The Shifting Meaning of a Good Death, A History of Euthanasia

“ It first became the expression for the attempt of the physician—originating in human compassion, developed by medical science—to alleviate the end of a dying person by soothing his pain. But then the meaning of the word, and with it the concept of euthanasia, was expanded, and towards the end of the 19th century it meant assistance in dying through an abbreviation of life if the life of the suffering person had lost its value in view of immediate and painful death, or as a result of an incurable disease. ”

“ So the greatest boon that follows the attainment of extreme old age is euthanasia,—an easy death, not ushered in by disease, and free from all pain and struggle.1 For let a man live as long as he may, he is never conscious of any moment but the present, one and indivisible ”

“ This purely painless process, this descent by oblivious trance into oblivion, this natural physical death, is the true euthanasia; and it is the duty of those we call physicians to secure for man such good health as shall bear him in activity and happiness onward in his course to this goal. For euthanasia, though it be open to every one born of every race, is not to be had by any save through obedience to those laws which it is the mission of the physician to learn, to teach, and to enforce. Euthanasia is the sequel of health, the happy death engrafted on the perfect life. ”

“ In the admirable liturgy of the churches of England and of Rome, there is a fervent prayer for protection against “battle, murder, and sudden death.” From death uncontemplated, unarranged, unprepared for, may Heaven in mercy deliver us! But if ever ready, as we should be for the inevitable event, the most kindly mode of infliction must surely be that which is most prompt and brief. To die unconsciously, as in sleep, or by apoplexy, or lightning, or overwhelming violence, as in the catastrophe of the Princeton, this is the true Euthanasia. ”

“ Ten times in my own observation I remember witnessing, with attentive mind, these phenomena of natural Euthanasia. Without pain, anger, or sorrow, the intellectual faculties of the fated man lose their brightness. Ambition ceases, or sinks into desire for repose. Idea of time, of space, of duty, lingeringly pass away. To sleep and not to dream is the pressing and, step by step, still pressing need ”

“ Though to acquire or impart form is delightful in art, in thought, in generation, in government, yet a euthanasia of finitude is also known. All is not affectation in the poet who says, “Now more than ever seems it rich to die”; and, without any poetry or affectation, men may love sleep, and opiates, and every luxurious escape from humanity. ”

“ Why, it must be asked again, should all this unnecessary suffering be endured? The patient desires to die; his life can no longer be of use to others, and has become an intolerable burden to himself; the patient's friends submit to the inevitable, but seek the means of robbing death of its bitterest sting—protracted bodily pain; the medical attendant is at the bedside with all the resources of his knowledge and his skill ready to his hand; he could, were he permitted, bring to his patient immediate and permanent relief. ”

“ Charlotte began, earnestly.
But her husband interrupted her. "No condolences are due, dear. He gave a dying man the most merciful sort of euthanasia, and at the same time demonstrated a new method as daring as it was triumphant. With a case taken a month earlier it would have saved a life. The demonstration is a contribution to science. If he received no applause it was because we don't applaud in the presence of death, but there was not a man there who didn't realize that in certain lines the country surgeon could give them a long handicap and still win." ”

“ Euthanasia.—Every now and then there is a discussion in the newspapers {724} of the justifiableness of euthanasia, that is, the giving of a pleasant death to those who are known to be incurably ill and who are doomed to suffer pain for most of what is left of their existence. The question usually discussed is whether patients have the right to shorten their own existence and then, also, whether their physician might have the right or, even as some people say, the duty, to lessen human suffering by abbreviating existence for such incurable cases. ”

“ Euthanasia might become a wholesome doctrine if time should dissolve our present, perhaps animal, feelings, and replace them by more economical sentiments. But, as we are, it could only be an esoteric doctrine for the few who might have opportunities of ending hopeless misery by chloroform without giving needless pain to their friends. ”

“ Nature kills by slow and protracted torture; we can defy it by choosing a rapid and painless end. It is only the remains of the old superstition that makes men think that to take life is the special prerogative of the gods. With marvellous inconsistency, however, the opponents of euthanasia do not scruple to "interfere with the course of nature" on the one hand, while they forbid us to interfere on the other. It is right to prolong pain by art, although it is wrong to shorten it. When a person is smitten down with some fearful and incurable disease, they do not leave him to nature ”

“ So long as life has some sweetness left in it, so long the offered mercy is not needed; euthanasia is a relief from unendurable agony, not an enforced extinguisher of a still desired existence. Besides, no one proposes to make it obligatory on anybody; it is only urged that where the patient asks for the mercy of a speedy death, instead of a protracted one, his prayer may be granted without any danger of the penalties of murder or manslaughter being inflicted on the doctors and nurses in attendance. ”

“ IV A Respondents claim that a patient facing imminent death, who anticipates physical suffering and indignity, and is capable of responsible and voluntary choice, should have a right to a physician's assistance in providing counsel and drugs to be administered by the patient to end life promptly. ”

“ Human beings, with rare exceptions, are tenacious of life, and are most unwilling to die. Doctors, on their side, live with the single purpose of postponing death: not one of them will compromise the matter for a moment. It can never be a question with him whether a life is worth preserving, or whether there is{17} reluctance to let it go. ”

“ "I did not think that it was so monstrous. It is wrong to become absorbed in the divine law to such a degree as not to perceive human law. Death belongs to God alone. By what right do men touch that unknown thing?" ”

“ This being so, can a Doctor, or any other man, ever presume to contribute his share to the shortening of a person’s life by aiding him to commit suicide? We must emphatically say No, even though the patient should desire death: the Doctor cannot, in any case, lend his assistance to violate the right and the law of the Creator: “Thou shalt not kill.” ”

“ The court also rejected certain categorical distinctions that had been drawn in prior refusal-of-treatment cases as lacking substance for decision purposes: the distinction between actively hastening death by terminating treatment and passively allowing a person to die of a disease; between treating individuals as an initial matter versus withdrawing treatment afterwards; between ordinary versus extraordinary treatment; and between treatment by artificial feeding versus other forms of life-sustaining medical procedures. ”

“ The hastening of death is the voluntary termination of life; and the voluntary termination of life is suicide.
If, then, the fact that death is near and inevitable does not make the voluntary termination of life anything less than suicide, may not the applicability of that word depend upon the motive which prompts such voluntary termination? ”

“ It is assumed in this case, and must be, that a State's interest in protecting those unable to make responsible decisions and those who make no decisions at all entitles the State to bar aid to any but a knowing and responsible person intending suicide, and to prohibit euthanasia. How, and how far, a State should act in that interest are judgments for the State, but the legitimacy of its action to deny a physician the option to aid any but the knowing and responsible is beyond question. ”

“ The argument is that a progression would occur, obscuring the line between the ill and the dying, and between the responsible and the unduly influenced, until ultimately doctors and perhaps others would abuse a limited freedom to aid suicides by yielding to the impulse to end another's suffering under conditions going beyond the narrow limits the respondents propose. The State thus argues, essentially, that respondents' claim is not as narrow as it sounds, simply because no recognition of the interest they assert could be limited to vindicating those interests and affecting no others. ”

“ Second, the State argues that the right could not be confined to the mentally competent, observing that a person's competence cannot always be assessed with certainty, Brief for Petitioners 34, and suggesting further that no principled distinction is possible between a competent patient acting independently and a patient acting through a duly appointed and competent surrogate, id., at 46. Next, according to the State, such a right might entail a right to or at least merge in practice into "other forms of life-ending assistance," such as euthanasia. ”

“ Of course that is possible, not only because the costs of care might be more than family members could bear but simply because they might naturally wish to see an end of suffering for someone they love. But one of the points of restricting any right of assistance to physicians would be to condition the right on an exercise of judgment by someone qualified to assess the patient's responsible capacity and detect the influence of those outside the medical relationship. ”

“ The progress of medical science opened up the problem of experiments on human beings already in the past century, and eventually made it ripe for decision. It is not the first time that a state has adopted a certain attitude with regard to euthanasia with a change of ideology.
Only the statesmen decide what is to be done in the interests of the community, and they have never hesitated to issue such a decision whenever they deemed it necessary in the interest of their people. Thereupon their rules and orders were carried through under the authority of the state, which is the basis of society. ”

“ There was the decree and on it there was my name. It is no good saying that I could have feigned sickness. I do not live this life of mine in order to evade fate if I meet it. And thus I assented to euthanasia. I fully realize the problem; it is as old as mankind, but it is not a crime against man nor against humanity. It is pity for the incurable, literally. Here I cannot believe like a clergyman or think as a jurist. I am a doctor and I see the law of nature as being the law of reason. In my heart there is love of mankind, and so it is in my conscience. ”

“ An incurable disease under the circumstances speedily finds a fatal termination. A patient laid up with a disease, which only admits of a palliative treatment, lives so long as the course of the medical treatment is continued, and will die almost simultaneously with its discontinuance. Just as a prop or a pillar can prevent the collapse of a tumbling edifice, so palliative measures, judiciously applied by a skilful physician, may keep off the inevitable in a disease which knows no radical cure. ”

“ The hospice movement in America is an organized voluntary effort to enhance health care for dying people and their families. Hospices, expanding rapidly as a vital component of health care, provide a compassionate way for terminally ill patients to approach death naturally in a supportive environment and surrounded by family members. ”

“ Each year, approximately 700,000 terminally ill patients and their families rely on the invaluable end-of-life care provided by the 3,100 hospice programs located in the United States. Hospice care allows a terminally ill individual to receive professional medical services, pain management therapy, and emotional and spiritual support, without having to enter a hospital. This focus on the patient's quality of life during his or her last illness can make the best of the most challenging of situations. ”

“ Hospice care plays an important role in American medicine by easing a patient's suffering while reaffirming individual dignity in a familiar, comfortable environment. Across our Nation, hospice care providers are assisting in hospitals, nursing homes, and private residences, offering physical, emotional, and spiritual support to patients who often have a short life expectancy. ”

“ I also had a few people who were beyond help because their vital organs had been so badly damaged that they knew they were dying, and they wanted to die in peace without medical intervention, in a supportive hospice cared for by people who could confront death. ”

“ He wants more, not less in this life because he expected so much of the other. Thus the belief in immortality is one of the psychic roots of modern hygiene although the question whether it can all go over into orthobiosis and humaniculture still remains open. If all were cut off in their prime, like Jesus, for example, another life would be even more desired and believed in, for the longer and better we live the less we care about it. Thus the answer to the problem of euthanasia strictly considered must remain in abeyance, at least until humanity is more complete. ”