A Pro-Life Primer on Euthanasia

By Eileen Doyle, R.N.

Definitions and Examples

The definition of euthanasia is simple: "Easy, painless death." But the concept of euthanasia proposed by adherents of the euthanasia movement is complex and has profound consequences for all.

Because the subject involves the discipline of medicine (diagnosis, treatment, prognosis, medical ethics and so on) as well as the discipline of law, the general public will have difficulty understanding it without some knowledge of these matters.

The purpose of this study is to inform our readers clearly and coherently enough that they can make sense of the euthanasia question.

We begin with the definition of terms.

Definition of Terms

• Euthanasia: traditionally, an easy, painless death. Now used to mean "mercy killing," "assisted suicide," or "involuntary euthanasia."

• Voluntary euthanasia: death administered to one who asks for it. In practice, truly voluntary euthanasia requests may be very rare, since the patient rarely gives informed consent because the alleged consent is influenced by depression, improperly treated pain or other factors that are not controlled but could be controlled.

• Involuntary euthanasia: death administered without the recipient's consent, commonly known as "mercy killing," as in the case of children or incompetent adults.

• Active, direct or positive euthanasia: direct killing of the patient by administering lethal drugs or other direct means of ending life, or by withholding or withdrawing ordinary means of sustaining life such as food and water, protection from exposure and so on.

• Passive, indirect or negative euthanasia: ambiguous. Can be the decision by patient, parent or guardian and physician to withhold or withdraw extraordinary means of sustaining or prolonging life, such as deciding against high-risk surgery for a patient dying of cancer or kidney failure. When the intent is not to cause death but rather to reject extraordinary treatment, this results in the acceptance of death or continued life, whichever occurs, but it is not true euthanasia. The terms "passive," "indirect" or "negative euthanasia" should not be used since they play into the hands of euthanasia advocates by confusing legitimate actions with euthanasia, thereby desensitizing people to the fact that euthanasia is killing.

  More importantly, passive euthanasia is sometimes defined by others as the withholding of lifesaving treatment with the intention and result of causing the patient's death. This is the equivalent to active, direct euthanasia.

• Ordinary means: food, drink, rest, medicines, treatments and operations which offer a reasonable hope of benefit for the patient and which can be obtained and used without excessive expense, pain or other inconvenience.

• Extraordinary means: those treatments, medicines and operations which are gravely burdensome to the patient, and which cannot be obtained or used without excessive expense, pain or other inconvenience or which, if used, would not offer a reasonable hope of benefit to the patient. A court recently has defined extraordinary means to include food and has ordered the removing of food from a patient for the purpose of killing the patient.

The Position of Medicine, Theology and Law on Euthanasia

Active, direct or positive euthanasia is forbidden by law, and by most doctors and theologians. Under the common law it is murder or manslaughter in English-speaking countries, regardless of compassionate motives or consent of the victim.

To withhold or withdraw ordinary means of sustaining life is equivalent to direct or active euthanasia. Thus this is direct killing and consequently should be forbidden by medicine, theology and law. Killing patients by withdrawing food and fluids has been advocated by some theologians, physicians and courts.

To withhold or withdraw extraordinary means of sustaining life is not forbidden as such by medicine, theology or law.

When it is necessary for the comfort of the dying patient to give drugs to alleviate pain even though they may indirectly shorten his life or deprive him of the use of reason, it is neither active euthanasia nor is it forbidden by medicine, theology or law. Proper use of painkillers can relieve pain without destroying reasoning power.

Suicide

Suicide is the act and intent of a person to cause death to himself by direct killing (such as by lethal drug) or by withholding or withdrawing ordinary means (self-starvation).

The following is based on a legal analysis of suicide by Robert M. Byrn, professor of law at Fordham University School of Law, in an article, "Compulsory Lifesaving Treatment for the Competent Adult," Fordham Law Review, Volume 44, October 1, 1975.

Suicide had at one time been a crime with a penalty of "ignominious burial" and forfeiture of property. In the U.S. this penalty was abolished so that suicide is no longer strictly speaking a crime. But that does not make it lawful "in the sense that a right has been conferred."

Professor Byrn cites a 16th-century judge's legal objections to suicide:

1. It is an unnatural violation of the rules of self-preservation, because a "right" to suicide is the "apparent contradiction in a claim of right to destroy the life from which all rights flow."

2. It is a breach of (God's) commandment, "Thou shalt not kill." In modern law, "the value of human life qua human" means that killing oneself shows disvalue for human life qua human. This constitutes aggression against life, and treats life as property rather than unalienable.

3. Suicide is "against the King," depriving him of a subject, "transformed in American law to an inherent function of government to protect human life and not allow its destruction by legally permitting self-destruction.

4. It is an "evil example" to the King's subjects. So modern government "retains the power to bar conduct which will encourage suicide as an 'evil example' to other susceptible members of society."

Attempted suicide - in some states a crime but not punished.

Aiding and abetting a suicide or a suicide attempt - in many states a crime.

Preventing another from committing suicide (or from inflicting serious harm to himself) by the use of reasonable force - legal in many states.

Patient's Rights and Medical Care

Professor Byrn, in the previously cited article, also gave a summary of the relevant legal decisions concerning patients' rights to refuse medical care.

Legally Competent Adult Patients

Medical care per se - according to Anglo-American law every competent adult has the freedom to seek or not to seek medical care and to refuse to consent to any specific treatment proposed, under the common law right of bodily integrity and intangibility.

Lifesaving Medical Care

Competent adults may reject even lifesaving care under the right of bodily integrity and intangibility and also, if applicable, under the constitutional right of free exercise of religion (e.g., a Jehovah's Witness refusing a blood transfusion because it is against his religious beliefs).
1. They may not refuse lifesaving care if there is a compelling state interest in requiring treatment for the common good (e.g., immunization to prevent the spread of communicable disease).

2. A parent might be required to undergo lifesaving treatment if there is a compelling state interest in protecting the welfare of a child from being deprived of his needed caretaker.

3. Suicide attempts which result in life-threatening injuries may require lifesaving treatment which is given without requiring the patient's consent.

4. Rejection of lifesaving medical care is not legally equivalent to suicide because in those cases decided by the court none of the patients had a specific intent to cause his own death, but simply to accept the consequences of the life-threatening illness, "to let nature take its course" rather than undergo the burden of treatment.

Legally Incompetent Patients

These are patients who lack the ability to make legal choices, so that no right to refuse consent is involved. Therefore court-ordered life-saving treatment is not a subordination of patient choice. The court will usually order lifesaving or ordinary care, but treatment that is extraordinary is not required.

Minor Children

Prof. John A. Robertson, of the Wisconsin University Law School, wrote an article on medical care for children ("Involuntary Euthanasia of Defective Newborns - A Legal Analysis," Stanford Law Review, Vol. 27, 1975). He stated:

"Under traditional principles of criminal law the omission of ordinary care by parents, physicians and nurses creates criminal liability. The crimes committed may include murder, involuntary manslaughter, conspiracy and child abuse or neglect.

"Generally a person is criminally liable for homicide by omission if: 1) He has a legal duty to protect another; 2) with knowledge or gross negligence he fails to act; 3) and such failure proximately causes the death of the other.

"The pervasive practice of withholding ordinary medical care from defective newborns demonstrates we have embarked on a widespread program of involuntary euthanasia."

Case Studies

Discussion of the following cases is concerned only with whether or not the decisions are legal or illegal and not with their moral implications.

Determine whether the cases involve ordinary care or extraordinary care, and whether the decisions given would be legal or illegal:

1. An infant is born with Down's syndrome, indicating probable mental retardation. He needs very low-risk surgery for an easily correctible intestinal defect. If untreated the baby will not be able to retain food and will die. The parents refuse surgery, stating that the mental retardation will mean a less than meaningful life for the baby.

   Answer: This case involves ordinary care; illegal decision: Parents may not refuse ordinary care; the refusal of surgery would result in the proximate cause of death for the child they have a legal duty to protect. Courts, however, usually have ruled in favor of parents' refusal.

2. A seven-year-old girl, auto-accident victim with severe internal bleeding, needs an immediate blood transfusion to prevent death. Her parents refuse consent because blood transfusions are forbidden by their religion (Jehovah's Witnesses).

   Answer: This case involves ordinary care; illegal decision: Parents may not invoke their right to free exercise of religion to refuse lifesaving care for their child, for that would be a violation of the child's unalienable right to life, which takes precedence over all other fundamental rights.

3. A baby is born with anencephaly (part or most of the brain matter absent), with a prognosis of living only a few weeks or months. A decision is made to withhold all nourishment by mouth or other means.

   Answer: Ordinary care; illegal decision: Ordinary care is mandatory for all patients regardless of prognosis. However, in practice, many children like this are starved.

4. A 55-year-old man with severe circulatory problems has gangrene of the leg. Amputation is necessary to save his life. The man refuses consent.

   Answer: Ordinary care - with qualifications. This is one of those difficult cases which could be classified as extraordinary care if it would involve great psychological harm to the patient to be deprived of his leg. Morally he might feel free to refuse surgery but legally it would probably be ordinary care which would be lifesaving, the usual course of treatment for gangrene and of minimal risk.

   Legal decision - competent adults have the legal right to refuse treatment under the right of bodily integrity and intangibility. It would not be classified as suicide since the patient did not have the intent to cause his own death, but did not want the consequences of loss of limb resulting from surgery.

5. A 50-year-old woman is dying of cancer. She has only a few days to live. She has severe anemia due to the cancer. Even though a blood transfusion is the usual treatment for severe anemia, the decision is made not to give it.

   Answer: Extraordinary care - this is an example of a treatment that is ordinary care in most instances but becomes extraordinary care due to the circumstances of the particular case. The transfusion would not be effective against the advanced cancer and would be burdensome to the patient.

   Legal decision - extraordinary care is not obligatory.

6. An 87-year-old incompetent woman with congestive heart and kidney failure has primary cancer of the intestine. Surgery is the usual treatment for such cancer but the family and doctor decide against it.

   Answer: Extraordinary care - because of the advanced age and serious medical condition of the patient the surgery that might be considered ordinary care becomes extraordinary care because of its high risk under these circumstances.

   Legal decision - extraordinary care is not obligatory.

7. A 45-year-old man has a bleeding ulcer for which he needs a blood transfusion. He refuses treatment because of religious beliefs which forbid transfusions of blood.

   Answer: Ordinary care; legal decision - competent adults have the right to refuse even lifesaving treatment involving ordinary care under the right of bodily integrity and intangibility. In addition, this patient also had the right to refuse under the free exercise of religious right.

8. A baby is born with spina bifida (open spine with spinal cord exposed) and hydrocephalus (excessive fluid surrounding the brain). Immediate surgery is necessary to close the exposed spinal cord to prevent dangerous infection that could cause death, and to install a shunt to drain the excess fluid in the brain to prevent brain damage. The parents refuse consent because the child may be physically handicapped, involving hardship for the child and parents.

   Answer: Ordinary care - because of the recent advances in spina bifida surgery and medical care, what had been high-risk surgery at one time is no longer so risky.

   The Spina Bifida Association of America filed an amicus curiae brief to the New York State Court of Appeals Oct. 28, 1983, in the Infant Jane Doe case. The brief states, "Nearly all patients who receive prompt and proper treatment now survive . . . have normal lifespans. . . . Left untreated, many die or live with greatly impaired futures, facing physical disabilities far more severe than they would have experienced with proper treatment and mental disabilities [which] proper treatment would have spared them altogether."

   Illegal decision - because the surgery involves ordinary care.

9. A baby is born with the same condition as above, spina bifida, but in addition the baby has no kidneys, a rare and fatal condition for which there is no treatment. No surgery was done for the spina bifida.

   Answer: Extraordinary care - ordinary care (surgery for spina bifida) becomes extraordinary care because the fatal kidney condition makes surgery useless. The baby will die regardless of treatment.

   Legal decision - useless treatment not required.

10. 5-year-old man stabs himself in the chest in a suicide attempt. Emergency chest surgery is needed to save his life. The man refuses consent.

    Answer: Ordinary care; illegal decision - even though he is a competent adult, surgery to treat his injuries may be done without his consent because they were incurred as a result of a suicide attempt.

The Euthanasia Movement and Its Goals The Position of the Euthanasia Movement

The Euthanasia Society of America was formed in 1938 with the aim of proposing legislation to allow active voluntary euthanasia. Three past presidents and one treasurer also favored involuntary, active euthanasia, according to Yale Kamisar in Euthanasia and the Right to Death.

In 1967 the society's name was changed to the Euthanasia Educational Council and it officially supported voluntary, passive euthanasia. Many of its members, however, were in favor of active euthanasia.

Dr. Joseph Fletcher, on the advisory council of the Euthanasia Educational Council, advocated in the Atlantic Monthly (April 1968) that a parent has the right to choose active, involuntary euthanasia for his child who has Down's syndrome.

The Euthanasia Educational Council held a series of conferences since 1968 with publications of the proceedings showing advocacy for not only active, voluntary euthanasia but also for active, involuntary euthanasia if society were ready to accept it.

In Attitudes Toward Euthanasia, a publication of the Third Euthanasia Conference (1970), Dr. Marvin Kohl, Ph.D., said, "In some situations, especially in certain cases of euthanasia, morality demands the killing of the innocent" (p. 6).

And Dr. Joseph Fletcher remarked that he welcomed the fact that Judge Russell Frankel of the N.Y. Federal District Court and others had adopted this statement for public use, "We should make a study of whether suicide and other laws can be modified to enable victims of terminal illnesses to avoid the unwelcome prolongation of life with assistance and without penalty" (p. 11).

The Rev. M. McKinney, former president of the Euthanasia Educational Council, spoke in 1971 at the Fourth Euthanasia Conference, and his remarks were published in Dilemmas of Euthanasia: "When the society began its work some 30 or 40 years ago, the primary thrust was . . . to try to get laws passed allowing voluntary euthanasia . . . our board came to the conclusion that it was a mistake to try to push for legislation and that the educational task before us was enormous" (page 31).

At that same conference a doctor thought it wrong to keep alive a grossly retarded child because it would harm parents and family. Commenting on the idea of euthanasia for children, Dr. Joseph Fletcher stated, "In terms of educational strategy . . . we use tactics of emotional gradation. If . . . in old age it is less tragic than in youth, we begin with that . . . Then we can begin to apply them to more difficult ages emotionally."

On the same point Dr. Ruth Russell thought euthanasia for children ought to be legalized.

In 1978 the Euthanasia Educational Council's newsletter, Euthanasia News (Winter 1978), quoted the current views of Dr. Fletcher, president emeritus of the Euthanasia Society of America, renamed the Society for the Right to Die. He admitted that the need for euthanasia because of unbearable pain was now invalid because of modern analgesia, but the new emphasis was respect for the dignity of patients and concern for their loss of personal qualities even if they had no pain. He favored a change in the law to allow active euthanasia.

In his book, Humanhood: Essays in Biomedical Ethics (Prometheus Books, 1979), Dr. Fletcher advocated "a new ethical concept centered on the quality of life to replace the old ethics based on the sanctity of life." He asserted that in some cases active euthanasia is a "moral obligation."

In November 1978 the Euthanasia Educational Council, formerly part of the Euthanasia Society to America, changed its name to Concern for Dying. But the goals had not changed!

The executive director, Mrs. A.J. Rock Levinson, stated in a letter that "our people believe rational suicide to be acceptable but that to foist our ideas too strongly and too soon on a society not yet ready to consider them, we will damage, if not destroy our effectiveness" (Euthanasia News, March 1978).

Strategy

Since the euthanasia movement's goal is to legalize active, voluntary and, in some cases, involuntary euthanasia, what has to be legalized is what cannot be legalized! That is, we cannot legalize the killing of people who are innocent of unjust aggression against other's lives.

Under our system of law, which must abide by the Constitution, laws permitting the killing of innocent citizens would be clear violations of the Fifth and Fourteenth Amendments of the Constitution and therefore invalid. This point is crucial! It demonstrates that the only way euthanasia could be legalized is by a court decision, not by a statute.

Even more important, killing the innocent, regardless of motive, is a violation of our most cherished principles as a people, embodied in the concept of unalienable rights - to life, liberty and the pursuit of happiness.

This sanctity-of-life ethic, as it is called, while rapidly eroding among elites in the academic, medical and legal spheres, is still held in high esteem by millions of ordinary American citizens who would be outraged to find it swept away and replaced by a new, "enlightened" quality-of-life ethic, conceived and orchestrated by those same elites.

Euthanasia advocates are well aware of these formidable obstacles, so they must devise a strategy which will overcome them. By analyzing their tactics and programs, a definite strategy becomes clear:

1. They are asserting that there is a constitutional right to die and have geared their educational programs to the general public, professional groups in medicine, theology, nursing and law to persuade people to accept this concept.

2. They propose to redefine legal personhood and replace the sanctity-of-life ethic with the quality-of-life ethic.

3. They discuss "hard cases" and blur the crucial distinction between cases involving ordinary care (legally mandatory) and extraordinary care (not legally required). Recall that the definition of active, direct or positive euthanasia includes the withholding or withdrawal of ordinary care!

Analysis of the Strategic Concepts

We will examine first the idea of a constitutional right to die, and all that that implies, and then we will turn to consideration of redefining legal personhood, coupled with the establishment of the quality-of-life ethic.

The constitutional right to die: In order to legalize euthanasia, a way must be found to circumvent the Fifth and Fourteenth Amendments to the Constitution, which protect the lives of innocent persons, since society is not about to repeal those amendments.

So euthanasia proponents propose a new, additional unalienable right - a "right to die." This way people can choose to forfeit their right to life in favor of their right to die.

This right, they say, could find precedent in the constitutionally protected right of privacy granted by the Supreme Court abortion decisions of 1973 (Roe v. Wade, 410 U.S. 113, and Doe v. Bolton, 410 U.S. 179). The Court could simply extend that right to include decisions about dying.

In the publication of the Fourth Euthanasia Conference, Dilemmas of Euthanasia, Prof. Cyril Means acknowledged the legal problems posed by euthanasia and proposed a method of winning through the court for someone "who is conscious but suffering from an incurable malady" under the Eighth Amendment, which forbids the state to impose cruel and unusual punishment.

Therefore the state could not forbid a patient to take "measures to alleviate his suffering even by shortening or terminating his own life." If the patient is unconscious, a guardian or committee could be appointed on his behalf.

In response to comments that there should be a test case in the Supreme Court and the idea that the right to die entailed a "claim on other people to help us die," Professor Means, as a law professor, gave his opinion that "we have a system of constitutional adjudication whereby people can assert rights as against the state or as against their professional aides like doctors and others. Consequently, if one makes a claim of such a constitutional right and gets it before a court and the court says, 'you have got it,' you can have it without legislation. In every other country . . . you would have to get through legislation" (p. 36).

Persuading much of society to accept the idea of a right to die has been relatively easy, especially with all the help of the media publicizing the phrase "right to die."

Propaganda began in the late 1960s and early 1970s at euthanasia conferences and in the media and with the introduction of right- to-die or living-will legislation in state legislatures. By 1978 the Euthanasia Society had changed its name to the Society for the Right to Die, announcing plans to get right-to-die legislation passed in as many states as possible and, by 1981, reporting success in 11 states. The Society for the Right to Die again changed its name to Choice in Dying, its current name in 1992.

Right-to-die or living-will legislation: This merits further discussion, since these bills are being promoted vigorously in many state legislatures as part of the euthanasia strategy.

The short-term purpose, seemingly innocuous, is to have states legalize living-will documents. These documents were conceived by the Euthanasia Society in 1967. In them the person states, "If there is no reasonable expectation of my recovery from extreme mental or physical disability, I direct that I be allowed to die and not be kept alive by medications, artificial means or heroic measures."

Objections to right-to-die or living-will legislation:

1. Legally, patients already have the right, under the common law right of bodily integrity and intangibility, to refuse extraordinary care, which is at issue in this type of legislation.

2. Physicians may feel constrained by the legal limitations of these documents and discontinue treatment too soon. Inevitably, some patients will die who might have recovered.

3. If living wills are legalized, then physicians of patients who have not signed them might assume that patients want maximum treatment and refuse to discontinue inappropriate treatment, thereby causing excessive hardship and expense for patient and family.

4. Living-will documents are signed before, often long before, the circumstances of a particular illness occur. Therefore it is doubtful that they fulfill the legal requirements of informed consent as stated in the federal guidelines, which require that "a patient must be given . . . a detailed explanation of the procedures, benefits and alternative procedures connected with his treatment . . ."

   The patient may not sign a consent document waiving his legal rights or releasing an institution or agent from liability for negligence (R. Hummel, Hospital Progress, June 1976, p. 55).

5. The terminology is so broad and, in some cases, so vague it becomes medically and legally ambiguous. It is virtually impossible to write a bill comprehensive enough to cover the special circumstances of each patient's medical condition, which would be essential for the practice of good medicine and good law.

6. Some groups such as the elderly, the immature or the indigent might be unduly pressured, because they do not want to be a "burden," to cut down on the increasingly higher medical costs for treatment.

7. The terminology in some of the bills is so ambiguous it could be construed to allow withholding ordinary care. For example, "artificial means" might be interpreted to exclude the use of tube feedings for patients unable to take food by mouth, thus denying a patient all nourishment.

All of the living-will type of legislation is geared to blur the distinction between ordinary and extraordinary care.

The long-term purpose of right-to-die or living-will legislation is the great propaganda value in conditioning people, state by state, to accept that they have a "right to die."

However, the goals of active voluntary and involuntary euthanasia cannot be achieved by such legislation since direct killing or the withholding of ordinary care are not permitted and any attempt to pass such laws would quickly bring a challenge in the courts, which is where the euthanasia advocates plan and hope to win all their goals.

It would be the Supreme Court which would ultimately have to decide: Do we or do we not have a constitutional right to die? The implications are awesome and will be dealt with subsequently in our study of the question. Fortunately, in Cruzan v. Harmon, 110 S. Ct. 2841 (1990), the U.S. Supreme Court decided that the U.S. Constitution does not include a "right to die."

Redefine "legal person" and replace the sanctity-of-life ethic with the quality-of-life ethic: Under the Constitution, all innocent persons are guaranteed the protection of their lives. The dictionary defines "person" as "a human being" and defines a human being as "a person." The U.S. Constitution gives rights not to human beings, but rather to persons. Title I U.S. Code Section 1 defines "person" to include individuals. The 1947-1948 U.S. Congress first enacted the definition of "person" without making it clear that every human being or individual is a person. After a few months' exposure to publicity from the Nazi War Crimes trials Congress realized that the method the Nazis used to justify the holocaust was to define Jews and other unwanted humans as non-persons. Defining them as non-persons took away all their rights and protections. The same Congress that had passed Title I U.S. Code Section 1 a few months before then changed Title I U.S. Code Section 1 to make certain that every human being had to be defined as a person by defining every individual to be a person. Euthanasia adherents propose that we redefine "person" to exclude some classes of human beings; that human beings must pass certain tests before being declared persons who have unalienable rights.

Daniel Callahan (not in favor of euthanasia) in Abortion: Law, Choice and Morality defines "person" as "one who is capable of rationality, interaction with others, affectivity and culture making."

Joseph Fletcher, a leading euthanasia advocate, gave his version of "person" in Attitudes Toward Euthanasia: "Something that has to be answered in terms of cerebration, memory, sense of futurity, some evident clinical capacity for interpersonal relationships, will or purpose; lovingness . . . a minimum I.Q.; utilitarian questions about social productivity and its potential . . ."

The argument goes that those human beings who fail to qualify as persons under this new definition can then be legally denied unalienable rights, so to kill them would then not be a violation of law.

This is precisely what the Supreme Court abortion decisions of 1973 ruled concerning all human beings before birth, declaring they were not persons because they were not "capable of meaningful life" and were "not persons in the whole sense." Thus they were deprived of their unalienable right to life and it became legal to kill them.

Euthanasia advocates argue that other classes of human beings could be declared non-persons, without unalienable rights, in order for them to be killed legally. The abortion decisions could be used as precedent.

In The Right to Die with Dignity, publication of the First Euthanasia Conference (1968), Dr. Henry Pitney Van Dusen said the term "life" meant "the total personal being - body, mind and spirit."

Florence Clothier argued for "death of the body for those whose central nervous system and mind are already dead . . . these once men and women."

Chaplain Robert Reeves argued that when illness caused someone to lose his freedom, integrity and dignity, then his personhood was gone and we should find a way to give him "an honorable exit from life."

In Dilemmas of Euthanasia (publication of the Fourth Euthanasia Conference), Prof. Cyril Means, euthanasia movement leader (also pro-abortion leader in the Supreme Court abortion cases), said, "What is sacred and what the law seeks to protect is not human life itself, but the human person."

Dr. Joseph Fletcher argued that a new ethical concept based on the quality of life must replace the old ethics based on the sanctity of life, in Humanhood: Essays in Biomedical Ethics (Prometheus Books, 1979).

Definition-of-death bills: These pieces of legislation define death as a "total cessation of all brain function" and are supported by euthanasia advocates as part of their strategy of redefining personhood.

William J. Curran, J.D., refers to "brain death - a form of irreversible coma, which is a quality-of-life standard" (New England Journal of Medicine, February 2, 1984, p. 298).

Willard Gaylin wrote in Harper's Magazine in September, 1974: "The problem [of euthanasia] is well on its way to being resolved by what must have seemed a relatively simple and ingenious method. As it turned out, the difficult issues of euthanasia could be evaded by redefining death."

Arguments against definition-of-death bills: Paul A. Byrne, M.D., and Paul M. Quay, S.J., Ph.D., presented many arguments against brain-related criteria for death, including the following: "Cessation of total brain function, whether irreversible or not, is not necessarily linked to destruction of the brain or to the death of the person" (JAMA, 242: 1985-1990, 1979; and Understanding Brain Death, Nebraska Coalition for Life Educational Trust Fund).

Irreversible cessation of breathing was, at one time, a sign of death but when it was discovered that non-functioning of the respiratory organs did not always mean the destruction of the organs, it led to the use of mechanical ventilators or respirators to take over the lost function. This saved many lives.

So, too, with heart functioning; when it was found that cessation of heartbeat did not mean the destruction of the heart, mechanical means of resuscitation of heart functioning were contrived.

Drs. Byrne and Quay cited the work of P. Safer ("On Evolution of Brain Resuscitation," Critical Care Medicine, 1978, pp. 199-202) on successful brain resuscitation in cases where both brain-related criteria and the older, generally accepted criteria would have declared that death had occurred.

The authors spoke of the "recoveries of all those who have shown for many hours, or even days, no discernible brain function as a result of various depressant poisons or of hypothermia."

They later stated that "almost all sets of criteria depend for their reliability on the absence of drugs (and a number of other medical conditions) that can mimic death by suspending brain activity for lengthy periods."

Yet several of the greatest experts in this field (who themselves accept the notion of "brain death") state that it is often impossible to find out whether such drugs or other conditions are present or absent.

They further state that there are more than 30 different sets of medical criteria to determine irreversible cessation of brain function, and that "one out of every 12 patients declared dead by the various criteria strongly urged upon state legislatures and courts, still shows non-random function of the cortex of the brain, the part where sensation, feeling and consciousness seem to reside."

Dr. Byrne, Father Quay and attorney Peter Salsich have, in an in-depth article in the Gonzaga Law Review, presented reasoning as to why it is necessary to pass a statute worded as follows: "No one shall be declared dead unless the respiratory and circulatory systems and the entire brain have been destroyed. Such destruction shall be determined in accord with universally accepted medical standards." The Gonzaga Law Review article is "Brain Death - the Patient, the Physician, and Society" (18: 3, 1982/83, pp. 429-516). A reprint is available from American Life League.

Arguments Against Euthanasia

Some Arguments Against Voluntary Active Euthanasia

Germain Grisez and Joseph M. Boyle, Jr., authors of Life and Death with Liberty and Justice (University of Notre Dame Press, 1979, pp. 149-170), offered the following objections to legalizing voluntary active euthanasia:

1. Patients will have to be told the full extent of the pain, suffering and hopelessness of their medical condition all at once rather than in gradual, tolerable stages, in order to safeguard the legal requirements of informed consent needed for truly voluntary euthanasia.

2. Patients not wanting euthanasia would inevitably hear about their dreadful prognosis from other patients with similar medical conditions, relatives and so on, and have to bear the burden of such unwanted information.

3. It will cause conflict for people who are morally opposed to euthanasia but who might be tempted to accept it anyway to avoid the burden of suffering. This will add a second burden of feeling guilty for having violated their consciences.

4. Patients may be tempted to choose euthanasia from altruistic motives, even though morally or otherwise opposed, so as not to be a "burden" or from a feeling of guilt for using scarce medical and economic resources.

5. No matter what the safeguards, patients not wanting euthanasia may become anxious that they will be included as victims.

   Very sick or debilitated people in hospitals or nursing homes are often confused, anxious and not too reasonable. Emotional regression is common. Just knowing that people around them are being killed could arouse in them tremendous apprehension that all the reassurance in the world will not ease.

6. The family or loved ones of a patient choosing euthanasia may find it morally repugnant (as with suicide) and suffer much more grief than if it were a natural death.

   Most of the objections concern the harmful effects of legalizing euthanasia on those who are opposed to euthanasia. Grisez and Boyle argued, "From the point of view of sound jurisprudence, the self-interest of the opponents of euthanasia can no more be excluded from consideration than the self-interest of its proponents." They stated that legalizing voluntary euthanasia would serve no public interest but only the personal, private interest of those demanding legalization.

   The authors believe that the most decisive argument against legalization is the one based on the "jurisprudential principles of justice and liberty." The argument is as follows:

7. "If voluntary active euthanasia is legalized without regulation, those who do not wish to be killed are likely to become its unwilling victims; this would deny them the protection they presently enjoy of the law of homicide. And since the denial is to serve a private interest, it will be an injustice.

   "If voluntary active euthanasia is legalized with close regulation, which will involve the government in killing, those who abhor such killing will be involved against their wishes, at least to the extent that the government and institutions will be utilized for this purpose.

   "Since the government's involvement will be required only as a means to the promotion of a private interest, this state action will unjustly infringe the liberty of all who do not consent to mercy killing as a good to whose promotion state action might legitimately be directed.

   "A solution involving a compromise between legalization of voluntary active euthanasia without regulation of the practice and legalization with close regulation, which will involve the government in mercy killing, would mean some degree of lessened protection together with some degree of government involvement, a situation which will result in injustice partly due to the reduced protection of the lives of those who do not wish to be killed and partly due to the unwilling involvement of those who do not wish to kill.

   "Since the stated conditions are all the possible conditions under which voluntary active euthanasia could be legalized, legalization is impossible without injustice.

   "Therefore, the legalization of voluntary active euthanasia must be excluded" (p. 153).

   On these points, the authors further argued that "The public has a liberty to stand aloof from the killing of human beings. This consideration, together with the already well-argued point that even voluntary euthanasia cannot be legalized without undue danger or extensive public involvement, poses a very serious dilemma for proponents of legalization. . . . Nor will it do to say that the liberty of those who abhor mercy killing to stand aloof would only be slightly infringed by governmental involvement in this practice. Reading a few Bible verses each day in the public schools is only a little establishment of religion. But that little is too much for those who take conscientious objection to it" (pp. 169, 170).

8. The psychological burden of having to make such a decision rests on an already overburdened patient. Most of us find making major decisions very difficult. We are often filled with conflict, ambivalence and anxiety and would be over the enormous consequences of that choice.

   If we were asked to choose regarding euthanasia, which conflicts with our instinct for self-preservation, the pain of having to choose could put an unbearable pressure on most people.

   If we choose death, there is no undoing the choice and no way of knowing from experiences of others who have made that choice if it is a good one or a bad one, because those who have made it are no longer alive to advise us.

   It is also relatively rare to find a patient with a fixed and enduring wish to die. What we claim we would do while in good health and under no threat is not an indicator at all.

   Avery Weisman, M.D., of the department of psychiatry at Harvard Medical School, brought up this point in his book On Dying and Denying: "When healthy people are asked what they would do should they be found to have an incurable illness, many promptly declare they would commit suicide. Actually, evidence indicates suicide is rather infrequent among cancer patients. . . .

   "The intention to take one's own life rather than submit to fatal illness is rarely implemented. . . . The option to destroy oneself is not an expression of freedom, but one of despair . . ." (pp. 25-38).

   Elisabeth Kubler Ross, M.D., who has done extensive studies involving dying patients, stated in Attitudes Towards Euthanasia (publication of the Third Euthanasia Conference), "Our interviews have shown that all patients have kept a door open to continued existence and not one of them has at all times maintained that there is no wish to live at all."

9. Euthanasia portends harmful effects on good medical care. Alfred Jatetzki, M.D., associate professor of surgery at Columbia-Presbyterian Medical School, stated in Dilemmas of Euthanasia (publication of the Fourth Euthanasia Conference), that it was hard to be certain a patient was really dying in many cases.

   He cautioned that many doctors have had patients whom they thought hopeless recover, and stated, "As the medical sciences progress, it becomes more and more of a problem . . .

   "If we ... are thinking of ten patients who were put through a great ordeal and only one or two or three benefit from it, then this becomes a major moral issue. . . . The doctors cannot help but be influenced by maybe even those two or three . . ."

   Lawrence V. Foye, M.D., in his statement before the Senate Special Committee on Aging, August 7, 1972 (as reported in the AARP News Bulletin, September 1972), expressed a similar concern:

   "If a physician withholds maximum efforts from patients he considers hopelessly ill, he will unavoidably withhold maximum effort from the occasional patient who could have been saved." He reasoned that the only way to be sure a case is hopeless is to try all available therapies and find them of no avail.

   Jonathan H. Pincus, M.D., associate professor of neurology at Yale University School of Medicine, declared in a New York Times letter on January 24, 1973, "Many patients who could have been allowed to die are alive and doing well because of some new advance in therapeutics which occurred during the course of their illness . . . when a doctor is considering possible therapeutic courses of action for his patient, homicide would not be among them!"

   Another of his concerns was that fewer health care resources would be allocated to those considered "better off dead."

   A Dr. Lebensohn spoke at the Third Euthanasia Conference, according to Attitudes Towards Euthanasia: "His [the physician's] mere presence in the room is a symbol of hope. . . . If he is associated in the mind of the patient or of the public with being also the terminator of life . . . there is going to be a great conflict, fear and distrust, similar to that which occurred in the time of Rome, where the poisoners were very prevalent."

10. There are the subtle but nonetheless powerful pressures exerted by those who are involved in the care of the hopelessly ill. If the patient decides to hang on to life rather than choose to be put to death, hard-pressed medical personnel and economically and emotionally exhausted families may become less tolerant of these "better-off-dead" patients.

    Their feelings could be expressed in countless unspoken and even spoken ways, exerting pressure on the patient to choose death against his own real wishes or making him feel unloved and unwanted while he remains alive.

    Perhaps those few who would truly choose euthanasia if it were legal might find a meaning in their suffering, knowing that a liberty for themselves is a liberty worth rejecting if it would cause great harm to many others.

Arguments Against Non-Voluntary Active Euthanasia

Grisez and Boyle in Life and Death with Liberty and Justice moved the debate to non-voluntary active euthanasia. The basis of their argument against it is, as with voluntary euthanasia, that to legalize it would be a violation of the jurisprudential principles of justice and liberty.

The authors reasoned that even though euthanasia advocates attempt to show that Anglo-American legal conceptions of justice have religious roots, this point is irrelevant, since "they are an essential part of the consensus upon which the legitimacy of American government rests" (p. 217).

Further, the authors pointed out "that no advocate of euthanasia has challenged the requirement of equal protection of the laws. . . . The manner in which they argue for their proposals shows they are seeking to meet the requirement of equal protection of the laws with respect to the law of homicide" (p. 217).

Instead of denying equal protection, euthanasia advocates have three ways of arguing against applying the principle:

1. They assert that killing some human beings is a benefit to the ones killed rather than a harm, since their quality of life is so poor: life is no longer a good to be protected by the law.

2. They believe that even though some human beings may belong to the human species, they don't merit equal protection because they should not be legally classified as persons.

3. They argue that there is a compelling state interest sufficient to deny equal protection of the law to a certain class of people: those who are permanently dependent, institutionalized, not able to contribute to society and being cared for by public funds.

The compelling state interest they see there rests on the high public expense of the care of these people, which they say is sufficient to override the right of these unfortunates not to be killed.

They further claim that the state interest overrides the "liberty [of other citizens] to stand aloof" from killing.

Therefore, this class of dependent people should be killed to ease the economic burden and, it is further asserted, it would be less unjust to kill them than to let them die of neglect, as we do now.

(Richard Trubo gave examples of some institutions for the retarded spending less for food on each patient a day than a pet owner spends on his cat.)

Grisez and Boyle made the following points to refute this argument:

Killing these patients is not a necessity (that is, not the only way) to solve the problem of great economic costs. There are certainly alternatives short of the drastic one of killing the patients!

Even if the state ceased to pay for their care (a step certainly not advocated by any means), it would be no more unjust than killing them and would at least leave open the possibility that other private interests would provide the care.

Killing them would offer no hope at all. At the very least, the state, in refraining from killing them, is not violating its duty to provide equal protection of the law of homicide and has protected other citizens' liberty to remain aloof from killing.

The authors maintained, "Money is only a means, not a substantial public purpose in itself. The preamble to the Constitution of the U.S. mentions justice and liberty, public tranquility and the common defense, civil unity and the general welfare.

"It does not mention saving money . . . [Therefore] budgetary considerations as such never offer a compelling reason to override the liberty of citizens."

Euthanasia advocates claim that these dependent people make no contribution to society in return for the economic costs of their care. Grisez and Boyle questioned why the contribution is considered only in economic terms, rather than non-economic ones:

"The non-economic contribution of the helpless to society can be much more significant if it not merely generates psychological satisfactions but provides an occasion for exercising moral qualities of compassion and fairness."

They contended that the economic and the non-economic view each represent a particular worldview and asked, "Why should it be fair to impose one of these worldviews rather than the other upon helpless individuals? Equal protection of the law of homicide ought not to be modified to leave some class of individuals unprotected on the ground that on one or another worldview - perhaps even a widely held set of ideals and interests - such individuals contribute nothing" (pp. 228, 229).

If net burden to society is the criterion, the authors pointed out that "The wealthy consume tremendous amounts of scarce resources" and questioned whether they contribute sufficiently "to approximate the costs they impose on society."

Is a handicapped child or a millionaire a greater burden? The answer is purely subjective, depending on personal values or worldview. The rich and the powerful, of course, are in little danger of losing their right to equal protection.

It might also be argued there are numerous other classes of dependent citizens receiving enormous amounts of public funds: prisoners, those in drug or alcoholic abuse programs, people on Medicaid, Medicare and Social Security, welfare recipients, farmers receiving subsidies.

The list could go on and on. It is surely unfair discrimination to single out one group as candidates for killing because of a compelling state interest in saving funds.

It Used to Be Killing

Changes in dictionary definitions reflect changed perceptions on the part of the dictionary makers as to how the public uses the word in question. Check the definitions for "euthanasia" below and ask yourself, "Have we really forgotten that euthanasia is killing?"

From a pre-1950 dictionary: "Mode or act of inducing death painlessly or as a relief from pain."

From Webster's Third International Unabridged Dictionary (1968): "1. An easy death or means of inducing one. 2. The act or practice of painlessly putting to death persons suffering from incurable conditions or diseases."

From Taber's Cyclopedic Medical Dictionary (1981): "1. Dying easily, quietly and painlessly. 2. The act of willfully ending life in individuals with an incurable disease." (References provided by Mrs. Mary Stone, Allentown, PA.)

Should Voluntary Euthanasia Be Legalized?: Second Thoughts

The propaganda onslaught for legalizing voluntary euthanasia has been "sweet talking" the nation into believing that this is a beneficial private choice imposing no burdens or harm to others so why should those who wish it for themselves be denied the legal right to have it?

On the contrary, we argue that the legalization of voluntary euthanasia would impose enormous harmful consequences on the lives of many, including the person requesting it!

Harm to the Patient Requesting Euthanasia

1. It would rarely be a truly free choice. It would be very difficult to obtain valid informed consent. It is rare to find a patient with a fixed, rational, enduring wish to die. Fear of pain, rejection, loneliness and lowered self-esteem because of dependency are all variables that can influence the patient's wishes. As these needs are met the desire for death recedes.

   If a patient is depressed or in pain, informed consent is not possible and the physician may not be able to assess depression in a patient he does not know well.

   The result could be that a goodly number of patients would be killed who didn't really want it. Uncontrolled depression and pain are thought to be the two most frequent reasons why patients seek euthanasia. Both can be controlled so that the reason for seeking euthanasia vanishes.

2. Diagnoses and prognoses are not always accurate. Errors would lead to unnecessary deaths for some patients.

Harm to Others

1. There would be subtle pressure on other patients to request death to ease the burden on family and overworked doctors and nurses. There would be financial pressures, especially for the elderly, incurably ill or disabled. This might be in conflict with the patient's moral code and real desire to live, and could cause enormous suffering for the patient already burdened by his illness. If such a patient actually did sign for euthanasia it would be a totally invalid consent.

   For patients morally opposed to euthanasia who courageously accept their difficult end, the temptation to take the easy way out of suffering could cause great conflict, weakening their resolve to do the right thing. With little support from society, this could impose an additional burden on their already overburdened lives.

   Care and advances in treatment may deteriorate for those so-called "better off dead" patients who refuse the option to die.

2. Some families of patients choosing euthanasia will be morally opposed and angry at the patient for causing conflict. Or the family may feel they let the patient down in not meeting his needs for care and, just as in cases of suicide, feel guilt and anger directed against the patient. Death under such circumstances would hardly be the peaceful one promised by the death-with- dignity crowd.

3. Giving doctors the legal power to kill their patients gives them power that no human being should have. Killing an innocent human being, for whatever reason, can have terrible moral consequences for the killer. It is unfair to demand that the healer become the killer on request! And nurses are inevitably involved as parties to the killing. To be obligated to work in a profession contaminated by killing turns the hospital into a schizoid world of curing some and killing others.

   There could be a loss of trust in their doctors by patients fearful of the healer/killer role. (In Holland elderly people are often afraid to go into the hospital, where doctors might kill them!)

   Physicians and nurses might be required to participate in what is to them morally and ethically wrong.

Harm to Society

1. Voluntary euthanasia would soon lead to non-voluntary euthanasia. If legalized, voluntary euthanasia statutes would eventually be brought before the Supreme Court. The Court would have to decide that these laws are either a violation of the unalienable right to life or that there is an unalienable right to die. If it decides the former, then euthanasia could not be legalized, but if it decides the latter, then all people would have to be allowed the same constitutional right to die. Then guardians could demand this right for children and incompetent persons. State-appointed guardians could exercise the right for the mentally ill or mentally retarded who have no next of kin. Thus we have non-voluntary euthanasia. It would also extend to those who are not terminally ill, since the law may not discriminate but must be granted to all as a constitutional right. This would extend the killing on a massive scale, and would be very tempting as a solution to skyrocketing medical costs of federal and state budgets! But think of the moral cost of all this killing to our American society!

2. Granting a constitutional right to die as a fundamental right would so undermine the fundamental constitutional right to life that it would be virtually cancelled out as a guaranteed right. This would put the protection of all citizens' lives on very shaky legal ground. (Fortunately, in Cruzan v. Harmon, in 1990, the U.S. Supreme Court found that there is no right to die in the U.S. Constitution. The U.S. Supreme Court also found in Cruzan v. Harmon that a patient's medical care can be cut off pursuant to state law if the patient has previously expressed a wish that medical care be cut off under the existing circumstances, even if cutting off medical care would cause the death of the patient.)

3. Granting a private right serving no public interest and indeed causing so much harm to others and society would involve the government in sanctioning killing merely to serve the private interests of the few at the expense of the many whose liberty and life would be put at risk. Those who request that euthanasia be legalized may come to realize that it would be unfair to impose such harm on others merely to "benefit" the few.

Consequences of the Euthanasia Movement's Goals

If the strategy of the euthanasia movement to legalize voluntary and non-voluntary euthanasia should be successful in securing a "constitutional right to die" or a "redefinition of personhood," what are the probable long-term consequences for American society?

Consequences of a Constitutional Right to Die

The Supreme Court abortion decisions granted women the right to abortion as a fundamental constitutional right under a "right to privacy." Such a right is disputed by many constitutional law scholars, but as long as the decision is not reversed it is operative and serves as a precedent.

A number of state court decisions have used this same right to privacy as a precedent to declare the right to die, or the refusal of medical care, to be a fundamental right under the right to privacy.

In a 1973 Pennsylvania case, a patient in a state mental institution refused surgery for cancer. The state court ruled in her favor: ". . . The right to privacy includes the right to die which the state should not interfere with . . ."

In reviewing the case, Prof. Robert Byrn questioned the "court's resort to the right of privacy" rather than the "traditional right of bodily self-determination which includes the right to refuse life-saving treatment in a non-emergency" (Byrn, Robert M., Fordham Law Review, October 1975.)

The New Jersey Supreme Court, in its Karen Quinlan decision, declared that the constitutional right to privacy "is broad enough to encompass a patient's decision to decline medical treatment under certain circumstances in much the same way as it is broad enough to encompass a woman's decision to terminate pregnancy. . . ."

The court cited as precedent the abortion decision of Roe v. Wade (Matter of Quinlan, 355, A2d at p. 663).

A Massachusetts state court in the Saikewicz case recognized that there was a constitutional right of privacy involved in decisions about medical care and that the non-competent patient had the same rights as the competent patient. The court allowed a mental patient's guardian to refuse chemotherapy for leukemia on his behalf (Superintendent of Belchertown State School v. Saikewicz, 370 NE2d 417).

A New York State Appellate Court, in a case involving a Brother Fox who was on a respirator and in a coma, ruled that this non- competent patient had a right to refuse treatment (the respirator). The ruling was based on the "constitutional right of privacy" cited by the Supreme Court abortion decisions and that non-competent patients have the same constitutional right of privacy as competent patients (Matter of Eichner v. Dillon, March 27, 1980).

Fundamental U.S. Constitutional Rights

U.S. Constitutional rights can be fundamental or non-fundamental. Fundamental rights cannot be restricted unless there is a compelling state interest. The U.S. Supreme Court will strictly scrutinize any restriction of a fundamental U.S. constitutional right. If a future U.S. Supreme Court holds that the right to die is a fundamental right, every state will have unrestricted euthanasia on demand, in spite of contrary state laws, in the same way every state had unrestricted abortion on demand after Roe v. Wade.

The Next Step

If an assisted-suicide initiative such as those in Washington in 1991 or California in 1992 or a similar law passes, euthanasia will be the law. Even if such a law does not pass, euthanasia advocates may use the courts to establish euthanasia by a scenario such as the following:

A case (probably initiated by euthanasia advocates) will be brought involving a terminally ill competent patient dying a slow, painful death without the aid of a respirator or other extraordinary medical care.

The patient will demand the right to exercise his alleged constitutional right to die, a right he cannot exercise because he lacks the means. A physician will offer to supply the means - a painless poison.

Having bestowed a right to die as a fundamental right, will the court now be able to deny this patient the means necessary to exercise that right?

A leading euthanasia advocate, law professor Cyril Means, spoke of a Supreme Court abortion case heard prior to Roe v. Wade in which an attorney argued that the woman had a right over her own body. Justice Blackmun countered that if this were accepted then the Court might also be compelled to hold unconstitutional all laws against suicide (Dilemmas of Euthanasia, a publication of the Euthanasia Council, December 4, 1971).

Grisez and Boyle, arguing as opponents of euthanasia in Life and Death with Liberty and Justice, nonetheless saw the logic in the argument that if the court is going to allow a consitutional right to die then there would be entitlement to means and "obviously active euthanasia must be permitted."

And Then, Death on Demand

If the right to die should come to encompass the right of the terminally ill to be killed on request, how does the court then argue against the right to die being exercised by those patients who may not be dying but who find their illness too great a burden?

Would it not be unfair discrimination and denial of equal protection of the law to allow some the right to die but to deny it to others?

How can the state decide for an individual citizen what constitutes for him an unbearable burden? Since each person's tolerance for suffering and hardship is purely subjective, there can be no objective standards to measure this.

If a right to die is found to be a fundamental right, a court would have no choice but to allow each person to decide for himself. In other words, it would become death on demand - like abortion on demand, a purely private decision.

Death on Whose Demand?

This brings us to the constitutional right to die for non- competent patients. They may not be denied constitutional rights simply because they are non-competent.

Parents would have the responsibility to demand the right for their children to die, and court-appointed guardians would have to assert the right of their non-competent charges to die. How easily it could become non-voluntary euthanasia on demand!

The absurdity of the concept of a constitutional right to die becomes clear. It would become virtually impossible to regulate or prevent a "private right to kill" vast numbers of people who find life a burden or decide it is a burden for others. We have evidence of this in the millions of lives destroyed in the exercise of that other private right - the right to abortion.

The Folly of the Elite

It is astounding that it is among the intellectual elite - scholars, physicians, jurists and even theologians - that the concept of a constitutional right to die has been promoted to bring about their utopia of a painless world! Seemingly none of them have thought carefully and deeply enough about their proposals to realize the long-term disastrous consequences for society.

There is an important lesson here for all of us "ordinary citizens": to do our own thinking rather than let our "elites" do it for us! Becoming an educated electorate (as Jefferson advised) is the price we have to pay to remain a free people.

Consequences of Imposing the Quality-of-Life Ethic

The U.S. Declaration of Independence states: "We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life . . ." Unfortunately, the absolute protection for your life in the Declaration of Independence was not put into the Constitution. The Fifth Amendment states in part: "No person . . . shall be deprived of life, liberty or property without due process of law." The due-process clause of the Fourteenth Amendment extended this prohibition to the states. This permits you to be killed, so long as the killing is done with due process. Due process is an ambiguous phrase which means different things to different judges.

There is another even worse threat: the Nazi non-person trick. You can be killed if they decide you are not a person. A person need not be a human, since corporations have been defined as persons by Congress for the purpose of giving them constitutional rights. According to the Roe v. Wade decision, the opposite also holds true and humans need not be given the rights of persons if the humans are not yet born. If the U.S. Supreme Court could ignore the definition of "person" to include individuals found in Title I U.S. Code Section 1 in order to permit killing by abortion, there is no inherent reason why it could not also ignore the same definition and find that the elderly, the sick and the dying have lost personhood.

Euthanasia advocates intend to attack the sanctity-of-life ethic as a religious doctrine because it is based on the religious belief that human beings are created by God in His image. They fail to realize that whatever the religious beliefs upon which it was founded, its principles embodied in our Constitution are right now held dear by the vast majority of American people.

They propose to replace this sanctity-of-life ethic with a new one which we call the quality-of-life ethic. But underlying this new ethic is another religious belief of secular humanism: that human life is the result of random evolution. Secular humanism denies or questions the existence of God or at least God's involvement in human affairs - a remote God.

The Supreme Court has declared that secular humanism as a world-view is a religion in the First Amendment sense (Torasco v. Watkins, United States v. Seeger, Welsh v. United States).

Redefining Some People

This quality-of-life ethic proposes that some human beings have a quality of life so poor that they ought not to be classified as legal persons with unalienable rights. To be declared a person with human rights, a human being must be able to pass certain tests. The tests vary according to who is proposing them but in general require that to be declared a person (with unalienable rights) a human being must be able to: Think and reason; give or receive love; be useful in some way; be capable of meaningful life, i.e., able to enjoy or appreciate life.

Those who fail the test would lose legal personhood and have no unalienable rights. Therefore, these human beings could be killed without violating anyone's unalienable rights.

This is precisely what the Court did in the abortion decisions declaring the unborn not persons, thus allowing them to be killed. The whole idea is pure legal fiction, a subterfuge to quiet the consciences of the American people, who should have a horror of killing innocent people.

Killing a "non-person" demoted to a less-than-human status by legal fiat seems then to be more like killing a dog or a cat to put it out of its misery. Then all can pretend that no evil, unjust deed has been done.

This quality-of-life ethic also holds that even among those who pass the tests of personhood, there may be many who have a quality of life so poor because of grave illness or birth defects that life itself is no longer a value to be preserved for these people. So to take these lives would not be an injustice but a benefit for them.

And, finally, this quality-of-life ethic permits a compelling state interest sufficient to deny the unalienable right to life to a class of citizens: permanently dependent, institutionalized people who put an inordinate burden on the state to provide public funds and medical resources for their care.

The Awesome Result

If the proponents of this quality-of-life ethic succeed in having it replace the sanctity-of-life ethic, what would be the consequences?

1. It would destroy the underlying principles embodied in our Constitution, reducing it to a worthless, ineffective, hypocritical document.

2. It would be an injustice to the vast majority of Americans, who have adhered to the principles of the Constitution and who treasure our Constitution, to have those principles overridden and the Constitution destroyed by a small elite who wish to impose their own set of principles, not accepted by most people.

3. Large numbers of people whose unalienable right to life is now protected by the law of homicide would be killed without their consent because somebody else had decided they are not persons. These could include newborn infants with birth defects, autistic children, psychotic people, the senile aged, comatose people, those with severe drug or alcohol addiction, and so on. All these could easily fail the tests of personhood.

   Then there are the huge numbers of people who by somebody's definition other than their own have lives not worth living, and who could be disposed of.

   And finally there are those millions of dependent, institutionalized people on the public dole eating up the valuable resources of the powerful, so-called non-dependent taxpayers. To dispose of them - the dependents - might become a "patriotic duty," as it did in Nazi Germany.

   Equal protection of the law would become a mockery.

4. The psychological and spiritual damage to those who do the killing and to those who permit it would corrupt our entire nation. Many would be a party to killing and to the lying to ourselves that we are doing good rather than admitting the crimes.

5. If the Cruzan decision holding that there is no right to die is reversed, inordinate power, tyrannical power, would be vested in the Supreme Court. For it would be the Court that would probably ultimately decide who is and who is not a legal person; who has and who has not a sufficient quality of life to give him or her value worth preserving; and at what point there is a compelling state interest sufficient to override the unalienable right to life of dependent citizens.

   As with the concept of a constitutional right to die, the concept of a quality-of-life ethic becomes absurd as well, when analyzed to its logical conclusions. For we would literally be handing over our priceless freedom and all unalienable rights to an oligarchy of nine Justices on the Supreme Court.

   And for what? To give power to an elite few to create their idea of a "brave new world" - for themselves, who in turn might become victims themselves should misfortune make them dependent and powerless.

Euthanasia in Practice: Infanticide

Until now we have been studying euthanasia as a theory that is not yet legally permitted. However, one form of euthanasia - infanticide - is actually being carried out by physicians on handicapped infants in nurseries throughout the country.

Infanticide in Practice

John A. Robertson, professor of law at the University of Wisconsin Law School, wrote, "The pervasive practice of withholding ordinary medical care from defective newborns demonstrates we have embarked on a widespread program of involuntary euthanasia . . . Public policy condemns the practice, and until recently the medical profession rarely acknowledged its existence.

"But now, as a result of newfound technological skills and perhaps changing attitudes toward social utility assessments of human life, the practice has come to be accepted in the interstices of medical and legal practice" ("Involuntary Euthanasia of Defective Newborns - A Legal Analysis," Stanford Law Review, Vol. 27, 1975).

David Dempsey, an author, reported, "Senator Kennedy convened a 'right to survive' hearing in Washington . . . Dr. Raymond Duff estimated several thousand severely handicapped babies were left to die each year" (The Way We Die, Macmillan Publishing Co., NY, 1975, pp. 102, 103).

Dr. C. Everett Koop, on the occasion of his winning the highest award for pediatric surgeons, gave an address, "The Slide to Auschwitz," to the American Academy of Pediatrics. He stated, ". . . In 1973 I expressed the concern that abortion of somewhere between a million and two million unborn babies a year would lead to such cheapening of human life that infanticide would not be far behind.

"Well, you all know that infanticide is being practiced right now in this country . . . I am concerned that there is no outcry . . . I am concerned about this because when the first 273,000 German aged, infirm and retarded were killed in gas chambers, there was no outcry from the medical profession either, and it was not far from there to Auschwitz" (Human Life Review, Spring, 1977, pp. 103-113).

E. Thomas Dowd, associate professor of human services and studies at Florida State University, and William G. Emener, director of a rehabilitation counseling program at the University of Kentucky, warned professionals in the rehabilitation field that if the current climate (tolerant of abortion and euthanasia for those with severe disabilities) continues, it will mean the rapid extinction of their profession.

They noted that the bureaucrats and social planners are already making decisions as to who shall live and who shall die and this will be extended as medical and economic resources dwindle (Journal of Rehabilitation, August-September, 1978).

Grisez and Boyle in Life and Death with Liberty and Justice stated that "Nonvoluntary euthanasia is being widely practiced, admitted and ignored by legal authorities" through the practice of "selective non-treatment of defective infants." The authors referred to an article in the journal Mental Retardation, Vol. 14 (1976), "Right to Life/Involuntary Pediatric Euthanasia," by Harvey A. Syevens and Richard A. Conn.

Carlton Sherwood, Pulitzer Prize-winning journalist, did an investigative series on denial of care and even food and water to newborn infants in hospitals across the country. It was presented on WNEV-TV in Boston in November 1982 in a program called "Death in the Nursery." He found evidence of "over 100 firm bona fide cases" and stated that medical writers have known about this practice for over 10 years but did nothing about it for fear of upsetting the medical establishment.

He also reported that two of the country's leading neonatologists (specialists in newborn care), Tausch of Harvard and Haller of Johns Hopkins, "argued for infection death" of these handicapped infants. He hoped his series would "bring pressure to bear to bring a sense of ethics and morality back to the medical profession" (interview with National Right to Life News, March 24, 1983).

Proposals for Legalizing Infanticide

James Watson, Nobel laureate for his discovery of DNA, "would not declare a child alive until three days after birth" (Time, May 28, 1973).

His co-discoverer of DNA, Sir Francis Crick, stated that newborns should have to pass certain genetic tests before retaining the right to life (Commentary, September 1972).

Denial of personhood to infants would be the basis for legalizing infanticide for handicapped babies, as advocated by geneticist Colin Austin at an international medical science conference (Amatai Etzioni, Genetic Fix, p. 139).

Dr. Robert Williams of Washington State Medical School opposed granting personhood until the end of the first year (Journal of the American Medical Association, August 11, 1969).

John Lachs, Ph.D., at Vanderbilt University, called some defective infants "beings that are only human-looking shapes" rather than persons and advised that they be put to death as animals (New England Journal of Medicine, Vol. 294, no. 15).

Winston Duke, nuclear physicist, compared the killing of an infant to killing a chimpanzee (Journal of the American Medical Association, August 1972).

Ethicist Tristram Engelhardt considered not only infants but all children ". . . entities defined by their place in social roles rather than . . . persons." He said he would allow infanticide (Marvin Kohl, ed., Beneficent Euthanasia, Prometheus Books, NY, 1975, p. 1983).

A proposal for legalizing infanticide was given by F. Raymond Marks, a University of California attorney at the Sonoma medical conference. He compared infanticide with abortion. He stated that in Roe v. Wade the Supreme Court "made up the fiction" that the unborn child was not a legal person to allow the woman the decision to dispose of her unwanted ones while still "pretending we were adhering to the sanctity of life."

He argued that if parents cannot nurture their defective child, it is an unwanted child. If we allow abortion so as not to force women to bear unwanted children, we should not force unwilling parents to nurture their unwanted newborn children. He said, "We would prefer a system that broadly defined a class of infants declared as non-persons who could be disposed of by their parents."

He compared the plight of the doctor who commits an act of mercy killing to the doctor who performed abortions before they were legal and suggested that the killing be legalized as it was in Roe v. Wade - by declaring the infants non-persons.

He contended that the interest of the state in maintaining the lives of defective children is offset to a great extent by the high cost of keeping them alive (Jonsen and Garland, eds., Ethics of Newborn Intensive Care, pp. 97-183).

Changing Attitudes of the Medical Profession

Surveys of physicians have shown a shift away from traditional medical ethics. A survey in Pediatrics, Vol. 60, in 1977 showed that 76.8 percent of physicians would deny ordinary lifesaving surgery to Down's syndrome babies if parents did not want care given. Further, 63 percent would allow the baby to starve to death.

The Journal of Mental Retardation, April 1980, reported that 10 percent of doctors would want active killing of Down's syndrome babies even if the babies had no medical problems; another 10 percent would never treat the child or give any medical care; 20 percent would approve of actively killing a Down's syndrome baby with duodenal atresia and only 5 percent would do everything to save the baby's life.

At the 1976 Sonoma Conference (referred to above), 17 out of 20 participants answered yes to the question "Would it ever be right to directly kill a self-sustaining infant?"

Eugenic Abortion Leads to Eugenic Infanticide

The promotion of eugenic infanticide does not come out of the blue. It is a logical sequel to eugenic abortion, which was given legal sanction by the 1973 Supreme Court abortion decisions and aggressively promoted by government-funded programs, the medical profession and the media, and through prenatal diagnosis programs for genetic defects.

In most cases there is no treatment and eugenic abortion is the option chosen by 95 percent of the women affected.

These prenatal diagnostic programs have now become part of routine medical care with very little public opposition. In fact, opposition to eugenic abortion is considered "inhumane": an eccentric minority view.

The truth is that eugenic abortion is a deceptive, fancy term for a brutal, horribly painful execution of a viable or nearly viable baby whose "crime" is that he is a victim of genetic disease. Every physician knows this, but few condemn it publicly.

Physicians are also well aware that it is the same baby, whether inside or outside the womb. So the few moral (or rather immoral) steps from the delivery room to the nursery are easy ones for them.

The general public, bowing to the leadership of the medical profession, follow like lambs to the slaughter. Few dare to question the authority and leadership of the medical profession for fear of public chastisement or because of moral laziness - it is easier to condone convenient evils by assigning responsibility for them to our leaders.

And so eugenic infanticide will become respectable in the same way that eugenic abortion became respectable - through the leadership of medical elites who have betrayed their own code of medical ethics by abandoning their patients to exterminative medicine.

Those physicians who have publicly opposed this ominous trend toward exterminative medicine, often at great personal cost, are the true moral leaders of their profession.

Infanticide and Wrongful-Life and Wrongful-Birth Lawsuits

The legalization of eugenic abortion gave rise to at least two kinds of lawsuits in American courts: 1) Actions of wrongful birth by parents seeking damages against physicians who fail to detect handicaps by prenatal diagnosis which might have allowed parents to prevent the birth of a handicapped baby by eugenic abortion; and 2) actions of wrongful life in which a handicapped child sues a physician and possibly his own parents for failing to use prenatal diagnostic techniques to detect his handicap and abort him to prevent his birth.

Dennis J. Horan, who lectured in medical law at the University of Chicago, and Steven R. Valentine analyzed this novel practice in "The Doctor's Dilemma: Euthanasia, Wrongful Life and the Handicapped Newborn" in Infanticide and the Handicapped Newborn, Horan and Delahoyde, editors, Brigham Young University Press, 1982, pp. 48 and 49.

They observed, "The proliferation of wrongful birth actions and widespread evidence of the practice of infanticide in American hospitals" could result in a "more permissive stance towards the practice of infanticide."

The authors noted that wrongful-life and wrongful-birth suits are based on the theory that life as a handicapped person is a life not worth living. This leads to questioning "whether such life is worth protecting under criminal law," with eventual non- enforcement of homicide laws for handicapped babies.

Another point they made is that obstetricians who deliver a child with birth defects might fear wrongful-life/wrongful- birth lawsuits, causing them to advise parents against treatment for the child.

The authors argued further, "In fact, the law regarding wrongful birth and wrongful life could evolve so as to hold physicians liable if they aggressively treat a handicapped newborn child whose life then becomes a 'burden' to himself and his parents."

Court Decisions on Denial of Care for Handicapped Infants

Two recent state court decisions are significant because they permitted the withholding of ordinary, lifesaving medical care for a minor and in so doing actually sanctioned the violation of the common law on homicide.

The Infant Doe-Bloomington Baby Case. A baby was born in 1982 in a hospital in Bloomington, Indiana. He had Down's syndrome and a congenital abnormality in his esophagus (esophageal atresia and tracheoesophageal fistula) which prevented the swallowing of any fluid or food.

Minimal-risk surgery with a 90 percent success rate was advised by all three pediatric consultants as ordinary medical care, the "only acceptable treatment." Without surgery, death by starvation and dehydration was a certainty.

The parents, advised by the obstetricians, refused consent. The case was brought to court and the judge ruled that there should be no interference with the parents' decision because the parents' right of custody and control of a minor child was a "sacred right" and there was no possibility of a "minimally adequate quality of life" because of the Down's syndrome.

Even though there were offers to adopt the baby, when the case reached the Indiana Supreme Court, the court let stand the decision to deny surgery.

The baby died an agonizing death by starvation shortly after. When the case reached the U.S. Supreme Court, they refused to hear the case.

The Baby Jane Doe Case. In October 1983 an infant at University Hospital, Stony Brook, Long Island, NY, was diagnosed as having spina bifida-meningomyelocele (a congenital condition in which the spinal vertebrae fail to close, allowing spinal cord and nerves to bulge through the opening and for the fluid-filled sac to protrude from the back).

The baby also had hydrocephalus (buildup of spinal fluid in the spaces surrounding the brain) which often accompanies spina bifida. In addition, microcephaly (undersized brain) was diagnosed on the basis of 31 centimeters head circumference.

Initially, surgery to repair the spina bifida and a shunt to drain the fluid on the brain were planned, but after consulting with a neurologist who predicted severe mental retardation, the parents refused consent.

When the case was first brought to the court the first judge ordered surgery as ordinary care and necessary to save the baby's life. Two later court rulings reversed this decision and upheld the parents' decision to deny surgery.

The baby continued to live despite a severe infection of the affected area and a bout of pneumonia. Skin eventually grew over the exposed area. The parents finally agreed to a shunt operation for the increasing hydrocephalus and the baby went home.

The important points in this case are:

1. The experts in spina bifida care agreed that surgery for meningomyelocele and a shunt for hydrocephalus are the acceptable course of treatment; they are ordinary medical care.

   The amicus curiae brief of the Spina Bifida Association of America in the New York State Court of Appeals on this case stated, "Nearly all who receive prompt and proper treatment now survive and can expect to have normal intelligences and normal lifespans."

   They stated further that if surgery is delayed or denied, there is a greater chance of dangerous infection in the spinal cord or brain, rapidly becoming fatal or causing mental retardation.

   Many untreated spina bifida cases die and many "remain alive with greatly impaired futures, facing physical disabilities far more severe, and mental disabilities which proper treatment would have spared them altogether."

   The brief also contested the microcephaly diagnosis, stating that a 31-centimeter head circumference was within the normal range and not at all uncommon for spina bifida babies.

2. Mental retardation, whether due to microcephaly or Down's syndrome or any other cause, should not strip a baby, who is a citizen, of his unalienable rights. Nor does a mentally retarded baby lose the protection of the common law against homicide. He should have the same right to ordinary, lifesaving medical care as any other baby.

3. The only witness who argued that surgery was extraordinary care was the neurologist. Even the other defense witness, Dr. Butler, head of the University Hospital Department of Neurosurgery, agreed that it was ordinary medical care.

4. The two court decisions in the parents' favor were clearly in error by not requiring surgery that constitutes ordinary care.

5. With few exceptions, the media coverage of the case fed right into the euthanasia movement strategy by obscuring the crucial distinctions between ordinary care (which should be legally required) and extraordinary care (not legally required). The media also promoted quality-of-life arguments in highlighting the parents' suffering and right to privacy to make decisions about care for their baby while totally ignoring the unalienable right to life of the baby.

This case did much to advance the philosophy of the euthanasia movement. And the denial of the best that medical care has to give did not promote the well-being of Baby Jane Doe.

Baby Jane Doe Update

By 1990 the dire predictions for Baby Jane Doe were proven wrong. Newsday had extensively covered the case in 1983 but reported an entirely different outcome for Kerri Lynn (the baby's real name) in a September 2, 1990, article: ". . . she is learning at a level far beyond what doctors testified she would." She was living at home with her parents and sister in a loving relationship and attended special ed classes at a BOCES Learning Center. The principal stated, "Her intelligence level is considerably higher [than merely trainable] and is between low normal and educable."

Three doctors interviewed by Newsday all agreed that surgery at birth would have led to a much better outcome. Dr. John Freeman, head of birth defects treatment at Johns Hopkins, said that treated spina bifida patients "will have normal or near normal intelligence and none will have unremitting pain." Dr. Butler, the neurosurgeon who testified at the original case, later said that the decision not to operate to close the baby's spine caused an infection that delayed implanting the shunt to drain excess fluid from the brain. This delay was the cause of most of the brain damage Kerri Lynn has today. It was Dr. C. Everett Koop, the renowned pediatric surgeon, and Surgeon General at the time, who tried to have independent doctors examine the baby but was refused. He stated, "If they had been brought in, she probably would have been treated and she would have been normal today."

Legal Protection for Handicapped Infants

Some protection for handicapped infants was attempted by the passage of the 1984 Child Abuse Prevention and Treatment Act "Baby Doe" amendments which prohibited "withholding of medically indicated treatment" from disabled infants with life- threatening conditions and required that an infant "must under all circumstances receive appropriate nutrition, hydration and medication . . . and must be given medically indicated treatment - defined as treatment most likely to correct or ameliorate the condition."

It was difficult to determine the effectiveness of this law but the 1989 U.S. Civil Rights Commission Report on "Medical Discrimination Against Children With Disabilities" attempted to do so and they concluded, "This close working relationship [with the medical profession for information and assistance] had also led to heavy reliance by many child protective agencies on the very medical care facilities and personnel whose actions, advice, or neglect are at issue in cases of suspected medical care discrimination. Taken together . . . such close working relationships among State child protective services agencies and members of the medical profession has resulted in a substantial failure of many such agencies to enforce effectively the Child Abuse Amendments of 1984."

Old Violence in a New Guise

It is impossible to discuss euthanasia as it is now practiced without considering where it leads, and this compels drawing a parallel with Nazi Germany.

We are told, and rightly so, "Never forget the Nazi Holocaust, for we must not allow it to happen again!" Yet in discussing pro-life issues, any suggestion that there might be ideas or attitudes about the sanctity of life today similar to those in Nazi Germany that led to the Holocaust is met with outrage!

But such outrage is due to fear and ignorance. A careful study of the period prior to the Holocaust concerning attitudes and treatment of Germany's so-called "dependent, surplus people" reveals unnerving similarities with our own post-World War II period in America.

Then and Now: How It All Began

In Germany it started with abortion. William Brennan in The Abortion Holocaust - Today's Final Solution (Landmark Press, St. Louis, 1983) documented that the killing of the innocent began with the legalization of abortion in 1933 by the Nazi government, after years of pressure by leaders of the German medical profession.

By 1934, after decades of agitation by the eugenics movement's leaders, eugenic abortions were legally permitted and encouraged. Brennan cited Dr. H. Pall as launching the campaign at the Berlin Society of Public Health Culture meeting in 1921, when he said, "If physicians should be able to fix in the public mind that it is a crime to bring sick children in the world, then eugenic ordinances and laws that today are looked on as baleful interferences with personal freedom would come to be accepted as a matter of course" (p. 23).

These ideas were soon put into practice through hereditary health courts to decide on candidates for eugenic abortion. Brennan noted that "eugenic abortion and euthanasia proposals proceeded alongside one another throughout the 1920s and into the 1930s" (p. 22).

The violence moved on to eugenic euthanasia. Fredric Wertham, M.D., told this horror story in his book A Sign for Cain - An Exploration of Human Violence (Warner Paperback Library, 1969). He revealed that the killing began with large numbers of mental patients in Germany's psychiatric hospitals considered "among the best and most humane in the world," and that those who took part in the killing were leading professors of psychiatry at the top universities and medical schools in Germany.

Wertham wrote, "In the latter part of 1939, four men, in the presence of a whole group of physicians and an expert chemist, were purposely killed with carbon monoxide gas. . . . They were ordinary mental patients of a state psychiatric hospital. . . . This successful experiment led to installations of gas chambers in a number of psychiatric hospitals where at least 275,000 patients were killed" (pp. 150-151).

Eventually, these gas chambers were ". . . dismantled, transported to the east and erected in concentration camps. Some of the psychiatrists went from the hospitals to the concentration camps to select the new victims" (p. 177).

After the mental patients came ". . . superfluous people, the unfit, unproductive, useless eaters, misfits, even merely the aged and infirm living at home in good health, with their families" (p. 155).

At first Jews were excluded because they did not deserve the "benefit of psychiatric euthanasia."

Next came the children. Wertham said, "Thousands . . . were killed at both psychiatric institutions and pediatric clinics. . . . Children with mental disease, mental defectives . . . even slightly retarded . . . handicapped children, children with neurological conditions and Mongoloid children" (p. 156).

Eventually included were those with "badly modeled ears, bed wetters, those difficult to educate." It started with infants and then moved to those between 3 and 17 years.

There were special methods for killing the children ". . . by increasing doses of luminal and other drugs either spoonfed as medicine or mixed with their food. Their dying lasted for days, sometimes weeks" (p. 175).

Another method was starvation. Wertham described one such hospital experience: "In the children's ward were some 25 half-starved children ranging in age from one to five years. The director of the institution, Dr. Pfannmueller, explained the routine. 'We don't do it with poisons or injections, our method is much simpler and more natural.'

"With these words, the fat and smiling doctor lifted an emaciated, whimpering child from his little bed, holding him like a dead rabbit. He went on to explain that food is not withdrawn all at once, but the rations are gradually decreased. 'With this child,' he added, 'it will take another two or three days.'"

It was very important to make clear the fact that it was not the Nazis who instigated these eugenic exterminations but rather the elite of the German medical profession. Leo Alexander, M.D., a consultant at the War Crimes Trials at Nuremberg, in an article in the New England Journal of Medicine (241:39-47, July 14, 1949), stated that the first direct order for euthanasia was not issued by Hitler until 1939. He remarked, "Even before the Nazis took open charge in Germany, a propaganda barrage was directed against the traditional, compassionate 19th century attitudes toward the chronically ill, and for the adoption of a utilitarian, Hegelian point of view.

"Sterilization and euthanasia of persons with chronic mental illness was discussed at a meeting of Bavarian psychiatrists in 1931. By 1936, extermination of the physically or socially unfit was so openly accepted that its practice was mentioned incidentally in an article published in an official German medical journal."

He observed, "It is rather significant that the German people were considered by their Nazi leaders more ready to accept the exterminations of the sick than those for political reasons. It was for that reason that the first exterminations of the later group were carried out under the guise of sickness."

Alexander warned that all of these crimes had "started from small beginnings . . . with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as a life not worthy to be lived."

Another misconception about the German euthanasia program regarding the killing of children was that it was against the wishes of the parents. James Burtchaell addressed this point in his book Rachel Weeping (Andrews and McMeel, Inc., 1982). Accounts of the Nuremberg Trials (1:827, 826, pp. 817, 894) are his sources for his statement that "In anticipation of the liquidation of defective children, a survey was done of parents which disclosed that they mostly acquiesced in it. An analyst reported that 'most of the relatives agree to it.' . . . The policy was . . . to leave the release form signed by parents quite vague, 'in order that their conscience should not bother them later.'"

And Now - In America

Here, too, it started with abortion. The killing of America's innocent began with the legalization of abortion in a number of states starting in the 1960s and culminating in the 1973 Supreme Court decisions legalizing abortion on demand for the entire term of pregnancy.

Brennan stated that "eugenics was one of the major indications used to justify legalizing abortion" prior to the Supreme Court ruling, which not only permitted abortion for eugenic reasons, but for any reason. This opened the floodgates for a nationwide program of eugenic abortion for victims of genetic disease, such as Tay-Sach's, Down's syndrome, neural tube defects, hemophilia, and so on. Medical diagnostic technology advances in the 1960s and 1970s made it possible to detect these and scores of other genetic diseases in babies in utero, for which abortion as a "responsible" decision was promoted by the new eugenicists, the medical geneticists.

These prenatal diagnostic programs were financed by private foundations and public funds and, after a barrage of media propaganda, heartily endorsed by the public. By now they have become part of standard prenatal medical care. Indeed, court decisions in a number of states rule that a physician can be sued if he fails to inform his patient of the danger of genetic disease and her option for abortion.

And when genetic disease is diagnosed, most women choose abortion, even though these abortions cannot be done until near or at the time of viability. Dr. Jack Willke, M.D., has stated that "survivability has dropped to 24 weeks with some survivors at 20 weeks." He listed 22 cases of infants under 24 weeks who have survived, ranging from 20 weeks to 23 weeks (National Right to Life News, May 11, 1989).

Just as in Germany, the violence has moved on to eugenic euthanasia for newborn infants with genetic disease and other birth defects. It is being practiced by highly esteemed members of the medical profession in some of our nation's top medical centers, and openly admitted in prestigious medical journals and even at congressional hearings. (See "Euthanasia in Practice: Infanticide," ALL About Issues, January 1985, p. 20.)

Recently, as these infanticide practices became known to the public, by and large there was no substantial opposition. On the contrary, the media and the public, with few exceptions (pro-life and handicapped-rights groups) gave them a decidedly sympathetic ear.

The prevailing attitude seemed to be that the public should mind its own business and not butt into parents' private anguished decisions about life or death for their babies. It was an extension of prevailing public attitudes about the abortion decision.

In both cases, no consideration was given to the unalienable right to life of babies either before or after birth. This attitude coming through across the nation reflected a quality-of-life ethic.

Then and Now: Not Enough Resources for All

After World War I, in the 1920s and 1930s Germany was in serious economic distress as a result of the war, followed by the Great Depression. In addition, Richard Rubenstein, in The Cunning of History (Harper & Row, 1975), spoke of the large number of "apatrides" - stateless people in Germany, with no guaranteed rights, as a result of the division of countries after World War I.

The German leadership under Hitler decided that Germany's economic-medical-social resource pie was not big enough for all, so only the racially and eugenically fit would be allowed to share it. This was the rationale for eliminating Germany's "surplus people."

The first to go were the most dependent: the mentally and physically handicapped; then the weak and the old; and, finally, the Jews and other "apatrides." Since all of these groups were first demoted to subhuman status, non-persons without legal rights, not one law was violated in the whole ghastly process! Such was Germany's solution to its "overpopulation" problem.

And Now - In America

After World War II economic life in America was booming, bringing along with it new technologies using synthetic materials that began polluting the environment. Pretty soon, along came what Allan Chase called "the new scientific racism" under the guise of the population control movement, whose leaders resurfaced from the pre-World War II American eugenics movement. They proclaimed that overpopulation was the primary threat to our environment.

Using clever, well-funded propaganda techniques they bombarded the American people, the government, and the media with the idea that drastic worldwide population control was essential to save the environment and prevent world famine. America's and the world's economic-medical-social resource pie was not big enough for all! Dissenting voices, even from among some of the world's top demographers (who were the experts in the field, rather than the eugenicists and biologists), were not to be tolerated.

Allan Chase, in his book The Legacy of Malthus, The Social Costs of the New Scientific Racism (Knopf, 1977), traced the origins and activities of these population control leaders during this period. For example:

There was Guy Burch, who, with Irving Pendell, wrote a highly influential book, Human Breeding and Survival, in 1947. Burch had been director of the American Eugenics Society and, in the Birth Control Review in 1926, had advocated quotas against Jews, Italians and Negroes. He proposed that the U.N. foster laws to sterilize the socially and biologically unfit; argued that since overpopulation leads to war, sterilizing the unfit would be a peace measure; and thought that health tests should be required before permitting people to breed.

Garrett Hardin, who had a great impact on population control ideas, in his 1949 biology text cited Burch and his views as his first reference. He advocated sterilizing the unfit, abortion on demand, lifeboat ethics. Health care and feeding the poor were bad because they would only increase their numbers.

William Vogt popularized all Hardin's ideas in a best-seller, Road to Survival, and Case said, "Every idea in the book became the accepted conventional wisdom of the post-war generation."

Hugh Moore, the "Dixie Cup King," spent millions to promote these ideas. He merged the Planned Parenthood Federation with his World Population Society and became "the showman salesman of population control."

The Paddock brothers wrote Famine 1975, with dire warnings about the need for drastic measures to cut overpopulation with triage and lifeboat ethics policies of abandoning the hopeless countries to famine so they would not continue to breed.

Paul Ehrlich, another disciple of Vogt, wrote The Population Bomb, another highly popular molder of public opinion. He, too, advocated sterilization, abortion and triage as essential.

In 1970, President Nixon, influenced by these ideas, established the Population Commission, allotting $387 million for population control while at the same time cutting down on funds for cancer research. Chase says, ironically, that with all of the furor over an American population explosion, the U.S. Census Bureau shows it never existed.

Since all of these population control leaders considered legalized abortion on demand an essential tool for solving the population problem, they exerted great influence to change public policy. It was this influence, especially when exercised by powerful converts to the cause such as the Rockefellers and others, rather than the feminist movement or crusaders in the medical profession, that probably carried the most weight in changing public policy from restrictive to permissive abortion on demand.

In addition, it was to the economic advantage of the leaders of big industry to blame people for pollution; this took the pressure off industry, so reluctant to dilute their profits by having to clean up their act.

Even the Justices of the Supreme Court apparently bought the myth, for in the 1973 abortion decisions, they specifically referred to these pressures of overpopulation. Their decision opened the legal gates to dispose of the first of America's "surplus people," the new "apatrides" - babies before birth. The big targets were to be the biggest eaters of the resource pie: Welfare recipients' children, and children with genetic disease.

Sanctity-of-Life Ethic (Rule)

Human beings, because of their very nature, are of intrinsic value. They do not have to earn their value; it belongs to them simply because they are human and alive. Therefore they are entitled to the protection of their lives.

The Declaration of Independence states and the Constitution should agree and declare:

1. Each human being (person) is the possessor of an unalienable (which no one can take away) right to life (and other rights).

2. The government cannot give or take away this right because it does not belong to the government, it belongs to the people (each human being).

3. The primary purpose of government is to protect this right.

So:

All Human Beings = Persons = Possessors of an Unalienable Right to Life

Until:

The Supreme Court abortion decisions of 1973 declared:

1. It was legal to kill human beings up until the time of birth if their being alive caused problems for their mothers.

2. The unborn might be human beings biologically but they were not to be considered persons legally with entitlement to the unalienable right to life (or any human right) because they were not "persons in the whole sense" and because they were not "capable of meaningful life."

   This decision was a violation of the sanctity-of-life ethic and an act of tyranny - the Court usurped a power it should not have lawfully possessed to deprive a class of human beings of their unalienable rights. The Court replaced the sanctity-of-life ethic with a quality-of-life ethic, which protects nobody.

Quality-of-Life Ethic (Rule)

The quality-of-life ethic (rule) holds that only those human beings who pass certain tests are to be declared persons with an unalienable right to life - or any human rights. They must be able to: 1) think or reason; 2) give and receive love; 3) be useful in some way; 4) have a meaningful life (be able to enjoy or appreciate life).

Some Human Beings = Persons = Possessors of an Unalienable Right to Life;
and Some Human Beings = Not Persons = Not Possessors of an Unalienable Right to Life

Unborn human beings are the first class of human beings to have failed the tests of personhood and lose all human rights by court decree. Other classes of human beings in danger of "failing" the personhood test are: People suffering from permanent brain damage, senility or psychosis; autistic children; mentally retarded children or adults; severe long-term alcoholics or drug addicts. The list could be expanded or restricted but under the quality-of-life ethic the power to decide would be with the courts, not the people, and the concept of unalienable rights would be destroyed and the lives of all human beings would be in jeopardy. The only standard that is safe and fair for all human beings is the sanctity-of-life ethic, which only requires that one be human and alive to be entitled to the protection of his life.

This Time We Are Resisting

The cost/benefit aspect of aborting babies with genetic disease was clearly spelled out in one federal government publication, What Are the Facts About Genetic Disease? (U.S. Dept. of Health, Education and Welfare No. 75370). It boldly stated that the cost of treating Tay-Sach's disease victims was $1,750,000 per 50 cases while the cost of prenatal diagnosis and abortion was only $17,500 per 50 cases!

Members of Congress came to similar conclusions when Senator Jacob Javits urged Congress to pass the Genetic Disease Amendments of 1978. He stressed that "fully 20 percent of the total cost of health care in the U.S. is accounted for by genetic disease," a large part of which is paid for by the federal government.

He gave as an example the 3,000 to 5,000 Down's syndrome babies born each year at a cost of more than a billion dollars a year for institutionalized care. (He erroneously implicated that all babies with Down's syndrome are in institutions.)

He then went on to propose a solution: Prenatal diagnostic services with the option for aborting genetic disease victims as part of a nationwide system of primary health care (Congressional Record - Senate S 2401, February 27, 1978).

The pressure to cut down on genetically "defective" babies before birth also came from leaders of the new eugenics movement, the medical geneticists. With few exceptions, most of them vigorously promoted prenatal diagnosis and selective abortion as the first of the new eugenic solutions. Dr. Aubrey Milunsky stated plainly that there is no point in prenatal testing by amniocentesis unless the intent is to have an abortion for defect (Genetics and the Law, Aubrey Milunsky, George Annus, ed., Plenum Press, 1976).

For those babies who slip through the eugenic abortionists' fingers the next logical solution is eugenic infanticide, for which there is ample support in the medical community.

And Leon Kass of the National Academy of Sciences Committee on Life Sciences and Social Policy predicted, "A child with genetic defect, born at a time when most of his potential fellow sufferers were destroyed prenatally is liable to be looked upon by the community as one unfit to be alive, as a second class or even lower human type" (Psychology Today, September 1975).

The economic reverses of recent years could have a profound effect on America's willingness to share the pie with all in need. Regardless of the reality, many perceive the pie as shrinking as the numbers of eaters grow.

Medicaid and Medicare, which pay for the medical resources needed by most handicapped and aged people, consume a huge part of the federal budget. And the aged will be around 20 percent of the population in another 10 to 15 years. Yet today there is a critical shortage of adequate health care facilities for them, and the cost of medical care is increasing enormously every year.

There is little doubt that America has the wealth of resources to give all a share of the pie. The question is whether America has the will to do it. Do we lack the courage to face reality as we go drifting and dreaming into our own final solutions?

Then and Now: How the Healers Became the Killers

What caused the Nazi physicians to abandon the sanctity-of-life ethic and take part in, or acquiesce in by not opposing, those 275,000 euthanasia killings? Frederic Wertham argued that "in the previolence phase most influential was the book The Release of the Destruction of Life Devoid of Value. This was published in 1920 by eminent leaders in their field - a jurist, Karl Binding, and a psychiatrist, Dr. Alfred Hoche.

Wertham said it "crystallized the thinking of a whole generation" and showed that "violence does not actually come from the uncontrolled instincts of the undereducated, but frequently is a rationalized policy from above."

An English translation of the book, written and published by Robert L. Sassone, gave incisive commentary on these ideas and how they were carried out in the German "euthanasia" program, and compared these views with present-day American arguments for euthanasia.

Wertham stated that The Release of the Destruction of Life Devoid of Value was responsible for the ideas that generated the German "euthanasia" program, according to defendants in the Nuremberg War Crimes Trials after World War II.

The book proposed scuttling the sanctity-of-life ethic in favor of a new ethic which would fit the definition of the quality- of-life ethic being advanced today in America.

Dr. Hoche argued, "There were times - they seem barbaric to us now - when the elimination of babies born unviable or persons who later became unviable were quite common. Then came the phase, in which we are still living, and during which the support of every existence no matter how worthless has become the highest norm. A new time will come when we no longer in the name of higher morality will carry out this demand that has its origin in an exaggerated idea of humanity. The present morality places too much value on mere consideration of existence and asks too high a sacrifice" (p. 40).

And Professor Binding, a jurist, proposed that "Granting worth and dignity is not dependent on the consent of the tortured sick person" (p. 13), but framed it as, "Is there any human life that has to such a degree lost its legal rights, that its continuation is of no value for itself or to society?" (p. 14).

Among those he listed as candidates for legal non-personhood are "the incurably mortally ill person," and "incurable idiots" who are just a caricature of true man, whose relatives, guardians and managers of institutions should decide their fate (p. 20). Mothers who oppose this should have to take responsibility to finance and care for the child themselves.

Last on the list were the unconscious as a result of injury, and the terminally ill.

Dr. Hoche contended that "not even the Hippocratic Oath is really binding anymore" (p. 30) and asked the same question as Binding: "Is there any human life which has lost so many human characteristics [that] the continuation of the life for the person as well as society has lost all its value?" (p. 33).

As an example, he considered "incurable idiots" to be "mentally dead" and worried about their "imposing the greatest burdens on the environment and society" (p. 35). He calculated the average yearly expenses of the care of 20,000 to 30,000 over their average lifespan of 60 years, including medical and nursing care, and concluded that the resources could be better spent on more productive people.

Hoche's definition of a mentally dead person coincides with our present-day quality-of-life proponents' definition of a legal non-person.

He is one who "has no clear conception, feeling or will power. They cannot conceive a word picture of what is going on in life. They have no sensitivity to the environment. Even when they are the object of love or caring by a third person, the mentally dead person is not sensitive toward his environment and does not realize he is being loved or cared for. . . ."

"The most important thing, though, is the lack of the possibility of the mentally dead person knowing himself, the absence of self consciousness" (p. 37). He concluded that "if you take away his life you are not invading any of his rights," because he has none.

Then he attempted to reassure his readers that there would be "carefully designed safeguards" against abuses of legalized euthanasia.

Another powerful influence on physicians of the time was the eugenicists, typified by Ernst Ruedin, with their lopsided ideas on the effect of heredity on mental disorders. Wertham cited these ideas as leading to compulsory sterilization and eventually to the mass killing of psychiatric patients.

Peter Breggin, M.D., in his article "The Psychiatric Holocaust," Penthouse, January 1979, delved into the causes of the Holocaust and said, "[as a psychiatrist I] was astounded and shocked when I came upon the missing piece of the puzzle. German psychiatry played the single most important role in developing the ideology and practice of mass sterilization and mass murder. Without the support of English and American psychiatry, Hitler's racial programs might never have become so acceptable, and without the active efforts of German psychiatry, the extermination program would never have gotten off the ground."

He contended that "The organized, systematic murder of mental patients [was] a necessary step in the events that led up to the murder of 6 million Jews. Psychiatry established the principles and practices that led to the Holocaust and carried out many of the actual murders."

He, too, noted the influence of Ernst Ruedin, "the world's most renowned eugenic psychiatrist" who, when visiting the U.S. in 1930, was "praised by leaders of the eugenically-oriented Carnegie Foundation" and who received funds from the Rockefeller Foundation that saved Ruedin's work, endangered by financial recesses.

Breggin said, "Without modifying his already racist, eugenic ideas, Ruedin then went on to become the chief architect of Hitler's racial hygienic legislation. . . .

"The tie between Hitler and the eugenic psychiatrists was so close that much of Mein Kampf is literally indistinguishable in language and in tone from major international journals and psychiatric textbooks of the time. . . .

"Many articles in the world's leading medical journals monitored and heaped praise on Hitler's eugenic legislation and policies."

He cited articles in the July 1942 issue of the Journal of the American Psychiatric Association, "debating a final solution for America's retarded," quoting Foster Kennedy's advocacy for legislation to kill the "utterly unfit," incurably retarded five- year-old children. The editors argued the need for a "public educational program" to overcome public resistance.

All this was proposed in America while Germany's Final Solution program was well known to American psychiatrists. Breggin said that even before Germany's Sterilization Act, California "systematically sterilized 15,000 psychiatric inmates and became the world's chief experimental area for eugenics . . . with American eugenicists providing Germans with detailed information on the California experience and then supported Hitler's programs in American journals."

And Now - In America

Of all that is being written in America on the subject, nothing better expresses the "new" philosophy emerging within the medical profession to rationalize killing the patient as a medical expedient for social good than the now famous (or infamous) California Medicine editorial (September 1970, Vol. 113, No. 3).

It restates, in English, all the arguments that were stated in German and then acted upon only 40 years before. It could be considered the manifesto of the quality-of-life advocates and its appearance in one of the nation's most prestigious medical journals lent much credence and "respectability" to its ideas. It confirms Wertham's view that violence comes as "a rationalized policy from above."

The editorial begins by referring to "the traditional Western ethic" with its emphasis on "the intrinsic worth and equal value of every human life regardless of its stage or condition" and that such "reverence for each and every human life has also been a keystone of Western medicine" but then predicts that "it is being eroded at its core and may eventually even be abandoned."

Among the "social realities" that will undermine this ethic, population expansion heads the list; next comes dwindling resources and third and "perhaps most important, a quite new social emphasis on . . . the quality of life." It then warns that "it will become necessary and acceptable to place relative rather than absolute values on such things as human lives . . . which is at variance with the Judaeo-Christian [sanctity of life] ethic . . . [and that] the process of eroding the old ethic and substituting the new has already begun. It may be seen most clearly in changing attitudes toward human abortion" and that "abortion is becoming accepted by society as moral, right and even necessary. . . .

"This shift in public attitude has affected the churches, the laws and public policy rather than the reverse. Since the old ethic has not yet been fully displaced it has become necessary to separate the idea of abortion from the idea of killing, which continues to be socially abhorrent. The result has been a curious avoidance of the scientific fact, which everyone really knows, that human life begins at conception and is continuous whether intra or extra-uterine until death.

"The very considerable semantic gymnastics which are required to rationalize abortion as anything but taking a human life would be ludicrous if they were not put forth under socially impeccable auspices. It is suggested that this schizophrenic sort of subterfuge is necessary because while a new ethic is being accepted the old one has not yet been rejected."

The editorial then further predicts that physicians will become involved in death selection and death control in order to promote the new quality-of-life ethic.

It is interesting to note that only three years later the U.S. Supreme Court endorsed this quality-of-life ethic in denying legal personhood to babies before birth because they were not "capable of meaningful life" and were "not persons in the whole sense."

It is even more interesting that the West German Supreme Court abortion decision of 1976 refused to deny the unborn legal personhood. The decision noted, "Underlying the basic law are principles for the structuring of the state that may be understood only in light of the historical experience and the spiritual-moral confrontation with the previous system of National Socialism . . . Human beings possess an inherent worth . . . which uncompromisingly demands unconditional respect for the life of every individual human being, even for the apparently socially 'worthless'" (Robert E. Jonas and John D. Gorby, "West German Abortion Decision: A Contrast to Roe v. Wade - With Commentaries," The John Marshall Journal of Practice and Procedure, Vol. 9, No. 3, Spring 1976, p. 662).

Leo Alexander, M.D., who had been a psychiatric consultant at the Nuremburg War Crimes Trials, saw this Hegelian point of view which corrupted German medicine beginning to seep into American medicine as far back as 1949.

In that year, writing in the New England Journal of Medicine, he noted that with the rise of scientific medicine, there was "a subtle change of attitude," with physicians becoming "dangerously close to being mere technicians of rehabilitation."

Patients who could not be fully rehabilitated for "social usefulness" were . . . "in an increasingly utilitarian society . . . being looked down upon . . . as unwanted ballast" ("Medical Science Under Dictatorship," New England Journal of Medicine, 241:39-47, July 14, 1949).

Acquiescence of the People

In the first phase of the Holocaust in Germany, the "euthanasia" killings took place in hospitals, institutional settings, under the management of the medical profession, giving the violence an air of privacy and respectability.

The public did know; the churches knew but the opposition was not great enough or persistent enough to bring the horrors to a halt. It was easy for the people to avoid their responsibility with few moral leaders to remind them over and over of their duty to oppose the evil.

Wertham said that at first the people were opposed to the violence but, because they failed to act strongly enough at the beginning phase, they eventually succumbed. He said, "We can reconstruct a whole fever curve: Puzzlement, indecisiveness, refusal, illusion, awakening, awareness of the closing in of the propaganda and the violence, insecurity, passive resistance, disappointment with the wrong prognostications of the liberal leaders, emptiness, anxiety, hope of help from the other countries, helplessness, resignation, toleration, disappointment, indifference, submission, fascination with the new dynamic regime, adherence" (A Sign for Cain, p. 148).

He concluded, "People, practically all people, can be incited to violence. They may not carry it out themselves; they may only help from a distance and tolerate and thereby foster it."

He spoke of George Sorel, a political theoretician of violence, whose theory was the necessity for a belief in a "myth" - dehumanization of the victims - turning them into subhumans to make their destruction morally permissible. All of the groups destroyed, from mental patients to Jews, were first depersonalized into a separate category of non-persons through massive propaganda before the actual killing took place.

And Now - In America

The killings by abortion and infanticide here and now are also confined to clinics and hospitals under medical direction, giving them the same aura of privacy and respectability. Abortion has the added "distinction" of being legally sanctioned by the nation's highest court.

Then there is the constant bombardment of propaganda that those who oppose these practices should "mind their own business," "not impose their own morality," and so on. When the federal government attempted to investigate possible violations of handicapped infants' rights to medical care, it became a case of Big Brother barging into parents' and physicians' private business.

All of the prestigious groups that can influence the public - the medical associations, law societies, the press and other media and even many of the churches, those in the judiciary, politicians, professional and service groups - rather than courageously denouncing all this violence, these groups are vehemently endorsing it as something good, a right deserving of protection.

The victims of the violence, just as in Germany, are depersonalized and declassified into non-persons, subhumans without human rights, in order to soothe America's collective conscience.

The one crucial difference is that there was no pro-life movement in Germany to rise up in opposition as the violence began. While here in America, as the very first seeds of violence were sown with the liberalization of the abortion laws, along came the first grass-roots pro-life groups in opposition. As the violence grew, so did the pro-life movement, to arouse the conscience of the nation. Its importance is incalculable!

Euthanasia in Disguise

Assisted Feeding and Euthanasia

The strategy of the euthanasia movement over the past eight years has achieved remarkable success in one area: blurring the distinction between ordinary and extraordinary care.

Recall the definition of active, direct or positive euthanasia. It is killing the patient by direct lethal means (e.g., a poison) or by withholding or withdrawing ordinary means of sustaining life, such as food and water.

Medical Ethics on Assisted Feeding

Providing food and water by feeding tube for patients unable to take nourishment orally has been considered ordinary care. Traditional medical ethics stipulated that feeding tubes be provided when required unless the patient is imminently dying or is unable to metabolize nourishment due to his medical condition (such as pervasive metastatic cancer) or a pathology (stomach adhesions, for example) exists making it impossible or risky to insert the device.

Types of Feeding Tubes

Feeding tubes are simple devices. They are very effective in providing food and water and are not burdensome, intrusive, painful or expensive.

There are four kinds of tubes used:

1. The nasogastric (N-G) tube is a thin, flexible plastic tube threaded through the nose and into the stomach and taped in place. It is appropriate for short-term use.

2. The gastrostomy tube inserted directly into the stomach.

3. The jejunostomy tube is inserted into the small intestine.

4. The gastrostomy button is a skin-level device which allows the conscious patient to remove or insert the feeding tube at will. The last three types can be inserted on an outpatient basis under local anesthesia. They are appropriate for long-term use. They are the most comfortable and unobtrusive for the patient.

Consequences of Denial of Food and Water

Withholding or withdrawing feeding tubes that provide essential food and water (either with or without the patient's prior consent) will certainly cause the patient to die of dehydration and starvation rather than from his underlying medical condition. It is a death that is extremely inhumane and beneath human dignity, whether it occurs in a desert in Africa or in a high-tech medical center in the U.S.A.

It is exceedingly difficult to care for someone dying of dehydration and starvation. Brain cells shrink, causing convulsions; the skin and mucous membranes dry out, causing untreatable bed sores that fester and bleed; the stomach lining dries out, causing dry heaves and vomiting; the respiratory tract dries out, causing thick secretions which plug the lungs, causing respiratory distress. Eventually all organ systems fail and death results after an agonizing period of from five to about twenty-one days.

Moral and Ethical Arguments on Assisted Feeding by Feeding Tubes

1. Assisted feeding is no different from other forms of medical treatment that physicians may discontinue and patients may refuse.

   Answer: Food and water by assisted feeding is not medical treatment but supportive care. Nurses, patients' families and, in some cases, patients themselves can provide it. Thousands of people are fed at home this way.

   The theologian Father Robert Barry, O.P., refuted this argument in Homiletic and Pastoral Review, March 1989, when he asked, "What is the medical condition that food and water treat? If hunger and thirst are medical conditions, why are not being dirty and cold also medical conditions? Hunger and thirst are no more medical conditions than the need for sleep, sanitary care or protection from exposure, for they are basic needs that all living animals have whether well or ill. And if the inability to swallow, for example, is a medical condition, then why is not being so weak after surgery that one cannot wash also a medical condition?"

2. Assisted feeding is artificial feeding, so it is not morally required.

   Answer: Food and water are not changed into medications or artificial substances by being poured through a tube into the stomach. The tube is merely a conduit for bringing the nourishment to the stomach to be digested in the same manner as orally ingested nourishment.

   Father Barry in that same article stated it well when he said, "Many compare nasogastric tubes . . . to respirators . . . but if [they] are compared to anything, they should be compared to urinary catheters. An artificial stomach would be properly comparable to a respirator as both duplicate and replace a bodily function, while nasogastric tubes and urinary catheters are merely passive conduits for substances."

3. Some patients (those in a persistent vegetative state) have a fatal pathology, the "inability to swallow as a result of brain damage," and according to Father Kevin O'Rourke assisted feeding would not be required. The patient would die as a result of the pathology rather than from being denied assisted feeding. He also argued that these patients are permanently incapable of pursuing the spiritual purpose of life, so treatment would be ineffective.

   Answer: Bishop James McHugh rebutted the contention of a fatal pathology in these patients because the brain is not progressively deteriorating and the patient is not dying from some other pathology, so the denial of assisted feeding introduces a new cause of death. It could be said that people who have diabetes suffer from a fatal pathology. Would that justify the denial of insulin to keep them alive?

   To cause death because the patient cannot pursue the spiritual purpose in life is not valid moral reasoning. There are many other people unable to pursue a spiritual purpose in life, such as Alzheimer's patients, the severely retarded or those with severe untreatable mental illness. Would assisted feeding if needed by them be optional as well? Professor Charles Rice stated the moral view of life correctly when he said, "Biological life is in itself a good [intrinsic value]. It is not a good only to the extent it is useful for something else - pleasure or meaning or usefulness."

4. Assisted feeding of some patients (those in a persistent vegetative state) is excessively burdensome because of the cost of care and the emotional cost to the family.

   Answer: It is not the cost of the specific treatment, assisted feeding, that is high. That cost is the same as or even less than that of feeding by mouth. There is no physical burden to the patient in assisted feeding if done appropriately. The burden, emotional and economic, is in caring for a helpless patient over a long period of time who isn't dying soon enough to lift that burden from others. But that is the same situation with many other patients not in persistent vegetative state - the frail elderly, the mentally disabled or severely retarded, Alzheimer's patients, etc. Surely we don't propose to lift the burden of their care by refusing to feed them as well.

1986: The Floodgates Open for Euthanasia in Disguise

In 1986 the American Medical Association Council on Ethical and Judicial Affairs broke ranks with traditional medical ethics and proclaimed a new quality-of-life ethic for medicine. The obligation to provide ordinary medical care for all patients was negated for a class of severely disabled but not dying patients - those in irreversible coma. All medical treatment, including assisted feeding, could be denied these patients. This would bring about their deaths by dehydration and starvation.

The AMA blessing on this practice of killing the patient by denial of ordinary care was the stamp of approval for euthanasia in disguise as expressed in their carefully couched statement: ". . . if a patient's coma is beyond doubt irreversible and there are adequate safeguards to confirm the accuracy of diagnosis . . . it is not unethical to discontinue all means of prolonging medical treatment" (Issues in Law and Medicine, Vol. 5, No. 2, 1989, p. 160).

Court-Approved Euthanasia in Disguise

The 1980s marked the beginning of over 100 state court decisions allowing removal of assisted feeding of food and water from non-dying patients in various stages of disability. Some patients were unconscious; some were in a persistent vegetative state (permanent state of sleep-and-wake cycles without cognition). Others were semi-conscious or were victims of stroke or Alzheimer's disease. In one case, Ione Bayer's, even feeding by syringe into the mouth (a common practice for feeding frail elderly patients) was denied as "unnatural."

In another case, Carrie Coons, a stroke victim, woke up nine days after a court order to remove her feeding tube was issued but not yet carried out. She decided to continue being fed.

These cases and other aspects of withholding food and fluids were discussed in an excellent booklet, "Life Cycle #113," available from the National Right to Life Educational Trust Fund.

In September 1991 the Indiana Supreme Court issued a ruling on Sue Ann Lawrance. Daniel Griffith, Staff Attorney for the National Center for the Medically Dependent and Disabled, wrote in National Right to Life News, September 24, 1991: "In what may be the most dangerous opinion yet issued by a state high court in a 'right to die' case, the Indiana Supreme Court has given families virtually unlimited authority to withdraw life-sustaining nutrition and hydration from incompetent family members." James Bopp, President of the National Legal Center, commented on the ruling, "There is no limitation to a third party's decision, in effect, to terminate a disabled patient's life. The decision can be made regardless of the patient's condition, the treatment or care involved, or even the duration of the patient's incompetency. A patient with even temporary unconsciousness can have his or her life terminated at a third person's request."

State and Federal Laws Endorsing Euthanasia in Disguise

"Forty one states and the District of Columbia have 'living will' laws and at least twenty nine states authorize durable power of attorney for health care," according to Thomas Marzen, General Counsel for the National Center for the Medically Dependent and Disabled.

Living wills state what treatment should be withheld or withdrawn when a patient is terminally ill, but some states allow treatment to be ended if the patient is "permanently unconscious."

In about half the states, living will laws allow food and fluids to be denied.

Laws establishing durable power of attorney for health care allow a person to designate someone else with the right to make health care decisions for him - this includes the right to refuse all treatment - food, fluids, insulin, antibiotics, etc. (David Andrusko, "Federal 'Living Will' Law Passed," National Right to Life News, January 29, 1991.)

On the federal level, "The Patient Self-Determination Act of 1990" became law as part of the Omnibus Budget Reconciliation Act. David Andrusko discussed this very important law in that same article.

The law requires all health care facilities receiving Medicare funds (virtually all of them do) to inform every patient of his health care decision rights under state law (whether statutory laws governing living wills or durable power of attorney, or health care proxies, or as recognized by court decisions of the state). Facilities that do not comply could lose all federal funding.

There is a "conscience" clause in the law which was added to preserve any "State law which allows for an objection on the basis of conscience for any health care provider or any agent of such provider which, as a matter of conscience, cannot implement an advance directive."

Thomas Marzen predicted that the act "will provide a powerful impetus for people to execute living wills and durable powers of attorney for health care and for states that have not yet enacted statutes that specifically authorize such documents to do so."

The Supreme Court Cruzan Ruling

Nancy Cruzan, at age 25, suffered brain damage as a result of an auto accident in 1983, with a diagnosis of persistent vegetative state. Although severely disabled she was not in pain and was not dying. She received food and water via a gastrostomy tube. Her parents requested the removal of her tube feedings but the Missouri Supreme court denied their request. The case then went to the U.S. Supreme Court.

On June 25, 1990, the court ruled 5-4 against the withdrawal of tube feedings, with Rehnquist, White, O'Connor, Scalia and Kennedy opposed to their removal and Stevens, Brennan, Blackmun and Marshall for the removal of tube feedings.

The case was decided under a Fourteenth Amendment liberty interest right to refuse medical care and not, as some states have held, under a constitutional right to privacy. The court ruled that with reference to the withdrawal of artificially provided food and water from an incompetent patient a state may (but does not have to) require that there be clear and convincing evidence that the patient would want it withdrawn.

Professor Charles Rice, Professor of Constitutional Law at the University of Notre Dame, in studying the decision, made the observation that these cases involve 1) patients who are not dying, 2) withdrawal not of medical care but of food and water that is neither burdensome or useless ordinary care, and 3) the intent to cause death.

He predicted the following consequences as a result of this decision: 1) Since states are not required to have clear and convincing evidence of patients' wishes, some states can and have given carte blanche to doctors and families to starve incompetent patients. 2) It will encourage the use of living wills and durable power of attorney as legally binding by state law. (Forty-one states have already passed living-will statutes and Congress is attempting to pass legislation requiring all states to have such laws or forfeit Medicaid and Medicare funding.) 3) This trend is likely to favor euthanasia since the court has made the starvation of incompetents a political matter to be decided by state legislatures, eroded (as predicted by the famous 1970 California Medicine editorial). The aging of the population and the AIDS epidemic with the high health care costs will be the incentive for euthanasia acceptance (The Wanderer, August 16, 1990).

The Opinions of the Justices Are Quite Revealing:

Rehnquist:

1. Concerning a physically able adult deciding to starve to death, the state has the power already to intervene to prevent this.
2. In the Cruzan case context (where the patient is not physically able) it may require clear and convincing evidence of the patient's wishes by the state. Is he implying that a disabled person has a right to suicide by starvation if he gives prior consent?

O'Connor:

1. Artificially given food and water are not different from other medical care.
2. Speculated that the Constitution might require states to implement decisions of patient's surrogate or to honor living wills.

Scalia:

1. Federal courts should stay out of these cases - American law always gave states power to prevent suicide, by force if necessary, including suicide by failing to take appropriate measures to preserve life (ordinary care).
2. Suicide is not justified to avoid pain.
3. Starving oneself to death is the same as putting a gun to one's head. The cause of death is the intent to end one's life.
4. Any argument allowing the removal of feeding tubes could be applied as well to denial of food and water to people able to ingest them.

Brennan (with Blackmun and Marshall):

1. There is a fundamental right to refuse artificial feeding.
2. There is a fundamental right to choose to die with dignity (timing one's own death). It should be left to the conscience of the individual.

Stevens:

1. The choice of death should be left to the individual conscience - the right is fundamental.
2. Questioned the personhood of a patient in persistent vegetative state - he may be biologically alive but there is no consciousness.
3. Questioned whether such a life would be protected by the Declaration of Independence or the Constitution.

Conclusion: The Cruzan decision should be seen in context of the ongoing right-to-life issues battle on abortion and euthanasia between the sanctity-of-life ethic and the quality-of-life ethic, which involve two essential points: 1) Personhood and 2) Right of control over one's own body.

The Quality-of-Life Ethic Says:

1. Personhood - Being biologically alive, a living human being, does not necessarily entitle you to be declared a person (with legal rights, constitutional rights). You must pass the tests of personhood to qualify - be able to think, reason, be able to give and receive love, be capable of a useful life, be capable of a meaningful life. In the Supreme Court abortion decision, the unborn, though biologically they are living human beings, were declared not persons because they didn't pass the tests of personhood. So too can some patients be declared not to be persons (e.g., those in persistent vegetative state).

2. The right of control over one's own body is absolute. The constitutional right to privacy granted to women the absolute right to control their bodies in the abortion decision of Roe v. Wade. The same right to privacy could be extended to decisions about medical care and decisions about the timing of one's own death, thus elevating the right to choose death to the level of a constitutional right, a right that must be granted to all, competent and incompetent, children as well as adults. This would require that suicide, assisted suicide, voluntary and non-voluntary euthanasia be legally mandated.

The Sanctity-of-Life Ethic Says:

1. Personhood - All living human beings are persons with unalienable rights. They do not have to pass tests to be declared persons. (Since the Fourteenth Amendment gives all power to enforce the Fourteenth Amendment to Congress, and Congress has in Title I, U.S. Code Section 1, defined every individual to be a person, it is an abuse of judicial power for the U.S. Supreme Court and lower courts to hold that some humans are not persons.) "Biological life is in itself a good [intrinsic value]. It is not a good only to the extent it is useful for something else - pleasure or meaning or usefulness" (Rice). All living human beings have an unalienable right to life and innocent human life may not be taken for any reason. Nor is one justified in taking his own life. Therefore suicide, assisted suicide, voluntary and non- voluntary euthanasia would be prohibited. 2) The right of control over one's body is not an absolute right. The common-law right of bodily integrity and intangibility, which allows the right to refuse medical care, is not absolute. Patients may refuse extraordinary care but not ordinary care if the intent is to refuse it in order to commit suicide.
   Traditional medical ethics adhered to the sanctity-of-life ethic for over 2000 years, but the shift toward the quality-of-life ethic has begun and, if it succeeds, will inevitably force physicians and nurses to become enmeshed in a bloodbath of killing.

Postscript on the Cruzan Case

After the Supreme Court ruling on the Cruzan case a second trial was held in which three people testified that Nancy had spoken with them years before about her wishes in circumstances such as the present ones. Judge Charles Teel accepted their testimony as "clear and convincing evidence" of Nancy's wishes and ordered that there be no more tube feedings. Subsequently Nancy died in December 1990. One of Nancy's nurses, angry that Nancy had been so readily described as in a persistent vegetative state at her trials, asked bitterly, "Do carrots cry? Nancy has tears." Another nurse, head of the unit, added, "We don't want her blood to be on our hands." And the hospital administrator said, "Man's laws said it's all right, but this doesn't change moral law." Dr. Davis, who removed her feeding tube after a night of not much rest, remarked, "I had a dream last night that I went back into her room and she was sitting up talking to her mother. . . . That turns out to be a nightmare" ("Anger in Hospital at Death Order," The New York Times, December 16, 1990).

One Last Question

If the denial of ordinary care, by withholding assisted feeding for incompetent patients, is in fact non-voluntary euthanasia, then doesn't it follow that the refusal of assisted feeding through living will or advance directive statements, or supposedly prior "clear and convincing evidence" statements of patient wishes is in fact consent to voluntary euthanasia?

Legal Voluntary Euthanasia: The Tiger Is at the Gate

The euthanasia debate has been going on for many years. The legalization of abortion has given it great impetus because the legal sanction to kill one class of human beings has succeeded in clouding our collective consciences into accepting as a good the killing of other classes of human beings for their own benefit as well as ours.

Public opinion polls have shown that people are becoming more receptive to the legalization of euthanasia. These opinions are not the result of thoughtful analysis. They are more apt to be a "top of the head" assent based on pro-euthanasia slogans and emotional appeals promoted through the mass media.

Recently, the debate has become quite volatile thanks to two notorious euthanasia showmen. Dr. Jack Kevorkian has his suicide machine built to rescue damsels in distress, not from death but for death (note that all his clients have been women!).

Kevorkian's competitor in the death business is Derek Humphry, founder of the Hemlock Society, hero of the assisted suicide movement and author of the best seller Final Exit, a book of recipes for self-annihilation.

Both sound like something out of central casting but they are having a powerful impact on the euthanasia battle.

Dr. Jack Kevorkian is a pathologist who captured public attention in 1990 after using his suicide machine to help a woman diagnosed as having early Alzheimer's disease commit suicide. He was acquitted because Michigan has no law against assisted suicide. Then the following year he committed what he called "physician-assisted suicide" on two women who were not terminally ill. One had multiple sclerosis and the other claimed to have pelvic disease (not found on autopsy). He has been indicted for both deaths. Just recently, according to a Newsday article of Feb. 10, 1992, he admitted that he is "counseling four patients who want to end their lives." He has also written a book, Prescription Medicide: The Goodness of Planned Death.

Derek Humphry helped his first wife commit suicide to end her suffering from terminal breast cancer. Then he wrote a book, Jean's Way, defending his actions. A year later he married his second wife and together they founded the Hemlock Society, which aggressively promoted euthanasia. The society has grown rapidly with a membership of 30,000 and 51 chapters by 1990. The AIDS epidemic was a big factor in this growth. His latest book, Final Exit, a "how to commit suicide" manual, has gained much media attention. (Suicide-prevention groups are concerned that it will be used by depressed young people to find an easy out.) A postscript to Humphry's story is that his second wife, after developing breast cancer, accused him of abandoning her. She repudiated her support for euthanasia and the Hemlock Society and eventually committed suicide.

Euthanasia Initiatives

Derek Humphry and the Hemlock Society were prime movers in getting a euthanasia initiative, #119, on the November 1991 ballot in the state of Washington. It is one of the few states that allows initiatives.

Polls taken prior to the voting predicted a good chance of winning. But the measure was defeated by a small majority of 54 percent to 46 percent.

If the initiative had passed, Washington would have been the first state and the only place in the world where voluntary euthanasia would be legal. Physician-assisted suicide would have been a constitutional right under the state constitution!

The success in defeating this initiative was due to the concerted efforts of many groups united in a tremendous public education effort.

The people were given the facts and the people said: "No!"

Euthanasia advocates were not discouraged by the Washington state defeat. They used paid signature gatherers to place essentially the same measure on the California ballot. Expect them to try something similar in your state.

Euthanasia in Holland: Shades of the Past

Of all the countries in Europe, it is incredible that it is in Holland that a euthanasia bloodbath has taken such a hold on the medical profession, the government, the churches and the people, with hardly a whimper of opposition!

Holland was the only country to take a stand against the Nazi euthanasia program, when all the Dutch physicians turned in their licenses in protest. Now it is the Dutch physicians who are doing the very deeds they so abhorred just five decades ago! What happened?

This review of the euthanasia experience in Holland will look for clues into how and why a country so sane and civilized could let it happen. The hope is that we will not follow in their tragic footsteps.

The Dutch physician Richard Fenigsen, M.D., PhD., has written extensively on the subject and given us a wealth of information. In one paper published in Issues in Law & Medicine, Vol. 6, No. 3, Winter 1990, "Euthanasia in the Netherlands," he traced support for euthansia in a book, Medical Power and Medical Ethics, by Dr. Jan Hendrik van den Berg, published in 1969. The author repudiated the ethic of unconditional respect for life (sanctity-of-life ethic) and promoted a new ethic (quality-of-life ethic), which would allow doctors to terminate lives; in fact, they had a duty to terminate meaningless lives and the lives of defective children - by involuntary euthanasia. The book was highly influential and his ideas were supported by Protestant church leaders and ministers, Catholic intellectuals, ethical bodies; even voluntary-euthanasia movement leaders approved his promotion of involuntary euthanasia.

In fact, the author's advocacy of involuntary euthanasia reflected the views of the Dutch people. In 1986, 77% supported involuntary euthanasia (76% were for voluntary euthanasia.) By 1990 support for involuntary euthanasia might have reached 85%. It took more than one book to have that kind of influence. Finigsen argued that propaganda for euthanasia played a key role in shaping public opinion over the past 20 years, "The selective information supplied to the Dutch public has been of utmost importance in shaping opinion on euthanasia . . . . Among those thousands of publications and telecasts some were open-minded . . . most favored it or discussed euthanasia as an established practice beyond any dispute . . . . It was difficult to find publications objecting to euthanasia."

Fenigsen reasoned that the great interest in the subject was that it was genuine news. "'Thou shalt not kill' was news 3500 years ago: it isn't any more. Legal, logically justified, morally approved killing is news. Printable matter is supplied in abundance by the organized pro-euthanasia movement. There is little counteraction from the other side; until recently, the opponents of euthanasia used to put too much confidence in the stability of the traditional system of values, and they still find it awkward publicly to expound truths that in their view are self-evident."

Another point he made is that once it is no longer a theoretical debate and the first patients die by euthanasia then proponents have a high stake in suppressing opposing views that might prove them wrong and therefore morally responsible for supporting wrongful killings.

The majority will not tolerate dissident views on euthanasia. Opponents are accused of "imposing their views." Fenigsen spoke of a doctor who killed the residents of a senior citizens home without their knowledge. The condemnation was not directed against the doctor but against the judge who by sentencing him made a criminal of him and "adversely influenced the practice of euthanasia in the country. Critics of euthanasia are sued by the Dutch Society for Voluntary Euthanasia, those opponents of euthanasia who are Jewish are implicitly and explicitly met with the reproach that their personal reminiscences of the Nazi era and the resulting bias make them unqualified to pronounce judgments on euthanasia."

In discussing the impact of euthanasia on the medical and nursing professions, Fenigsen noted, "Remorse and guilt afflict . . . many doctors and nurses who carry out euthanasia."

Twenty years ago Dutch intellectuals influenced by the German and Anglo-Saxon eugenics ideas were ardent supporters of involuntary euthanasia but they began to mute their open support when there was a chance that Parliament would favor voluntary euthanasia but was opposed to involuntary euthanasia in the years 1975 to 1978. But the public went right on advocating involuntary euthanasia.

When the Dutch argue for involuntary euthanasia for children they do not use eugenics arguments but rather that it is for the good of the child, his parents and the community. However, the language used reveals the underlying attitudes. Disabled newborns are spoken of as "severely misshapen," "incomplete," "unfit," facing "a primitive life, a meaningless life." Fenigsen said, "These babies are not viewed as people . . . it is their whole being that is devalued, their humanity represented as incomplete and questioned . . . . The lives of the babies are so devalued as to make euthanasia imperative . . ."

Euthanasia is the most discussed issue and "the pro-euthanasia movement is supported by all the major Dutch political parties and by the majority of Dutch Catholics, Protestants and agnostics."

The author spoke of "an important current favoring the improvement of the human race by extermination of weaklings . . . but they mute their rhetoric to conform with the official platform; but when euthanasia for infants with disabilities, persons who are mentally retarded, and demented persons is discussed, or the policy of allowing certain groups to die out is promoted, the supporters of extermination reveal their presence in an unmistakable way."

The supporters of the "right to choose" and "right to die" are another forceful voice for euthanasia.

In 1987 the Health Council granted children the right to request euthanasia, with or without parental consent!

Dr. Fenigsen brought the euthanasia program up to date in an article, "Report of the Dutch Governmental Committee on Euthanasia" in Issues in Law & Medicine, Vol. 7, No. 3 Winter 1991. He stated, "It is the first official admission that active involuntary euthanasia is regularly practiced in the Netherlands."

It is important to note that while euthanasia is still not legal in Holland, there are guidelines for doctors performing euthanasia. If they conform to these guidelines they will not be prosecuted. Violations of the guidelines are widespread and there are virtually no prosecutions. The whole system is a farce.

The report showed the following:

Annually there are 25,306 cases of euthanasia (19.4% of all deaths). There are 2,300 cases of active voluntary euthanasia, 400 of physician-assisted suicide. There are 1,000 cases of active involuntary euthanasia. There are 5,800 cases of life- prolonging treatment withheld or withdrawn at patient request - 4,756 died, and 25,000 cases without patient consent, of which 8,750 were done with the intent to terminate life. Of the 22,500 patients who died of an overdose of morphine, 8,100 were done with the intent to terminate life, of which 4,941 were done without consent. There were 8,750 cases of life-prolonging treatment stopped with the intent to cause death without cconsent.

There were 59% of doctors who found involuntary euthanasia "conceivable" and 27% have actually performed such acts. Fourteen percent of the patients who underwent involuntary euthanasia were competent, 11% were partially competent, 8% were demented elderly patients and the reasons cited were: low quality of life; no prospect of improvement; family couldn't take it any more. Forty-one percent were killed without family knowledge.

Conclusion

One of the biggest lessons to be learned from this sorry tale is that those of us who realize the terrible evil of euthanasia must take part in the public debate at every opportunity with a vigorous and courageous defense of the sanctity-of- life ethic. We have excellent arguments defending our position but we must prepare ourselves well and be willing to publicly defend them.

Eileen Doyle, R.N., is a member of New York State Nurses for Life and is a foremost expert on the defense of those threatened by euthanasia, whether in old age or immediately upon birth.

©1996, American Life League