A beautiful and talented woman was happily married to a doctor. She contracted Multiple Sclerosis. Before it kills her, she learned she would become completely incapacitated, existing in a living death and a burden on her husband. The specialist refused to help, but her loving husband released her. The defence was: mercy killing out of love. This was the plot of the 1941 film, ‘I accuse’, Ich klage an. The accusation is against the ban on mercy killing. It was a skilful propaganda film produced in Nazi Germany, where the leadership was worried about public opinion about the euthanasia programme that had been underway for some time. An excellent account is M. Burleigh, Death and Deliverance: Euthanasia in Germany 1900-1945 (Cambridge University Press, 1994). The film shows euthanasia in a rosy light. It is apparently balanced, the characters are sympathetic, and the issue is simple: unbearable suffering, for the MS victim and her partner, no hope of survival, assisted suicide as an act of love and mercy. Sound familiar?
Euthanasia is the big issue of our time because more and more countries are legalizing it: we are at a tipping point. The alliance between the kind of arguments used in Ich klage an and material interest are powerful. End of life medicine and palliative care cost more than euthanasia, whether medicine is privately financed or provided by the state: providing medical care for the old is much more expensive than a needle. Yet the moral cases is weaker even than in the 1940s because the Hospice movement has shown how much can be done to make the dying bearable.
In palliative treatment, some clear ethical thinking is required. Morphine may shorten life. The questions is one of intention. Is the intention to manage pain, or is it to end life in order to reduce pain? There is a world of difference. Those who takes up extreme mountaineering know that their life expectancy is severely diminished, yet it is not their intention to get killed. Even if the indirect consequence of an act is certain, it does not have to be intended. To stay with mountaineers: if there is only enough oxygen for one person, and the climber who has it gives it to someone else out of friendship, the giver does not have the intention to die even if it is an inevitable consequence. If the government builds new road, it knows that road accidents will occur on it, for sure, but does not intend them. So ‘yes’ to morphine, ‘no’ to euthanasia.
Sometimes it is renamed ‘assisted suicide’, perhaps to avoid the Nazi associations. Similarly, the word ‘dignity’ has been repurposed in sinister ways, as if it were in some way dignified to have a needle stuck in your arm, and as if death bravely born were incompatible with human dignity. To Christians in particular this should be an offensive idea, but not just for them. Manipulation of language has enabled changes in attitude – a form of hidden persuasion. To get legislation passed, rhetorical skill uses the language of unbearable pain – the ‘Ich klage an’motif - and freedom of choice. This concept of total freedom looks like a legacy of the long discredited 1950s philosophy of existentialism. (Maynard Keynes: ‘Practical men who believe themselves to be quite exempt from any intellectual influence, are usually the slaves of some defunct economist. Madmen in authority, who hear voices in the air, are distilling their frenzy from some academic scribbler of a few years back”. In fact the suffering of the chronically clinically depressed is arguably greater than physical pain mitigated by effective pain killers. Once the thin end of the wedge has been inserted, the logical conclusion will eventually follow: there is no reason to discourage the clinically depressed from taking their own lives, in fact the process should be facilitated, even in the young if the depression is chronic.
Slippage from an initial position of ‘imminent death, unbearable pain, strict safeguards’, which helps to get legislation through, goes in other directions too. In Belgium now, the under aged can be euthanised. In Holland there was a case when a woman suffering from dementia was euthanised while resisting, and held down by her family, because she had at an earlier point said she wanted euthanasia but wished to choose the right time. What happened can hardly be regarded as a free choice at the time when it happened: no doubt about it, she was struggling to live.
The language of ‘safeguards’ and ‘free choice’ is a little detached from the real world. Parents who fear to be a burden, relatives who only want to spare a love one pain – that is a best case scenario. One imagines that children would always put their parents before their own financial needs - or those of their own children - but that rosy view of human nature is not always born out by reality, so the elderly may be subtly encouraged by those around them speed up the process. The regrettable fact is that not everyone is unselfish and indifferent to money, especially money they want to leave to their own children, which means that insidious and powerful psychological pressures are at work even when all concerned are well intentioned. Once euthanasia/assisted suicide are legal, loving parents who want to help their children and grandchildren will feel that they are selfish to let their savings drain away on health care. In general, they ‘don’t want to be a burden’. They feel unspoken pressure to ‘do the right thing’. They may feel, and sometimes it may be true, that visiting them takes it out on their loved ones. Once euthanasia is legal, something that is formally a free choice may come to seem like an moral obligation, and reluctance to be euthanised to be an act of selfishness. The ‘freedom’ is fake.
Sometimes expression of a wish to die may be an oblique way of hinting to loved ones that it would mean a lot to be able to see more of them. Conversely, the repressed guilt of the children with no time to visit nudges them towards support for euthanasia. But actually those who pick up the burden of giving time to the old and very ill themselves benefit greatly, as this writer knows from personal experience. If friends and relatives are willing to give time to someone they love, the end of life becomes a different experience for all. It is true we put pets to sleep, but this is the point: we don’t care for humans in same way as for pets. For Christians, end of life is the end of the race for eternity. But for non-Christians, it should weigh that those we love or should care for are not pets.
Written by Pr. David L. d’Avray FBA
Pr. David L. d’Avray FBA is Emeritus Professor of History at UCL.