Since I have had terminally ill relatives who in many cases really wished there was some way they could end their suffering, I would support euthanasia and physician-assisted suicide (PAS) in such situations, as long as it was purely voluntary and something individuals did of their own free choice. I would certainly not support any policies where the state or other powerful political and economic institutions enforced euthanasia against the will and free choice of people, s in the Third Reich, but if I knew someone who asked me to help them commit suicide for this reason I would assist them if I could. I would also support their decision to refuse any further medical treatment, and in fact I have when this has happened with some of my relatives, although I will not mention any of the details.
PAS and euthanasia have gone on throughout recorded history, although they are rarely discussed openly because of the moral, legal and professional prohibitions against them. Many years ago, a speaker once asked a large group of physicians at a medical convention to raise their hands if they had never practiced euthanasia or PAS, and not a single hand went up. It goes on all the time, in fact, and is rarely prosecuted, although Dr. Jack Kevorkian was a noteworthy exception. In his case, though, most physicians believed that his methods and evident hunger for publicity were severely flawed (Brody 136). Recent polls show that over two-thirds of adults in the U.S. favor PAS while 72% intend to leave a living will that will end life support or resuscitation if they are in a terminal or permanently unconscious or brain dead condition (Forman, 2008, p. 89). PAS advocates argue that end-of-life care today is deficient and expensive, despite the establishment of hospices for the dying over the last thirty years. Since avoidance of unnecessary pain and suffering is a rational-utilitarian goal, and a prolonged and painful death is often undignified, PAS should be allowed. Physicians also have a duty to “relieve suffering” which cannot always be done with palliative care in all cases (Brody 137).
I also wanted to make it very clear that I am aware of the T-4 ‘euthanasia’ or medical killing program in Nazi Germany and this is definitely not the type of policy I advocate. In the Third Reich, Hitler order the extermination of the mentally ill, handicapped and those with incurable diseases, and this example is used frequently by opponents of voluntary euthanasia and PAS. This actually occurred in a totalitarian police state ruled by one party, with an ideology based on eugenics, Social Darwinism and ‘scientific’ racism, but this regime also came to power after an economic collapse. Its leaders frequently pointed out the need to use medical and economic resources for the younger and healthier population, such as soldiers, productive workers in the armaments industry and women able to bear large numbers of children. Members of the society considered weaker, inferior, ‘useless eaters’ or racially and politically undesirable were slated for destruction. Physicians and nurses seemed especially susceptible to the political, economic and biological ‘logic’ of such arguments, and joined the Nazi organizations in far greater numbers than any other professional groups. For example, 45% of all German physicians joined the Nazi Party in 1933-45, compared to 25% of lawyers and 24% of teachers, while only 9% of the general population joined. Over 7% of physicians were members of the S.S. compared to just .6% of the total population, and participated willingly and enthusiastically in euthanasia, sterilization, genocide of the Jews and Gypsies and experiments on concentration camp prisoners (Kater 79). Over 400,000 Germans were involuntarily sterilized and at least 100,000 euthanized, while the personnel involved in this program moved to Poland in 1941-42 to establish the first death camps there. After all, they had become technical experts in mass killing and disposal of bodies, and could be readily assigned to this much larger task of genocide. Most of them were never punished for their crimes and continued to teach and practice medicine in postwar Germany, where they influenced future generations with the ideology (Kater 82).
Over the last thirty years, the overall trend has been increasingly liberal or libertarian in allowing individuals greater freedom of choice over how and when to die. I am therefore not surprised that some states and foreign countries have begun to take the next step and allow voluntary self-termination of life under certain conditions. This raises important questions about how to improve palliative and custodial care for terminal patients at the end of life, and whether and under what conditions PAS might be permitted. In these situations, physicians will not only require informed consent in the legal sense, but will also have to consider the emotional and psychological needs of dying patients and their families far more than often seems to be the case at present.
WORKS CITED
Brody, H. “Assisting in Patient Suicides Is an Acceptable Practice for Physicians” in R.F. Weir (ed). Physician-Assisted Suicide. Indiana University Press, 1997: 136-54.
Kater, Michael. “Criminal Physicians in the Third Reich: Toward a Group Portrait” in F.R. Nicosia and J. Huener (eds). Medicine and Medical Ethics in Nazi Germany: Origins, Practices, Legacies. Beghahn Books. 2002: 77-92.
