In July, 1997, the Supreme Court declined to interfere with legislative acts to prohibit what has been called "physician-assisted suicide," in two cases, Quill v. Vacco and Washington v. Glucksberg, after hearing oral arguments on January 8, 1997. What is described as a "right" to die strikes me as a cover story, and what it will cover up is general encouragement for the disabled to avail themselves of this "right." Those who have a cognitive deficit (they need not be long-term unconsious) will simply be killed.
The logic of euthanasia cannot be limited, once it is allowed at all. The pivotal assumption is that it is better to be dead than sick or disabled, and once this is granted, then killing the disabled is a positive good, and a service to them. This assumption -- in older language, that some lives are not worthy of living, _Leben unlebenswert_ in the German usage of the 1920s to 1940s -- is what is being proposed by the euthanasia movement. Once legitimized, it effectively downgrades the lives of those it pretends to benefit.
The goal of the euthanasia movement is not just "assisted" suicide; it will mean doctors killing patients. It would be unfair to accuse the euthanasia movement of plotting directly to kill all the disabled in America, and they would be justly outraged if I were to do that. What they are doing is, however, more than what Karl Binding and Alfred Hoche did in Germany in the 1920s. Hoche and Binding merely laid the theoretical groundwork for euthanasia; many in America have gone well beyond that, though they are reluctant to acknowledge the logical import of their program.
The killing of patients without their consent or against their wishes is already happening now, right here in America. Michael Martin in Massachusetts and those working for him had to fight to prevent him from being starved (they won). Robert Wenlund in Stockton, California may yet be starved; a court hearing on October 21, will decide. This, despite the fact that he is conscious, can operate his own electric wheelchair, and is making slow progress recovering from the brain damage of a vehicle accident. Marjorie Nighbert was starved and dehydrated in Florida, despite her pleas for food.
Euthanasia has become debatable in America in the 1980s as it was not before. Richard John Neuhaus wrote about it in 1988, with extensive comment on the rationales offered. <"The Return of Eugenics," _Commentary_ 85#4 (1988/04) 15.> The term "eugenics" seems too narrow, but the larger movement of which it is emblematic has ambitions that are all-inclusive. The motive is to take control over human life rather than treating it with respect. Respect imposes some restrictions on what can be done to the living.
The project of control has been extended in America by gradual stages,
pushing the limits of the acceptable, waiting for opposition to the
formerly unacceptable to dissipate, and then pushing the limits again.
This was not how it began. Euthanasia became an issue only after
life-extending techniques became available in the 1950s and gave some
measure of control over dying that was welcome in some cases, morally
ambiguous or burdensome in others. At first, doctors gained some
measure of control over the process of dying, and then patients (or
more accurately, prospective patients) sought to gain for themselves
some of that control. Carlos Gomez gives an account of the changing
practices to 1991.
The beginnings of the recent movement to legalize euthanasia were
somewhat later, and at first not widely approved. Derek Humphry, an
early and persistent advocate, founded the Hemlock Society in 1980 to
promote euthanasia.
Since 1990, there have been several ballot initiatives in the Western
states, thought to be the most liberal and most likely to approve
them.
Each ballot initiative has included elaborate assurances of safeguards
against misuse, and the proposed safeguards have always been shown to
be easily subverted. More importantly, the proponents of euthanasia
have implicitly conceded that abuse is possible: the elderly and the
ill could be encouraged to avail themselves of this "right," and
thereby eliminated as a drain on other people's attention and
resources. That would be only the beginning.
"Medicide," as Jack Kevorkian has called it, could become the
treatment encouraged by insurance companies, simply by balking at any
other treatments. Availability of easy suicide and euthanasia would
make it permissible to neglect or abandon patients thought to have
insufficient quality of life. There is today a widespread prejudice
against people with major disabilities. When such people express an
interest in suicide, that desire is viewed as rational, where it would
not be in an able-bodied person in a similar situation.
Significant increase in killing has been effected by blurring the
distinction between ordinary and extraordinary care. Starvation and
dehydration have become morally permissible, construed as withdrawal
of the extraordinary care that is implicit in feeding through a
naso-gastric tube. (Why is this extraordinary, when it is easier than
feeding by mouth?) But starvation and dehydration are ugly,
especially when the patient is conscious. And so, once they are
generally accepted, they will lead to active euthanasia when lesser
means won't work. If death is desired, and action to achieve that end
is permissible, the most efficient and painless way to achieve it will
of course be sought. Once again, the governing motive is to relieve
those in power of the burden of co-suffering that is imposed on them
by the one being starved and dehydrated.
The Netherlands provides a window into what is ahead for America, for
it has tolerated widespread euthanasia for some time. It began
informally around 1973, and became widespread in the 1980s.
By the late 1980s, the Dutch practice of euthanasia had attracted
misgivings and become generally known, if not openly acknowledged.
The authorities wanted to ascertain the extent of the practice, and
also to articulate a judicial rationale for it that could be openly
acknowledged by the courts. An investigation was undertaken,
published in 1991, surveying the activities of the year 1990.
<_Report of the Committee to Study the Medical Practice Concerning
Euthanasia_, I., and _The Study for the Committee on Medical Practice
Concerning Euthanasia_, II., 2 vols., The Hague, 1991/09/10, also
known as the Remmelink Report, for J. Remmelink, the Attorney General
who chaired the committee.> An analysis in Engish has been made by
Richard Fenigsen. <"The Report of the Dutch Government Committee on
Euthanasia," _Issues in Law and Medicine_ 7#3 (1991) 339-344.> The
Report in its conclusions gives assurances that are quite at variance
with the numbers supplied in its body.
Now compare the German practice during World War II, in the project to
simply eliminate all persons with disabilities or cognitive deficits.
It makes a quite striking contrast with the later Dutch experience.
There was not much historical attention to it from the end of the war
until the 1980s, when euthanasia became a live issue in other
countries. In the Netherlands, euthanasia has been informally
pioneered by doctors and rationalized afterwards, but in Germany
things were somewhat different. Though the German program was carried
out by doctors, it had original involvement by the National Socialist
party and received articulated justification beforehand. Among the
recent accounts are those by Hugh Gregory Gallagher and Michael
Burleigh.
The biggest contrast between the T-4 program and the Netherlands in
the 1980s is that the German doctors were centralized, methodical, and
candid about what they were doing, at least among themselves. (They
made every effort that the "patients" not realize what was happening
to them, lest they "become excited.") In the Netherlands, as in
America more recently, it has been decentralized, without government
support, not in the least methodical (yet). But it bears some
emphasis that it was the German doctors who did it, the National
Socialist Party merely suspended the law of murder. There were fewer
cover stories and more lies to protect the program. There was
ideological preparation in eugenic theory, both in Europe and America.
That preparation was no doubt greatly accelerated by the virtual
hounding of Jewish doctors out of the profession early in the National
Socialist years.
It is encouraging that protest worked some when it was tried, and
discouraging that it was tried so seldom. The existence of the
program was generally known within the profession; it is not as if the
doctors were ignorant. Most doctors who were invited to send their
patients to be killed or to participate in the killing did so. Had
the doctors and the Churches protested more consistently, or protested
on behalf of Jews, Gypsies, homosexuals, Seventh Day Adventists and
others, much more killing might have been stopped. Evidently, once
the groundwork was laid, the practice became unstoppable. That
groundwork is being laid informally in America today by those who
advocate legalizing euthanasia.
It is not hard to see the more radical motives for euthanasia.
Richard Rubenstein traces what may be called functional genocide
through the English-speaking world in an essay in _After Auschwitz_.
<"Modernization and the Politics of Extermination; Genocide in
Historical Context," in _After Auschwitz_, 2nd ed., Baltimore, Johns
Hopkins University Press, 1992.> Economic changes devised and enforced
by fiat in England in the sixteenth century (the enclosure of
previously public grazing land) created an economically superfluous
population which was managed locally to some extent. Mostly, it was
eliminated by exporting it, some to America, more to Australia. In
both places, the immigrants in turn displaced the aboriginal
populations. The English establishment treated the Irish no better;
the population of that oppressed island was reduced substantially by
British policy in the nineteenth century. The signal contrast between
the German and English-speaking examples is that the Germans knew what
they were doing, whereas the English and their colonists were
"self-deceived" in the sense of Herbert Fingarette: they did not spell
out; the Germans spelled out.#f~
These observations should serve as ample warning that self-deception
and cover-stories will abound in any killing programs in America, as
indeed they have. Look again for a moment at the prerequisite for
self-deception, the ability to conduct an engagement in life without
spelling out what is going on. That is to say, without looking at the
goals and motives. This is a very remarkable ability -- to get from
here to there, never having been there before, without what one might
have thought are "essential" features of _knowing_ what is there. It
is an ability to size up a situation, even innocently, for what its
next potential is, and to proceed on to the next, and the one after
that. When initial choices have been covered up, or not recognized,
they can carry implicit within them many of the later choices. One
has then made moral commitments that are not obvious at first, and
which seem benign or compassionate at first, but which nevertheless
commit one later on to activities that were formerly thought to be
evil. Or at least deprive one of a consistent reason to resist those
formerly evil practices.
As a prospective victim of these practices, I would say they are still
evil, and should be resisted in every possible way.