Commentary on Euthanasia
by Norman L. Pawlewski
Former Iowa Commissioner of Public Health
If I were to title this commentary, I would use something like the title of a recent Broadway play, “They Shoot Horses Don’t They?”
A recent “Des Moines Register” article quoted Dr. Christian Barnard, South African surgeon, as saying “the time has come for doctors to practice ‘active euthanasia’ (mercy killing) to put hopeless and suffering patients out of misery.” He said a few other things like: “We’re not here to prolong the life or conquer death;” “Medicine should improve the quality, not necessarily the length, of life;” “I even believe the newly conceived fetus has the right to live…The problem is, what is life? How do you define it?;” and “You’ve agreed to destroy a life, the quality of which you don’t even know. Yet you say you can’t act to destroy a life, the quality of which you know has disappeared.”
The last quote is a reference to the legalization of abortion in the United States. A week later the “Register” editorialized about Dr. Barnard’s statements. The editorial writer defined euthanasia as a “good death,” although the word derived from the Greek really means “easy death,” and went on to cite statistics from a Louis Harris poll which show that the American public is increasingly favoring “easy death.” Good is not a synonym for easy; in fact, they are often opposites. To quote the editorial: “The trend may indicate a growing belief that honoring the sanctity of life requires concern for the quality of life. To allow a terminal cancer patient to live out his final weeks in agony is a denial of the sanctity of life; to allow his body and mind to deteriorate into a grotesque parody of his former self before the eyes of his family is surely a denial of dignity.”
I wonder if the “Register” editor used the same source to define sanctity of life as he used to define euthanasia? Somehow just as the word easy became good, sanctity becomes quality. I would ask both Dr. Barnard and the editorial writer: “Who defines quality? What and whose standard is used?” After the hopeless and dying (which even Dr. Barnard agreed couldn’t be defined), how about the impaired and institutionalized? Certainly their quality of life might be questioned. In addition, aren’t they a drain – financially, emotionally and physically – on society in general and on their relatives in particular?
Dr. Barnard said, “Unplugging machines and stopping treatment of a patient riddled with terminal bone cancer is not sufficient if that patient – and the patient’s family – must experience two more weeks of suffering while the patient lies in agony waiting for death.” By all means let us relieve the suffering of relatives everywhere; it is their right and our obligation. But what of the right of the patient – I thought all who dedicate their lives to the healing arts had an obligation to relieve the suffering of the patient while sustaining life. Isn’t the doctor/patient relationship a contract between them? How did the relatives suddenly become a party to it? Surely, in some cases, they are involved and should be considered – but not at the expense of the patient. Has the Hippocratic oath become the hypocritic oath? Only a hypocrite would swear to preserve human life with all his or her ability and then violate that oath by taking a life because it was of questionable quality.
I find it difficult to understand how physicians, nurses and others in health care – right down to the person who collects and washes the bed pans – can dedicate their lives to learning and practicing healing, and yet, suddenly, by enactment of a law, change their entire philosophy of life without affecting the quality of service to all their patients.
Studies have shown that when cases in need of medical heroics are selected by some survival potential criteria rather than on a take-them-as-they-come basis, all quality and quantity of effort diminishes to an unacceptable level. As a reference, compare the European and American experience with Spina-Bifida and other neural-cord defects. In Europe, they select the best surgical risks; here we correct every patient where surgery itself won’t kill the baby. Our success rate, taking all risks, is far better than the European experience where they only accept the best risks. Why? Because the harder you try against the greatest odds, the better you get against the better odds.
The old adage, “When the going gets tough, the tough get going,” has certainly been true of our medical practitioners. I would sure hate to see the quality of our medical progress in saving those at greatest risk deteriorate because of a philosophy that some life is more worth saving than some other life. As George Orwell said in Animal Farm, “All pigs are created equal, only some pigs are more equal than others.”
Although I was disturbed and more than a little disgusted by Dr. Barnard’s proposal and the “Register’s” support of it, I was not shocked, as I might have been a few years ago. Anyone who reads the newspapers and other periodicals, watches television or listens to what government, medical and media spokemen are saying, could see this new definition of “sanctity of life” coming. As a friend of mine often says, “The tracks are as easy to follow as an elephant with a nosebleed across a snow-covered field.”
During this legislative session, at last count, “Right to Die – Death with Dignity” and “Living Will” legislation was introduced in 19 states. Many states have already enacted similar legislation and one at least, California, was amending its “Living Will” statute because it was too restrictive. Some “Living Will” legislation may be appropriate and even desirable; I have not reviewed them but believe that most provide for acts of omission, such as withdrawing life-support machines when it can be reasonably judged that it’s the machine that is doing the living and not the patient.
Quite often, the patient is not capable of making a decision or communicating it to the professionals tending to his or her needs. The “Living Will” spells out the conditions under which the “plug can be pulled.” The person’s permission has been granted at some prior, more lucid and rational time of his or her life. There are some problems with this contract, which I won’t go into, but leave the subject with the observation and caution that all the circumstances under which the “Living Will” may come into play cannot be foreseen, and once made, the person making it may be powerless to prevent its enforcement, even if he or she may have a change of mind.
To my knowledge, no “Living Will” or “Death with Dignity” or other such legislation has been introduced in Iowa. The state health department will carefully scrutinize any attempt. Congressman Richardson Preyer (Dem., N.C.) who was quoted in the Barnard article as saying he favored withdrawing life-support machines, “acts of omission,” was opposed to “acts of commission” which he said are permitted in a few states. I don’t know which states, but I’m going to find out so that I don’t make the mistake of traveling in them. I could be involved in an accident and have some kindly humanitarian put me out of my misery because my injuries might prevent me from enjoying a quality life. Absurd? Look for that elephant with the bloody nose.
You may notice that this section of “Iowa Health” is titled “Commentary,” which means it is written for the expressed purpose of presenting to the reader my opinions on issues, generally in the area of health care. I write what I believe to be true and of interest to you. They are my thoughts and how they might reflect on my functioning as a public servant is for the reader to decide. Whether you agree or not is of interest. If I’m to be honest in presenting my perspective, I will say what I think you need to hear and think about, not what I know you would like to hear and not think about. I believe that I was not merely the result of a cosmic accident, the probability of which is incalculable. I was designed intelligently, deliberately and lovingly.
I agree with the theory that my ancestors were raised up from the dust of the earth by command and did not slither from the primordial slime by chance. I am the product of divine inspiration, not monkey business. I believe that of you as well. If we are merely accidents, products of chance, merely parts of a gigantic cosmic machine over which nothing or no one has any control, then let us by all means strive to perfect the machine by redesign and elimination of the worn out, defective, unwanted or unnecessary parts as we do with a toaster, TV set or any other machine.
But, if we are unique in the universe, wonderfully and purposefully made, as one author put it, part of a universal plan, then we have an obligation to do all we can to preserve to the fullest extent within the power granted us “every opportunity for greatness” which is what we are because we are human. Dr. Francis Shaeffer, noted philosopher and theologian, has said that our worldview and consequently our definition of sanctity of life are directly dependent on our view of origin. I couldn’t agree more. If life is a gift, it is precious not because of the recipient but because of the giver. We are special, not because we are the center of the universe as the humanist claims, but because we originate and are in the image of the Center of the Universe. We must protect and care for every ounce of life given us while some of the responsibility is still ours.
I recently read the following in an Ann Landers column in the “Des Moines Tribune.” The author is Pastor Martin Niemoeller of Germany. “In Germany they came first for the Communists, and I didn’t speak up because I wasn’t a Communist. Then they came for the Jews and I didn’t speak up because I wasn’t a Jew. Then they came for the trade unionists, and I didn’t speak up because I wasn’t a trade unionist. They came for the Catholics and I didn’t speak up because I was a Protestant. Then they came for me, and by that time no one was left to speak up.”
Pastor Niemoeller left out one important group “they came for.” Sometime between the Communists and the Jews, they came for the sick, the crippled, the mentally retarded and mentally ill. They went to the gas showers and ovens long before the Jews. They were a drag on the “quality of life” of the new society Nazism was “creating.” Can it happen here? What’s that I see in the snow? Could it be elephant blood?
I think I’ll speak out, long before they come for the Poles.
