DOCTORS AND THE _ RIGHT TO KILL
By HARRY ROBERTS
AFEW weeks ago, a patient of mine, having shaken hands,- handed me a note. He had, for several days, been reduced to this method of communication, the disease of his larynx having at last made speech impossible. Here is the note : Dear Dr. Roberts,—As I anticipated, I can no longer swallow milk. My poor starved bones are sore. I am so weak that I hope you will assure my wife that my life is now very short. I thank you for your. kind attention', and I want to make one last request of you. I trust you will grant it. You know the torture I am in, and you know that in any case I can live but a very short time. Will you save me from this painful death? I am, yours gratefully Biographical history is full of such instances. Berlioz, in his Memoirs, speaks of the death of his sister " from cancer of the breast, after six months of horrible suffering. . . And not a doctor dared have the humanity to put an. end to this - martyrdom by letting my sister inhale a bottle of chloroform. This is done to save a patient the pain of a surgical operation which lasts a quarter of a minute ; but it is not done to deliver one from a torture lasting six months. . . The most horrible thing in the world, for us living and sentient beings, is inexorable suffering ; and we must be barbarous or stupid, or both at once, not to use the sure and easy means now at our disposal to bring it to an end." Every doctor who has been long in practice has encountered such a situation again and again. It is one of the many dilemmas with which we are faced. The law of our country and the acknowledged code of our profession are in clear enough agreement. Our consciences are not always thereby set at rest. We are haunted by the reminder : "Do- unto others as you would they should do unto you."
What are we doctors to do in these circumstances ? If we accede- to our patient's wish, we are; as the law stands, guilty of the- crime of murder. ConSequently, it is often cowardice, rather than conscience or profes- sional honour, that leads us to observe the established convention. I suspect, however, that very many doctors do, on occasion, allow their sympathy and their feeling of pity to override their prudence. To a humane man, the inclination to administer the merciful overdose is often almost—not infrequently, quite—irresistible.
In its administration, there is, however, more common sense in the English law than is generally recognized. Motive is very seriously taken into account both by judges and by juries. I expect that most- readers will remember the case of a man who, some six or seven years ago, was tried at the Chester Assizes for drowning his four-year-old daughter in a bath. As summarized in The Lancet, the facts of the case were of a pathetic kind, to which most doctors could find parallels in their own experience. The man's wife 'had died earlier in the year from tuberculosis. This child contracted tuberculosis, and developed gangrene in the face. The lather nursed the child with the greatest care day and night. The doctor told him that . she could not live long. The father could not bear to see. her suffer any longer, and drowned her. The jury returned a verdict of " Not Guilty " ; and Mr. Justice Branson made these Significant comments : It is a matter which gives food for thought, when one comes to con- sider that, 'had -this poor' child been an animal instead of a hUinan being, so far from there being anything blameworthy in the man's action - in putting an end to its suffering, he would actually have been liable to punishment if he had not done so." A similar verdict was returned in a French court in the case of a youth who, because he could no longer watch her agony, shot his cancer-aftlicted mother with a revolver.
We are all agreed about our duty to a mortally wounded dog or cat lingering in a painful death-struggle. Law and conscience are here at one. Why these differences in the official conception of humanity and of duty ? The issue can scarcely be that of the sacredness of life, or even of the peculiar sacredness of human life ; for, through greed, fear, or motives of expediency, we subsi- dize professional soldiers and professional hangmen. The basic postulate is hard to conic .by.
The possibilities of euthanasia —that is, of easy, painless death, deliberately imposed or accepted—have lately been brought to public notice by the discussions at the Congress of the Royal Sanitary Institute. Two dis- tinguished and experienced doctors there urged the desirability of legalizing the painless destruction of " human mental monstrosities " in whom improvement is unattainable, whose participation in even the simplest life of humanity is impossible. To me, the case of these congenital imbeciles is far less pathetic than is that of those born with terrible physical deformities, yet with minds sensitive to the opinions and feelings of others. It is doubtful if congenital idiots experience much mental distress ; and they are at least as " humanly " intelligent as many of those animals which ladies of fashion delight to pamper. We need to discriminate very carefully between facilitating the death of an individual at his own request and for his own relief, and the killing of an individual on the ground that, for the rest of us, such a course would be more economical or more agreeable than keeping him alive.
The philosophers and theorists are almost unanimous in their commendation of euthanasia, and in their abuse of the physicians who hesitate to hasten and facilitate the passing of their suffering patients. " I esteem it," said Bacon, " the office of a physician not only to restore the health, but to mitigate pain and dolors ; and not only when such mitigation may conduce to recovery, but when it may serve to make a fair and easy passage ""; and he quotes the epigram composed of Epicurus, who, " after his disease was judged desperate, drowned his stomach and senses with a large draught of wine "—and then Stygias ebrius hausit aquas. In this matter, men of action are more hesitant. Napoleon,• who must have witnessed more painful and hideous deaths than any doctor, held that "au fond it vaut toujours mieux souffrir; qu'un homme finisse sa destinee quelle soit." We may credit him with a willingness to act up to his own creed. Doctors, on whom would fall most of the responsibility for administering the coup de grace, should euthanasia become general and legal, are perhaps the least enthusi- astic advocates ; not from lack of sympathy, but because they know better than does the public the sinister possibilities attendant on the giving of increased licence to the less reputable members of their profession.
What, then, is the moral of it all ? Strict Roman Catholics will, for the most part, probably share with Napoleon the conviction that each one of us must " dree his weird." Most of us take a less absolute view. But the slope that starts with contraception and proceeds through abortion to the painless slaughter of undesirables is a slippery one, of which we cannot see the bottom. In many parts of China, female infants are said to be exposed or otherwise destroyed at birth. .:They,_ also, are un- desired. Though, personally, I would not hesitate pain- lessly to end the life of an individual suffering from a painful and incurable disorder such as cancer of the larynx, I am not an enthusiast for the legalization of such acts, unless they are to be heavily safeguarded. I prefer at present, to take my own risks. I am sure that this is the feeling of most sympathetic and responsible doctors. When our sympathy outweighs our fear of the law, let us act on it. On the other hand, so long as doctors depend on individual fees paid by patients or their friends, tile legitimizing of professional murder, under whatev cr euphemistic_ name it may be committed, is dangerous. Such licence must be lirnited.to carefully selected officials, immune from financial or social temptations.
Finally, we may well ask ourselves if we do not attach undue value to earthly life. Are we not, perchance, allowing ourselves to be deceived by our self-preservative tendency to rationalize a merely instinctive urge ; and to attribute spiritual and ethical significance to phenomena appertaining to the realm of crude biologi- cal utility ?
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