Popular Science Monthly/Volume 3/May 1873/Euthanasia
THERE is a small knot of thinkers in Birmingham who come together to discuss philosophical topics, and call themselves The Speculative Club. In 1870 they published a volume of seven essays, which were written with much ability, and some of them with great boldness. The sixth article of this volume is by Samuel D. Williams, and is entitled "Euthanasia," which being interpreted means an easy or desirable mode of death. The writer begins by referring to the opposition which was made to the administration of chloroform for relief of pain, and more especially in cases of childbirth, which was regarded as a revolt against the divine decree, "In sorrow shalt thou brings forth." This prejudice having passed away, the writer raises the question of the application of chloroform to a relief of the sufferings which often attend the approach of death, and observes: "It is difficult to understand why chloroform should be rightly recurred to, to render less painful the natural painful passage into life; and yet, that it should be almost an offence to so much as suggest a like recurrence to it in the still more painful passage out of life. "Why, he asks, should the patient about to be operated upon by the surgeon always have a refuge from suffering open to him, and yet the patient about to suffer at the hands of Nature the worst she has to inflict, be left without help or hope of help? Mr. Williams lays down and defends the following proposition: "That in all cases of hopeless and painful illness it should be the recognized duty of the medical attendant, whenever so desired by the patient, to administer chloroform, or such other anæsthetic as may by-and-by supersede chloroform, so as to destroy consciousness at once, and put the sufferer at once to a quick and painless death; all needful precautions being adopted to prevent any possible abuse of such duty and means being taken to establish, beyond the possibility of doubt or question, that the remedy was applied at the express wish of the patient."
After describing the tortures of lingering disease leading to inevitable death, the writer remarks:
"Cases such as this abound on every hand; and those who have had to witness suffering of this kind, and to stand helplessly by, longing to minister to the beloved one, yet unable to bring any real respite or relief, may well be impatient with the easy-going spirit that sees in all this misery—so long as it does not fall upon itself—nothing but 'the appointed lot of man;' and that opposes, as almost impious or profane, every attempt to deal with it effectually.
"Why, it must be asked again, should all this unnecessary suffering be endured? The patient desires to die; his life can no longer be of use to others, and has become an intolerable burden to himself; the patient's friends submit to the inevitable, but seek the means of robbing death of its bitterest sting—protracted bodily pain; the medical attendant is at the bedside with all the resources of his knowledge and his skill ready to his hand; he could, were he permitted, bring to his patient immediate and permanent relief. Why is he not allowed to do so, or, rather, why should not his doing so be a recognized and sovereign duty?"
To the objection that such a course would be a violation of the sacredness of life, the author rejoins:
"It may well be doubted if life have any sacredness about it, apart from the use to be made of it by its possessor. Nature certainly knows nothing of any such sacredness, for there is nothing of which she is so prodigal; and a man's life, in her eyes, is of no more value than a bird's. And, hitherto, man has shown as little sense of the value of man's life as Nature herself, whenever his passions or lusts or interests have been thwarted by his brother man, or have seemed likely to be forwarded by his brother man's destruction. A sense of the value of his own individual life to himself, man has, indeed, seldom been deficient in; and, by a kind of reflex action, this sense has slowly given birth to, and alway underlies, the sense, such as it is, of the value of other men's lives. But even to-day, and amid the most civilized countries of Europe, 'the sacredness of man's life' is thrown to the winds, the moment national or political passion grows hot, or even when mere material interests are seriously threatened. And, indeed, seeing that life is so transitory a thing, and that, at the best, it has to be laid aside forever, within the brief space of its threescore years and ten, it is hard to understand the meaning of the word 'sacred' when applied to it, except in so far as the word may signify the duty laid on each man of using his life nobly while he has it.
"The objection, then, based on the sacredness of life, may be dismissed; life is a thing for use, and is to be used freely and sacrificed freely, whenever good is to be won or evil avoided by such sacrifice or use; the man who is ever ready to face death for others' sakes, to save others from grinding pain, has always been reckoned a hero; and what is heroic if done for another, is surely permissible, at least, if done for one's self; the man who could voluntarily give up his life to save another from months of slow torture, would win everybody's good word: why should he be debarred from taking a like step when the person to be rescued is himself?"
It is furthermore urged that the sacredness of life is violated by existing medical practice, where, in cases of extreme and hopeless suffering, physicians administer drugs which give present relief, at the expense of shortening the patient's life.
To the objection that submission to the will of Providence forbids the shortening of pain in this way, the writer replies that "by the same principle we should submit to the will of Providence, and not seek to escape any pain. Not submission to surrounding circumstances—another term for God's will—but successful effort to bend them to his purposes, is man's chief business here; and every useful thing he does is a successful attempt to change, for his own or others' benefit, some of the conditions of life which surround him."
And thus the author of "Euthanasia" goes on attacking current ideas, and taking his own view of the economy of the world. Nature is to him not a mighty, beneficent mother, any more than she is a dread and relentless power—
"Death by disease is always death by torture, and the wit of man has never devised torture more cruel than are some of Nature's methods of putting her victims to death.
"One of the main facts, then, that men have to make familiar to their thoughts and to adjust their lives to, is, that they are born into a world on the painful riddle of which speculation can throw no light, but the facts of which press hard against them on every hand; and from these facts the truth stands out clear and harsh, that not enjoyment, but, in the main, struggle and suffering, is what they have to look for, and that, to bring this suffering into bearable proportions, should be one of the chief aims of their lives."
The publication of this essay made but little stir at first. But it was separated from the volume, and published in a pamphlet with preface by Rose Mary Crawshay, and in this shape went to the third edition. The subject has been lately taken up in the Fortnightly Review, by Mr. Tollemache, under the title of "A New Cure for Incurables." Planting himself on Mr. Williams's ground, he reproduces his chief arguments, and adds others, with a view of strengthening the case. To illustrate how far pain reconciles us to death, he says:
"It is probably from surgical cases that the strongest arguments for euthanasia may be drawn. One of the highest authorities respecting such cases, the late Sir Benjamin Brodie, said that a very moderate amount of pain, if continued for a long time, would make any one heartily tired of life. He remarked also, that during his whole life he had known only two dying persons who showed any fear of death; and that both those died of bleeding. One cause of this singular circumstance probably was, that in these two cases there was hardly any pain to distract the mind; and the fact is curious, as showing how rare, in Sir Benjamin's experience, such painless deaths must have been."
The publication of this paper gave the discussion a fresh impulse, and numerous articles and letters have appeared in the English press, a few in favor of Euthanasia, but most of them decidedly against it. The Saturday Review, which had at first coquetted with Mr. Williams's theory as a novelty, upon sober reflection condemned it. The following is a part of its argument:
"It is of primary importance to inculcate a regard for the sanctity of human life. The reluctance to take life is indeed often pushed to an extreme by the opponents of capital punishments. But nobody can say that the mass of the population have as yet pushed their tenderness to the verge of effeminacy. A little story, related for a different purpose in the Fortnightly Review, illustrates very prettily a sentiment which is not so uncommon as might be desired. A sensible Scotchman watching by the bedside of his dying wife became impatient at the poor woman's anxiety to express her last wishes, and civilly requested her to 'get on wi' her deeing.' Now, among the poorer classes, where the inconvenience inflicted by people who 'take an unconscionable time in dying' is necessarily felt much more keenly than with people in a different rank, it is to be feared that this delicate hint is frequently followed up by some practical remonstrances. 'They pinched his nose beneath the clothes,' as Barham says, on the authority of a real occurrence, 'and the poor dear soul went off like a lamb.' Suppose, in fact, the case of a small cottage, where the invalid has become a heavy burden upon his family instead of a support, where the expense of providing medicine and attendance is most seriously felt, and where the sick-room is also the only dwelling-room, must there not frequently be a strong temptation to give him a quiet push or two along the downward path? If it were understood to be the law that invalids might be finished off when the case was hopeless, would not the temptation be frequently overpowering? Yes, it is replied, but the doctor and the parson must be present. That is all very well, but, if the practice became common, the people would quickly learn to take the law into their own hands. For it is to be observed that this is one of the cases where nobody could tell tales. A man on the verge of death does not require to have his throat cut or a dose of arsenic administered. A judicious shake, an omission to cover him properly, or the exhibition of an over-dose of laudanum, will do the business effectually, and no possible proof remains. Once allow that such things may be done with due precautions, and the precautions will soon be neglected as troublesome formalities. Why bother the doctor and the parson, why ask the sick man's consent, when the case is so clear? Of course the system need not be openly mentioned, but it would be speedily understood to be a highly convenient practice. The advocates of the scheme admit that the precautions of which we have spoken are absolutely necessary to prevent abuse; and we may add that it is simply impossible to enforce their observance. The practice itself once sanctioned, nothing is clearer than that people could, if they chose, carry it out in their own methods. No practice, again, could be more directly destructive of any strong persuasion of the sanctity of life. We need only read a few police reports, to understand how great is the existing tendency to violence of all kinds. Infanticide, as we know, prevails to a terrible extent, and wife-killing is not much less popular. Admit that the slaughter of invalids is also right under certain limitations, and it is easy to guess the consequences. The devotion which the poor display in cases of sickness is often among the most touching and amiable features of their character. In spite of the temptations we have noticed, they will often make noble sacrifices for the comfort of their dying relatives. Tell them plainly that they are rather fools for their pains than otherwise, and that they had better suggest suicide to the sufferer at the earliest opportunity, and you do your best to encourage, not merely suicide, but the cruel murder of a helpless man. A deathbed, instead of being the scene for calling forth the tenderest emotions and the noblest self-sacrifice, will be haunted by a horrid suspicion; the sick man fearing that his departure is earnestly desired, and his friends inclining to the opinion that killing is not murder, but kindness. The agitation of the question, what is the proper moment for smothering your dying father instead of soothing him, is not favorable to the development of those sentiments and the inculcation of those lessons which we generally associate with a sick-bed. In fact, the plan which certain eccentric philanthropists have advocated with such queer enthusiasm has a direct tendency to make men greater brutes than they are, and they are quite brutal enough already."
The Spectator objects that "the gravest of the merely rational objections we can bring against Mr. Tollemache is, that the ideas of which he is the advocate would plainly lead to two entirely new phases of feeling—impatience of hopeless suffering instead of tenderness toward it, where there was any legal difficulty in the way of getting rid of it by the proposed new law—and further, a disposition to regard people as 'selfish' who continued burdens upon others without any near and clear chance of the complete restoration of their own powers. Suppose it were permitted, as Mr. Tollemache wishes, that, on receiving the testimony of two or three physicians that a man's case is hopeless, he might, if he chose, elect to die, and that popular feeling came to sanction that choice as the right choice; what can be clearer than that, in the absence of any relations to whom such patients were dear, and who took pleasure therefore in prolonging their life, there would spring up a tone of habitual displeasure and irritation toward all who chose to go on giving unnecessary trouble to the world, and that very soon the standard of 'unnecessary' trouble would begin inevitably to become lower and lower, so that all the organized charity which now expresses itself in our hospital system would gradually suffer 'a sea-change' into something by no means 'rich or strange'—a sort of moral pressure, on poor invalids with any thing like a prospect of long-continued helplessness, to demand the right of ridding the world of themselves? We say that it is in this reflex effect of the new code of feeling upon our thoughts of disease, in the transformation it would certainly make of pure pity into impatience and something like reproachful displeasure, that the extreme danger of arguing out this sort of question, on the superficial considerations of the balance of pain and pleasure for each individual case, is best seen."
In a letter to the same paper, Mr. F. A. Channing says: "It is odd that men whose thought is mainly an outcome of modern science should fail to apply what is, perhaps, the most striking conception of modern science—that of time in relation to growth—to questions such as this of Euthanasia. If the central human instincts on which morality rests are the slowly-won product of ages of moral growth, a practice out of harmony with the most fundamental of those instincts, however speculatively excellent, could not be introduced without mischief. It would sacrifice too much of human feeling before it had time to put itself on a rational footing. Even in the individual philosopher it may be doubted whether reason could remodel instinct so as to make the sense of duty in such a case really complete. In most men the overridden instincts would merely be replaced by selfishness and cruelty to the helpless. They would lose the gentleness of strength, without gaining the least glimpse of the new morality.
"In Euthanasia we are offered a refined copy of the customs of some savage tribes, among whom life is more difficult to maintain, and so less valuable. But, then, their instincts are on the level of their customs. There is no jar between calculation and sentiment, such as we should have. Such a jar would make the practice, if adopted among us, spring from an estimate of personal advantages, and not from the half-thought-out sense of what is best, which is duty to most men. And, where such imperative instincts as the desire to keep life for ourselves and our friends at all costs are directly repressed in forming and acting on this estimate, the result must be moral loss to all except the philosopher who has had time to think his soul to oneness under the rule of reason. Euthanasia might become a wholesome doctrine if time should dissolve our present, perhaps animal, feelings, and replace them by more economical sentiments. But, as we are, it could only be an esoteric doctrine for the few who might have opportunities of ending hopeless misery by chloroform without giving needless pain to their friends. That is, it would be applicable only in the way Prof. Newman deprecates.
"It may, of course, be urged that there has been a latent change in men's notions of life and death which only needs expression, and that, if men talked freely, many would be found to talk Euthanasia. But facts like the growing aversion to capital punishment seem to point the other way. It is not because we feel less keenly the horror of murder, but because we are more scrupulous about taking even the least worthy life. Take the growing leniency toward infanticide. It is not because there is a change of opinion as to the duty of keeping even superfluous babies alive, but because we are more reluctant to take a woman's life in vengeance for a child's. Again, the sense that under certain circumstances it would be better for us or those dear to us to die, is surely far from being the true wish for death overwhelming the passionate impulse to keep up life to the last.
"It might be said, too, that the apology of Euthanasia stands on the same footing as the apology of cowardice, such as those French towns showed whose people did not think it worth while to hold out. Was it, or was it not worth while?".