Euthanasia

The seventeenth chapter of Halliday Sutherland’s 1936 book, “Laws of Life,” dealt with Euthanasia. His contribution to the debate is still relevant today and is published as the New South Wales parliament considers a Bill for Voluntary Euthanasia.

In November, 1931, the President of the Society of Medical Officers of Health, Dr. C. Killick Millard, [1] proposed “That individuals, who have attained the years of discretion, and are suffering from an incurable and fatal disease which usually entails a slow and painful death, should be allowed by law — if they so desire, and if they have complied with the requisite conditions — to substitute for the slow and painful death a quick and painless one.” Doctor Millard also drafted a Bill for the legalisation of euthanasia, and now Lord Moynihan has founded the Voluntary Euthanasia Society for the purpose of promoting a Bill to legalise euthanasia in cases where the patient wishes to terminate his sufferings.

Dean Inge [2] concludes that “Euthanasia should be permitted, but only in very exceptional cases.” He may be assured that the cases would be very exceptional, and Lord Moynihan would be disappointed if he imagines that patients suffering from incurable diseases will become members of his society. It is the everyday experience of doctors and nurses that patients even in the last stages of cancer or tuberculosis cling to life. Only once have I known a patient who asked for an overdose of morphia. I have told his story in Arches of the Years, and on reflection very much doubt if he was altogether sane. The will to live is the most powerful instinct on life, stronger than sex or any other appetite, and for that reason it is probable that suicide is committed in a moment of temporary insanity. The only two suicides known to me personally were men who I always regarded as insane although they were never certified. It is not physical pain, but mental anguish that drives men and women to suicide. Many of us have experienced moments of unhappiness so intense as to make us say, “I wish I were dead,” but the mood passes and we resume the march.

Hope humbly then; with trembling pinions soar;
Waits the great teacher Death; and God adore.
What future bliss, He gives not thee to know,
But gives that hope to be thy blessing now.
Hope springs eternal in the human breast:
Man never Is, but always To be blest:
The soul, uneasy and confined from home,
Rests and expatiates in a life to come.

Alexander Pope, from An Essay on Man.

In those lines Pope expresses the Christian attitude towards the mystery of suffering.

In another medium the same thought has been expressed by Watts in his picture of Hope playing her Harp on the top of the earth. [3] All these strings are broken bar one, and that one is the Thread of Life.

Yet even the late Dr. Henry Maudsley, who was an agnostic, thought that idiots, imbeciles, and the incurably insane had a place in the scheme of things, if only to arouse feelings of pity and thankfulness in the minds of those who were not so afflicted. He was the greatest alienist of his time, and was also a great philanthropist, because he left his fortune to found the Maudsley Hospital for the Prevention of Insanity.

Dean Inge writes that “Pain patiently borne no doubt ennobles the character, but there is no reason why we should not use every means of reducing or removing it; it seems unlikely that unnecessary cruelty can be part of the will of God.” Most unlikely! As a small child I learned that near the nettle the dock grows, and for the relief of pain there is morphia. “If,” writes the Dean, “I refuse to put a mangled horse or dog out of its misery, I may be fined for cruelty. If I help a human being, who is dying horribly by inches from cancer, gangrene, or locomotor ataxy, to shorten his or her sufferings, from which there can be no released but death, I may be hanged for murder.” That is an appeal to sentimentality, and incidentally gangrene and locomotor ataxy are not painful diseases, although the former is most unpleasant for those in attendance on the patient. The essential difference between man and animal is that that man has a soul.

The teaching of the Catholic Church on this subject have been well stated by Monsignor Hallett, [4] Catholic Medical Guardian, April 1932 Professor of Moral Theology at Wonersh:

Man has no right over his own life, and can transfer none to others. The State has but a strictly limited right over the lives of its citizens, insofar as it can punish malefactors. ‘He is the Minister of God, and avenger to execute wrath upon him that doeth evil’ (Rom. Xiii. 4). Beyond that the State cannot go. It is bound to support and protect the law of God, which is the only moral basis of its own authority.

The moral law of God, exhibited by right reason, is confirmed by the teaching of Holy Scripture and the authority of the Church. In the busy rush of life, reason often blinded by passion or beguiled by sophistry, may show sometimes but a dim light, yet the faithful Catholic is not left without guidance, for he knows the Catholic Church to be infallible in teaching morality as well as faith, and to be the authoritative exponent of the Sacred Scriptures. Such an advantage has even an unlettered Catholic over learned Deans and Canons who share not his faith.

Catholic morality, then, distinguishes between the prohibition of taking one’s own life, and the duty of preserving it. The former, as a negative precept, does not admit exception or degree, but the latter, a positive precept, must of necessity admit exception. It is the difference between taking one’s own life and allowing it taken to be taken, and though the distinction may be, in extreme cases, a very thin one, yet it is a dividing line upon one side of which is right and upon the other wrong. In ordinary circumstances there is little difficulty, but in extreme cases the line between right and wrong must necessarily be a fine one, and there can be little wonder that sometimes errors have been made, and they may demand our sympathy. Yet it is of the greatest importance to have right principles, four by these errors of judgement may be corrected. An error in the application of a principle is far less disastrous than an error in the principle itself. One who says ‘I know murder is never licit, but I honestly think this act not to be murder,’ is in a far less dangerous position (from the point of view of general morality) than the man who says ‘I know that this act is murder, but I am not sure that murder is always wrong. For if moral principles admit of exceptions, they are no longer principles, but matters of expedience.

We may illustrate the point by the example Dr. Millard gives of soldiers dying rather than surrendering. They do not kill themselves but they allow themselves to be killed. They are not, then, guilty of violating the negative precept, and before deciding whether they violate the positive precept we must consider the circumstances. If it is of great military importance that the post should be held to the end, if to hold up the enemy even for a few minutes is greatly advantageous, etc., etc., then the defenders will be justified in fighting until they are killed. On the other hand, if they had no important military purpose, but acted, shall we imagine, merely through vainglorious pride, they would be acting immorally, though naturally they might be excused from personal guilt through ignorance.

In general, then, it is the teaching of Catholic moralists that a man must take reasonable care of his life, but that he is not bound to take extraordinary means to preserve it. He may expose his life to more or less serious risk in proportion to the gravity of the cause. He may work at dangerous occupations to earn a living, he may attend to cases of cholera or smallpox or to lepers or the plague-stricken at grave risk to his own life for the sake of charity. Men must take reasonable precautions against sickness, they must not refuse proper medical advice or nursing, if they are seriously ill. They must not refuse food or ordinary remedies. But they are not bound to undergo operations of extreme gravity or to go to live, say, in Australia, [5] in order to lengthen their lives. In such cases they may allow their disease to take its course and are not bound to resort to ‘extraordinary’ means to delay death. In order to alleviate grave pain, the Catholic moralist, in agreement with Dr. Millard, will permit the administration of drugs, even though the result may be a slight abbreviation of life. To take another example: if a man is assured by his doctor that unless he gives up tobacco and alcohol he will never make old bones, he will not be condemned by Catholic moralists if he refuses, apart from special circumstances, e.g., of responsibility for others, to make the sacrifice.

The principle in all these cases is the same, viz., that whilst a man is never that whilst a man may never directly take his own life or directly aim at or intend his own death, yet he is bound to take only ordinary and not ‘extraordinary’ means to preserve his life, even though he foresees clearly the near approach of death as a consequence of his refusal to take such ‘extraordinary’ means.

Monsignor Hallett in the Catholic Medical Guardian, April 1932.

So far as the medical profession is concerned, it is our duty to alleviate suffering, but not to kill. Indeed, the very first aphorism of Hippocrates was premum non nocere. Dean Inge writes:

We very properly hide away the most distressing cases of illness, and many people do not know how horrible the preliminaries of death sometimes are. In order to help myself to form an intelligent opinion on this question, I spent an hour in the Museum of the Royal College of Surgeons, and purposely looked at the most dreadful among the exhibits. What I saw made my blood run cold. It was far worse than the old dungeon at The Hague, with all the instruments of torture in working order.

Dean Inge in the Evening Standard, 30th October 1935.

Had the Dean being accompanied on his tour of the museum by a pathologist, he would have been even more horrified to hear his companion exclaim: “What a beautiful specimen!” Everything depends on the point of view.

As a doctor I would say that the Dean gave himself a distressing experience, and to no purpose at all. Being a layman he probably imagined that the more abnormal the tumour, the more painful the disease. That is not so, and some tumours are painless, although no one can bear the thought of cancer of the tongue with equanimity.

Dean Inge comes to the following conclusions:

And yet, though all the arguments seem to be strongly in favour of the proposed change in the law, I could not bring myself to bring I could not bring myself to add my name to the signatures in favour of Lord Moynihan’s Bill. For consider a very typical case — the commonest case, probably, that would arise if the Bill became law. A woman is suffering from inoperable cancer. The doctor reluctantly informs her that she will probably live for some months in dreadful pain, and perhaps with those repulsive symptoms which often accompany the later stages of the disease.

On hearing this she asks for euthanasia. Her written request has to be countersigned by her nearest relative — her husband. He is asked to give his consent to the curtailment of his wife’s earthly existent by some months; to antedate the inevitable parting; to forgo the tender ministrations in which the great love of a lifetime might find its last expression; to sign the death-warrant of his nearest and dearest. Can one imagine a more horrible dilemma?

My position, I confess, is rather illogical. But in a question like this, natural feelings cannot be disregarded. The human spirit can often triumph over pain with a quiet heroism which amazes the onlookers. Those who have seen many deathbeds would only rarely, I think, wish that they had been anticipated by an overdose of morphia.

Dean Inge in the Evening Standard, 30th October 1935.

In admitting that his views on this subject are illogical, Dean Inge merely proves that he is very human and, I would add, very humane. The euthanasia now demanded is to be voluntary on the part of those suffering from painful or incurable disease. Why voluntary? Would it not be advisable to extend the blessings of an easy death to all idiots, imbeciles, and incurable cases of insanity? A newborn infant, if deformed by a clubfoot as was Lord Byron, would be saved a great deal of discomfort and trouble in later life if it were killed, painlessly of course, immediately after birth. Many old people are burdened many old people are a burden to themselves and an expense to their children. In such cases we might follow the example of some of the more savage African tribes amongst whom there are no old people. As soon as men or women show signs of age they receive a happy dispatch from their children, who club them on the back of the head. Our children, not being savages, would lead us to the Lethal Chamber — “This way, mother! You can’t see very well, so take my hand. I am taking you for a long walk.”

“Thank you, dear. It’s a long time since you took me for a walk.”

When responsible and thoughtful members of society begin to advocate the prevention and destruction of human life by means of contraceptives, abortion, infanticide, sterilisation, and euthanasia, it is an evil omen, and the sign of a civilization whose creative power is spent.

“Souffrir plutôt que mourir, c’est la devise des hommes.”

Notes

[1] Public Health, November 1931.

[2] Evening Standard, 30th October 1935.

[3] Click the hyperlink to see this painting. For more information about it, go to https://www.tate.org.uk/art/artworks/watts-hope-n01640

[4] Catholic Medical Guardian, April 1932.

[5] When Monsignor Hallett wrote these words in 1932, travel to Australia was not as quick and easy as in our own times. On the other hand, the Australian government’s reaction to the coronavirus has meant that for many, including many Australians stranded abroad, travel to and from Australia is not permitted.

Photo credit: “The former coat of arms of the New South Wales Legislative Assembly” by Coekon. The original photograph has been altered.