ON THE USES OF EUTHANASIA
I
THE proposal to forestall a painful death by a painless one is not, to normal sensibilities, “shocking.” If persuaded of its expediency no physician should give it a hesitating advocacy through fear of being thought brutal. It is an error to suppose that familiarity with death and suffering exhausts the springs of compassion in one born compassionate. Like many other qualities, compassion grows by use: none has more of it than the physician, the nurse, the soldier in war. He to whom the menace of an injustice is a louder voice than the call of conscience has no standing in the House of Pain, no warrant to utter judgment as to the conduct of its affairs.
Pain is cruel, death is merciful. Prolongation of a mortal agony is hardly less barbarous than its infliction. Who when sane in mind and body would not choose to guard himself against a futile suffering by an assurance of accelerated release? Every memory is charged with instances, observed or related, of piteous appeals for death from the white lips of agony, yet how rarely can these formulate the prayer!
To its concession, regulated by law, there is the objection that law is frangible and judgment fallible. But that objection has no greater cogency in this than in other matters; laws we must have, and execute them with such care as we can. Our courts sometimes err in the diagnosis of crime, yet they warrant our trust in the general service of our need. The mariner’s compass is fallible, the winds baffle and the waves destroy; yet we have navigation. Even the anarchist cries out against law, not because it does not accomplish its purpose, but because, roughly, it does.
We build civilization with such tools as we have; if we waited for perfect ones the structure would never rise. The juror is no more nearly just and infallible than the physician; if we can entrust ourselves with death as a penalty for crime we need not shrink from the no more awful responsibility of according it as a boon to hopeless pain. In neither case can a blunder do more than hasten the inevitable. “When I was born I cried,” said a philosopher; “now I know why.” He did not know why; it was because at the moment of his birth Nature spoke the sentence of his death.
It may be that proponents of euthanasia for suffering incurables are pushing their adventurous feet too far ahead in the march of mind to expect anything better in the nature of encouragement than a copious dead-catting and bad-egging from laggard processionists arear. Sometimes, however, they get decenter treatment than they have the hardihood to claim: occasionally, through the roar of calumniation is heard the voice of dull and dignified protestation, even of argument. For example, The British Medical Journal once pointed out, with more gravity than grammar, that “the medical profession has always strongly set its face against a measure that would inevitably pave the way to the grossest abuses, and which would degrade them to the position of executioners.”
I don’t know that the medical profession speaks with any special authority in a matter of this kind. Perhaps it knows a little better than other trades and professions that cases of hopeless agony are of frequent occurrence, but as to the expediency of relieving them by the compassionate coup de grâce—of that a physician is no better judge than anyone else. As to the fear of being “degraded to the position of executioners,” the position is not degrading. The office of executioner—even when execution is punishment, not mercy—is, and should be considered, an almost sacred office. Its popular disrepute harks back to the bad old days when a majority of the people in countries now partly civilized were criminal in act or sympathy, living in hate and terror of the law—the days of Tyburn Tree with its roaring mobs, cheering the malefactor and pelting the hangman. It was not from fear of a merely social reprobation that the mediæval headsman wore a mask; it was from fear of being torn to pieces if ever recognized unguarded in the public street. A man of to-day, ambitious to prove his descent from a criminal ancestry, can most easily do so by damning the hangman. His humble origin is no disgrace to him if he is a good citizen, but it makes him invincible to the suasion of argument against his fad. One might as profitably attempt to reform the color of his eyes or dissuade him from the shape of his nose.
II
“It is a physician’s mission to cure disease and alleviate suffering,” says Dr. Nehemiah Nickerson. “There is a point beyond which he can not cure disease; after that it is his duty to alleviate suffering.”
A mission implies a mandate; a mandate an authority superior to that of the missionary. I do not know from what higher authority a physician derives his own, nor who has the right to lay down the lines within which his activity must lie. Within the civil and the moral law he is a free agent—free to observe or disregard the customs of his trade, as conscience may determine. He has no mandate, no mission.
It is true, however, that to cure disease and to alleviate suffering are purposes commonly recognized as important among those belonging to the practice of medicine. Having failed to accomplish the first, how far may a physician go in accomplishing the second?—that is a question that finds no answer in any imaginary mandate. It is not even answered by the Decalogue, for the commandment “Thou shalt not kill” has so many obvious and necessary limitations that its value as a guide to conduct is virtually nothing. Dr. Nickerson believes he may go so far as to kill the patient he can not cure. Moreover, he candidly affirms his habit of doing so. I am told that he is a distinguished physician; there is apparently nothing in his frank avowal to lessen his distinction. It would not surprise, indeed, if his fame should take attention from even the officers of the law. To make himself an object of lively interest in quarters where the several kinds of distinction in his profession are commonly overlooked he has only to descend from generals to particulars, naming the patients whom he has turned out of the frying-pan of physical pain into whatever state awaited them, and the means (under Providence) which he employed to that end.
A man may be the best judge of what he is for, but by laymen unskilled in physic it is usually held that a physician’s business is not only to cure disease and alleviate suffering, but to prolong life—to save it altogether being impossible, for all must eventually die. But laymen have no mandate always to be right; now and again they have been in error. The righteousness and expediency of releasing an incurable sufferer from the horrors of life should not be clouded and discredited by an erring advocacy.
When a horse or a dog incurs the mischance of a broken back no question is raised as to the propriety of “putting it out of its misery.” Unable to cure it, we kill it, and in doing so feel a comfortable sense of benevolence, a consciousness of having performed a disagreeable duty, of having discharged an obligation inseparable from our dominion over the beasts of the field. It may be said that in the instance of a human being similarly incurable the dominion is lacking. But that does not go to the root of the matter, and is, moreover, untrue; for a helpless man is as much subject to our power as a helpless animal, and as much a charge upon our good will. And in many cases he is as little capable of deciding wisely what is good for him. A wounded bird or squirrel will manifest a strong indisposition to be “put out of misery,” by struggling to escape into the bush; a man will sometimes beg for death, even when he does not know himself incurable. If there should be a difference in the treatment of the two in respect of the matter in hand it would seem that the beast should be spared and the man killed.
But Dr. Nickerson’s critics think that a different rule should hold, because the man is an immortal soul, whereas the beast is a thing of to-day, divinely ordained to “perish.” To this it may be said in reply: All the stronger reason for a reversal of our practice, for in putting the man out of his misery you would not really kill, but only change, him; but the animal having only one life, in taking that you make him “poor indeed,” depriving him of all that he has.
That the man is an immortal soul is, however, a proposition which, after centuries of discussion, remains unsettled; and those who hold Dr. Nickerson’s view must in conscience forego the advantage of the argument which their generous opponents try to thrust upon them. If we actually knew human beings to be immortal many of the current popular objections to killing them would disappear, and not only soldiers but physicians and assassins could work at their trades with a comparatively free hand, along lines of usefulness not always and entirely divergent. Surely there could be no great wrong in “removing” a good Christian, whether he were ill at ease or not: to translate him to the shining altitudes of Paradise is distinctly to augment the sum of human happiness. For that matter, it would not be difficult to demonstrate logically the proposition that any Christian may rightly slay any other Christian upon whom he can lay his hands. True, he is forbidden by his religion to do so. All the more noble and generous of him to invite eternal punishment in order to abridge his brother’s season of earthly trial, insure him against backsliding and usher him at once into the Kingdom of Delights. In point of mere expediency a general observance of this high duty is open to the objection that it would somewhat reduce the church militant in point of numerical strength. But this is perhaps a digression.
It is urged that not knowing the purposes of the Creator in creating and giving us life, we should endure (and make our helpless friends endure) whatever ills befall, lest by death we ignorantly frustrate the divine plan. Merely pausing to remark that the plan of an omnipotent Deity is not easily frustrated, I should like to point out that in this very ignorance of the purpose of existence lies a justification of putting an end to it. I did not ask for existence; it was thrust upon me without my assent. As He who gave it has permitted it to become an affliction to me, and has not apprised me of its advantages to others or to Himself, I am not bound to assume that it has any such advantages. If when in my despair I ask why I ought to continue a life of suffering I am uncivilly denied an answer, I am not bound to believe, and in lack of light may be unable to believe, that the answer if given would satisfy me. So the game having gone against me and the dice appearing to be loaded, I may rightly and reasonably quit.
That is the way that a logical patient would probably reason if incurable and in great pain. I confess my inability to discern the fallacy of his argument. Indeed, it seems to me that so far as concerns baffling the divine purpose the patient who calls in a physician and tries to recover is more obviously guilty of attempting to do that than the patient who tries to die. To an understanding that accepts life as a gift from God, illness might very naturally seem a divine intimation of God’s altered mind. To one thinking after that fashion voluntary death would necessarily appear as cheerful submission to the divine will, and the taking of medicine as impious rebellion.
The right of suicide implies and carries with it the right to put to death a sufferer incurably ill; for the relief which we claim for ourselves we cannot righteously deny to those in our care. We would naturally expect a medical advocate of suicide to kill a patient occasionally, as humanity may suggest and opportunity serve. Dr. Nickerson’s frankness is shocking, but on a survey of the entire question it seems a good deal easier to point out his infractions of the law than his disloyalty to reason and the higher sentiments which distinguish us from the priests that perish.
1899.