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Endnotes and References
The problem is beautifully described in a short story by Richard Selzer who offers an insight into the emotional problem health care professionals encounter in such situations. The story does not offer a solution—indeed it neither sets out to do so nor can. But as a description of a terrible moral (even if not ethical) problem is has no peer. See R. Selzer, Down from Troy: A Doctor comes of Age (NY: Chivers, North America), 1992.
P. Carrick, Medical Ethics in Antiquity (Boston: D. Reidel Publishers), 1985.
In the first century, early Christianity forbade all killing whether as capital punishment, in war or even in self-defense. This posed a great problem for the Roman Empire. On the one hand, they could not ignore an ever-growing segment of their population. On the other hand, they could not condone capital punishment or give citizenship to persons who refused to serve in the army. The first church-state accord resulted. The church permitted killing those who were fighting an unjust war and those who had broken a just law. The definition of what was “just” and what “unjust” was left up to the state. Curiously enough, killing in self-defense remained proscribed until about the time of St. Augustine. An excellent description of this “doctrine of innocence” can be found in J. Rachels, The End of Life. (NY: Oxford University Press, 1986), pp. 11–13
See Sir Thomas More, Utopia, trans. and ed. by R.M. Adams (NY: Norton), 1975. One of the best and earliest discussions of this book can be found in K. Kautsky, Thomas More and His Utopia, trans. by R. Ames (NY: Russell & Russell), 1959. Another excellent source is G.M. Logan, The Meaning of More’s Utopia (Princeton, NJ: Princeton University Press), 1983
Euthanasia as conceived by the Nazis was neither a “good death” nor a death brought about so as to benefit (or to prevent harm to) the person killed. While this program was carried on in semi-secrecy, the propaganda made for abandoning persons termed “nutzlose Fresser” (“useless eaters”) was clearly visible to all. The extermination of the Jews was not termed “euthanasia:” the euphemism ”euthanasia” was too evidently a euphemism to allow its use even at that late date. It is frightening to realize that the tentative lists of persons believed to be “genetically unfit” and proper subjects at least for sterilization, was later used when it came to the Nazi “euthanasia” program. For example, “the feeble-minded, the pauper class, the criminal class, the epileptics, the insane, the constitutionally weak, or the asthenic class, those predisposed to specific diseases or the diathetic class, the deformed, those having defective sense organs, as the blind and the deaf“) was a list first suggested by an American, Bleeker Van Wagenen, at a conference in at the University of London in 1912 in his “Preliminary Report of the Committee of the Eugenics Section of the American Breeders’ Association to Study and to Report on the Best Practical Means for Cutting off the Defective Germ Plasm in the Human Population,” Problems in Eugenics, Ed. by W.C. Adelphi (NY: The Eugenics Education Society), 1912. The most definitive work on this subject is E. Klee, Euthanasie im NS-Staat (Frankfurt a/M, Deutschland: Fischer Tachenbuch Verlag), 1991, As background, the following also can be recommended: L. Alexander, “Medical Science under Dictatorship,” New England Journal of Medicine, 1949; 241: 39–47; R.J. Lifton: The Nazi Doctors. (NY: Basic Books), 1986 and K. Moe, ’should the Nazi Research Data Be Cited?” Hastings Center Report, 1984; 14(6): 5–7.
E.H. Loewy, “Drunks, Livers and Values: Should Social Value Judgments Enter into Transplant Decisions?” Journal of Clinical Gastroenterology, 1987; 9: 436–441.
I Kant, Foundations of the Metaphysics of Morals, trans. by Lewis White Beck (Indianapolis, IN: Macmillan Publishing, 1986), p. 47.
The point that patient’s in hospitals today rarely die when nothing to prolong their life can be done, is a point evident to all who have worked as nurses, physicians or ethics consultants in a hospital. The point is made in two papers: E.H. Loewy, “Futility and its Wider Implications,” Archives of Internal Medicine, 1993; 153: 429–431 and E.H. Loewy, “Futility and the Goals of Medicine,” European Philosophy of Medicine and Health Care, 1993; 1(2) 15–27.
T.E. Quill, “Palliative Options of Last Resort: A Comparison of Voluntarily Stopping Eating and Drinking, Terminal Sedation, Physician assisted Suicide and Voluntary Active Euthanasia,” Journal ofthe American Medical Association, 1997; 278(23): 2099–2104.
There is a fairly substantial literature on the problem of self-delusion. See: M.W. Martin, Self-Deception and Morality, (Lawrence, Kansas: University Press of Kansas), 1986.
E.H. Loewy: Moral Strangers. Moral Acquaintances and Moral Friends: Interconnect-edness and its Conditions (Albany, NY: State University of New York Press), 1997.
J. Rachels, The End of Life (NY: Oxford University Press), 1986.
W. Gaylin, et al., “Doctors Must Not Kill,” Journal of the American Medical Association, 1988; 259: 2139–2140.
D.W. Amundsen, “The Physician’s Obligation to Prolong Life: A Medical Duty Without Classical Roots.” Hastings Center Report, 1978; 8(4): 23–31
E.D. Pellegrino, “Toward a Reconstruction of Medical Morality: The Primacy of the Act of Profession and the Fact of Illness,” Journal of Medicine & Philosophy, 1979; 4(1): 32–56.
L.R. Churchill, “Bioethical Reductionism and Our Sense of the Human,” Man & Medicine, 1980; 5: 229–247.
See A.E. Chin, et al., “Legalized Physician-assisted Suicide in Oregon-the First Year’s Experience,” New England Journal of Medicine, 1999; 340(7): 577–57; the details can be found on the Internet under http://www.ohd.or.state.or.us/cdpe/chs/pas/ar-index.htm (1998).
R. Pear, “House Backs Ban on Using Medicine to Aid in Suicide,” New York Times, 28. October 1999, Vol. CXLlX(51,689); p. 1, 29.
J. Hardwig, “Is there a Duty to Die?” Hastings Center Report, 1997; 27(2): 34–42.
There are a number of papers that speak to this issue. Among others, see D. Ozar, “AIDS, Risk and the Obligation of Health Professionals,” Biomedical Ethics Review, ed. by J. Humber and R. Almeder (NY: Humana Press) 1989 and E.H. Loewy, “AIDS and the Human Community,” Social Science and Medicine, 1988; 27(4): 297–304.
E.H. Loewy, “Healing and Killing, Harming and not Harming: Physician Participation in Euthanasia and Capital Punishment,” Journal of Clinical Ethics, 1992; 3(1): 29–34.
J. Hardwig, “What about the Family?” Hastings Center Report, 1990; 19(2): 5–10.
T. Kushner, “Having a Life versus Being Alive,” Journal of Medical Ethics, 1984; 1: 5–8.
There is a vast literature dealing with this point. For a general review, which includes discussion about the implication of the churches in both preparing the soil for and failing to resist the Nazi atrocities see, for example, J. Weiss, Ideology of Death: Why the Holocaust Happened in Germany (Chicago: Ivan R. Dee, Publishers), 1996 and R. Hilberg, The Destruction of the European Jews (NY: Holmer and Meier Publishers), 1985. For the role of physicians in the holocaust, see A. Mitscherlich and F. Mielke, Medizin ohne Menschlickkeit: Dokumente des Nürnbergers Arzteprozesses (Frankfurt a/M: Fischer Tachenbuch), 1986 and H. Friedlander, The Origins of Nazi Genocide: From Euthanasia to the Final Solution (Chapel Hill, NC: University of North Carolina Press), 1997.
M. Burleigh, Death and Deliverance: “Euthanasia ” in Germany, 1900–1945 (NY: Cambridge University Press), 1994.
E.H. Loewy and R.S. Loewy, “Lebensunwertes Leben and the Obligation to Die: Does the Obligation to Die Rest on a Misunderstanding of Community?” Health Care Analysis, 1999; 7: 23–36
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(2002). Suicide, Assisted Suicide and Euthanasia. In: The Ethics of Terminal Care. Springer, Dordrecht. https://doi.org/10.1007/0-306-46836-0_6
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