Reading “I’ll See Myself Out, Thank You”

“Ironic, isn’t it, that we can buy 50 different types of pasta or ice cream? We can choose a million styles of hair, or clothes, holiday destination or car. Tidal waves of consumer choice lap against us every waking minute. Yet when we need help to effect a simple, primary decision to ease out of life; when we want to avoid becoming a living shell, stuck in bed, in pain, staring at the wall for months on end, and thereby condemning our relatives to a similar suffering, we are denied that choice.” – Melanie Reid, journalist, severely disabled as a result of falling off a horse

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Eugenics vs Euthanasia

In light of information gleaned from Chapter 11, The Gene, I shall revisit my previous post on  whether severely disabled children may be euthanised.

In 1933, the Nazis enacted the Law for the Prevention of Genetically Diseased Offspring. The law mandated that “Anyone suffering from a hereditary disease can be sterilised by a surgical operation.” An initial list included mental deficiency, schizophrenia, epilepsy, depression, blindness, deafness and serious deformities. The law stated that “Once the Court has decided on sterilisation, the operation must be carried out even against the will of the person to be sterilised…where other measures are insufficient, direct force may be used.”

The slip from sterilisation to outright murder came virtually unannounced and unnoticed. In 1939, Richard and Lina Kretschmar petitioned Hitler to allow them to euthanise their child, Gerhard. Eleven months old, Gerhard had been born blind and with deformed limbs. The parents – ardent Nazis – hoped to service their nation by eliminating their child from the nation’s genetic heritage. Sensing his chance to ramp up gene-cleansing efforts, Hitler approved the killed of Gerhard. 

To justify the exterminations, the Nazis had already begun to describe the victims using the euphemism lebensunwertes Leben – lives unworthy of living.

The killing began with “defective” children under three years of age, but by September 1939 had expanded to adolescents. Juvenile delinquents were slipped onto the list next. Jewish children were disproportionately targeted – forcibly examined by state doctors, labeled “genetically sick” and exterminated, often on the most minor pretexts.

By October 1939, the program was expanded to include adults. 

The eugenics movement in 1933 differs starkly from euthanasia in terms of purpose. The former sought to produce a superior society by means of genetic selection while the latter seeks to relieve an individual from suffering. Thence, the former encompassed a broader scope of illnesses, many of which will not fall under the eligibility criteria of euthanasia. Furthermore, while the courts were able to order involuntary sterilisation, euthanasia of adults must be voluntary, with full and informed consent. This then begs the question of whether severely disabled children may be euthanised.

Firstly, can severely disabled children possess a will to live? If yes, how can we determine that will? If the will to live is determined, arguably, involuntary euthanasia will be ethically and morally wrong.

In 1939, Gerhard Kretschmar was involuntarily euthanised. Today, he would have failed the first of four requirements, which is the presence of hopeless and unbearable suffering. As society has progressed over the years, more has been devised to improve the lives of others such that suffering may be bearable and life, of hope. More importantly, the purpose of involuntary euthanasia today lies in the interest of the child, and not the parents’ or the state’s.

In order not to slip into humanity’s horrific past, power must not go unchecked and unchallenged. The horror of the Nazi era began when the German parliament endorsed the Enabling Act, granting Hitler unprecedented power to enact laws without parliamentary involvement. Support for genetic cleansing grew due to state-controlled media, propagating only one side of the story. The slip of judiciary and medical judgement was likely due to the political and psychological environment of the Nazi reign. Hence, one should not trust fully and blindly the systems of power, but question with one’s own conscience.

Ethics – Sanctity of Life

An excerpt from Practical Ethics by Peter Singer:

If we base the right to life on characteristics such as capacity for self-awareness, ability to plan for the future and have meaningful relations with others; we must grant some animals a right to life as good as, or better than retarded or senile humans. 

One may conversely say that severely retarded and hopelessly senile have no right to life and may be killed for quite trivial reasons, as we now kill animals.

Having recently watched Children of Darkness (1983) and When a Mother’s Love is Not Enough (2009), I have a few questions:

  1. Should parents be allowed to euthanise their severely disabled child?  Most severely disabled children suffer extensive and endless physical pain, and never have the mental capacity to comprehend what they’re going through. Furthermore, families bear huge medical costs, and suffer emotionally, mentally and physically. Euthanasia will relieve both the child and his/her family.
  2. What is life/living?  In my opinion, life is little worth living without the ability to think. Yet, what level of mental capacity is sufficient to make living worthwhile? Who is to set the bar?
  3. Is the slippery slope argument a strong one? Many have argued against euthanasia as the criterion may become increasingly lax, allowing parents to end the lives of less severely disabled children. As the line between mercy killing and killing blurs, it becomes problematic to govern society. In this regard, I wish to differ as I believe that a system of checks and balances can be set up to ensure that the strictest criterion has been met before grant of application. In Netherlands, the Groningen Protocol sets out directives with criteria under which doctors can perform child euthanasia without fear of legal prosecution. The termination of a child’s life (under age 12) is acceptable if 4 requirements were properly fulfilled: (a) presence of hopeless and unbearable suffering (b) consent of the parents (c) medical consultation  had taken place (d) careful execution of termination.
  4. Should child euthanasia be limited to children under 12 years of age? Many adults, by reason of illness or accident, suffer to be like children again and return to the care of their parents. Without formerly expressing their will for withdrawal of life support under such circumstances, most continue the rest of their lives in palliative care. To these adults, what is living? or rather, what was living? To their parents, is there a solution?