A Modest Proposal

CABIN JOHN. — The voters of Washington State have wisely rejected what is known as the "right to die" referendum.

This would have provided the state's physicians the legal authority to assist in the suicide of their terminally ill patients. Of course, there would be safeguards: The doctor must determine that his patient does in fact wish to die, that the patient is terminally ill and, in the doctor's opinion, has less than six months to live. Another doctor must corroborate these findings. Only then may the doctor "assist" his patient. Other procedures must be followed if the patient is comatose.


Once before in modern history, from 1939-1941, such authority was given to physicians. A government, upon urging from the medical establishment, authorized "that persons who, according to human judgment, are incurable can, upon a most careful diagnosis of their condition of sickness, be accorded a mercy death." To prevent misuse of this authorization, the German head of state insisted on adding the words "upon a most careful diagnosis of their condition of sickness."

Careful safeguards were established. The patient's private doctor was required to fill out a lengthy questionnaire, providing not just a medical history but economic and social information as well. This questionnaire was then appraised by a committee of four (later three) physicians who, although they had not personally seen the patient, determined on the basis of the evidence presented to them, whether a "mercy death" was called for. The decisions of these physician committees were then, in turn, reviewed and approved by a committee made up of the leading medical professors of the nation. Only then would "euthanasia" be administered.


The program started slowly enough. It soon gained momentum. Before it was over, not just the terminally ill, but the paralytic, the blind, the deaf, the epileptic and those with mental disabilities became eligible. In a training film made to inform physicians, a professor stated that the "incurably mentally ill" had a "right to die." Given that premise, he went on to ask, reasonably enough, "Is it not the duty of those concerned to help the incapable -- and that means total idiots and incurable mental patients -- to their right?"

In another film for German doctors, explaining the euthanasia program for "incurables," the point was made that, "Every person would prefer death to such an existence." The film

concluded, "Our National Socialist state, taking into account the purpose and value of human life, has adopted measures by which those afflicted of an incurable mental anguish can be relieved of their inhumane suffering and hellish existence by an unforeseen and gentle death."

The physicians of Germany, in filing out the questionnaires, found themselves in the uncomfortable position of determining which of their patients had "lives worth living" and which were but "useless eaters." Despite the safeguards, despite initial reluctance, the physicians developed an unexpected enthusiasm for euthanasia. As a result the experimental program turned out badly. A kind of "runaway euthanasia" developed and before it was over more than 200,000 disabled German citizens lost their lives at the hands of their physicians. In the summer of 1941, the German head of state ended the official program because of the protests of patients, their families and friends and religious leaders.

The authors of the Washington referendum were poorly advised to entrust such decision making to physicians. Physicians are ill equipped for such matters. All their training has been directed toward caring and healing. When killing is brought into the equation, they become confused. As the German example demonstrates, they tend to confuse the patient with the disease: killing off the former to eliminate the latter. It is not a good idea.

If it is to be state policy to provide death on demand to its citizens, it is best to divorce physicians from any such proceeding. It is perhaps time for a modest proposal: Should not the state set up a Termination Bureau which would provide a comfortable death under pleasant circumstances to eligible, applicant citizens? Terminators would not be physicians; they could be veterinarians trained in putting animals to sleep, or perhaps vocationally retrained hangmen.

In this way the Hippocratic tradition of medicine, which has served doctor and patient so well over the centuries, would be preserved. And, this being a free society, those who wish to have themselves killed would also be accommodated.

Hugh Gregory Gallagher, a polio paraplegic, is the author of "By Trust Betrayed: Patients, Physicians and the License to Kill in the Third Reich" (Henry Holt, 1990).