Life Unworthy of Life

A Concise History of Euthanasia
by Ian Dowbiggin.
Rowan and Littlefield, 176 pages, $22.95

To read Ian Dowbiggins’s A Concise History of Euthanasia is to learn that in more than a century of advocacy for euthanasia, the arguments have barely changed at all.

The drive to legalize killing as an acceptable answer to the problems associated with human suffering is a relatively recent phenomenon in human history. True, as Dowbiggin reports, assisted suicide and what we now call euthanasia were unremarkable in antiquity: Roman doctors were allowed to kill their patrons if requested, for example. Indeed, Dowbiggin writes, the Hippocratic Oath’s ancient requirement that doctors forebear assisting the suicides of patients may have been a “kind of protest against the frequency with which euthanasia was practiced.”

But once Christianity became dominant in Europe, the doctor’s role changed dramatically. Deeply influenced by the Judaism that viewed suicide as “an affront to God that demonstrated contempt for the gift of life,” Christianized Europe forbade the practice of exposing disabled infants, and doctors (such as they were) ceased participating in the intentional ending of their patients’ lives.

During the next 1,500 years, suicide was universally deemed in the West to be a reprehensible act against God and community. Death-bed suffering was to be accepted stoically, and the role of doctors was merely to be present and caring for patient and family throughout the ordeal. Those who short-circuited these travails with suicide were unmercifully condemned. Indeed, medieval society’s response to the tragedy of suicide was not in the least what we today would consider Christian. “Self murder,” as it was then known (the word suicide wasn’t coined until 1642), was deemed so heinous that the body of a suicide victim would be dragged through the streets and his property confiscated to impoverish his heirs.

Attitudes toward suicide and the duty of doctors to alleviate suffering rather than merely bear witness to it began to shift in the eighteenth century, Dowbiggin reports. With the coming of the Enlightenment, some philosophers and public intellectuals saw suicide “as a rationalist protest against conventional morality.” Thus Voltaire and, especially, David Hume argued that people should be free to commit suicide if they perceived their lives to be too burdensome. But even then, Dowbiggin notes, “the boundaries between a right to suicide and a social duty to kill oneself were never terribly clear.”

Yet it wasn’t the emerging rationalism of the Enlightenment that launched the international euthanasia movement we see in our time: For every Hume and Voltaire, there was a Kant and Wesley arguing powerfully against what today is called the “right to die.” Rather, it was the explosion of nineteenth-century materialist thinking that finally shattered society’s religion-based moral and ethical consensus against suicide and mercy killing.

In other words, this change in attitudes toward mercy killing was a symptom, not a cause. What was really going on, the author asserts rightly, was an epochal shift away from the belief that human life has intrinsic value simply because it is human. Thus it is hardly surprising that euthanasia advocacy emerged concurrently with the rise of even more pernicious and destructive movements such as eugenics and social Darwinism.

Dowbiggin traces modern euthanasia advocacy back to 1870 and an essay by a schoolteacher named Samuel D. Williams. Williams was the first to redefine the word euthanasia away from meaning a peaceful natural death experienced amid the love of family while in a state of grace, to the act of mercy killing, a definition that has stuck to this day.

It is fascinating how this first essay contained many of the same arguments that are voiced by contemporary proponents of assisted suicide. (Dowbiggin should have reproduced it in an appendix.) For example, Williams argued that the merciful medical practice of using strong drugs to control pain, which by his time had become a standard medical practice, was no different from mercy killing, because some patients died from palliative treatment, still a central argument of the euthanasia advocates.

Williams also promoted a strong social Darwinist mindset that became prominent among many elites of the time, which saw the killing of dying, elderly, and seriously impaired individuals as simply a merciful means of carrying out nature’s “mortal struggle.” This, too, remains a prominent strain in current euthanasia advocacy, although the more politically savvy contemporary assisted suicide activists generally focus on feel-good assertions of “compassion” and “choice.” Still, the so-called duty to die and the idea of euthanizing infants who are born disabled or dying, a practice Dowbiggin duly notes led to mass murder in Germany, continues to be heard. The promotion by Princeton’s notorious Peter Singer of infanticide is the most obvious example, an act soon to be legalized formally in The Netherlands. One of Britain’s most prominent public intellectuals, Baroness Mary Warnock, whom the London Times has called Britain’s “philosopher queen,” was recently quoted as promoting a duty to die among the elderly as a remedy to their being “a nuisance” and a financial drain on family and society.

As Dowbiggin traces the waxing and waning tides of euthanasia advocacy since 1870, several distinct and constant themes stand out. First, many (though certainly not all) euthanasia advocates—Peter Singer, Jack Kevorkian, Hemlock Society founder Derek Humphry, Australia’s “Dr. Death” Philip Nitschke, Episcopal bishop John Shelby Spong, among many others—argue from distinctly anti-traditional, un-Judeo-Christian starting points. Second, many euthanasia advocates reject belief in the intrinsic value of human life as irrational and anti-scientific. Third, there is seen among most advocates a fixation on personal autonomy. Fourth, euthanasia supporters tend to exhibit a visceral revulsion to suffering and see death as an appropriate method of controlling it. Fifth, euthanasia is generally viewed as merely one important element in a longer laundry list of progressive political goals (and thus, Dowbiggen notes, euthanasia has long been considered a feminist cause because of the worry that the “burden” of caring for the very sick and elderly falls most heavily on women).

The tactics of euthanasia activists have also remained generally constant for the last one hundred years: constant recourse to euphemisms to describe killing, scaremongering about the likelihood of unrelievable suffering, and attacks against political opponents as theocrats attempting to impose superstition on society.

Then there are the sporadic appearances of renegades who decide to spur euthanasia into wider public acceptance through what anarchists called the “propaganda of the deed,” either by publicly announcing their intent to commit suicide as a way of breaking society’s resistance to mercy killing or breaking the laws against assisted suicide and daring society to stop them.

Jack Kevorkian is the best known of these today, but he was not the first. In 1915 the “Black Stork,” a physician named Harry Haiselden, refused to perform surgery to save the life of a disabled infant named Alan Bollinger. When prosecutors failed to bring a case against him, he used his notoriety to mount a public campaign to legalize euthanasia for disabled persons”including writing a movie script about the Bollinger case. Another example was the 1935 suicide of noted feminist Charlotte Perkins Gilman, who publicized her plans beforehand, stating that she preferred “chloroform to cancer.” Gilman’s suicide was similar to recent cases of pre-publicized assisted suicides such as those of Canadian Sue Rodriguez in 1994 and Australian Nancy Crick, who committed suicide in 2002 in the presence of euthanasia advocates who applauded while she took her overdose. (Crick had cancer but her autopsy showed she was not terminally ill.)

Dowbiggin’s time-line narrative includes it all: German intellectual advocacy of the concept of “life unworthy of life” beginning in 1920; the popularity of euthanasia in America during the 1930s; the public revulsion against the death agenda in the wake of the Holocaust; the Dutch experience; and the sudden turnaround in the movement’s political fortunes in the United States, which culminated in Oregon’s legalization of assisted suicide in 1994.

Unlike some historians who write about radical social movements, Dowbiggin does not ignore those who have worked vigorously against the euthanasia movement. Most gratifyingly, he gives due credit to Cecily Saunders, one of the twentieth century’s great medical humanitarians, for her almost single-handed creation of the modern hospice movement. And he highlights the important contribution of University of Minnesota law professor Yale Kamisar, who warned as far back as the 1950s that “the legal machinery initially designed to kill those who are a nuisance to themselves may someday engulf those who are a nuisance to others.”

Recent cases such as the 1993 murder in Canada of twelve-year-old Tracy Latimer by her father, Robert, because she had cerebral palsy, as well as the pressure New York editor George DeLury admitted placing on his wife Myrna Lebov to commit suicide in 1995 because she had multiple sclerosis, illustrate Kamisar’s prescience. (DeLury initially depicted his participation in Lebov’s suicide as altruistic. But this defense shattered when it was revealed that he had pressured her to kill herself, writing in his diary, “I have work to do, people to see, places to travel. But no one asks about my needs. I have fallen prey to the tyranny of a victim.”)

A Concise History is occasionally too concise. The issues of suicide and mercy killing in China, Japan, and the East are treated too swiftly. Only one paragraph is devoted to the influential thinking of Kant. And I was worried up to the end of the book that the author would ignore the many contributions of the modern disability-rights movement to thwarting the ambitions of euthanasia activists. At the book’s close, Dowbiggin nods briefly in their direction—too little credit for a group crucial since 1996 in preventing assisted suicide from being legalized in the United States beyond the borders of Oregon.

But overall, Dowbiggin has produced a well-written text of considerable breadth given its self-imposed limits. Those generally interested in the topic will find all they need to know about the whys and hows of euthanasia belief and advocacy in this short and easy-to-digest book. For students and scholars, Dowbiggin has fulfilled the promise of his title and produced the best available concise history of euthanasia. That the subject could sustain a longer treatment in the future should still trouble us all.

Wesley J. Smith is a senior fellow at the Discovery Institute, an attorney for the International Task Force on Euthanasia and Assisted Suicide, and a special consultant for the Center for Bioethics and Culture. His newest book is the updated and revised Forced Exit.