EUTHANASIA AND ASSISTED SUICIDE
Pieter Admiraal, MD, PhD, an anesthesiologist and specialist in
palliative care for cancer patients, presents a review of the social
and cultural attitudes about euthanasia and assisted suicide.
Throughout history it was sometimes approved and sometimes
forbidden, approved because it was a way out for suffering,
terminally ill persons, or for reasons of dignity, forbidden because
it violated the rule against killing and letting God instead of the self
be master of one’s life. In the last and this century many physicians
supported it and legislation was proposed but never approved. The
Nazi brutalities were not euthanasia, but they tended to put on hold
any legislative initiatives. These are only now starting again,
beginning in the Netherlands and now also in the USA.
A short history of euthanasia
The word euthanasia originated in Greece. It comes from two Greek words, eu (good), and thanatos (death). In its most neutral form, then, “euthanasia” means a good death. Since most of us would want a good death for ourselves and for others, this cannot be the aspect of euthanasia that engenders so much dispute today. Instead, that dispute comes from social, cultural, and religious values that come into conflict about duties we have to die well and duties others have to assist us.
Conflicts of this sort have always surrounded the idea. Plato and Socrates regarded suffering as a result of painful disease to be a sufficient reason for stopping life through suicide. We all know that Socrates died by taking hemlock, not because of a painful illness, but for a noble reason, to uphold the very rule of law that had condemned him to death. Plato’s and Socrates’ views on the matter diverged from those of Aristotle, who argued that suicide was not courageous and was an offense against the state. Pythagoras and Epicures also condemned suicide. Yet in some city-states of Ancient Greece, suicide was approved. Magistrates kept a supply of poison for anyone who wished to die. Perhaps it was against this widespread acceptance that the Hippocratic physicians took an oath to “give no deadly drug,” as they were part of a reform movement of physicians influenced by Pythagorean ethics.
The Stoics, another later branch of Ancient Greek and then Roman philosophy, accepted suicide as an option when life was no longer acceptable for any serious reason. To the Romans, suicide for halting life during painful terminal illness was acceptable. Due to the Stoic influence, the idea of dying well was a summum bonum, the highest good, and part of a noble life: “A good death gives honor to a whole life,” said Epictetus, a Roman Stoic thinker. In Rome, people were permitted, sometimes expected, to commit suicide to escape from disgrace at the hands of an enemy, or scandal (as it is in Japan even today), or as an alternative to public execution (as Field Marshall Rommel, a German hero, was given the option by the Nazis when it was learned he had plotted to kill Hitler).
With the advent of Christianity in the Roman Empire, this viewpoint waned. Under the growing influence of this religion, and its acceptance as the official religion of Rome at the time of Constantine, suicide was no longer acceptable. The rule against killing had its origin in the Christian view of the Commandment, “Thou shalt not kill,” and the pacifism of Christ and the early Church. Life was seen as a gift from God over which persons had to take ordinary care. St Augustine, for example, argued that suicide was against the Sixth Commandment, against killing, and that life and suffering were divinely ordained for the individual. The moment of death was in God’s hands, and to usurp it was a sinful act of pride, a denial of God’s power over human life. Persons who committed suicide were usually buried outside the city walls, at a crossroads, where...
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