Euthanasia and Senicide

Although throughout history individual philosophers from Plato and Seneca to Montaigne and Hume justified self-induced death for those who were severely sick and suffering, social policies aimed at discouraging suicide have reflected the religious view of life as a divine gift. The waning influence of religion contributed to the questioning of such policies. Physicians, however, were not significantly involved in this questioning until the discovery in the eighteenth century of analgesics and anesthetics that could relieve suffering in dying patients, as well as easily and painlessly end life.

Greater interest in medical euthanasia coincided with the birth in the early twentieth century of the modern hospital as an institution that could provide curative medical and surgical treatment. As medicine learned to control acute infectious disease, life expectancy gradually increased from a norm of forty in 1850 to almost double that figure in 2000. Degenerative and late-onset diseases made the discussion of end-of-life care more urgent, and the role of the physician more important.

Interest in euthanasia at the turn of the twentieth century coincided with the development of the eugenics movement in the United States and Europe. Stimulated by advances in genetics and a misguided attempt to hasten the process of natural selection that had recently been described by Charles Darwin, eugenics envisioned a perfection of the human race, initially through sterilization of the unfit or degenerate, variously defined as criminals, prostitutes, alcoholics, epileptics, and the mentally ill. Thirty states passed sterilization laws; eventually sixty thousand Americans were sterilized; and the movement was embraced by figures ranging from Theodore Roosevelt and Woodrow Wilson to Oliver Wendell Holmes.

Although Germany was not the first country to embrace eugenics, it took hold there more deeply than elsewhere, led by Ernest Haeckel, a famed and respected biologist and social scientist. Haeckel advocated euthanasia for the "hundreds of thousands of incurables—lunatics, lepers, people with cancer etc.. . .artificially kept alive," whom he saw as a drain on the economy and a threat to the health of the Aryan race (Gallagher). Alfred Hoche and Karl Binding, a psychiatrist and an attorney, respectively, built on Haeckel's work to write The Permission to Destroy Life Unworthy of Life (1920), an influential book much admired by Adolf Hitler. Hoche and Binding proposed that those who were retarded, deformed, or terminally ill, and those damaged by accident or disease, should be put to death to further racial hygiene and/or because they were a burden to society.

When the Nazis came to power, they legalized voluntary euthanasia, but soon adopted the Haeckel/Hoche/Binding proposals on a scale that even those three men could hardly have imagined. Under the T-4 program (Tiergartenstrasse 4 was the Berlin address from which the program was administered) German doctors ended the lives of several hundred thousand mentally ill children and adults with conditions considered incurable, ranging from schizophrenia to senility.

The postwar revulsion to the holocaust, and to the role of physicians in implementing it, discredited the euthanasia movement. A significant minority of advocates, however, while not stressing the eugenic aspects of euthanasia, continue to see it as a necessary social remedy for the increasing number of old people, the inadequacy of nursing homes, and the economic cost to families and society of caring for the elderly. In the words of Eliot Slater, an English psychiatrist and advocate of euthanasia, "When a chronically sick man dies, he ceases to be a burden on himself, on his family, on the health services and on the community."

In the past some nomadic tribes of Native Americans and Eskimos, such as the Shoshone (Steward) and the Ahtna (De Laguna and McClellan), motivated by the need to move in pursuit of food and other necessities, felt the need to abandon the elderly—a practice known as senicide. Derek Humphry, founder of the Hemlock Society, believes that social and economic necessity will force modern societies in the same direction. He writes, "One must look at the realities of the increasing cost of health care in an aging society, because in the final analysis, economics, not the quest for broadened individual liberties or increased autonomy, will drive assisted suicide to the plateau of acceptable practice." Pietr Admiraal, one of foremost Dutch practitioners of euthanasia, believes that by 2020 Europe may resort to euthanasia to deal with a large population of elderly people. Admiraal says he is glad he will not be alive to see it, but he remains a strong advocate of euthanasia (Hendin).

The revival of interest in euthanasia in the 1970s and 1980s, however, was primarily centered on compassion for suffering patients, most of whom were elderly. It was considered in part to have been a reaction to modern medical technology that permits maintenance of a pointless semblance of life and creates fear of painful and undignified death.