General Articles

ARE THEY BETTER OFF DEAD?

The law declares it a crime. But when a hopeless patient screams for merciful death should the physician refuse?

SIDNEY KATZ November 1 1947
General Articles

ARE THEY BETTER OFF DEAD?

The law declares it a crime. But when a hopeless patient screams for merciful death should the physician refuse?

SIDNEY KATZ November 1 1947

ARE THEY BETTER OFF DEAD?

The law declares it a crime. But when a hopeless patient screams for merciful death should the physician refuse?

SIDNEY KATZ

ON A stormy, winter day in December, 1941, legal history was made in a Calgary, Alta., courthouse.

The principals in the case being heard by Justice S. J. Shepherd of the Alberta Supreme Court were Mr. and Mrs. Victor Ramberg. They were charged with murder.

Without prompting, they had confessed to the court that they had deliberately taken the life of their 2 ■'¿-year-old son. Yet after only 10 minutes of deliberation, the jury returned with a verdict: “Not Guilty.”

The full significance of this decision was not appreciated at the time; bombs had rained down on Pearl Harbor only a few days before and every other subject was temporarily forgotten.

Let us examine, briefly, the factsof the Ramberg cast?. *

Victor and Dorothy Ramberg were a popular couple in their home town of Kenoma, 32 miles nort heast of Calgary. Their marriage was regarded as highly successful. When the baby was born, their neighbors showered t hem wit h gifts and good wishes.

It was soon discovered that the infant boy was fatally diseased. A cancerous growth was eating away at his optic nerves, leaving the child blind and threatening him with a slow and painful death.

His incessant heartbreaking shrieks drove the young couple frantic. They spent most of their savings canvassing doctor after doctor, specialist after specialist, always receiving the same sorrowful verdict:

“We can’t do a thing. The boy will live for another year or so in pain and then die.”

Desperate, the parents made their decision one October day. Mr. Ramberg attached a rubber hose to the exhaust pipe of his car and ran it into the room where the child lay sleeping. He started up the engine and went away with his wife for several minutes. When they returned the boy was dead.

Defense Counsel A. L. Smith pointed out to the jurors that they were trying the first case in Canada with a defense based on euthanasia—or, as it is popularly referred to, “mercy killing.” In concluding his address he stated:

“They loved their child and could not bear to have him suffer. If you acquit them, if may begin a new era in which decent people like Vic and Dorothy Ramberg will not be classed with murderers and cutthroats because they have been merciful.”

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Acquitted, the two saddened parents left the courtroom and walked to their freedom weeping.

The acquittal of the Rambergs touched off new discussions in Canada on an old controversial issue: is it right to end the life of a person who is racked with pain and for whom no cure is possible?

Millions of heated words have been written and spoken for and against the practice of euthanasia. Doctors, lawyers and clergymen have searched their consciences and have arrived at sharply divergent answers.

Should euthanasia be sanctified by law? If so, would it be open to abuse? Would heirs of a rich invalid, in certain cases, take advantage of such a law to hasten his death?

Who should be eligible for euthanasia? All who are a burden to themselves and the community ? Or should we permit its use only in the case of infants who are born monstrosities or mentally defective? Or would it perhaps not be best to reserve merciful release for suffering, incurable adults who voluntarily demand it?

Finally, one of the biggest posers who should make the final decision as to who is to live and who is to die?

Advocates of euthanasia think the acquittal of the Rambergs by a Supreme Court jury is indicative of a changing public attitude. A few decades ago, they will tell you, a plea of mercy killing would have been thrown out of court.

“Today,” says Rev. Francis Potter, founder of the Euthanasia Society of America, “the person

will moved strive to kill in every out of way mercy to be will lenient.” find that the court

The Courts Show Mercy

THIS LENIENCE is reflected in many of the out hanasia cases that have come to the attention of the Canadian public during the past few years. Take the Davis case, for example.

Late one summer night in 1942, Dr. H. A. McFarlane, the family physician, was urgently summoned to the home of 68-year-old George Herbert Davis in Elmwood, a suburban district of Winnipeg. When he got there, he found the lifeless body of Mrs. Davis in the bedroom. Her head was badly beaten.

Mr. Davis explained that his wife, a chronic invalid, had been continually pleading for morphine to sooth her pain. “Tonight I felt that I couldn’t stand it any more,” he sobbed. “A sort of heat wave came over me.”

Later, Dr. McFarlane, who knew the family for

¡years, gave newsmen the story behind the tragedy. They were fine people devoted to each other. They never quarreled. For 16 years Mrs. Davis had been afflicted with an agonizing case of dropsy. Up until four years ago, when both her legs had been amputated, she was unable to lie down and was forced to sleep in a sitting position, propped up on a chair. Lately, her suffering had grown more acute...

Mr. Davis was sent to trial for murder, but a jury acquitted him.

The same sympathetic attitude is usually shown t he mercy killer by the American courts.

Edith Reichert, a 28-year-old mild-mannered Brooklyn housewife, was the daughter of a Baptist minister. Her brother, George Horne, 26, had a long history of mental illness. On several occasions he had attempted suicide.

In the King’s Park State Hospital, where she visited him, he often said, “This place is more than I can stand. If I had a gun I would shoot myself.” The hospital records listed his case as “hopeless—' recovery doubtful if at all.”

Mrs. Reichert tried in every way to help her brother back to sanity, but failed. All her life she had great affection for him. When he suffered pain, she suffered too. One day, on a visit to the institution, she smuggled in a sawed-off 22-calibre target rifle and fired four shots into her brother’s body. As he lay bleeding to death she sighed, “It’s all over now.”

After extensive testimony

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from several psychiatrists, Edith Reichert was placed in a mental hospital for observation. One month later she was declared legally sane and became a free woman.

Many Canadian doctors oppose legalized euthanasia on religious and moral grounds. However, there appears to be a growing number of general practitioners, specialists and officers of important medical associations and organizations who have come to favor merciful release as a humanitarian principle.

“When you look down at the paintwisted face of a patient, week after week, and know that he is beyond your help,” one doctor told me, “It seems barbarous and stupid not to help him.’

Canadian doctors who hold this opinion are reluctant to air theirviews in public. All the medical men I interviewed v7ho favored euthanasia made me solemnly promise that they would not be indentified in any way in this article.

“To come out flatly in favor of euthanasia,” I was told again and again, “is the same as announcing your retirement from medical practice. Prejudice against it is very strong among certain sections of the Canadian public.”

After an intensive search I was only able to find one case of a Canadian doctor who publicly advocated euthanasia. He was Dr. Omar Hague who, a few years before the war, was a radiologist in the St. Boniface Hospital in Manitoba. When asked by a reporter for his views on the subject, he gave a direct answer:

“1 think legalizing euthanasia would lie a fine thing. You have only to visit the congenital diseases department of any hospital to realize that many inmates are better off out of this world.”

For his candor, Dr. Hague was dismissed from his post. He sued the hospital and won three months’ severance pay. “A professional man has a perfect right to express himself on scientific matters,” declared the justice who handed down the decision.

What Doctors Do

Regardless of the law and convention, however, the practice of euthanasia is endorsed by some Canadian doctors. “I have known doctors to risk professional ruin and criminal prosecution to perform what they regard as a supreme act of mercy,” 1 was told by a responsible medical source.

Let us look at some of the cases where doctors have decided to take the law into their own hands.

For obvious reasons no names are mentioned and the facts have been somewhat altered as a future protection for the people involved.

The scene is a delivery room in a Maritime hospital. At the moment of birth the doctor’s experienced eye recognizes that the infant will never, never develop normally; probably not survive beyond the third or fourth year. The child’s head is grotesque, the brain is partially missing and there is a mass of tumors at the base of the spine.

To deliver the baby alive means a frantic struggle, with every second precious. The doctor deliberately delays and the child is born dead . . .

A prairie farmer had a tractor accident during the harvesting season. He was picked up from the ground screaming and rushed to the hospital where it was found that he had a serious spinal injury. No hope was held for his recovery.

The pain was so penetrating that the

farmer became semi-immune to morphine. A dose which first produced four hours’ sleep soon produced only three, then two, then almost none. The doctor gave the patient an intravenous injection which sent him into the ending sleep of death . . .

in an Ontario community, a prominent lawyer had a two-year-old son who was a congenital idiot, blind and muscularly unco-ordinated. The child could not even recognize his own mother. Depressed, the father besought the family doctor for help.

“For all our sakes, you must do something at once,” he pleaded with him.

At his next visit, to the lawyer’s home, the doctor took a hypodermic needle from his bag and loaded it with a lethal narcotic. He carefully punctured the child’s arm. Later that day it died in its sleep . ..

The Doomed Children

All of the physicians, in the above cases, temporarily set aside their solemn obligation to prolong human life. But they knew from long experience that the greatest mercy they could bestow was to end the unfortunate victims’ lives quickly and peacefully.

“The real tragedies occur when a suffering cripple is left to face a prolonged death struggle,” a practitioner told me. “It exacts a heavy toll of the patient, his family and the community.”

This is particularly true of infants who are seriously defective from birth. Many never go home to live with their families hut are placed in special wards of public institutions which dot the country from Halifax to Vancouver.

Frequently these days, due to the shortage of bed space, parents are asked to keep such children at home for at least a few years. Despite all the mother’s care, the child seldom lives beyond six or seven years.

When, by some miracle, it does survive beyond that, the nerve-racked parents are often driven to take some desperate measure.

As we have seen, in Canada no organized group promotes euthanasia, while individual citizens usually shy away from public discussion of the subject.

In the United States, however, the euthanasiasts have banded together under the name of the Euthanasia Society of America, Inc., forthepurpose of passing a hill which would legalize voluntary mercy killings.

From their headquarters on 57th Street in New York City the euthanasiasts carry on a vigorous campaign to combat “the misunderstanding, prejudice and fear which are still prevalent.” The society’s literature goes out all over the country, and makes prominent use of the names of the 1,800 physicians—as well as many clergymen, writers and other prominent personalities—who are members.

A search of the society’s membership files revealed that there is only one Canadian member— Mrs. A. N. Jenks of Montreal. She told me she and her late husband had belonged for a number of years hut that they had taken no active steps to recruit further members among their fellow citizens.

One of the most zealous crusaders for the cause is the Rev. Charles Francis Potter, who founded the society eight years ago. Mr. Potter minces no words in his advocacy of merciful release.

“The coup de grâce is given as a matter of fact to a horse with a broken leg or a sick old dog,” he has often repeated, "It is cruel and inhuman to deny it to humans.”

At present the Euthanasia Society is

concentrating all its energies to obtain passage of a voluntary euthanasia bill through the New York State Legislature. This would enable any sane person over 21 suffering from a painful, incurable malady to have bis life ended. Let us examine how legal euthanasia would be practiced if this bill were placed on the statute books:

David Larke, who lives in a community near Albany, say, is eligible for euthanasia. At 20, as an apprentice machinist, he had a bad accident which resulted in osteomyelitis—chronic inflammation of the marrow of his bones. During the next 18 years he submitted to 31 excruciatingly painful operations without being any closer to recovery. When told that he must undergo his 32nd, with no hope of final recovery, he announced to his doctor, “I can’t stand this a minute longer. Please let me die.”

He fills in the official petition form addressed to the court. In abbreviated form it reads as follows:

“1, David Larke, am suffering from severe physical pain caused, as 1 am advised by my physician, by a disease for which no remedy affording lasting relief or recovery is at this time know'n to medical science.

“1 am desirous of anticipating death by euthanasia and hereby petition for permission to receive euthanasia . . .”

Accompanying the application is a certificate from the family doctor explaining the nature of disease in detail, and the impossibility of any recovery.

When the judge receives the petition he appoints a committee of three persons, at least two of whom are qualified physicians. This committee visits David Larke and his family to make sure that all concerned understand the importance of the petition and to make certain that everything is actually as represented in the documents, for every precaution must he taken to prevent an abuse of euthanasia. Within five days they report that David Larke’s request should he granted.

Four days later the three men again visit the suffering man. They ask him if he has changed his mind: if so they will not proceed with the euthanasia. The patient repeats only that he still wishes to die.

A minute later the physician who heads the committee takes a hypodermic needle out of his hag and gives the sufferer an injection. His 18 years of prolonged torment have come to an end.

A Doctor’s Confession

There are some euthanasiasts who regard the hill just described as being too restricted. “Why not,” they suggest, “extend it to legalize euthanasia for all who are a burden to themselves and to the community—infant monstrosities, mental defectives anti the like, who are incapable of granting consent?”

To which the Euthanasia Society replies, “More will be accomplished by presenting a measure that will probably encounter the least opposition, namely, voluntary euthanasia. The public is readier to recognize the right to die than the right to kill, even though the latter be in mercy.”

The same viewpoint is held in Britain, where the Voluntary Euthanasia Society has been functioning since 1935. Here, too, the euthanasiasts can point to many brilliant minds that have been attracted to the movement— people like Julian Huxley, George Bernard Shaw, Clemence Dane, the Very Reverend Hewlett Johnson, Dean of Canterbury, G. B. Stern, Margaret Kennedy, Prof. H. Laski, David Low, Vera Brittain, C. E. M. Joad and Dr.

W. R. Inge, ex-Dean of St. Paul’s Cathedral, London.

Canadian doctors are envious of the way some of their British colleagues can openly expresstheir views. ForSir James Purvis -Stewart, K.C.M.G., C.B., M.D., F.R.C.P., a distinguished nerve specialist, told of the following incident in his career:

Me was called to the bedside of a friend late one night. He had known for some time that she was dying of a disease for which no cure or relief was possible. She begged for release from life.

“I will not say what action I took,” says Dr. Purvis-Stewart, “but next day the sufferer failed to awake.

“Had I been placed in the dock and charged with the killing of that dear friend, I might, perhaps, under pressure of legal conditions, have been convicted and condemned. Such a risk ought no longer to exist.”

When a recent campaign to pass the voluntary euthanasia bill through the New York State Legislature was in progress, a brief statement was published bearing the signature of 54 prominent American clergymen.

“There is nothing in the proposed measure,” they declared emphatically, “that is contrary to the principles or morality of religion.”

As might have been expected, the reaction was immediate. Clerics representing churches which reject mercy killing as the negation of all religious teachings were equally as emphatic in their replies.

The Moral Argument

At the risk of oversimplification, I shall attempt to enumerate the chief points of religious controversy and summarize the arguments advanced by both sides.

Is euthanasia a violation of the Sixth Commandment?

According to Rt. Reverend Monsignor Robt. E. McCormick of the Archdiocese of New York, euthanasia is murder, pure and simple.

“How any ministers of the Christian Protestant denomination can support legalized euthanasia is beyond comprehension,” says Monsignor McCormick. “It is definitely against the natural law, the innate moral code, the teachings in the Old Testament of the Jewish law and the teachings of Christ.”

On the other hand, Mr. Potter, the founder of the Euthanasia Society, is of the opinion that there is no commandment against euthanasia.

“There is not,” he says, “and never was, in either the original Hebrew of the Old Testament or the original Creek of the New Testament, any commandment ‘Thou shalt not kill.’ What the Old Testament Ten Commandments said, and what Jesus said in repeating them was, ‘Thou shalt not commit murder,’ which is quite different. All murder is killing, but not all killing is murder.”

In support of his claim that “Thou shalt not kill” is a mistranslation, Mr. Potter says that the English Revised Version corrected it to “Thou shalt do no murder.” It is also corrected in the Rook of Common Prayer and in the accepted modern translations, Catholic by Dr. Knox, Protestant by Dr. Moffatt, and Jewish by the Jewish Publication Society 1917.

A renowned Canadian scholar, Prof.

Theophile J. Meek, professor of Oriental languages at University College, University of Toronto, agrees with Mr. Potter on the matter of translation. Prof. Meek has translated the Sixth Commandment directly from the Hebrew as “You must notcommit murder.”

A Jewish point of view has been expressed by Dr. Sidney Goldstein, a prominent rabbi, lecturer and writer in the field of social sciences. “Many rabbis would approve of a program of euthanasia containing the proper safeguards,” Dr. Goldstein has declared.

In a sermon at St. Paul’s in Toronto, the Rt. Rev. Robert J. Renison, Anglican Bishop of Moosonee, told his congregation, “The time might come when I might feel it my duty and privilege to go quietly to the God from whom 1 came, without consulting anybody else. It is a personal thing between a man and his God.”

Is Suffering Wrong?

Is suffering part of a divine plan for the good of man's soul and therefore not to be interfered with?

Roman Catholic churchmen have long upheld the doctrine that pain has been ordained by heaven to strengthen the individual and to encourage human sympathy. “An outstanding law of the universe,” says Rev. Ignatius W. Cox, S.J. Ph.D., Professor of Ethics, Fordham University, “is that human progress depends on man’s ability to rise superior to pain, suffering, toil and labor. Every worth-while human success, every great work of art, of achievement, illustrates this law.”

Comments Dr. W. R. Inge, ex-Dean of St. Paul’s Cathedral, London, England, “1 do not think we can assume that God wills the prolongation of torture for the benefit of the soul of the sufferer.”

As to the effect of pain on the human personality, Dr. Hugh Cabot, formerly of the Mayo Clinic, observes, “I have found in my long experience that pain does not build character. Suffering does more damage to man and his spirit than it does good.”

Should euthanasia be permitted inasmuch as the Almighty reserves for Himself the power to decide the moment at which life shall cease?

“For 200 years,” says Professor Cox of Fordham University, “the Catholic Church has answered ‘No’ to euthanasia, claiming that the right to destroy belongs only to one who has exclusive ownership over the thing. Catholics have always laid supreme emphasis on

the individual value of human existence. Human life belongs to God— beginning, development and end.”

If this is so, reply several prominent clerics, doctors and jurists, one can argue that it is also morally wrong for a doctor to lengthen human life by surgery, blood plasma, penicillin and a host of other medical practices that are universally accepted by civilized society today.

Every time the question of legalizing euthanasia comes up for public discussion, one of the most frequent questions is: “In this age of rapid

medical progress, is it not true that the patient considered incurable today fhay be saved tomorrow?”

Dr. A. L. Wolbarst, treasurer of the Euthanasia Society and at one time associate editor of the Journal of the International College of Surgeons, discussed this point in an address delivered at New York Medical College.

“We are told that it would be unwise and inhuman to administer euthanasia to a patient dying from metastatic cancer, for example, because a cure for cancer might be found tomorrow.

“Such a cure, when and if discovered, will be of little, if any, value to the man or woman so far advanced in cancerous toxemia as to be an applicant for euthanasia.”

Dr. Wolbarst deals with another possible danger: Since doctors some-

times err, is it not possible that euthanasia will claim the life of a patient who might otherwise recover? “The common experience of physicians is that a man who is so near to death that he begs for merciful release has little or no chance of recovery,” says Dr. Wolbarst. “If a miraculous improvement does take place, it is only for a brief period.”

The rapid advance of medical science has greatly prolonged our span of life. An unhappy result is that an increasingly large number of people are reaching the age where degenerative diseases tend to occur. Last year, for example, almost 200,000 people in Canada and the United States died of cancer. The doctor, therefore, will come face to face with the question of euthanasia more frequently in time to come.

Failing an enlightened ruling from the public, the physician at the bedside of a patient, torn between his oath to prolong life and the merciful impulse to put a suffering human being out of his misery, must continue to make his own decision.