Death, Dying, and Euthanasia

Edited by Dennis J. Horan and David Mall
(Aletheia Books, 1980)

Reviewed by Thomas J. Marzen, J.D.

Editor's note. 1998 is the 25th anniversary of the dreadful Roe v. Wade decision. In each issue this year NRLNews is presenting either a revealing portrait of the abortion mentality written by a pro-abortionist, or a thoughtful critique of the abortion mindset composed by a pro-life champion.

Death, Dying, and Euthanasia was intended as the definitive compilation of articles and essays on end-of-life issues when published in 1980. Its pro-life editors, attorney Dennis Horan and educator David Mall gathered the seminal writings of the most prominent combatants from both sides at the dawn of the modern euthanasia wars.

To their immense credit, 20 years and a thousand momentous events later, most of the collection is still fresh. The volume remains invaluable for basic source materials in the controversy. Even where dated, the book is interesting for what it reveals about the distances we have slid down slippery slopes in the past two decades. While, in retrospect, there were limitations to the pro-life response, this does not detract from the overall merit of this groundbreaking book.
All the then-disputed death and dying topics are addressed: definitions of death and the "brain death" controversy, the emerging debate on non-treatment of children born with disabilities, the early controversy on withholding and withdrawing treatment, and the basics on active euthanasia. The book contains much of the seminal writing with which any serious student of the issue should be acquainted.

Death, Dying, and Euthanasia includes both reprints of classic pro-and-con essays on euthanasia and equally valuable original material. Among the former is the Duff and Campbell 1973 article justifying decisions to withhold treatment from infants with disabling conditions at Yale-New Haven Hospital. There is also Yale Kamisar's 1958 article, "Some Non-Religious Views against Proposed 'Mercy-Killing' Legislation," along with a rejoinder by Glanville Williams, the English legal scholar who argues for legalized euthanasia. There is famed pediatric surgeon C. Everett Koop's essay on the proper treatment of the seriously ill child that was a prelude to his appointment as surgeon general.
Also found is Pope Pius XII's oft-cited address on prolongation of life along with two definitive essays by the one-and-only Paul Ramsey with titles that speak for themselves: "The Indignity of Death with Dignity" and "Death's Pedagogy." Included among the 36 authors is Joseph Fletcher, the original apostle of situational ethics, and his apology for euthanasia.

Then there is Leo Alexander's immensely important essay that traced the origins of the Nazi Holocaust to its eugenic roots, " Medical Science under Dictatorship." Also found is Fredric Wertham's "The Geranium in the Window: The 'Euthanasia' Murders," the earliest examination of the human disposal program for the mentally and physically ill and disabled in pre-Nazi and Nazi Germany. All classics, and all together in one 837-page book.

There are several original articles of lasting value as well: " Suicide and Euthanasia" by Germain Grisez, now perhaps the most prominent Roman Catholic moral theologian in the world; and " Death and the Rhetoric of Unknowing" by David Mall, discussing the linguistic twists and turns in the euthanasia debate. And there are brief essays on the death culture by the provocative Marshall McLuhan and by playwright Eugene Ionesco.

As this summary of its contents demonstrates, leading proponents of euthanasia are provided a forum in Death, Dying, and Euthanasia as foils to their pro-life opponents. But the pro- life commentators are more numerous and, the editors implicitly believed, more persuasive.

Now, nearly 20 years later, one can ask: Has the end-of-life policy debate unfolded along the lines that the contributors of the book might have hoped or predicted?

Yes and no. A few examples might illustrate the point.

The pro-life authors certainly recognized the moral sentimentalism and obeisance to the Great God Personal Autonomy which the Death Lobby reflects with religious fervor.

The pro-lifers did not tend to attack the foundational principles of the euthanasia crowd directly, perhaps because they recognized that worship of the Sentimental Self had already firmly taken hold in popular culture.

Instead, their principal non-religious approach to countering euthanasia advocacy was to play out the logic of the premises of the pro-euthanasia position to inescapable conclusions - - conclusions that the pro-life advocates assumed most people would find unacceptable. It was suggested that the inevitable and repellant end-point of accepting any euthanasia at all was the development of a governmentally compelled Holocaust scenario of some sort.

Certainly, the example of The Netherlands, a nation just beginning its euthanasia program in 1980, validates the slippery slope argument that was at the heart of the secular pro-life defense. "Rational, voluntary" assisted suicide for the "terminally ill" quickly mutated into non-voluntary mercy killing of disabled infants and the mentally disabled there.

The process has not yet run its course in The Netherlands, and is beginning to unfold in Oregon. Who can say what monstrous shape it will eventually take if left unchecked?

Yet, in America at least, it seems doubtful that euthanasia would become just like that practiced in Nazi Germany. Instead, Americans would insist on "choice" even while creating a social, economic, and legal climate that would strongly influence, and even coerce, the outcome toward a decision in favor of death.
Most fetal anomalies are now detected before birth in the U.S., and strong majorities of mothers now "choose" to have their disabled children aborted. The government does not march mothers of "defective children" off to abortion chambers against their will.

In a sense, it does not need to do so. Cultural, social, and economic mechanisms are firmly in place that together make a strong, even compelling, argument in favor of abortion.

The "invisible hand" of the supposedly "free marketplace" of ideas and "reproductive options" firmly leads the woman on to do her eugenic "duty."
Legalized euthanasia would almost certainly follow a similar pattern, with patients "choosing" it for themselves in some cases, and in other cases their families choosing it for them as the most practical, socially acceptable, and "humane" solution. Americans would franchise designer death, then market it as the best choice for the wise consumer until it has a virtual monopoly.

This is the more subtle way in which we would probably end up following the Nazi example, not with federal troops marching off "useless eaters" to death camps. We need to find a way to persuade people that the results would be just as evil: We would end up killing our weakest members just as the Nazis tried to kill theirs.For perhaps understandable reasons, in 1980 there seemed little awareness of the manner in which bean-counter consequentialism would influence the debate. The fact is, it costs big money and involves considerable medical expertise to provide curative treatment, life-sustaining treatment, and good palliative care.

Euthanasia in whatever form is typically marketed as a cheap and easy solution to such problems, presenting an incredible temptation in a health care financing and distribution system increasingly driven by the economic bottom line.
We have not yet fully come to terms with this problem.

Euthanasia becomes the preferred treatment option for many patients with expensive, painful, chronic, or disabling conditions. Our evolving "managed care" health care system, whether managed by the private corporations, the state, or both, can become a powerful engine driving us toward euthanasia.

The "Baby Doe" controversy was also coming to a boiling point in 1980. Several of the book's articles discuss development of non- treatment criteria for children born with serious disabilities. The pro-life authors loudly raised the alarm. But they also struggled, hamstrung by excessive allegiance to an ethic that provided virtually unrestricted discretion to physician and family in making even life-and-death decisions for children. The book was published only four years before passage of the federal Child Abuse Amendments of 1984, yet the idea of need for a such lawmuch less a federal law - - to prevent parents and doctors from in effect entering into a conspiracy to kill children by neglect would have been unthinkable and even objectionable to these authors.

This weakness in the opposition perspective is repeated in critiques of the California "living will" law (the model for the many such laws then marching through the states), and the seminal 1975 decision of the New Jersey Supreme Court justifying withdrawal of a respirator from Karen Ann Quinlan.

The pro-life response to these events suggested by the authors of this volume was, in sum, that legislative or judicial forays into end-of-life matters were offensive and unnecessary intrusions into decisions that should be left to physicians and family members. In retrospect, and quite incongruously, the pro- life position was too often wedded to the assumption that innately virtuous doctors and families would "just do the right thing" when it came to withholding or providing treatment if left to their own devices.

Intervening experience teaches a different lesson. "Families" do not always exist in any meaningful sense. They can be dishonorable, venal, and even murderous - - but are far more often confused, dazed, and utterly pliable in the hands of the medical profession. And, as witnessed by the various "futility projects" cropping up around the country, health care providers are beginning to play hard ball when patients and families do not comply with the doctor's "recommendation" not to treat. The requested treatment is declared "futile" by an ethics committee even if it would keep the patient alive, then the patient is denied the treatment in the hospital and in all the hospitals in the area in accord with a mutual enforcement agreement. So much for patient choice and family decisionmaking.

Moreover, this approach did nothing to slow the "living will" juggernaut. It offered no resistance to courts and legislatures that sought to "solve" the problem of end-of-life decisionmaking by giving virtually absolute life-and-death authority to family surrogates. Every state in the union (except three) and the District of Columbia now have "living will" statutes.

And worse, 28 states and the District of Columbia now have statutory surrogacy laws allowing families to withhold or withdraw all forms of medical care from mentally incapacitated persons, including tube feeding and hydration. The courts have almost universally proceeded along the same lines. (See story, page 4.)

Death, Dying, and Euthanasia mightily contributed to raising pro-life consciousness on euthanasia. Thus it played an important part in meeting the challenge of infanticide in the 1980s and those who are attempting to create a constitutional right to assisted suicide in the courts in the 1990s.

We avoided catastrophe in the U.S. Supreme Court last year when the High Court rejected the claim that there is a right to assisted suicide guaranteed by the Constitution.

But the Euthanasia Wars continue on even more viciously in the trenches: in Congress, state by state, issue by issue.

Death, Dying, and Euthanasia should be part of the basic training of anyone who would join this life-and-death fray.