Winter 1
The Case for Active Voluntary Euthanasia
Gerald A. Larne Joseph Fletcher Derek Humphry Helga Kuhse Robert L. Risley Pieter Admiraal
The Church Under Siege: Reflections on the Vatican/ Humanist Dialogue
Paul Kurtz
Also: George Bush and the Judiciary • Henry Morgent on Abortion Rights • Mathilde Krim on AIDS and Our Future IPTOO L ) WINTER 1988/89, VOL. 9, NO. 1 ISSN 0272-0701 Contents
62 LETTERS TO THE EDITOR 36 ON THE BARRICADES 66 IN THE NAME OF GOD 3 THE CASE FOR ACTIVE VOLUNTARY EUTHANASIA
4 Euthanasia: The Time Is Now Gerald A. Larue 7 Active Voluntary Euthanasia Derek Humphry 10 Excerpts from the Humane and Dignified Death Act... 11 In Defense of the Humane and Dignified Death Act Robert L. Risley 16 The Ethics of Active Voluntary Euthanasia Joseph Fletcher 17 Voluntary Euthanasia and the Doctor Helga Kuhse 20 Justifiable Active Euthanasia in the Netherlands Pieter Admiraal ARTICLES 22 AIDS and the Twenty-First Century Mathilde Krim 25 The Struggle for Abortion Rights in Canada Henry Morgentaler 44 The Church Under Siege: Reflections on the Vatican/ Humanist Dialogue Paul Kurtz 51 Unshrouding the Shroud Joe Nickell 52 Nietzsche's Der Antichrist: Looking Back from the Year 100 Robert Sheaffer 31 EDITORIALS President Bush and the Judiciary, Paul Kurtz I Religious Freedom and the 1988 Election, Robert Alley / I Survived the Humanist Congress, Tim Madigan 39 A FREE INQUIRY INTERVIEW The Frailty of Reason, Steve Allen, Jayne Meadows 57 BOOKS Mormonism Re-veiled, Vern Bullough I Sanctity of Life Versus Quality of Life, Gerald A. Larue / God and Stephen Hawking, Victor J. Stenger / Books in Brief
Editor: Paul Kurtz Senior Editors: Vern Bullough, Gerald Larue Associate Editors: Doris Doyle, Steven L. Mitchell, Lee Nisbet, Gordon Stein, Andrea Szalanski Managing Editor: Tim Madigan Executive Editor: Mary Beth Gehrman Special Projects Editor: Valerie Marvin Contributing Editors: Robert S. Alley, professor of humanities, University of Richmond; Paul Beattie, Unitarian Church, Pittsburgh; Jo-Ann Boydston, director, Dewey Center; Paul Edwards, professor of philosophy, Brooklyn College; Albert Ellis, director, Institute for Rational-Emotive Therapy; Roy P. Fairfield, social scientist, Union Graduate School; Joseph Fletcher, theologian, University of Virginia Medical School; Antony Flew, philosopher, Reading University, England; R. Joseph Hoffmann, chairman, Department of Philosophy and Religion, Hartwick College, Oneonta, N.Y.; Sidney Hook, Professor Emeritus of Philosophy, NYU; Marvin Kohl, philosopher, State University of New York College at Fredonia; Jean Kotkin, executive director, American Ethical Union; Ronald A. Lindsay, attorney, Washington, D.C.; Delos B. McKown, professor of philosophy, Auburn University; Howard Radest, director, Ethical Culture Schools; Robert Rimmer, author; Svetozar Stojanovic, professor of philosophy, University of Belgrade; Thomas Szasz, psychiatrist, Upstate Medical Center, Syracuse; V. M. Tarkunde, Supreme Court Judge, India; Richard Taylor, professor of philosophy, Union College; Sherwin Wine, North American Committee for Humanism Editorial Associates: Jim Christopher, Fred Condo Jr., Thomas Flynn, Thomas Franczyk, Robert Basil, James Martin-Diaz Executive Director of CODESH, Inc.: Jean Millholland Systems Manager: Richard Seymour Typesetting: Paul E. Loynes Audio Technician: Vance Vigrass Staff: Steven Karr, Lisa Kazmierczak, Marieen Kulman, Anthony Nigro, Alfrede Pidgeon
FREE INQUIRY (ISSN 0272-0701) is published quarterly by the Council for Democratic and Secular Humanism (CODESH, Inc.), a nonprofit corporation, 3159 Bailey Avenue, Buffalo, NY 14215. Phone (716) 834-2921. Copyright ©1988 by CODESH, Inc. Second-class postage paid at Buffalo, New York, and at additional mailing offices. National distribution by International Periodicals Distributors, San Diego, California. Subscription rates: $22.50 for one year, $39.00 for two years, $54.00 for three years, $4.00 for current issue; $5.00 for back issues. Address subscription orders, changes of address, and advertising to: FREE INQUIRY, Box 5, Buffalo, NY 14215-0005. Manuscripts, letters, and editorial inquiries should be addressed to: The Editor, FREE INQUIRY, Box 5, Buffalo, NY 14215-0005. All manuscripts should be accompanied by two additional copies and a stamped, self-addressed envelope. Opinions expressed do not necessarily reflect the views of the editors or publisher. Postmaster: Send address changes to FREE INQUIRY, Box 5, Buffalo, NY 14215-0005. The following statement was drafted by Gerald A. Larue, special editor of the euthanasia section of this issue, in cooperation with others. The Case for Active Voluntary Euthanasia
e, the undersigned, declare our support for the decrim- We support only voluntary euthanasia. We believe that Winalization of medically induced active euthanasia when once an adult has signed a living will expressing his or her requested by the terminally ill. personal wishes concerning treatment during a terminal illness We acknowledge that techniques developed by modern and/ or has signed a durable power of attorney for health care medicine have been beneficial in improving the quality of life statement enabling another to act on his or her behalf, the and increasing longevity, but they have sometimes been individual's wishes should be respected. Because most persons accompanied by harmful and dehumanizing effects. We are lack professional knowledge concerning methods of inducing aware that many terminally ill persons have been kept alive death, we believe that only a cooperating medical doctor against their will by advanced medical technologies, and that should be the one to administer the life-taking potion or terminally ill patients have been denied assistance in dying. In injection to the patient who has requested it and that the attempting to terminate their suffering by ending their lives doctor should be able to fulfill the patient's request without themselves or with the help of loved ones not trained in fear or threat of prosecution. medicine, some patients have botched their suicides and We respect the doctor's and the hospital's right to refuse to brought further suffering on themselves and those around participate in administering such terminal medications. We them. We believe that the time is now for society to rise would urge the medical profession to make clear the patient's above the archaic prohibitions of the past and to recognize right to change doctors and hospitals should his or her wishes that terminally ill individuals have the right to choose the for aid in dying be refused. We would urge that every effort time, place, and manner of their own death. be made to honor the terminally ill person's wishes in regard We respect the opinions of those who declare that only the to the time and place of death, and that if the patient desires deity should determine the moment of death, or who find family members to be present to give comfort, these requests some spiritual merit in suffering, but we reject their arguments. will be respected. We align ourselves with those who are committed to the We recognize that there may be some who would exploit defense of human rights, human dignity, and human self- the right to active voluntary euthanasia and take advantage determination: this includes the right to die with dignity. An of the ill and suffering. But we believe that protective laws underlying motive is compassion for those who wish to end can, and indeed must, be enacted to discourage and punish their suffering by hastening their moment of death. such action. There are those who would make a distinction between We respect the right of terminally ill individuals who do "active" and "passive" euthanasia; they would support the not wish to utilize euthanasia or hasten the moment of death. abandonment of "heroic" efforts to sustain life while opposing But we affirm that the wishes of those who believe in the any positive act to hasten death by increasing dosage of drugs right to die with dignity should be respected and that to do so or administering a lethal injection. We point out, however, involves the highest expression of moral compassion and that both passive and active euthanasia involve the intention beneficence. of ending a person's life.
Pieter Admiraal, M.D., Anesthesiologist, Reimer de Graaf Marvin Kohl, Professor of Philosophy, State University of New Gasthuis York College at Fredonia Bonnie Bullough, Dean of Nursing, State University of New Helga Kuhse, Deputy Director, Monash University Centre for York College at Buffalo Human Bioethics Vern Bullough, Dean of Natural and Social Sciences, State Paul Kurtz, Professor of Philosophy, State University of New York University of New York College at Buffalo at Buffalo Francis Crick, Nobel Laureate in Physiology, Salk Institute Gerald A. Larue, Professor Emeritus of Archaeology and Biblical Albert Ellis, President, Institute for Rational-Emotive Therapy Studies, University of Southern California at Los Angeles Roy Fairfield, Social Scientist, Union Graduate School Henry Morgentaler, M.D., President, Humanist Association of Joseph Fletcher, Professor Emeritus of Medical Ethics, University Canada of Virginia Medical School Robert L. Risley, Attorney, President, Americans Against Human Peter Hare, Chairman, Philosophy Department, State University Suffering of New York at Buffalo B. F. Skinner, Professor of Psychology Emeritus, Harvard Sidney Hook, Professor Emeritus of Philosophy, New York University University Rob Tielman, Co-president, International Humanist and Ethical Derek Humphry, President and Chief Executive Officer, National Union Hemlock Society Mitsuo Tomita, M.D., Assistant Clinical Professor, University of Edna Ruth Johnson, Editor, Churchman's Human Quest California at San Diego Euthanasia: The Time Is Now
Gerald A. Larue
he phone rings. The caller is a professor in Canada. the act of assisting death has been described as a final statement Her mother is in the hospital, in extreme pain and of love. T slowly dying of cancer. Medications cause grogginess I have encountered guilt in those whose loved one died or put her to sleep, but even in her drugged state she experi- in agony, begging for death, and the friend or relative or ences pain. She begs her daughter to help her die, to relieve lover did nothing to end the suffering. A rugged, elderly the suffering, to take away the pain. Even as the daughter Norwegian said, "He was my best friend. He asked me to talks with me from the hospital room the mother is moaning help him. He died in agony and I did nothing to help him in her sleep. I ask what the prognosis is. There is no cure. die. I have carried that burden ever since." A man in Arizona, The pain will continue and become more severe as the cancer in pained reminiscence, said, "She cried and moaned in the continues to invade vital organs. It is estimated that there morning, she cried and moaned at noon and during the night. will be two or three weeks of suffering before the exhausted, She begged me to help her die. She died crying and moaning. cancer-ridden woman will die. What can the daughter do? I can hear her cries still. I feel that I failed my wife when I note the details, record phone numbers—the daughter's she needed me most." home, the hospital room. I have no magic prescription. I The phone rings. The call is from an East Coast man I tell the daughter to talk to the doctor and then call me back. met at a humanist conference nearly twenty years ago. He Two days pass. I am haunted by the call, by the pain has AIDS and before the disease wastes his body and strength in the professor's voice, by feelings of my own helplessness. to the point where he becomes helpless and unable to act, I dial the hospital room. The daughter answers. "Oh, I am he wants to stockpile medication and die by his own hand. so glad you phoned. I have just given my mother the lethal I cannot recommend medication. I refer him to the book injection." I am stunned. What happened? "I did what you Let Me Die Before I Wake, by Derek Humphry.' He asks told me. I talked to the doctor. Today he came down the about euthanasia in Holland and I tell him of the magnificent hall and put a syringe in my hand and told me he never work of Pieter Admiraal, but warn him that Dr. Admiraal wanted to talk to me again about this matter." I ask what helps only his own patients. I probably will not hear from is happening now. "My mother and I said goodbye. I gave him again. her the injection. She is sleeping now and seems to be without His call reminds me of a young man who had had throat pain. She has that wonderful little smile that I love. It is cancer. It was in remission when he talked to my Death and the first time I've seen it in weeks." Dying class at the University of Southern California. Then, We meet a year later when she is in Los Angeles. What some eight months later, he phoned. He wanted to say good- are her feelings now? "I feel wonderful. My mother's death bye. His voice was weak and hoarse. The cancer had returned was peaceful. The suffering stopped. We said how much we and there was no cure. He owned a small, isolated cabin. loved each other. She thanked me for what I was about to He was inviting his closest friends (I was not one) to visit do. I gave her the injection and shortly afterward she died. with him, one or two at a time, to make their farewells. He I feel that I acted in love." But is there any guilt? "None died a short time later by his own hand. He was in control at all. I feel proud of what I did. I stopped her agony. She of his own death. He determined the moment and the mode wanted to die and I fulfilled her wishes. There is no guilt." of his death. He was in charge. He had time to make closure I have heard stories like this over and over again. Never with those who mattered most to him and even with some, have there been any feelings of guilt or of betrayal of trust like me, who were more distant friends. He died with dignity. or of having unnecessarily killed someone. In each instance, Pr here are others who did not die with dignity. Max Ferber, Gerald Larue is President Emeritus of the National Hemlock who wrote the moving piece, "I Cried, but Not for Irma,"2 Society, and is Emeritus Professor of Religion and Adjunct told my class that he watched his wife die in a hospital with Professor of Gerontology at the University of Southern tubes attached to almost every orifice of her body. She was California. comatose because of her medications. As he looked at this woman whom he loved and to whom he had been married
4 FREE INQUIRY for nearly fifty years, he felt anger at the indignity of her the request for death. This act is not murder, it is voluntary death. He wept, not because she was dead, but because of euthanasia—providing a good death, a dignified death. Simi- the manner of her dying. She was receiving the best medical larly, when such a patient is able to end his life without treatment, but her case was hopeless and the treatment simply assistance, the result should not be classified as suicide. prolonged her dying. The word euthanasia means a good death, a beneficial Max's anger drove him to actively support the California death, a dignified death. It signifies the termination of life Natural Death Act, which gives individuals the right to deny when the quality of life as defined by the patient has "heroic treatment" by signing a living will. This document degenerated to the point of meaninglessness, when the illness enables healthy persons to make known their wishes that heroic has reached a stage beyond the help of any physician or measures not be taken to prolong their lives should they medicine, when the pain has become unremitting and the become incompetent during a terminal illness. palliatives are inadequate and ineffective. At that point the I recall the young man I met at a Right to Die Conference afflicted person should have a choice: to continue to live in at Oxford. He was a quadraplegic, confined to a motorized wheelchair that he maneuvered with amazing skill. He hated In each instance, the act of assisting death his life. It had no quality. He wanted to die, but nobody would help him. He once attempted to steer his chair over has been described as a final statement of a cliff, but someone intervened. After I returned to America, love. I have encountered guilt [only] in those I read about his death. He had purchased a considerable whose loved one died in agony, begging for quantity of gasoline and spread it throughout the small cottage he owned. He then managed to ignite it and was cremated death, and the friend or relative or lover did alive. What a horrible way to die! How much more dignified nothing to end the suffering. and merciful his death would have been if a compassionate medical friend had been able to provide a lethal injection. pain or to die and end the suffering. Because many terminally Notions about the sanctity of life have meaning and sig- ill persons have been reduced to helplessness by their disease, nificance only when we are healthy and life is under our control. they need aid in dying. The time has come when the aid- The sanctity concept is reinforced by religious dogma and in-dying should be as readily available as a palliative when social abhorrence of killing except in extenuating circum- the patient requests it. stances, such as during wartime or in self-defense. To violate A properly signed and witnessed living will justifies legal- such generally accepted norms is to come under judgment ly, morally and, in most instances, theologically, the removal from religion, from society, and most of all from the law. of life-support equipment when a life that would otherwise We are told that "God gives life and only God should take end is being sustained artificially by machines. This form of life." In nontheological language this means that "nature euthanasia, popularly known as "passive" euthanasia, is widely produces life, nature terminates." Life and death are natural practiced throughout the world. Nevertheless, there have been facets of existence on planet earth. When this naturalistic cases, like that of Karen Ann Quinlan, when the heart concept is theologized, the caring dimensions of our common continued to beat and the lungs continued to function after humanity are set aside. We are informed that it is legally the machinery was removed. In such cases, if the patient has right and just, and theologically and sociologically proper, made the proper request, a lethal injection should be legally to prolong the life of a terminally ill person who is in intractable available, lending moral and perhaps theological support. pain. The doors of mercy and compassion are closed and Of course, some physicians may refuse to participate in legalistic thinking is in charge. euthanasia, and some hospitals may refuse the right to practice To challenge these beliefs is not to sanction suicide or euthanasia. The objections rest on religious, moral, and ethical murder. It is clear that the depression and despair that prompts interpretations, and decisions based on them deserve respect. normally healthy individuals to suicide can be dealt with psy- The patient and his family can find physicians and hospitals chologically; likewise, killing another for a selfish reason such willing to cooperate. Indeed, the wise patient and family will as anger cannot be justified. But euthanasia is something quite check with both the physician and the hospital to be sure different and must be separated from suicide and murder in that the patient's wishes will be honored. the eyes of society. On the other hand, there is good evidence that some doctors The wonderful progress of modern medical science has currently do give assistance in dying. There are those who, given us longer lives, medications to fight disease and control like Dr. Meyers in Scotland, Dr. Admiraal in Holland, and illness, and engineering that can cleanse kidneys, maintain Dr. Christiaan Bernard, formerly of South Africa, have made heart and lung functions, and so on. Our trained medical no secret of their participation in acts of active euthanasia. practitioners are committed to sustaining life through the In addition, polls taken in France, California, and Australia fullest use of such technology, but there are times when this have demonstrated that physicians are willing to admit to commitment can become a burden to the patient, to the family, the practice of voluntary active euthanasia, as long as their to the hospital, and to modest bank accounts. When the illness identities are not revealed.3 is terminal and the patient is in intractable pain and has In public, medical doctors generally maintain that they are expressed the wish to die with dignity, the time has come opposed to euthanasia. Off the record, however, some will when the medical doctor should be allowed to respond to admit that on numerous occasions they have administered
Winter 1988/89 5 huge overdoses of morphine to terminally ill patients for "pain stand, they will maintain silence about their private beliefs. control," knowing full well that the dosage is lethal and the The time has come to release medical personnel and hospi- patient will die. They protect themselves from potential law- tals from the fear of legal prosecution for practicing euthanasia suits or murder charges by using vague medical language to with patients who are terminally ill and who truly wish to justify their actions; they do not practice euthanasia, they die. It is possible to provide protective legislation against abuse. practice pain control. But in so doing they often bring about It is important that families and caring nonmedical persons the patient's death. be relieved of the burden of employing secretive ways to assist those they love who suffer terminal illness to die with dignity. Notions about the sanctity of life have One might argue against the young man in England who meaning and significance only when we are died in his self-made holocaust, but, horrible as his death was, he was in charge, he made the decision. It was not a healthy and life is under our control. [But] good death, but there was nobody to help him to achieve the doors of mercy and compassion are that end. Of course, not all quadriplegics want to die. I have met many who, despite their limitations, are living wonderfully closed when legalistic thinking is in charge. fulfilling, happy, and constructive lives. One world-class gymnast suffered a fall that left him quadraplegic. He controls At present, though most religious organizations oppose his motorized chair by blowing into small tubes mounted near voluntary active euthanasia, they support "passive" euthana- his face. He is now a sportscaster and a consultant to a firm sia4 based on the belief that by removing life-sustaining that designs equipment for the handicapped. He exudes machines, the physicians are not actively doing anything to enthusiasm about life and has no desire to die. bring on death, but are merely removing an impediment to But we are not all the same. I believe that if I were to natural death. This argument is obviously specious, for in become helplessly bedbound, limited in action and in the ability the act of removing the machinery, death is engendered. There to perform for myself, I would want to have the right to is fundamentally no difference between so-called passive choose for myself whether to continue to live. And should euthanasia and active euthanasia where lethal medication I, in my helpless state, decide not to live, I should like to causes death. have a caring physician administer a poison that would permit Humanist groups and Unitarian Universalists openly sup- me to die quietly and with dignity. I should not like to have port active euthanasia. When I have talked with clergy be- a nonmedical friend provide the lethal medication; there are longing to denominations that oppose euthanasia, I have just too many instances of bungled help. Furthermore, should encountered some church leaders who are well acquainted I be terminally ill and in intractable pain, and should my with the indignities and agony of terminal disease. They have continuing existence be a matter of only a few weeks, I should witnessed death without dignity among their parishioners and like to be able to bid farewell to those I love. To know that in their own families. But until their denomination takes a I am in control of my death would provide peace of mind even in the midst of pain. To be able to tell those who matter most to me how much I love them, to clear up any Doctors Polled on Life Support misunderstandings, to decide about the distribution of small Nearly eighty percent of American physicians favor possessions (my will takes care of other matters) would place withdrawing life-support systems from "hopelessly ill" or me in control of my being and my life right up to the last irreversibly comatose patients if the patients or their families moment. request it, according to a survey conducted by the American Not everyone would choose euthanasia. There are those Medical Association. who would prefer to fight for life in the midst of pain up The physicians were selected at random from the associa- to their last breath. This is their right. But we should all tion's files of active doctors, including members and nonmembers and physicians of various ages and both sexes. have the power to choose. The time has come for the legal- The doctors were asked: "Would you favor or oppose ization of voluntary medical euthanasia for the terminally ill. withdrawing life support systems, including food and water, from hopelessly ill or irreversibly comatose patients if they Notes or their families request it?" Fifty-eight percent answered 1. Derek Humphry, Let Me Die Before I Wake, Los Angeles: Hemlock/ "favor strongly," twenty percent answered "favor," five Grove, 1986. percent answered "oppose," ten percent answered "oppose 2. Max Ferber, "I Cried, but not for Irma," Readers Digest, April 1976. strongly," and seven percent answered "unsure." Sixty-seven 3. November 1987 Survey of California Physicians Regarding Voluntary percent of the doctors said they had been directly involved Euthanasia for the Terminally Ill, Los Angeles: The National Hemlock in such cases. Society, 1988. See also Helga Kuhse and Peter Singer, "Doctors' Practices Fifty-four percent said they were uncertain of the legal and Attitudes Regarding Voluntary Euthanasia," The Medical Journal of risks and responsibilities, while forty-three percent said they Australia, Vol. 148, 1988, pp. 623-627; and "5 French Doctors Aided in were certain. Ninety percent said doctors should initiate Deaths of Ill," International Herald Tribune, September 30, 1984. 4. Larue, Gerald A., Euthanasia and Religion, Los Angeles: Hemlock, discussions with patients or families, while 7 percent said 1985. • they should not.