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"A quick and painless death." (euthanasia)

Alexander the Great was not describing euthanasia but a problem all too familiar when he complained: "I am dying with the help of too many physicians." Yet the first use of the word euthanasia--by Posidippus Comicus--came less than forty years after Alexander's death. One has to move forward another four hundred years, however, to find the first precise use of the word in its modern connotation. Suetonius, writing in Latin about A.D. 120, used the Greek word when describing the sort of end for which the Emperor Augustus often prayed: "mors cita et sine cruciatu," a quick and painless death.

The desire for such an end is a normal part of human nature; moves to allow physicians legally to provide it started almost a century ago in Germany and have come close to realization in Holland. The German Reichstag debated, in 1909 and again in 1913, a bill to allow people to be helped to die by a doctor, so long as a panel of three doctors had shown that they were legally competent and incurably ill. The subject was again debated during the Weimar Republic, but the bill never passed. The Nazis' murder of mentally ill and handicapped people under the description of euthanasia, together with the events of the Holocaust, meant that it would be a long time before any similar bill could again be seriously contemplated in Germany.

Indeed, the Second World War has ensured that euthanasia remains a difficult topic elsewhere in the Old World. When teaching in Yugoslavia a few years ago, I found it impossible to discuss even the idea of letting people die: it seemed that in Yugoslav hospitals full resuscitative efforts were applied even in hopeless cases. After the session, some young doctors told me that they had to give the official line--that nothing remotely reminiscent of euthanasia could be contemplated--because a senior ministry official was present. To find out what really happened, I should go into the hills in Montenegro. There, when old people became a burden to their families and could no longer contribute, they would talk it over with the local doctor, and he would help them to a quick and painless death.

The first attempt to legalize voluntary euthanasia in Britain was the introduction of a bill in the House of Lords in 1936. It was effectively scuppered by Lord Dawson of Penn, the leading physician of the day, who argued that doctors' changing attitudes rendered it unnecessary: "It was an accepted tradition that it was the duty of the medical man to continue the struggle for life right up to the end. With time that has changed. There has gradually crept into medical opinion the feeling that one should make the act of dying more gentle and more peaceful even if it does involve curtailment of the length of life." The extent to which Lord Dawson followed that precept was revealed a few years ago. He had made the death of King George V--from bronchitis and heart failure--more peaceful by giving him approximately 50 mg of morphine and 65 mg of cocaine intravenously.

English law in this area has recently been clarified. In the Dr. Cox case, a rheumatologist was convicted of attempted murder and given a one-year suspended sentence for injecting potassium chloride intravenously into an elderly woman with severe arthritis and uncontrollable pain.

In the Tony Bland case, the House of Lords (the highest appellate court) found that tube feeding could be withdrawn from a young man in the persistent vegetative state. That decision was reached on the basis of his best interests, rather than by a substituted judgement test. In the course of their judgments the Law Lords made it clear that the provisions of an advance directive should be determinative. That will be good news to the British Medical Association, which issued a statement supporting living wills last November.

Living wills are also proving popular in Denmark, where a law came into force last September that requires doctors to check, on a central register, whether their terminally ill patients have made one. Since then 45,000 people, mostly aged over 50, have registered a living will on a form provided for the purpose. The Danish Medical Association, however, is not happy that doctors, legally, have to abide by what patients have said in their living wills.

The Netherlands have come close to providing the ideal of Emperor Augustus. There is an agreement among the Dutch attorneys-general that doctors who perform voluntary euthanasia according to strict criteria should not be prosecuted. A bill has now passed one chamber of the Dutch parliament: it would leave euthanasia as a criminal offense unless performed by a doctor in strict conformity to criteria similar to those already in use.

The furious reaction of the Vatican to mere codification of the present position--so furious that the Papal Nuncio was summoned to the Dutch Foreign Ministry to receive a protest--suggests no end is in sight to European debates on the permissible ways to achieve a quick and painless death.
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Author:Nicholson, Richard H.
Publication:The Hastings Center Report
Date:May 1, 1993
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