Euthanasia I
Michael A. Gillette, Ph.D.

I tuned in recently to a very interesting television documentary on The Learning Channel called "Selling Murder- The Killing Films of the Third Reich" (TLC 7/21/96, 10:00pm). This documentary presented old clips from Nazi propaganda films designed to justify to the German public the murder of individuals with mental retardation and mental illness.

The films did not, as you can well imagine, depict these killings as murder. Rather, they presented arguments to show that such individuals were living lives that were of such low quality that death was a reasonable option for them. The concept of euthanasia was invoked to justify the removal of such tormented people from the citizenry of the Third Reich.

The national debate that is shaping up in this country surrounding the permissibility of physician assisted suicide has special implications for individuals with developmental disabilities or with mental illness. As shown by the Nazi films, these populations are at significant risk that well-meaning individuals will set up a slippery slope that moves us from voluntary passive euthanasia toward involuntary active euthanasia.

Is this slip likely to take place? Just how dangerous is the practice of physician assisted suicide? Like all questions of ethics, the answer is not perfectly simple. Is physician assisted suicide dangerous? Yes!!! Is the practice too dangerous to allow? I am forced to answer 'No'.

Although risks exist in allowing active euthanasia, especially to populations that have limited abilities to develop their own competent desires or to communicate those desires, there are significant differences between the Nazi experience with euthanasia and the American experience at present. Prior to expounding on those differences, however, some definitions would be useful.

The first concept that must be understood is that of euthanasia itself. The word 'euthanasia' comes from the Greek prefix 'eu' meaning good or well (as seen in 'euphoria' and 'eugenics') and the Greek word 'thanatos' meaning death. Eu-thanatos, or euthanasia, literally means 'good death'. The concept of euthanasia encompasses all cases where the death of an individual is considered a good thing from the perspective of that individual. This, once understood, quickly shows that the project of the Nazis was mislabeled as euthanasia.

In addition to understanding euthanasia in general, there are two sets of distinctions that become important. First, the difference between active and passive euthanasia is often touted as being especially morally relevant. The paradigm example of active euthanasia is to provide a lethal injection. The paradigm example of passive euthanasia is to withhold the provision of mechanical ventilation. Gray area cases exist, however, such as the act of removing a patient from a respirator. This is clearly active in nature, and yet most people view this as passive euthanasia or "simply letting nature take its course".

An additional distinction that must be made is that between voluntary euthanasia (when a competent patient requests it), nonvoluntary euthanasia (when a patient cannot either request or refuse it), and involuntary euthanasia (when it is provided over a patient's competent refusal).

The American medical system is clearly supportive of voluntary passive euthanasia and against involuntary active euthanasia. DNR orders are routine in American hospitals. It is easy to develop examples where further provision of medical treatment would do harm to a patient, and patients are fully capable of refusing such care even if that results in their deaths.

It is also clear that Americans favor nonvoluntary passive euthanasia. If my loved one becomes incapacitated to make medical decisions, there are times when I gain the authority to refuse care for her, even when that refusal will result in her death.

The provision of a lethal injection over the objections of a competent patient would be classified as murder, however. No elements in the debate surrounding this issue have supported this sort of involuntary activity. In fact, we can all agree that involuntary passive euthanasia is equally wrong. All other things being equal, it would be unacceptable to withhold care from a patient who desperately wants to receive it.

The difficult problem develops when some of our citizens voluntarily desire to take a more active approach to ending suffering and need help in doing so. Should doctors be allowed to provide lethal injections at a patient's request? Many answer that they should not.

The most notable argument against such a practice is the claim that although we may begin with the best of intentions, we will find ourselves acting like Nazis in the near future. What starts as a merciful practice, ends up infringing on the rights of those least able to resist. We can start now with those who want to die, but we will end up killing those who are misfits, undesirable, expensive to care for, and easy to ignore. Those with mental retardation and mental illness are sure to suffer.

Does this argument work? I don't believe that it does. While I am cognizant of the danger of allowing physician assisted suicide, I will explain next month why I do not believe that such dangers are insurmountable.