous in prosecuting cases of physician-assisted suicide anyway.
If the immediate prospects for legalized euthanasia are remote, at least in Britain and the United States, there is no reason to be complacent. As important as Dowbiggin's and Kemp's books are, their perspectives are limited by their focus on the organized euthanasia movement, and Kemp doesn't take the story past the 1960s, except for a few pages in the conclusion. While these two books don't entirely neglect the intense contemporary debates within the medical profession or the academic bioethics community, of course, they relegate such matters to the periphery. Wesley J. Smith in Culture of Death: The Assault on Medical Ethics in America fills this gap admirably. Smith, a lawyer for the International Anti-Euthanasia Task Force, describes in great detail how developments in the field of bioethics have fostered a "culture of death" in the United States. He provides many shocking examples to illustrate the "quickly developing ethical crisis in a medical world that increasingly devalues some human lives and views people at the margins as expendable. Traditional morality and medical ethics are crumbling before our very eyes."
Smith makes a strong case by explaining how the "right to die" has indeed morphed into a "duty to die" in the minds of many health care professionals who have jettisoned the Hippocratic Oath. Individual autonomy has increasingly given way in the past two decades to decision-making by health care professionals and bioethicists, whose "futile care theory" measures the value of human life according to the financial cost of keeping the individual alive. We are now in the unenviable position where doctors and hospital staff make medical decisions contrary to the wishes and protests of individuals and their families, not in order to save life, but to end it.
Smith cogently analyzes this erosion of medical ethics, both in academic theory and in medical practice. One of the more disturbing cases he relates is that of Marjorie Nighbert, who was dehydrated to death in a Florida nursing home in 1995 despite her pleas for food and water. She had suffered a stroke that left her unable to swallow, and her brother, who had power of attorney, had her feeding tube removed. A judge refused to override this decision, so Nighbert died, pleading for help. Fortunately, some judges have intervened in similar cases elsewhere, sparing the lives of those threatened with an agonizing death through dehydration.
So what lessons can we draw from these works? Is there a slippery slope after all? First, Smith, Dowbiggin, and Kemp do not draw the same lessons from the material they present. Smith is a pro-life advocate strongly condemning the erosion of the sanctity of life ethic, while Kemp in his conclusion reveals sympathy for Peter Singer's support for euthanasia. Dowbiggin seems to fall somewhere in between, though it is not clear exactly where. However, he does explicitly present his story as a "cautionary tale." In any case, despite the euthanasia movement's lack of success in fully legalizing euthanasia in the United States and Britain, Smith's work shows that support for euthanasia is strong among bioethicists and the practice of euthanasia is already fairly widespread in American hospitals.
What is striking in all three works is that the struggle over euthanasia is part of a larger conflict between competing world views, a struggle that James Davison Hunter described earlier in Culture Wars. Legalization of voluntary euthanasia begins the descent down a slippery slope not because voluntary euthanasia necessarily implies involuntary euthanasia—one could quite logically support the former and oppose the latter—but rather because once human lives are no longer considered sacred, once individuals are free to dispose of their lives at their whim, and once the value of human life is measured according to standards such as happiness, pleasure, or—even more ominously—economic productivity, there is no longer any moral restraint on extending the "benefits" of a quick death to others, too, without their permission.
What these works suggest is that in order to defeat the euthanasia movement we will have to win a wider ideological battle. We will have to attack moral relativism and utilitarian ethics, which undermine Judeo-Christian morality. We must also grapple with Darwinism, which, at least in many of its permutations, denies the uniqueness of humans. Also, as J. P. Moreland and Scott Rae so eloquently argue in Body and Soul: Human Nature and the Crisis of Ethics, we will need to try to restore the traditional Christian belief in body-soul dualism, which underpins the sanctity of life ethic. Finally and most importantly, we need to counter our hedonistic, materialistic, and self-centered culture with true Christian compassion, self sacrifice, and self denial.
Richard Weikart is professor of history at California State University, Stanislaus.
1. See Richard Weikart, "Darwinism and Death: Devaluing Human Life in Germany, 1860-1920," Journal of the History of Ideas, Vol. 63 (2002), pp. 323-344; my forthcoming book, From Darwin to Hitler: Evolutionary Ethics, Eugenics, and Racism in Germany (Palgrave), explores this issue in greater depth.
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