The word euthanasia derives from a Greek word meaning "good death". In this commentary Dr Andrew Kania looks at the history of the subject, the wider moral canvas and ends with a quite succinct exposition of Catholic moral thinking on the subject.

Well, we put animals out of their misery, don't we?

A farmer in the Australian outback is long-hauling livestock to market. At a dusty point in the road the wheel of his truck sinks into a large pot-hole which had been covered over by dust. Startled, the farmer loses control of his vehicle and jack-knifes across the road. A scene of carnage awaits another farmer who a little while later comes driving toward the crash scene from the opposite direction. Stepping out of his vehicle the second farmer reaches for his rifle, and seeing the animals in great distress proceeds to destroy a number of cattle. Speaking aloud to himself, the second farmer, can be heard clarifying his reasons for shooting the poor animals: "Oh mate, you poor devil, you're in such pain". All of a sudden the farmer with the rifle, notices the farmer who has had the accident, lying with a broken arm and a broken leg. The second farmer walks over, rifle in hand, and asks the accident victim, "How are you mate?" To which the reply comes swift and clear: "Actually, I've never felt better in all my life".

Some history…

Derived from a Greek word meaning 'good-death', euthanasia may be defined as the deliberate taking of a person's life, due to (i) a medical practitioner perceiving the quality of a person's life to be poor, or (ii) that death is requested by a patient as a means to end pain, suffering, or a poor physical quality of life.

Euthanasia may be active, that is an action directly leading to a person's death, for example, lethal injection; or passive, that is an omission of life-giving treatment eventually leading to the death of a patient. Active and passive euthanasia, can be non-voluntary, voluntary or involuntary — depending on who has made the decision, and on what rationale the decision was made. In any event, the end-result is the same — a patient dies by the intervention of a third-party, usually a medical practitioner or a health-care official.

So why if the Ancient Greeks disapproved of euthanasia in the Hippocratic Oath, do we now contemplate the legalisation of such a programme? From where do we engender our rationale for euthanasia?

Jurist—Psychiatrist—Philosopher Karl Binding, Alfred Hoche and Friedrich Nietzsche

Fundamental to the modern euthanasia movement is the work of three Germans: the jurist, Karl Binding (1841-1920), the psychiatrist, Alfred Hoche (1865-1943), and the philosopher, Friedrich Nietzsche (1844-1900). Leaving the latter aside for one moment, Binding and Hoche were the co-authors of the 1922 publication, Die Freigabe der Vernichtung Lebensunwertem Lebens (Allowing the Destruction of Life Unworthy of Living). In this work, the authors formulated a rationale for the killing of patients which involved the organisation of a committee to make life and death decisions. This committee would consist, not surprisingly, of a jurist, a psychiatrist and a physician. Binding and Hoche also coined the phrase, "lebensunwertes Leben", or in English, that life which being born is now unworthy of living.

As for Nietzsche, the philosopher had made clear his support of euthanasia in his "Twilight of the Idols". Nietzsche was convinced that the world should comprise the strong, and that it was a responsibility of the strong to destroy the weak — put the weak out of the strong's misery. In another of his works, he writes: "The sick are the greatest danger for the well (society). The weaker, not the stronger, are the strong's undoing … What is to be dreaded by us more than any other doom is not fear, but rather the great pity — disgust and pity for our human fellows … The morbid are our greatest peril not the 'bad' men, not the predatory beings. Those born wrong, the miscarried, the broken — they it is, the weakest, who are undermining the vitality of the race, poisoning our trust in life, and putting humanity in question". (James, 1994, pp. 406 – 407)

The work of all three of these individuals was intrinsic as a philosophical base to the T-4 Euthanasia Program (Tiergartenstraße 4 or Aktion Tiergartenstrasse 4) during the NAZI regime. During T-4, approximately 200,000 people were put to death because of perceived 'defects' in their genetic make-up, defects not uncommonly related to race. Ironically the Euthanasia team were later to be given the official title of Charitable Foundation for Institutional Care. Gitta Sereny provides a grim insight into the T-4 Programme headed by such brilliant psychiatrists and physicians, as: Dr. Werner Heyde, Dr. Paul Nitsche, and Dr. Karl Brandt. Sereny writes: "Brandt under cross-examination at his trial said that sixty thousand insane people had been killed, and that 'feeble-minded and senile patients were included' … The killing of (German) children ended officially that autumn, though in reality they were still being killed as late as April 1945 – some by hanging". (Sereny, 1995, p. 198)

From such 'illustrious' beginnings we now come to the present day. Questions now abound about the right to die, and the codification of such processes under law. Once more, societies seek to give 'the elite' the right to kill, and by so doing, make the sanctity of human life ever more precarious a value to preserve.

In a 1996 study, Seduced by Death: Doctors, Patients, and the Dutch Cure, the author Hendin, in analysing the health care programme in the Netherlands for the terminally ill, noted that palliative care facilities in Holland were among the worst in Europe; this situation perhaps being a motivating cause for the introduction of euthanasia laws. Yet even more alarming is the extent by which when you give the opportunity to a physician to play the role of God, they do so and liberally so. According to Dr. Bert P. Dorenbos, President of Schreeuw om Leven (Cry for Life, 2005), "Two Dutch Governmental investigations of more than 20,000 cases conclude that euthanasia was practised in one way or the other. In at least 1000 cases every year the patient is killed without his consent. In more than 3000 cases every year the doctor killed his patient". In 2006, Holland also began seeking to introduce euthanasia laws for children and infants, the legislators in Holland defending this practice against comparisons with the NAZI's by stating that their motivations are based on compassion and not hate; the children should appreciate the distinction.

The view of Rene Girard…

The modern French Catholic philosopher, Rene Girard, provides us with much to ponder on by way of his musings regarding euthanasia. According to Girard: "The preoccupation with death in a subjective sense is peculiar to modern Western societies. In archaic societies death did not mean the same thing. Most of the time, death was interpreted as a consequence of violence, human and/or supernatural. So …[this] kind of focus … reflects a new freedom and is a kind of luxury, really. It is no accident from a religious point of view, that so many aspects of life are getting easier and easier. As they do, we have plenty of time to think about old age and death. The experience of death is going to get more and more painful, contrary to what many people believe. The forthcoming euthanasia will make it more rather than less painful because it will put the emphasis on personal decision in a way which was blissfully alien to the whole problem of dying in former times. It will make death even more subjectively intolerable, for people will feel responsible for their own deaths and morally obligated to rid their relatives of their unwanted presence. Euthanasia will further intensify all the problems its advocates think it will solve … The increasing subjective power of death converges with the fact that people are living longer lives. It is an enormous religious and ethical issue to my mind. In the Netherlands, where I gather assisted suicides have become commonplace, there are claims that some of the assisted suicides are not suicides at all. Even if they are, the suspicion will linger that they are not, and the fear of being murdered is going to merge once again with the fear of dying. Our supermodern utopia looks very much at times like a regression to archaic terror". (Girard, 2007, p. 278).

In short, euthanasia serves to open up a further series of anxieties in addition to that prime anxiety we have sought to control — choosing the exact moment of death. We begin to suspect those that we should have the greatest trust in: our health care practitioners — and our family members. Empowered over the weak, with the legal right to kill, the strong thus become, in an almost pseudo-Orwellian sense, (after their great revolt against God) — no longer minions of God, but God; and if absolute power corrupts absolutely, what greater avenue to lead to corruption, then taking on oneself the mantle of God?

The Catholic moral position…

The Catholic Church is quite clear in its stance on euthanasia: "Whatever its motives and means, direct euthanasia consists in putting an end to the lives of handicapped, sick or dying persons. It is morally unacceptable". (Catechism of the Catholic Church, par. 2227) In the eyes of the Church discontinuing medical procedures which are dangerous, extraordinary or 'over zealous' is morally acceptable, for then the medical practitioner does not will death, he or she merely accepts the fact that such continued treatment will not restore health. Yet even if this is the case — the Church teaches that all normal health care should be maintained, that is nutrition and hydration. The Church is, and will always be — life affirming.

If one accepts the Church's teaching, there is no risk of physicians putting patients out of their misery, nor of patients dying at any time, other than that prescribed by God. Death remains a fact of life, and not a weapon, nor a negotiable bargaining chip, nor an aspect of a political agenda; death remains what it essentially is, and will until the end of time, be — something that every living man or woman must face and inevitably embrace; and the Ancient Greeks in their wisdom understood this only too well.

Image Credits:
Clicking on the images in the body of the article will take you to the original source. The image used in the headline was sourced from: eslacs.tripod.com

©2008 Dr Andrew Thomas Kania

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