How Kindness Became Cruelty

Talking with a Bioethicist about Euthanasia

The world is a scary place when pain strikes and nothing can make it stop, and it’s even worse when the pain is part of a terminal illness, with no hope of relief. Offering such sufferers “death with dignity” sounds like a kindness—and indeed, that’s the argument made in a 1910 poem called “How Annandale Went Out,” by Edwin Arlington Robinson. The speaker is a physician; Annandale is his patient:

They called it Annandale—and I was there
To flourish, to find words, and to attend:
Liar, physician, hypocrite, and friend,
I watched him; and the sight was not so fair
As one or two that I have seen elsewhere:
An apparatus not for me to mend—
A wreck, with hell between him and the end,
Remained of Annandale; and I was there.

I knew the ruin as I knew the man;
So put the two together, if you can,
Remembering the worst you know of me.
Now view yourself as I was, on the spot—
With a slight kind of engine. Do you see?
Like this … You wouldn’t hang me? I thought not.

Recently I mentioned this poem to lawyer and bioethicist Wesley J. Smith after listening to him speak at a Discovery Institute seminar in Colorado. In Smith’s lecture he’d made the point that 150 years ago, euthanasia (so-called “mercy killing” or assisted suicide) was not an issue. Despite fewer and less effective painkillers and far more primitive palliative care, most people simply suffered through until natural death took them. No doubt there were instances when families or—as in the poem—physicians took matters into their own hands, but in general, even intractable physical pain was not seen as a reason to hasten death. Such killing was wrong. Finding meaning in whatever God sent you was right.

Today physical pain can be managed quite well, Smith points out, if not completely alleviated. We can have far gentler deaths than those experienced by any previous generation. So why, he asks, is euthanasia burgeoning?

A Culture of Death

For burgeoning it is. In the past few years “death on demand” laws have sprung up in Germany, Austria, Spain, Portugal, New Zealand, the Netherlands, and Canada. A few weeks ago Britain’s Royal College of Surgeons declared themselves “neutral” on the issue of physician-assisted suicide.

In Canada, Smith points out, “8 percent of people who die in Quebec are now killed by doctors or nurses.” He goes on to say that, “as if that weren’t enough, Quebec loosened the ‘strict guidelines’ again to allow people to order themselves killed in advance if they become incompetent.”

Notice that last part. Medically assisted dying is available as a remedy for not only intractable pain, but as a remedy for what Smith calls “existential anxiety.”

In fact, Smith says, this is the primary reason why people seek assisted suicide now—not because of physical pain, but because of existential pain. People fear the future. They fear that no one will take care of them; they fear that they’ll become a burden; they fear all manner of things, including poverty:

A disabled woman with quadriplegia named Rose Finlay in Canada has asked to be euthanized because she is destitute, and the disability benefits she applied for would not arrive in time for her to be properly housed and cared for.

According to Finlay, she was told that getting approved for disability benefits would take six to eight months, while according to a Canadian government website, it only takes a minimum of ninety days to get approved for MAID, which stands for medical assistance in dying. (And no, I’m not making up that ultra-creepy acronym, even though, yes, getting approved for a MAiD sounds like it came straight out of a ham-fisted sequel to Brave New World).

So, the Canadian government is characteristically glacial when processing disability benefit claims but Johnny-on-the-Spot when you want the government to kill you.

Many of Finlay’s fellow Canadians find death a perfectly reasonable solution to financial concerns. A recent poll in Canada shows 27 percent of those surveyed agreeing that euthanasia by physicians is acceptable for those suffering from poverty or homelessness.

Smith says there have “even been stories of case workers suggesting euthanasia to disabled people denied independent-living assistance, and to veterans with PTSD as an answer to their ‘suffering’ caused by a lack of social services.”

Worse, in many cases it’s no longer up to the sufferer. In Texas, a “futile care law” allows physicians to cut off wanted treatment. In the Netherlands, a man who killed his disabled wife was let off with a mere slap on the wrist because the homicide was attributed to caregiver burnout. He had refused offers of state assistance.

Again: Why now?

“Euthanasia” Then and Now

According to the Encyclopedia of Death, “Until late in the nineteenth century, the term euthanasia meant ‘efforts to ease the sufferings of the dying without hastening their death,’ but it soon came to include both passive withholding of life-prolonging treatment and active mercy killing.”

Indeed, “euthanasia” used to mean even more, according to Smith. It meant dying with your family around you, in a state of grace. But our priorities have changed. Smith, who has studied the issue for three decades, says that whereas once we focused primarily on living virtuous lives or protecting the innocent, now we focus primarily on eliminating suffering. And, he says, “eliminating suffering so easily morphs into eliminating the sufferer.”

And then, of death there is no end.

“Once a society accepts the noxious notion that killing is an acceptable answer to human suffering,” Smith writes, “the definition of ‘suffering’ never stops expanding.”

Today in various countries people can be killed because they are mentally ill, disabled, anxious, afraid of the future, or lonely. They can be killed because bystanders—including medical professionals—are tired of caring for them, or deem them unfit to live, or want to save money, or want to harvest their organs. Princeton bioethicist Peter Singer and others argue that if a family will “suffer” because of an unwanted baby, infanticide is permissible.

Which brings us back to the 1910 poem.

The Road to Hell

“That’s right about when all this started,” Smith said, and told me about Harry Haiselden, an Illinois doctor who, between 1915 and 1919, refused treatment to and even actively hastened the deaths of infants under his “care” whom he deemed unfit to live. One case, involving a baby who needed surgery, went to trial. Ultimately the coroner’s jury rebuked but declined to convict Haiselden. They wrote:

We believe that, morally and ethically, a surgeon is fully within his rights in refusing to perform any operation which his conscience will not sanction....

We recommend strongly that in all doubtful cases of this character a consultation of two or more surgeons of known reputation for skill, ethical standing and broad experience should decide upon the advisability or inadvisability of operative measures....

We believe that a prompt operation would have prolonged and perhaps saved the life of the child. We find no evidence from the physical defects that the child would have become mentally or morally defective.

Haiselden then wrote and starred in a movie about his actions, called The Black Stork, also known as “Are You Fit to Marry?”

These events are called by the Encyclopedia of Death and Dying “a crucial, defining moment in the history of euthanasia and in the relation between euthanasia and eugenics.” Eugenics refers to improving a bloodline by weeding out weaknesses (usually by sterilization or killing)—and “weakness” means whatever someone wants it to mean, including color of skin, cultural differences, or sexual proclivities.

The road to hell is paved with good intentions, so the saying goes, and it holds true in the case of euthanasia. The apparently merciful step of killing people who want to die due to acute pain has sent us down a slippery slope to killing people for just about any inconvenience whatsoever.

Reframing Suffering

What is a humane response to such developments? Smith writes:

We certainly have a positive duty to mitigate suffering whenever we reasonably can—the basis for many charitable and beneficent actions such as medical charities, organizations feeding the hungry, and the proliferation of humane societies.

But eliminating suffering is impossible. Not only is the goal Utopian, but it leads to ever-more-extreme distortions of decency and a collapse of public policy rationality—which ironically, can cause the very “evil” that suffering abolitionists yearn so desperately to prevent.

The goal of avoiding suffering has become an idol in our modern comfort culture—a god feasting on human sacrifice. A better goal is to serve those who are anxious or in pain by coming alongside them to recapture a sense of human life as meaningful and precious.

Canadian journalist Andrew Coyne once wrote about the rising tide of euthanasia, “A society that believes in nothing can offer no argument even against death. A culture that has lost its faith in life cannot comprehend why it should be endured.”

Why should life be endured?

One answer is that life should be endured because life is a gift given to each of us by God, and only He has the wisdom and right to decide when it should end.

Another is this: Life should be endured because quite often, people look back and discover that the most meaningful times were times of great suffering. Those were the times when they learned what they were capable of doing or enduring; when they pulled together with others to triumph over hardship, uncertainty, or pain; when friends and strangers surrounded them with love; when they saw with crystal clarity that their relationships and their souls were transcendent, and physical circumstances merely temporary.

As Léon Bloy once wrote, “Man has places in his heart which do not yet exist; and into them enters suffering, in order that they may have existence.”

Additional Reading:

• Greg L. Bock, “Suffering Defeated: A Dialogue about God and the Problem of Evil”
• John D. Martin, “Department of Parts: Governments Deceptively Promote Euthanasia to Seize Your Organs”
• Heather Zeiger, “Euthanasia by the Numbers”
• Nicole M. King, “Suffering Elderly: Putting Heart and Soul in End-of-Life Care”
• Amanda Witt, “Pitfalls of the Quest for a Pain-Free Life”