ORIGINAL

BY

C, EVERETT KOOP, M.D., Sc,D,
   SURGEON GENERAL
     OFiHE

    UA PUBLIC HEALTH SERVICE
lJ.S, DEPARTMENT OF HEALTH AND HUMAN SERVICES

PRESENTED AT THE INTERNATIONAL CONFERENCE ON
  EUTHANASIA AND THE FUTURE OF MEDICINE
CLARK UNIVERSITY, WORCESTER, MASSACHUSETTS
        OCTOBER 24, 1988


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(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC,)

  AS AN OFFICIAL OF THE FEDERAL GOVERNMENT, WHEN I SPEAK ON A

SUBJECT SUCH AS THE ONE BEFORE THIS CONFERENCE, I TRY TO SEPARATE

FACT, HISTORY, AND PREVIOUSLY ENUNCIATED PUBLIC POLICY POSITIONS

FROM MY OWN PERSONAL EXPERIENCE AND BELIEF,

   BUT THIS EVENING IS A LITTLE DIFFERENT -- AND A LITTLE MORE

DIFFICUILT -- BECAUSE THE GOVERNMENT HAS NOT STATED ITS OFFICIAL

POSITION ON EUTHANASIA, SOCIETY IS TRYING TO COME TO SOME

RESOLUTION OF THE MATTER, AND SO, LIKE YOURSELVES, GOVERNMENT

AND SOCIETY AS A WHOLE ARE LOCKED IN THE DEBATE AS WELL,

  HENCE, THIS EVENING I WILL ASK SOME QUESTIONS, HESITANTLY

VENTURE SOME ANSWERS, BUT PRESENT ESSENTIALLY NOTHING THAT I HAVE

NOT SAID ALREADY IN SOME OTHER FORUM IN THE LAST DECADE,


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AND I HOPE TO BE AS DISPASSIONATE AS POSSIBLE,

  THAT CAVEAT OUT OF THE WAY, LET ME SAY, HOWEVER, THAT I AM

TRULY HONORED TO BE YOUR FEATURED SPEAKER THIS EVENING,

THERE'VE BEEN SO MANY PEOPLE ON YOUR PROGRAM TODAY WHO ARE

CERTAINLY AS DESERVING OF THIS HONOR -- MAYBE MORE SO THAN I --

AND I WOULD NOT BE HONEST WITH YOU OR WITH THEM, IF I DID NOT

ACKNOWLEDGE THAT FACT,

  BUT IT'S A PECULIAR HONOR, IN A WAY 11, TO STAND BEFORE YOU,

THIS LATE IN THE 8TH DECADE OF THE 20TH CENTURY aa, WITH YOUR

MEMORIES -- AND CERTAINLY MY MEMORY -- STILL FILLED WITH VISIONS

OF WHAT OUR FELLOW HUMAN BEINGS HAVE DONE TO EACH OTHER a,, IN

JUST THIS CENTURY mm,  IN OUR VERY OWN LIFETIMES.


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   FOR EACH OF US -- IN MEDICINE, IN PHILOSOPHY, IN ETHICS, IN

LAW -- FOR EACH OF US AT THIS CONFERENCE, THOSE MEMORIES DO US

AND THE HUMAN RACE ITSELF VERY LITTLE HONOR INDEED,

SO I WANT TO BEGIN MY REMARKS THIS EVENING WITH THIS CAVEAT

FOR BOTH YOU AND ME:

WE ARE TRYING VERY HARD AT THIS CONFERENCE TO MAKE SENSE OUT

OF A PROFOUND HUMAN EVENT -- DEATH ITSELF -- AN EVENT THAT

MANY PEOPLE IN THIS CENTURY HAVE ALREADY TRIED TO RENDER

SENSELESS


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  SO MUCH EXCELLENT INFORMATION AND WISE OPINIONS HAVE BEEN

OFFERED THROUGHOUT THIS DAY, THAT I WANT TO SHIFT THE FOCUS THIS

EVENING AND SHARE WITH YOU A CONCERN THAT I BELIEVE WE 91l.

SHARE,   BUT IT'S A CONCERN THAT IS PARTICULARLY IMPORTANT TO ME

IN MY PRESENT ROLE AS BOTH A PHYSICIAN AND ALSO A MEMBER OF THE

GOVERNMENT OF A FREE AND COMPASSIONATE SOCIETY,

   THAT CONCERN IS "DEFINITION,"  DO OUR WORDS REALLY MEAN WHAT

WE THINK THEY MEAN?

   I PROMISE YOU I WILL NOT PROCEED TO READ PAGES FROM THE

DICTIONARY, BUT I DO BELIEVE IT'S WORTHWHILE TO TALK ABOUT WORDS

AND THEIR MEANINGS, BECAUSE THAT'S USUALLY A GOOD WAY TO LAY

BARE HUMAN MOTIVES,


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  BY THE WAY, I DON'T OFTEN HAVE THE OPPORTUNITY TO COMPLIMENT

THE DISCIPLINE OF PSYCHIATRY, SO I HOPE MY FRIENDS IN THAT

SERVICE WILL SAVOR THIS MOMENT,

  AS MANY OF YOU KNOW, I'VE ALWAYS HAD A PROBLEM WITH THE

TERM "EUTHANASIA" ITSELF, "GOOD DEATH" ,,a "HAPPY DEATH," FOR

ONE THING, THE TERM SEEMS TO HARBOR AN AMBIVALENCE ABOUT THE

ABSOLUTE VALUE OF HUMAN LIFE AND THE HUMAN EXPERIENCE IN GENERAL,

  TO ME, ANY SUCH AMBIVALENCE IS INCONSISTENT WITH THE

JUDAEO-CHRISTIAN TRADITION WITHIN WHICH I WAS RAISED, A TRADITION

WHICH, FOR ME, PLACES A CONSISTENT AND PRIMARY EMPHASIS ON THE

SUPREME VALUE OF HUMAN LIFE,


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   IT IS ALSO A TRADITION IN WHICH HUMAN LIFE IS VALUED NOT

MERELY IN THE ABSTRACT REALM OF THE INTELLECT BUT ALSO IN THE

CONCRETE WORLD OF SOCIAL INTERCOURSE,

  THERE IS, AFTER ALL, IMPLICIT IN THE CONCEPT OF EUTHANASIA

THAT DEATH IS THE RESULT OF SOMEONE'S CONSCIOUS CHOICE, IT IS,

THEREFORE, MORE THAN JUST AN ALLEGED "GOOD DEATH," IT IS A "GOOD

DEATH" THAT IS CONSCIOUSLY, SPEC IF1 CALLY BROUGHT ABOUT,

  ONCE AGAIN, IT IS A CONCEPT -- IT SEEMS TO ME -- THAT IS IN

DIRECT CONFLICT WITH A RELIGIO-SOCIAL TRADITION IN WHICH THE

HUMAN RACE IS PRESENTED WITH "A BLESSING AND A CURSE, LIFE AND

DEATH," AND WE ARE INSTRUCTED "ma #THEREFORE, TO CHOOSE LIFE,"


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  SO THE ELEMENT OF CHOICE HAS ALWAYS BEEN IN THE ENVIRONMENT,

BUT I DON'T THINK THERE'S EVER BEEN ANY DOUBT, THROUGHOUT THE

EVOLUTION OF OUR JUDAEO-CHRISTIAN HERITAGE, AS TO THE ONE WHO IS

TO DO THE CHOOSING, EACH ONE OF US MUST CHOOSE FOR HIMSELF OR

HERSELF,

AND WE'RE ENJOINED TO CHOOSE LIFE,

  EUTHANASIA, THEREFORE, SEEMS TO DIRECTLY CHALLENGE THESE TWO

VERY FUNDAMENTAL ASPECTS OF OUR CULTURE AND HERITAGE:


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FIRST, THAT OUR BASIC FRAMEWORK OF HUMAN VALUES IS INDEED

LIFE-CENTERED ,, ,

AND SECONI), THAT EACH INDIVIDUAL IS PERSONALLY RESPONSIBLE
FOR BEING A LIFE-CENTERED MEMBER OF THE HUMAN COMMUNITY,

  CHOOSING LIFE IS NOT A RESPONSIBILITY THAT CAN BE
DELEGATED, SUCH AS INSTRUCTING THE YOUNG OR METING OUT JUSTICE,

THIS ONE, EACH OF US MUST DO ON OUR OWN,


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  THUS, I QUESTION THE LEGITIMACY OF THE CURRENT DEBATE OVER

THE DIFFERENCE BETWEEN 'ACTIVE' AND 'PASSIVE' EUTHANASIA 11, THAT

IS, THE DIFFERENCE BETWEEN SOMEONE PLAYING AN ACTIVE ROLE TO

BRING ABOUT THE ALLEGED "GOOD DEATH' OF ANOTHER, AS OPPOSED TO

SOMEONE TAKING NO ACTION TO PREVENT DEATH FROM TAKING PLACE,

THE MOST COMMON ILLUSTRATION OF THIS IS THE 'CASE OF THE

DROWNING MAN,'


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*

   IF A MAN LEAPS FROM A BRIDGE INTO A RAGING CURRENT AND

TO DEATH, HE COMMITS SUICIDE -- LITERALLY, "SELF-DEATH" --

WHICH MANY SAY IS AN IMMORAL ACT, WITHIN THE TRADITIONS OF

OUR SOCIAL ORDER, WE KNOW THIS IS SO BECAUSE, IF HE TRIES

TO COMMIT SUICIDE BUT DOES NOT SUCCEED, SOCIETY WILL EXACT A

PRICE OF SOME KIND aa, A PUBLIC REBUKE AT THE VERY LEAST,

*

  ON THE OTHER HAND, IF You TAKE A MAN TO THE BRIDGE AND

THROW HIM OVER THE RAILING TO HIS DEATH, You HAVE KILLED

HIM, You ARE GUILTY OF THAT CAPITAL CRIME, AND SOCIETY WILL

EXACT A PRICE FROM You,


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+

  BUT WHAT IF YOU COME UPON THE BRIDGE JUST AS THE MAN

STUMBLES AND FALLS BY ACCIDENT OVER THE RAILING, AND YOU

HAVE SOME MEANS AT HAND -- A ROPE OR A FLOAT OF SOME KIND --

TO SAVE HIM? AND WHAT IF YOU DECIDE TO DO NOTHING 11, AND

THE MAN DIES? AGAIN, SOCIETY MAY HOLD YOU RESPONSIBLE FOR

MAKING A DECISION THAT DEFIES OUR COMMON, LIFE-CENTERED

SYSTEM OF VALUES, AND SOCIETY MAY EXACT A PRICE FROM YOU IN

THAT INSTANCE AS WELL,

  IN OTHER WORDS, YOU CANNOT DELEGATE THE INJUNCTION TO

"CHOOSE LIFE,"  INDEED, AS IN THE EXAMPLES I JUST MENTIONED, YOU,

AS THE BYSTANDER, CANNOT DELEGATE THAT INJUNCTION TO EITHER THE

SUICIDE OR THE ACCIDENTAL VICTIM,


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  AND, IF YOU RECALL THE CASE OF THE MURDER OF KITTY GENOVESE

IN KEW GARDENS, NEW YORK, 24 YEARS AGO, THE LINGERING HORROR OF

THAT EVENT WAS THE FACT THAT SOME 35 NEIGHBORS HEARD HER SCREAMS

AND DID NOTHING TO SAVE HER,

   THIS IS AN EXTREME EXAMPLE AND CERTAINLY NOT PART OF OUR

MEDICAL LITERATURE, HOWEVER, IT CLEARLY ILLUSTRATES THE

INTUITIVE REVULSION THAT SOCIETY FEELS TOWARD THE PASSIVE

BYSTANDER IN THE PRESENCE OF AN UNTIMELY DEATH,

AND, I'M AFRAID, ON CLOSER AND MORE THOUGHTFUL EXAMINATION,

THERE IS A DIRECT LINK BETWEEN THE PASSIVE NEIGHBORS OF KEW

GARDENS AND THE EQUALLY PASSIVE NEIGHBORS OF AUSCHWITZ,


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  EUTHANASIA, THEN, REMAINS -- IN MY MIND AT LEAST -- A PART

OF THIS CONTINUUM OF PERSONAL CHOICE THAT RUNS THROUGH THE

LIFE-CENTERED TRADITIONS OF OUR SOCIAL ORDER,

  IT APPEARS THAT WE, AS A SOCIETY, RETURN AGAIN AND AGAIN TO

JUDGE ADVERSELY THOSE WHO CHOOSE DEATH -- THEIR OWN OR SOMEONE

ELSE'S, AIDED OR UNAIDED -- IN A WIDE, ALMOST INFINITE VARIETY OF

CIRCUMSTANCES, HENCE, THE CURRENT DEBATE IN MEDICINE OVER WHAT

IS -- OR IS NOT -- AN APPROPRIATE "DELEGATION OF AUTHORITY" SEEMS

ALMOST IRRELEVANT,


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  WE'RE NOW EVALUATING THE UTILITY OF SUCH INSTRUMENTS AS

"DURABLE POWERS OF ATTORNEY" AND "LIVING WILLS" AND "BOARDS OF

REVIEW" AND SO ON a,, INSTRUMENTS WHICH JUSTIFY AND EVEN, TO SOME

EXTENT, CODIFY EUTHANASIA me, AND THUS ACQUIESCING IN AN
INDIVIDUAL'S CHOICE OF DEATH OVER LIFE IN CERTAIN MEDICAL

CIRCUMSTANCES , ,a EVEN THOUGH IT IS A CHOICE WE SIMPLY REJECT

EVERYWHERE ELSE IN THE SOCIAL ORDER,

  I MUST REJECT THE NOTION THAT MEDICINE IS SOMEHOW A SPECIAL

ARENA IN WHICH OUR LIFE-CENTERED VALUES MAY BE, OF ALL THINGS,

REVERSED, AND I DO SO BECAUSE THAT, IT SEEMS TO ME, IS THE

CENTRAL LESSON OF BINDING AND HOCHE,  IF WE DID NOT LEARN AT

LEAST THAT FROM THE HOLOCAUST, THEN WE LEARNED LITTLE OR NOTHING

AT ALL,


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  HENCE, REGARDLESS OF WHEN THE TERM "EUTHANASIA" WAS COINED

OR BY WHOM, I BELIEVE IT LIES OUTSIDE THE COMMONLY HELD, LIFE-

CENTERED VALUES OF THE WEST AND CANNOT BE ADMITTED WITHOUT

INCURRING GREAT SOCIAL AND PERSONAL TRAGEDY,

  AND I MUST AGAIN EMPHASIZE THE HIGHLY PERSONAL NATURE OF THE

TRAGEDY, FOR ME, AS BOTH A PRACTICING SURGEON AND, OF LATE, AS

THE SURGEON GENERAL, THIS ISSUE HAS APPEARED MORE FREQUENTLY IN

THE REAL GUISE OF AN ACTUAL HUMAN BEING AT RISK, AND LESS

FREQUENTLY AS AN INTELLECTUAL CONUNDRUM,

  PROBABLY THE MOST CELEBRATED EXAMPLE OF THIS WAS THE SO-

CALLED "BABY DOE" INCIDENT THAT OCCURRED IN APRIL OF 1982,


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   IT WAS -- AND STILL IS -- MY FIRM BELIEF THAT EVERY BABY

BORN IN THIS COUNTRY IS ENTITLED TO FULL CONSTITUTIONAL

PROTECTIONS AT BIRTH 1,s AT THE VERY LEAST,

   I ALSO PERSONALLY BELIEVE THAT THOSE PROTECTIONS APPLY AT

THE TIME OF CONCEPTION, AND, HENCE, I AM STILL OPPOSED TO

ABORT I ON-ON-DEMAND,

BUT, FOR THE MOMENT, LET'S TALK ABOUT "BABY DOE," WHO WAS,

IN FACT, BORN.


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   IN THE COURSE OF THE DEBATE SURROUNDING "BABY DOE" TWO

PHRASES EMERGED THAT CONFOUNDED AND ANGERED ME THEN ,a, AND THEY

STILL DO TODAY, ONE PHRASE IS "QUALITY OF LIFE,"

  THE PHYSICIAN, WHO ADVISED THE PARENTS OF "BABY DOE," SAID

THAT THEIR SON WOULD MOST LIKELY HAVE A VERY POOR "QUALITY OF

LIFE," IF HE WERE ALLOWED TO LIVE,

  LADIES AND GENTLEMEN, I'VE BEEN IN MEDICINE FOR A HALF

CENTURY, AND FOR THE PAST SEVEN YEARS I'VE BEEN LIVING ON THE

CAMPUS OF THE NATIONAL INSTITUTES OF HEALTH IN A HOUSE LESS THAN

A 100 YARDS FROM THE FINEST DNA-RNA LABS IN THE WORLD,


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AND I HAVE NO IDEA WHAT ANYONE ELSE'S "QUALITY OF LIFE" WAS

I II  IS 1.1 OR WILL BE, NO IDEA AT ALL,

  NOTHING IN MEDICINE -- AND NOTHING ANYWHERE ELSE IN OUR

WESTERN, JUDAEO-CHRISTIAN TRADITION -- ENABLES ONE PERSON TO

MAKE A TRUE JUDGMENT ABOUT ANOTHER PERSON'S "QUALITY OF LIFE",

  A HALF-CENTURY AGO THAT WAS PRECISELY THE ROOT OF THE

BINDING AND HOCHE THESIS maa THAT THERE WA SUCH A THING AS A

"LIFE DEVOID OF VALUE" , , , A LIFE THAT HAD NO "QUALITYa"


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  A HALF-CENTURY LATER THEIR THESIS REAPPEARED IN BLOOMINGTON,

INDIANA, IN THE PHRASE "QUALITY OF LIFE," THAT WAS THE CRITICAL

TERM FOR "BABY DOE'S" PARENTS AND IT REMAINS A CRITICAL TERM IN

MOST OF THE CONTEMPORARY PUBLIC DIALOGUE CONCERNING INDUCED

DEATH, OR EUTHANASIA,

  WE DON'T KNOW WHAT "QUALITY OF LIFE" MEANS, YET WE PERMIT IT

TO BE USED AS THE CRUX OF A MEDICAL DECISION REGARDING THE LIFE

OR DEATH OF A PATIENT,

THE SECOND TERM THAT FIGURED IN THE "BABY DOE" CASE WAS

THIS: "WITHHOLD NUTRITION AND FLUIDS,"


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  BECAUSE "BABY DOE" WOULD ALLEGEDLY HAVE A POOR "QUALITY OF

LIFE," THE PHYSICIAN RECOMMENDED AND THE PARENTS ACCEPTED THE

DECISION TO HAVE NO FURTHER NUTRITION OR FLUIDS GIVEN TO THEIR

SON a

  THIS DECISION SHOCKED ME BECAUSE, IN MEDICINE, NUTRITION

AND FLUIDS ARE LIFE ITSELF, HENCE, WHAT THAT DECISION REALLY

SAID WAS THIS: WE WILL STARVE TO DEATH "BABY DOE," SUCH

BLUNTNESS LACKS THE ELEGANCE OF THE NEW MEDICAL PHRASEOLOGY --

"WITHHOLD NUTRITION AND FLUIDS" -- BUT THAT'S WHAT IT MEANS,


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  I DON'T KNOW HOW LONG "BABY DOE" WOULD HAVE LIVED, HAD HE

BEEN GIVEN NUTRITION AND FLUIDS. AND I STRONGLY SUGGEST, THAT

HAD HE BEEN KEPT ALIVE, THAT WISER AND MORE EXPERIENCED HEADS

WOULD HAVE PREVAILED AND SOME NECESSARY LIFE-SAVING SURGERY WOULD

HAVE BEEN PERFORMED,

  BUT I Sm DON'T KNOW WHAT HIS ULTIMATE "QUALITY OF LIFE"

WOULD HAVE BEEN LIKE, IT COULD HAVE BEEN DIFFICUILT #aa OR IT

COULD HAVE BEEN SWEET, I DON'T KNOW, AND NOBODY ELSE KNOWS

EITHER,

  NEVERTHELESS, "BABY DOE" WAS A CHILD BORN IN THE HEARTLAND

OF AMERICA -- BLOOMINGTON, INDIANA -- IN A COMMUNITY AND OF A

FAMILY STEEPED IN OUR SOCIETY'S JUDAEO-CHRISTIAN VALUES -- AND A

WEEK LATER WAS KILLED THERE,


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WE'VE HAD "BABY DOE" AND, AS SURE AS I'M STANDING HERE

TONIGHT, WE'RE GOING TO HAVE "GRANNY DOE," TOO,

  IF SHE APPEARS ON MY WATCH, I INTEND TO PROTECT HER TO THE

BEST OF MY ABILITY, THAT IS A LIMITED ABILITY, TO BE SURE, AS I

QUICKLY LEARNED IN 1982,

  NEVERTHELESS, IF AND WHEN "GRANNY DOE" APPEARS ON MY WATCH,

I WILL WANT HER TO RECEIVE WHATEVER MEDICAL TREATMENT IS

INDICATED, AND I WILL PUBLICLY PRESS FOR THAT,


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  AND, JUST AS AN ASIDE, I WILL PAY SPECIAL ATTENTION TO HER

RECEIVING THE BEST POSSIBLE REGIMEN FOR THE MANAGEMENT OF PAIN.

FAR TOO MANY OF MY COLLEAGUES WHO MANAGE TERMINALLY ILL PATIENTS

IN INTRACTABLE PAIN FIND IT EASIER TO HASTEN THEIR PATIENTS' SO-

CALLED "DEATH WITH DIGNITY" THAN TO DO THE MORE DIFFICULT BUT

REQUIRED JOB OF EFFECTIVELY MANAGING THAT PAIN DURING THE

REMAINING HOURS OF LIFE,

  IN ANY CASE, I WOULD WANT "GRANNY DOE" TO RECEIVE WHATEVER

TREATMENT IS INDICATED, THAT DOES NOT MEAN PROLONGING THE ACT OF

DYING. BUT IT DOES AT LEAST MEAN PROVIDING HER WITH THE NUTRI-

TION AND FLUIDS NEEDED TO SUSTAIN LIFE AT ITS MOST BASIC LEVEL,


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  AND IF INDEED SHE WERE IN THE FINAL STAGES OF A TERMINAL

ILLNESS, I WOULD PRESCRIBE BASIC NUTRITION AND FLUIDS AND THEN

STAND BACK TO LET NATURE TAKE ITS COURSE,

I WOULD DO THESE T.HINGS IN SUCH A MANNER THAT SHE NOT BE

DIMINISHED AS A HUMAN BEING,

   AND THAT IS MY ESSENTIAL POSITION,   I HAVE NOT COVERED --

ALTHOUGH I'M QUITE AWARE OF -- A WHOLE RANGE OF ACTIVITIES

CALLED "HEROIC" OR "EXTRA0RD1NARY," BUT FOR THE FEW MOMENTS WE

HAVE TOGETHER TONIGHT, I THOUGHT I'D PASS UP THE TASK OF

UNRAVELLING WHAT THOSE CLICHES MAY CURRENTLY MEAN.

  IN ANY CASE, MY APPROACH TO "GRANNY DOE" IN A TERMINAL

ILLNESS WOULD NOT INCLUDE MUCH -- IF ANY -- HIGH-TECH, "HEROIC"

ACTIVITIES THAT WOULD DO LITTLE MORE THAN PROLONG THE AGONY OF

HER DEATH,


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  I BELIEVE MY APPROACH WOULD REFLECT, IF I MAY SAY IT, THE

"TRUE INTENT OF THE HEART,"  YES, IF THEY WERE NEEDED, I WOULD

SUGGEST THAT CERTAIN POWERFUL PAIN-KILLING DRUGS BE ADMINI-

STERED. AND I WOULD WANT EVERY EFFORT MADE TO HELP HER ABSORB

NUTRITION AND LIQUIDS,

  BUT THOSE DRUGS WOULD BE ADMINISTERED IN REASONABLE AND

EFFECTIVE DOSES THAT MAY, OVER TIME, ESCALATE, ULTIMATELY, SHE

MIGHT NOT TOLERATE THE HIGHER DOSES AND, AT THAT POINT, I ADMIT

THEY COULD CONTRIBUTE TO HER DEATHa

  BUT THAT IS NOT THE SAME AS GIVING HER ONE LARGE OVER-DOSE

OF A POWERFUL PAIN-KILLER EARLY IN THE MANAGEMENT OF HER CASE,

THE "INTENT OF THE HEART" IS CLEARLY DIFFERENT:

*

THE INTENT BEHIND THE GRADUAL ADMINISTRATION OF DRUGS IS TO

BE HER ALLY IN HER REMAINING HOURS OR DAYS OF LIFE AND TO

KEEP HER REASONABLY COMFORTABLE AS SHE SLIPS AWAY , . ,


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THE INTENT BEHIND THE LATTER APPROACH, THE DRUG OVER-DOSE,

IS TO GET HER "OUT OF HER MISERY" -- AND OFF OUR HANDS --

AS QUICKLY AS POSSIBLE,

AGAIN, IT IS NOT THE MEANS USED, BUT THE INTENT OF THE HEART

THAT SHOULD CONCERN US

  IF THIS SOUNDS TOO THEORETICAL, BELIEVE ME, TO THE

PRACTICING PHYSICIAN IT IS NOT THEORY BUT REALITY, AND FOR MANY

YEARS, I WAS A PRACTICING PHYSICIAN, AND, JUST AS AN ASIDE, LTE

ME BRIEFLY RECOUNT MY OWN CASE HISTORY OF THE LAST DAYS OF A

FAMILY MEMBER WHOM I SERVED AS PHYSICIAN, LET'S CALL HIM "UNCLE

HARRY,"

"UNCLE HARRY" WAS IN HIS LATE 7Os, HAD ALZHEIMER'S DISEASE,

AND HAD SUFFERED THROUGH SEVERAL BOUTS OF CARDIAC FAILURE, NOW

UNDER CONTROL WITH MEDICATION, HE LIVED WITH HIS WIFE IN A SMALL

APARTMENT IN A COMFORTABLE LIFE-CARE RETIREMENT CENTER, SHE WAS

ALSO IN HER 7Os, WAS ALERT, AND IN GOOD HEALTH,


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  ONE CHRISTMAS EVE, THIS ELDERLY COUPLE CAME TO THE

ADMINISTRATOR'S OFFICE AND ASKED FOR A ROOM IN WHICH "UNCLE

HARRY" -- AND POSSIBLY HIS WIFE AS WELL, IN SOME MAGIC WAY --

COULD QUIETLY DIE,

  NO SUCH ROOM WAS PROVIDED, BUT "UNCLE HARRY" WAS ADMITTED TO

THE INFIRMARY, HE WAS INCONTINENT, OBSTREPOROUS, DISORIENTED,

AND IN HEART FAILURE, HE CALLED ME BY MY FATHER'S NAME,

HE HAD TENDER, COMPETENT NURSING, WAS GIVEN FOOD, FLUIDS,

AND MEDICINE BY MOUTH. SOME HE SWALLOWED, SOME HE SPAT OUT,

   I WAS HIS PHYSICIAN, I KNEW HIS DISEASE PROCESS BETTER THAN

ANYONE, AND I KNEW THAT "UNCLE HARRY" WAS ALREADY IN THE PROCESS

OF DYING, WE WERE GIVING HIM FOOD AND LIQUIDS, BUT HE WASN'T

ACCEPTING ALL OF IT, YET, I DID NOT START AN INTRAVENOUS DRIP

NOR DID I INSERT A FEEDING TUBE,

  "UNCLE HARRY" WAS NOT IN PAIN, BUT HE WAS DYING, AND, AS

HIS ATTENDING PHYSICIAN, I CONCLUDED THAT THE TIME HAD COME FOR

ME TO STEP BACK AND LET NATURE TAKE ITS COURSE,


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THE TIME WAS PAST FOR TAKING EXTRA MEASURES TO PROLONG THE

ACT OF DYING, TRUE, I HAD AVAILABLE TO ME ALL THE HIGH-TECH

EQUIPMENT OF A MAJOR METROPOLITAN HOSPITAL, BUT "UNCLE HARRY" AND

I MIGHT JUST AS WELL HAVE BEEN IN A REMOTE, RURAL INSTITUTION

WITH MINIMAL EQUIPMENT, AS HIS PHYSICIAN, I MADE SURE HE WAS

LOVED AND CARED FOR AT THE MOST BASIC, HUMAN LEVEL -- AND I

BELIEVE THERE WERE MOMENTS OF CLARITY WHEN HE TRULY UNDERSTOOD

THAT, AND THOSE MOMENTS HELPED,

   I WOULD SAY THAT "UNCLE HARRY'S" DEATH WAS A "GOOD DEATH,"

BUT IT WASN'T EUTHANASIA, AS THAT TERM IS USED, IN DECIDING

AGAINST THE IJ, DRIP AND SO ON, I BELIEVE I BEHAVED ETHICALLY AS

HIS PHYSICIAN AND MORALLY AS HIS RELATIVE,

  "BABY DOE" LIVED FOR JUST ONE WEEK, BUT WE NEVER REALLY KNEW

HIM OR HIS FAMILY AT ALL, HOWEVER, THE SAME MAY NOT BE TRUE FOR

"GRANNY
DOE,"

   AND WHO MIGHT SHE BE?  HAVE WE ANY IDEA? THIS MIGHT

SURPRISE YOU a,, BUT I THINK WE KNOW.


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"GRANNY DOE" WILL PROBABLY BE SOMEONE WHO WAS NEVER REALLY

ENGAGED IN THE DEBATE THAT BRINGS US TOGETHER IN WORCESTER TODAY,

  SHE WILL BE SOMEONE WITH LITTLE OR NO EDUCATION BEYOND HIGH

SCHOOL aam PROBABLY A CHARITY CASE OR A MEDICAID CASE aa, THAT'S

VERY LIKELY.

  SOMEONE WITH MULTIPLE DISABILITIES 11, A WEAK HEART, POOR

VISION, EMPHYSEMA, ARTHRITIS, MAYBE SOME MEMORY LOSS , a a THAT'S

ALSO VERY LIKELY,


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  IN OTHER WORDS, "GRANNY DOE" WILL BE SOMEONE FOR WHOM

EUTHANASIA SEEMS TAILOR-MADE, IF I CORRECTLY UNDERSTAND ITS

ADVOCATES

AND LET ME AS BLUNT AS POSSIBLE ABOUT THIS,

  WHILE WE, WHO ARE ATTENDING THIS CONFERENCE, MAY REPRESENT

QUITE A RANGE OF OPINION REGARDING EUTHANASIA, THE HARD TRUTH IS

THAT EVERY ONE OF US HAS THE KNOWLEDGE, THE MONEY, THE FAMILY

SUPPORT, THE INSURANCE, THE CLERGY, AND ANYTHING AND ANYO_PIE, ELSE

WE NEED TO EASE US THROUGH OUR FINAL HOURS OF LIFE ON EARTH,


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   I LOOK OUT AT THIS AUDIENCE o, AS I LOOK OUT AT MOST

AUDIENCES IN THIS COUNTRY mm, AND I DO NOT SEE A POTENTIAL

"GRANNY DOE."  I DO NOT SEE ANYONE FOR WHOM A LIFE-OR-DEATH

CHOICE WILL HAVE BEEN DELEGATED, WILLY-NILLY,

  AND THAT'S THE FIRST SIGNAL THAT TELLS ME I'VE GOT TO BE

WORRIED ABOUT "GRANNY DOE,"  AS A CITIZEN OF THIS LIFE-CENTERED

SOCIETY, AS A PHYSICIAN, AND AS SURGEON GENERAL, I'VE GOT TO BE

ALERT TO THAT SIGNAL AND I'VE GOT TO BE WORRIED ABOUT THE

VULNERABILITY OF "GRANNY DOE,"


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AND IT OUGHT TO BE A SIGNAL FOR EVERYONE OF US

BINDING AND HOCHE WERE AWARE OF THAT, BUT THEY APPARENTLY

KNEW THAT THE SIGNAL WOULD BE IGNORED,

  IN THE GERMANY OF THE 1920s AND 193Os, THERE WERE MANY

VULNERABLE GROUPS WHO WERE OUTSIDE THE MAINSTREAM OF GERMAN

SOCIAL AND POLITICAL LIFE a,, GROUPS OF PEOPLE WHO WERE ACTUALLY

"INVISIBLE" OR WERE MADE "INVISIBLE":

MENTALLY RETARDED PEOPLE, OLD AND SICK PEOPLE, PHYSICALLY

HANDICAPPED PEOPLE, HOMOSEXUALS, GYPSIES, LABOR ORGANIZERS




I , I AND JEWS


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   INVISIBLE PEOPLE , , , UNKNOWN PEOPLE a mm PEOPLE WITHOUT

"QUALITY" ma, PEOPLE WHOSE LIVES WERE, ACCORDING TO THE STATE,

"DEVOID OF VALUE/'

BUT PEOPLE WHO FELL NEATLY WITHIN THE PRE-CAST DEFINITION OF

A "GOOD DEATH" 1.1 OF EUTHANASIA,

   I DON'T BELIEVE THE TERROR THAT GRIPPED NAZI GERMANY -- A

TERROR IN WHICH MEDICINE ITSELF PLAYED A HIDEOUS ROLE -- I DO NOT

BELIEVE SUCH A TERROR WILL EVER GRIP THIS COUNTRY,


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  BUT, AS I MENTIONED A MOMENT AGO AND AS I FEEL COMPELLED TO

REPEAT ONCE MORE, I AM A PHYSICIAN 11, A HEALER mum AND I DON'T

LIVE IN GENERALITIES, NEITHER DO ANY OF YOU,

  AND SO, WHILE THE TERROR OF STATE-SPONSORED EUTHANASIA MAY

NEVER GRIP AMERICA, IT'S POSSIBLE THAT THE TERROR OF THE

EUTHANASIAN ETHIC --.TOLERATED BY MEDICINE AND AN INDIFFERENT

PUBLIC AND PRACTICED BY A FEW PHYSICIANS -- IT'S POSSIBLE THAT

SUCH A TERROR MAY GRIP ONE INVISIBLE AND VULNERABLE AMERICAN,

ONE "GRANNY DOE":


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SOMEONE FROM A RACIAL OR ETHNIC "UNDERCLASS," PERHAPS a,, OR

A SIDEWALK SCREAMER , a, AN ILLEGAL, UNDOCUMENTED ALIEN 11, A

MOTHER OF 12 AND A GRANDMOTHER OF 33 . a, A NURSING HOME

RESIDENT WITH ALZHEIMER'S OR A "WELFARE QUEEN" a,, AN

URBAN INDIAN .a, AN ABANDONED MI GRANT PICKER,

GERMANY IDENTIFIED MILLIONS OF PEOPLE WHO WERE ELIGIBLE FOR

THE HONOR OF BEING LABELED "DEVOID OF VALUE,"

AND SO DO WE,


34

  AND SO DOES ANY SOCIETY THAT LOSES ITS WAY AND REPLACES ITS

FUNDAMENTAL HUMAN VALUES WITH A COUNTER-FRAMEWORK OUTFITTED WITH

A NEW AND FUZZY VOCABULARY THAT PERMITS THE HEALER ,,a TO BECOME

THE KILLER,

WE'RE SNARED IN A MARSHLAND OF NEW EUPHEMISMS AND CIRCUM-

LOCUTIONS, THEY ARE FAST BECOMING CLICHES, A SURE INDICATION

THAT THE DEBATE IS DETERIORATING FURTHER FROM RATIONALIZATION TO

IMPRECISION:

"QUALITY OF LIFE" a,, "WITHHOLD NUTRITION AND FLUIDS" ,a,

"DEATH WITH DIGNITY" , m, "ASSISTED SUICIDE" ma a "HEROIC

MEASURES" ,a, "PASSIVE EUTHANASIA" a,, "SURROGATE" ,,a

"EXTRAORDINARY CARE" m 8, AND SO ON,

THESE TERMS CAN MEAN DIFFERENT THINGS TO DIFFERENT PEOPLE,


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NOT LONG AGO, DURING A VISIT TO ENGLAND, I SPOKE WITH

SEVERAL INDIVIDUALS WHO ADVOCATE A "LOW CALORIE DIET" FOR INFANTS

BORN WITH SPINA BIFIDA,

  A "LOW CALORIE DIET" FOR A SPINA BIFIDA INFANT MEANS

STARVATION AND DEATH, SUCH AN INFANT NEEDS A REINFORCED DIET, IF

ANYTHING, TO SURVIVE THE ENORMOUS STRESS OF THE FIRST HOURS AND

DAYS AFTER BIRTH,

  THE EUPHEMISTIC "LOW CALORIE DIET," HOWEVER, IS PRESCRIBED

FOR PRECISELY THE REVERSE REASON: TO INSURE THAT THE INFANT DOES

NOT, IN FACT, SURVIVE AT ALL,


36

SO MUCH FOR "THE KING'S ENGLISH?

I DON'T THINK WE NEED TO SCRAP EVERYTHING WE KNOW AND START

WITH A TOTALLY CLEAR SLATE, THAT'S FOOLISH BECAUSE THERE m A

FEW TERMS THAT HAVE BEEN WITH US THROUGHOUT THE EVOLUTION OF OUR

PRECIOUS LIFE-CENTERED JUDAEO-CHRISTIAN HERITAGE,

  WE MAY NEED TO RETURN TO THEM AND SHARPEN THEM A BIT, TO

KEEP THEM RELEVANT TO THE CHALLENGES OF NEW TECHNOLOGIES AND SO

ON, BUT THEY ARE NEVERTHELESS STRAIGHTFORWARD AND HONEST TERMS

AND HARDLY OFFER THE COSMETICS THAT A CONCEPT SUCH AS EUTHANASIA

REQUIRES


37

"TO KILL" IS ONE SUCH TERM,

"SUICIDE" IS ANOTHER,

"IMMINENT DEATH" IS A THIRD,

  A FEW MOMENTS AGO I SAID, IN THE CASE OF "GRANNY DOE," I

WOULD PREFER TO PROVIDE HER WITH BASIC NUTRITION AND FLUIDS AND

THEN I WOULD "STAND BACK AND LET NATURE TAKE ITS COURSE," THAT'S

A PHRASE AND AN APPROACH I SUGGEST WE MIGHT WANT TO EXPLORE AND

RELY ON MORE AND MORE,


38

  BUT WE KNOW THESE TERMS ALREADY, WE'VE GROWN UP WITH THEM

AND WE RECOGNIZE THEIR PLACE IN THE GENERAL FRAMEWORK OF LIFE-

CENTERED VALUES THAT GOVERN OUR CHOICES IN THIS SOCIETY a  THEY

ARE ALREADY EMBEDDED IN OUR SOCIAL CONTRACT WITH EACH OTHER,

LET'S GO BACK TO THEM AND MAKE SURE WE STILL UNDERSTAND WHAT

THEY MEAN,

THERE IS SAFETY IN SHARED VALUES, SAFETY FOR THE BEST OF US

I I I AND SAFETY FOR THE WORST AND THE LEAST OF US,


39

  AND THE EXTENT TO WHICH WE CAN SAY THAT ,,m AND THE EXTENT
TO WHICH WE KNOW IN OUR HEARTS THAT IT IS INDEED TRUE , , , THEN
THAT'S THE EXTENT TO WHICH WE WILL HAVE FINALLY COME TO UNDER-
STAND THE'EXTENT OF THE INJURY TO OUR HUMANITY IN THIS CENTURY

, a, AND WHAT WE CAN DO TO HEAL IT,

THANK YOU,

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