|
WHY CAN'T WE LOVE THEM BOTH
by Dr. and Mrs. J.C. Willke
CHAPTER 25
EUTHANASIA
Qualifying euthanasia by calling it active or passive, direct or
indirect, voluntary, non-voluntary, involuntary, or assisted suicide only confuses the
picture.
Euthanasia Is When the Doctor Kills the Patient: Where and when was
euthanasia first legalized?
The original euthanasia program was to "purify" the
German race. It was a creation of physicians, not Hitler. He simply allowed the use
of the tools others had prepared.
The first gas chamber was designed by professors of
psychiatry from 12 major German universities. They selected the patients and watched them
die. Then they slowly reduced the "price tag" until the mental hospitals were
almost empty. They were joined by some pediatricians, who began by emptying the
institutions for handicapped children in 1939. By 1945, almost 300,000 "pure blood
Aryan" Germans had been killed. By then these doctors had so lowered the price tag
that they were killing bed wetters, children with misshapen ears, and those with learning
disabilities. Wertham, The German Euthanasia
Program, Hayes Publishing Co., Cinn, 1977, p. 47
What do you mean "price tag"?
When you take the giant step of placing a price tag on human life,
judging that it has only relative value, then you have made a fatal move, for price tags
can be marked down. The Nazis marked them down. Holland marked them down. Abortion
demonstrated the same thing. Make no mistake, the slippery slope is a startling reality.
Recall William L. Shirer who interviewed a Nazi judge condemned to death at Nuremberg. The
judge wept saying, "How could it have come to this?" Mr. Shirer responded,
"Herr Judge, it came to this the first time you authorized the killing of an innocent
life."
Hitler didn’t start with Jews then?
No, Hitler, taking his cue from these physicians,
after this eugenic killing of "defective" Aryan Germans, then used their gas
chambers and proceeded to eliminate "defective" races. He destroyed an entire
race of Gypsies, six million Jews, and perhaps almost as many captured Poles, Russians,
and central Europeans. Werthan, The German
Euthanasia Program, Hayes Publishing Co., Cinn, 1977, p. 47
But the program started with sterilization.
That’s true. The first and fundamental law
change was the Law for the Prevention of Progeny with Hereditary Diseases, promulgated by
Hitler on July 25, 1933. It was aimed at Aryan Germans, and its purpose was to purify the
race by eliminating those with supposed heredity diseases. In six years, the law was
responsible for the involuntary sterilization of an estimated 375,000 Germans. W. Deuel, People Under Hitler, 194 New York, 1942, p. 221
This law also legalized abortion for women who were
to be sterilized. Later, the "right" to legal abortion was extended to Jews,
Poles, Gypsies, and other racial minorities. ibid.,
par. 14
But didn’t
Hitler oppose abortion?
Wrong! Hitler only opposed abortion for "pure blood" Aryan
women. He allowed and even encouraged it for others. In an order to the SS, SD, and police
on June 9, 1943, Reichskommisar Kaltenbrunner directed: "In the case of eastern
female workers, pregnancy may be interrupted if desired." First, a racial exam was to
be done and then, "If a racially valuable result is to be expected, the abortion is
to be denied . . . if not valuable, the abortion is to be granted."
After the war, the War Crimes Tribunal indicted ten
Nazi leaders for "encouraging and compelling abortion," which it considered a
"crime against humanity." "Trials of War
Criminals," Nuremberg Military Tribunal, Washington, DC; USGPO, vol. IV, p.
610
You say
Holland is now on this slippery slope?
Yes, Holland was the first modern nation to legalize euthanasia.
What began as a few extraordinary cases, has now become routine. One hundred and thirty
thousand people die each year in Holland, and over 20,000 are killed, directly or
indirectly, by doctors. As many as half did not ask to be killed. These
now include newborn infants judged to have too poor a quality of life. A judge has
kayed direct euthanasia for a depressed person who was physically well. Killing has also
been allowed for depressed teenagers. Hospitalized seniors are routinely visited by an
organization that offers to oversee their case to prevent their doctor from killing them.
When asked whether they approved of euthanasia, senior citizens, healthy and living in the
economy, agreed by 50%. When the same question was asked of residents of nursing homes,
only 3% approved. Judges have set up qualifications that must be honored before a doctor
can kill a patient. These include repeated requests to die, uncontrollable pain,
"Force majeure" (doctor has no other choice), witnesses and two doctors who
agree.
In practice few of these criteria are even
considered. The big one . . . a voluntary request by a rational person repeatedly made . .
. has been routinely ignored. Acquittal After Assisted
Suicide, Brit. Med. Jour., 2/7/94
Really — involuntary?
"Documented cases of involuntary active euthanasia have been
reported by C. I. Dessaur and C.J.C. Rutenfrans, by myself, and others. K. F. Gunning
published his experience with the specialists who, when asked to admit an elderly patient
to the hospital, advised the general practitioners to administer lethal injections
instead. H. W. Hilhorst, in his extensive study (sponsored by Utrecht University and the
Royal Dutch Academy of Science), found that involuntary active euthanasia was being
practiced in eight hospitals. "Anxiety is growing among threatened groups.
Warnings have been published that elderly patients, out of fear of
euthanasia, refuse hospitalization and even refuse to consult doctors. An inquiry among
hospital patients showed that many fear their own families may ask for euthanasia without
consulting them. The Dutch Patients’Association placed a warning in the press that,
in many hospitals, patients are being killed without their will or knowledge, or the
knowledge of their families, and advised the patients and their families to carefully
inquire on every step in the treatment, and when in doubt, to consult a reliable expert
outside the hospital."
R. Fenigsen, "Involuntary Euthanasia in Holland," Wall
Street Journal, Sept. 30, 1987
J. Willke, "How Doctors Kill Patients in Holland," Nat’l
Right to Life News, May 23, 1989
J. Bopp et al., "Euthanasia in Holland," Issues in Law
and Medicine, vol. 4, no. 4, Spring ’89 pp. 455-487
What of other countries?
The Northern Territory in Australia in 1995 became the second nation
in the late 20th century to pass legislation to legalize euthanasia. Legalization in most
nations will be through the courts, probably not through legislation.
The courts could legalize?
Yes, just as abortion was legalized in the U.S. by its Supreme
Court, so euthanasia can also become legal.
But only for the narrow reason of physician assisted suicide?
Remember how abortion started—only for the most rare and tragic
cases? And now 99% of abortions are for social and economic reasons. Plan on euthanasia
following the same pattern. It did in Germany. It did in Holland. It’ll do the same
in Australia, the U.S. and elsewhere.
But I don’t want the doctor keeping me alive artificially. Why not
a law to permit death with dignity?
Proponents of euthanasia are quick to accuse doctors of not letting
a patient die in peace. The typical picture drawn is of an old man strapped in bed, in
constant pain, clearly dying. He has tubes in every natural body orifice and in several
artificial ones. The doctor is keeping him alive, perhaps to obtain a larger fee, perhaps
because the doctor does not want to admit that he has lost the battle for this man’s
life. A common observation in a retirement community is, "I don’t want to be
kept alive with all those tubes and painful and expensive treatments." Years ago,
truly life-saving treatments were limited. Only too often, the physician’ s role was
to comfort and eliminate pain as the patient progressed to an inevitable death. Then, with
the advent of antibiotics, better surgery, intensive and coronary care units and new
drugs, it became possible to prevent death from occurring. For physicians, there was a
learning process, from excesses in keeping dying people alive "too long" to
learning how to "let go" and allowing natural death to occur. Today, almost all
doctors handle dying patients well. Except in rare cases, the caricature of the old man
above is no longer valid.
But what if the
pain is uncontrolled?
Pro-euthanasia literature constantly emphasizes pain, uncontrollable
pain, constant, intractable pain, unrelieved, agonizing pain. Physical pain, with rare
exceptions, can be controlled. Sound advice, when confronted by a story of a person’s
loved one being in constant pain, is "Get another doctor." If your doctor
doesn’t know how to control pain, get one who does. "The claim that serious
physical pain is a valid reason to kill a patient does not hold up."
The second type of pain which is the main reason why
people ask to be killed, is emotional pain, loneliness, despair, hopelessness, being
unloved, anguish, isolation, loss of dignity, meaninglessness and weariness with life.
Remedies for this are less apparent. Editorial, Karl
Singer, Patient Care, May 30, ’94
Recent drug advances have given doctors long-lasting oral (and
dermal patch) forms of morphine which now is the drug of choice for severe cancer pain.
"Contrary to popular belief, patients in severe pain are less
likely than other cancer patients to approve of assisted suicide." ...what they
"are really interested in is getting rid of
their pain, not in dying." This study found that most people did not find depression
to be a reason to seek death, but that most who do seek death are depressed, concluding,
"There is a conflict between the avowed purpose and the probable practice of
euthanasia." E. Emanuel et al., Cancer Patients With Pain, Lancet, 6/29/96
Yes,
but I don’t want all those tubes in me!
Is the intensive care unit such a frightening,
painful place, that people do not want to return to it? A major study sheds light on this.
Senior patients, previously treated in an intensive care unit, were asked if they would be
willing to again undergo treatment in an I.C.U. "if it prolonged your life as
perfectly as it could be?" For 10 years? 96% said yes. The percent remained at a very
high level when re-asked for 5, 2 and 1 year each, for 6 months and 3 months. 74% still
said yes for just one month. M.Sanis et al.,
"Patients & Family’s Preferences for Medical Intensive Care," JAMA,
vol. 260, no. 6, Aug. 12, ’88, p. 797
Is life always
preferable to death?
One look at this was a study (in the American
Journal of Medicine, January ’96) that asked critically ill patients how many would
want CPR (cardio-pulmonary resuscitation) if their hearts stopped. In this survey of 1,664
such patients in five states, 72% wanted to be brought back. 27% said even a coma was
preferable to death, and 42% were willing to stay on respirators indefinitely. These
patients were in the advanced stages of acute respiratory failure, congestive heart
failure, cirrhosis, lung cancer, etc. R. Russell,
Seriously Ill Want CPR, Beth Israel Hosp., AMA News, Feb. 26, ’96
What about food and water?
To understand, we look at:
Comfort Care: Comfort care consists of TLC, Tender Loving Care.
This includes bathing, clean sheets, a warm room, a smile, a bath, proper positioning,
pillows, food, water and other personal care.
Therapeutic Care: This entails the use of drugs, surgery, etc.,
directed toward curing a disease, repairing an injury, removing a tumor, etc. Such therapy
can be divided into usual and customary, such as administering an antibiotic, splinting a
broken bone and removing an appendix; and extraordinary care, such as heart surgery, organ
transplants, etc. The care giver has always been seen as grossly negligent if comfort care
is not provided. It is a duty. Extraordinary treatment has never been mandatory and has
been judged in the light of many factors.
Mixed Up Priorities: Some have now moved food and water from
"comfort care" into "treatment." If then, a decision is made to
withhold further "treatment," food and water can be removed. If the doctor
removes therapy, the patient may sometimes die. If the doctor removes food and water, the
patient will always die, and painfully. Removing food and water isn’t "letting
him die," it’s "making him die."
Food and Water? When a patient is unable to
swallow, there are alternate means of giving food and water. Post-operative intravenous
fluids and nutrition are, at best, a temporary measure. For a period of weeks, food and
water can be given through a nasogastric tube. If swallowing is permanently impossible, a
gastrotomy tube can be inserted through the abdominal wall into the stomach. This provides
a permanent, convenient, painless way of feeding the patient. Euthanasia advocates label
the above three methods "artificial feedings." Rather, these are
"artificially administered" feedings. Such tube feedings are clean, inexpensive,
efficient and use simple nutritive milk-shakes. There are no soiled sheets or clothing to
clean up, and the care giver knows exactly how much was given.
But what of a terminal
condition?
Patients who are dying do go on to die. While the proponents of
euthanasia constantly speak about such cases, these are not their target at all. They are
rather concerned about those who somebody thinks ought to die, but who won’t . . .
the biologically tenacious. Commonly, such people are not in pain, are not on life support
systems, but are, by some judgments, a burden to society. These are people with strokes,
multiple sclerosis, Lou Gehrig’s disease, head injuries, quadriplegia, etc.
Suicide among those with serious handicaps is almost
non-existent. It is the "normals" around them who judge their quality of life to
be unacceptable, and who want them dead.
With rare exceptions, those who commit suicide are
clinically depressed. Clinical depression is usually a biochemical disfunction that can be
helped with drug therapy. 3 W. Peacock in Shewman, Active
Voluntary Euthanasia, Issues in Law & Medicine, Winter 1987, pg. 234
But couldn’t billions of dollars be saved if we just let terminally ill
people die?
In fact, that is what is happening. In a study of
1,150 critically ill patients who died during the study, in only 14% was there an attempt
to resuscitate. Twenty years ago most would have been. If all life-prolonging care would
be forbidden, it would only save one out of eight dollars spent on health care. Moreover,
most of this saving would come from withholding care for relatively young, critically ill
patients. J. Lynn, Terminally Ill, Forgoing . . . Care,
Dartmouth, Boston Globe, May 21, 1994
Are there other reasons to oppose euthanasia?
Yes.
- Doctors are frequently wrong in judging that a patient will die.
- When the only remaining living witnesses are the persons who
wanted her dead and the doctor who killed her, who is confirm that she really did ask to
die?
- If society approves euthanasia, how many elders will ask for it so
as to no longer burden their loved ones?
- How voluntary is "voluntary"? Doctors and family can
pressure a vulnerable patient into requesting death.
- Medical societies oppose
it in the U.S. (Vote AMA House of Delegates, June 26, ’96), Australia and elsewhere,
e.g., in Canada the CMA, in August, 1995 stated, "Doctors should specifically exclude
participation in euthanasia and physician-assisted suicide." 6 Toronto Globe and Mail, 8/17/94, pg. A1-3
What about
"Living Wills"?
These are misnamed, for they have nothing to do with living and
everything to do with dying. Nor are they wills; they are, rather, "death
wishes" or "death directives." Right to Life agrees that anyone who wants
to can sign one, but totally opposes making them binding by law.
Why
oppose legally binding "death wishes"?
- The Euthanasia Society started the idea, and that should give us
pause.
- Informed consent just cannot be intelligently given in a generic
fashion, for an unknown problem, at a future time.
- Legislation is not necessary; we have enough government
intervention.
- The patient and family can always get another doctor if the
present one seems unsatisfactory.
- A conscious patient can always refuse treatment.
- Many patients change their minds. With a signed document that is
legally binding, it may be too late.
- What does "terminally ill," or "artificial
means," or "heroic measures," or "meaningful," or
"reasonable expectation" mean? These definitions change with time and are
different in each case.
The Euthanasia Society started these wills?
Yes. The Euthanasia Society and its Foundation have since changed
their names to The Society for the Right to Die, which then changed its name to The
Society for Concern for Dying. They all have been head-quartered at 250 W. 57th St., New
York, NY 10019. On the Euthanasia Society’s advisory council as a founding member is
Abigail Van Buren, the "Dear Abby" newspaper columnist, who constantly pushes
these misnamed "living wills."
Before his death, Dr. Alan Guttmacher, head of Planned Parenthood
World Population, was also a prominent member of the Board of the Euthanasia Society of
America.
But what if I’ve made up my mind?
What a person says at the church social, or even in a doctor’s
office, is not necessarily what that same patient will say when actually confronted with
the possibility of dying. Life, however limited it may become, is a good that most people
cling to as long as they can. If you do honor their request, be sure to honor the most
recent one, not one casually uttered years earlier.
There is an analogy to
abortion?
Yes, they both kill living humans. They both are done for the same
reasons.
| REASON |
ABORTION |
EUTHANASIA |
| Usefulness |
a burden |
a burden |
| Wanted |
unwanted |
unwanted |
| Degree
of perfection |
handicapped |
handicapped |
| Age |
too young |
too old |
| Intelligence |
not yet conscious |
not really conscious
anymore |
| Place of residence |
in the womb |
in a nursing home |
| "Meaningful life" |
"does not yet
have"
Roe vs. Wade |
"no longer has"
Euthanasia Bills |
| Cost |
too poor |
too poor |
| Numbers |
too many children |
too many old folks |
| Marital Status |
unmarried |
widowed |
Is there an
alternative to euthanasia?
The real alternative to euthanasia is to provide loving, competent
care for the dying. A new concept for the dying arose in England, where institutions
called Hospices specialize in compassionate, skilled care of the dying. This concept has
spread throughout the Western world.
"Once a patient feels welcome and not a burden
to others, once his pain is controlled and other symptoms have been at least reduced to
manageable proportions, then the cry for euthanasia disappears. It is not that the
question of euthanasia is right or wrong, desirable or repugnant, practical or unworkable.
It is just that it is irrelevant. Proper care is the alternative to it and can be made
universally available as soon as there is adequate instruction of medical students in a
teaching hospital. If we fail in this duty to care, let us not turn to the politicians
asking them to extricate us from this mess." R.
Lamerton,Care of the Dying Priorty Press Ltd., 1973, p. 99 204
I’ve heard that many doctors are ignoring present laws and
assisting at suicide now. Wouldn’t it be better to legalize it along with specific
safeguards?
If this is true, these doctors are violating the law. Let’s for
the minute assume legalization with real safe-guards. What makes you think these same
doctors will now obey the new laws and respect these safeguards when they ignored and
violated the laws before? Dutch doctors routinely ignore such limits. Do remember the
earlier arguments for "safe, legal" abortions. Abortions are legal, but they are
not always safe.
So you don’t think assisted suicide can be controlled?
No. In Britain, the House of Lords Select Committee on Medical
Ethics examined this in detail. That committee, going in, was solidly prepared to accept
euthanasia. They went to Holland and investigated it actually happening. They reversed
their thinking completely saying that they "do not think it is possible to set secure
limits." They found "evidence indicating that non-voluntary euthanasia was
commonly performed. Vulnerable people — the elderly, the lonely, sick and distressed
— feel pressured to request early death.".."under
this, the interest of the individual cannot be separated from the interest of
society..".. R. Twycross, Journal Royal Society of
Medicine, Vol, 89, 1996, pg. 61-63
But don’t you think those in persistent vegetative states should be
given a release and allowed to die?
Not unless you want to kill some people who are
going to get better, if given enough time. Dr. Kay Andrews, Director of the Royal Hospital
for Neuro-Disability, stated, "Over a two-year period, 15 out of 18 patients, thought
to be in p.b.s., came around." Sunday
Telegraph, Feb. 11, 1996 205
And sometimes patients who have been in
"vegetative" states for a long time wake up, e.g., following an anesthetic
accident seven years earlier, the health authority in the north of England had discussed
applying to the courts to remove his feeding — but — after those seven years he
woke up and was "competent enough to indicate his refusal to be interviewed." Guardian (newspaper London), March 16, 1996
And many are aware. In a British study of 40
patients diagnosed as P.V.S., 17 or 43% were later found to be alert, aware and often able
to express simple wishes. This vital consciousness in their closed-in state, for some,
lasted several years. K. Andrews et al., Brit. Med. Jour., 7/6/96
A PLEA TO LAWMAKERS
In the event that you do take the tragic step of legalizing
euthanasia, please do not have a doctor do it. Rather hire a professional executioner. For
over 2000 years people have trusted their doctor to "Do no harm." This trust has
been seriously undermined by legal abortion. Please do not complete the destruction of
this trust and confidence.
|
