A Merciful End: The Euthanasia Movement in Modern America, by Ian Dowbiggin. Oxford University Press. 224 pages. $28.
Ian Dowbiggin, a professor of history at the University of Prince Edward Island, has just written a "must read" book on the history of euthanasia and physician-assisted suicide titled A Merciful End. If you wonder why "living wills" and health care "power of attorney" won support at the ballot box but physician-assisted suicide proposals mostly failed, this book explains all.
In brief, the majority of Americans recognized hidden and problematic agendas in legalized euthanasia and rejected it even as they supported ways to help patients avoid prolonged and unnecessary treatment when dying. Here again, in matters sociopolitical, one sees the prudential American touch -- you don't have to buy the theory and give up foundational traditions to solve a problem. How it all worked out, given the passion and social prominence of the advocates for death on demand, is carefully and interestingly described by Dowbiggin .
The book starts with the advocacy speeches of the enthusiasts for a "peaceful death" in the Progressive era and describes how these champions were simultaneously promoting the eugenic agenda of a merciful termination for those whose lives seemed meaningless and whose propagation they deplored. As enthusiasm for science and secularism grew at the beginning of the century, mercy killing -- for oneself if wanted and for the mentally subnormal if possible -- seemed somehow "advanced."
In the 1920s and '30s, several prominent Americans -- such as George Eastman of Eastman Kodak Co. -- killed themselves. They saw their actions as appropriate to their state in life. Eastman in his suicide note asked, "My work is done. Why wait?" Many modern religious leaders such as Felix Adler, founder of the Ethical Culture movement, and Harry Emerson Fosdick, the pastor at the interdenominational Riverside Church in Manhattan, saw opposition to euthanasia as "backward."
Dowbiggin calls the period of 1940-1960 one of "stalemate" when the forces for euthanasia first encountered a coherent opposition from doctors and others who explained that patients could be licitly given pain relieving medications even to the point of shortening life if pain relief, rather than killing, was the aim. This split from the euthanasia ranks those willing to support these established practices of "passive" euthanasia and who saw "active" euthanasia therefore as unnecessary and dangerous.
In the 1960s the Episcopal minister Joseph Fletcher attached the notion of patient autonomy or a "right to die" to active euthanasia and physician-assisted suicide. He drew help from abortion groups keen for "choice," from the eugenic groups encouraging mercy killing of the mentally handicapped, and finally from those worried about population growth. The last thought some restraint on population pressure would come from encouraging the elderly and infirm to seek death.
The links between euthanasia, eugenics, abortion and population control delineate a "Culture of Death" that to triumph needed advocates willing to flout the barriers of the Hippocratic medical tradition and break the laws by killing patients themselves. These men appeared in the 1980s and 1990s. The best known were Jack Kevorkian, Derek Humphries and Timothy Quill. Each did their best to push the agenda of euthanasia but each was eventually discredited.
Kevorkian, claiming he was providing release from painful death, killed 69 people in Michigan, only 17 of whom turned out at autopsy to be dying. He now rests in a Michigan jail. Derek Humphries, who inspired the Hemlock Society and the campaign for Oregon's physician-assisted suicide law, was revealed ready to push subjects who were ambivalent into death.
He was accused of suffocating his first wife and abusing his second. He is shunned as a pariah. Timothy Quill, a more quiet personality, helped several people to die but failed to recognize the psychiatric risk factors for suicide they carried. He succumbed to romantic fantasies and his incompetence has undermined him.
Dowbiggin describes the euthanasia movement once vigorous as now moribund. Opposition has broadened beyond the right-to-life organizations and the Christian right. The excess of women among the victims of Kevorkian, Humphries and Quill causes many doctors to wonder about the vulnerabilities of their patients to persuasion. And finally, when surveys were made of patients in terminal care, the vast majority wanted help to live and symptom relief. The only ones speaking of death were those with clear depressive states susceptible to treatment.
American medicine improved by fighting euthanasia. The fight drew doctors' attention to problems in patient care that they might have let pass. Better care for the dying and inspiration for hospice care can be directly tied to efforts on the part of physicians to answer the euthanasia proposals. Living Wills, Proxy Power of Attorney and Do Not Resuscitate Orders have assured patients and their families that they are not powerless when dying and need not surrender to a radical agenda of death. A direct attack on their concerns over neglectful physician services improved those services and pointed to a better future for all.
Dowbiggin's book shows why Americans vote against euthanasia and physician-assisted suicide. They notice that the advocates for a right to die also believe in a duty to die that profoundly alters the concept of responsibility to the sick embedded in the ethics of medicine. Americans don't agree with them.
Dr. Paul McHugh is distinguished service professor of psychiatry, and former psychiatrist-in-chief of Johns Hopkins Medical Institutions. He is a member of the Presidential Council on Bioethics. With Dr. Phillip R. Slavney, he wrote The Perspectives of Psychiatry, a medical school text.