Euthanasia

History

The Hippocratic Oath, taken by most Western physicians for over two millennia, states, “Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course” (Clendening 1960: 14). Nonetheless, some medical historians believe that many Greeks in Hippocrates' day (c. 470–c. 410 BCE) did not view euthanasia as invariably criminal or unethical. By the nineteenth century, however, the medical establishment had come to regard as unethical any action or inaction taken by a caregiver that could be reasonably foreseen to result in death, and Anglo-American common law criminalized such actions as homicide and assisting in a suicide (which itself was a crime at the time).

In the twentieth century, legal developments began to qualify this absolute ban. Suicide itself was decriminalized in the United States, and courts began to recognize a general legal right to refuse medical treatment. Eventually, the latter was found to imply a further right to refuse “extraordinary” treatment, such as life support, even when such an action was certain to end the patient's life. Recognized by state and federal courts, including the U.S. Supreme Court, and by physician's organizations, such as the American Medical Association (AMA), by the end of the twentieth century, this right had expanded to include the right to refuse food and water. A physician who fulfills a patient's request to withdraw life support, nutrition, hydration, or other treatment has not committed a crime. Individuals can make such requests prospectively, via an advance directive; a living will, for example, specifies conditions under which caregivers are to withhold treatment.

The “Euthanasia Program” in Nazi Germany

For some, the prospect of decriminalizing euthanasia raises the specter of a dark episode in human history. In the first decades of the twentieth century, when the German government became concerned with cutting the costs of operating mental hospitals (known then as asylums), some German psychiatrists began to contemplate “eugenic” measures to deal with acute, chronic, untreatable mental patients. When the Nazi party rose to power, the government instituted what was known as “euthanasia program.” Many psychiatrists participated, sterilizing mental patients and authorizing the execution of acute, untreatable individuals. Hundreds of thousands of men, women, and children were gassed, starved to death, or killed by lethal injection.

Opponents of euthanasia, especially Germans, emphasize [Page 646]these horrors. Some find any form of euthanasia reminiscent of the Nazi program. Others fear that legalization would set us on a path that would eventually endanger basic human rights, including the rights of the poor, the disabled, and the socially disfavored.

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