Remembering Auschwitz, or Forgetting It?

Now Choose Life

David C. Stolinsky, M.D.
Jan. 27, 2005

I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give a woman an abortive remedy.
– Hippocrates, Father of Medicine, c. 460-377 B.C.

Since neither a newborn infant nor a fish is a person, the wrongness of killing such beings is not as great as the wrongness of killing a person.
– Peter Singer, Prof. of Bioethics, Center for Human Values, Princeton, 1994.

Since the beginning of history, society assigned the task of saving life to physicians. If killing people was required, that task was given to executioners. How these two opposite roles became confused is recounted by Wesley Smith, an advocate of the rights of the disabled.

His book "Culture of Death: The Assault on Medical Ethics in America" is well written. But for me as a physician and the nephew of a Holocaust victim, reading it was alarming.

Smith introduces the leaders of "bioethics." The best known is Peter Singer, who equates humans with animals, and would allow parents to kill imperfect children up to one month old, later increased to up to three years old.

Singer was chosen to write the article on ethics for Encyclopaedia Britannica. It is frightening that he could hold such views, yet be embraced by many scholars.

Bioethicists condemn "paternalism," but only when it is directed toward saving life. It is "paternalism" for a physician to use his medical knowledge to decide what is best for his patient. Yet somehow it is not "paternalism" for ethicists – mainly upper-middle-class white males – to use their own subjective values to decide who is unworthy to go on living.

This decision is affected by how closely the patient resembles the ethicist in age, appearance, and mental or physical ability. Fetuses, infants, the elderly, the deformed, the disabled and the mentally impaired do not resemble ethicists – unless one sees that they are all in God’s image. But this requires what Singer calls religious "mumbo-jumbo."

If a skinhead declares that those unlike himself are unfit to live, it is called racism. If a professor does something similar, it is called bioethics. Come again?

A cousin of Charles Darwin coined the term "eugenics" and proposed selective breeding of humans. The eugenics movement gained favor among the elites of America and Europe in the early 1900s, much as the euthanasia movement is doing today.

A milestone on the road downhill was the publication in Germany in 1920 of "Permission to Exterminate Life Unworthy of Life" (Die Freigabe der Vernichtung lebensunwerten Leben). The "unworthy" included the incurably ill, the mentally ill or retarded, deformed children and the comatose. Killing was "healing treatment" to be administered by physicians.

For the first time, killing and healing were mixed together. And physicians’ loyalty was no longer to the individual patient, but to "society" or the state.

Once the Nazis took over, medical graduates no longer took the Hippocratic Oath, but an oath to the health of the state. Most American medical graduates also no longer take the Hippocratic Oath, but a variety of other oaths, including one that refers to "humanity" but mentions neither abortion nor euthanasia.

I believe the chief cause of the Hippocratic Oath’s demise is its ban on abortion. But in the Oath, euthanasia and abortion are next to each other. Discarding the second prohibition weakened the first. If all human life isn’t sacred, none is. Intermediate positions are weak and are being overrun one by one. Who is worthy to live becomes just a matter of opinion.

The phrase "life unworthy of life" was used by the Nazis, but it originated before anyone heard of Hitler. Nazism was a seed that fell on soil that had already been fertilized by the manure of viewing human beings not as having intrinsic worth because they are created in God’s image, but as having worth only if they are useful to others.

Those who now spread similar manure will not be able to claim innocence if similar seeds will sprout. The lesson of history is clear.

The Nazi euthanasia program utilized drugs, then gas, and was the physical and psychological prelude to the Holocaust. It was opposed so strongly by Catholic and Protestant churches that it was stopped, though it continued unofficially. Sadly, there was no organized opposition by physicians, many of whom were Nazi Party members.

Of all professions, medicine had the highest percent of Nazis. When leading doctors support late-term abortion, assisted suicide, euthanasia and cloning, remember not to expect moral leadership from the medical profession. This lesson too is clear.

Singer protests that he is unlike the Nazis because he is a social democrat – as if morality depends on party labels – and because his motives are different. Yet he claims that infanticide is ethical if it promotes the interests of the family or of "society."

The father of Baby Knauer, a developmentally disabled child who was the first person "euthanized" by the Nazis, stated, "Later, we could have other children, handsome and healthy, of whom the Reich could be proud." Where, precisely, does this view differ from Singer’s? Indeed, the Reich would be proud.

Singer adds that babies are "replaceable." But no two humans have the same genetic makeup except for identical twins, and even here the environment causes differences. Middle-school students know these facts.

Smith’s book describes partial-birth abortion, of which 3000 to 5000 may be performed annually, and dehydration of the cognitively disabled, which is now common practice in America. Dr. Fred Rosner, an opponent of starving and dehydrating patients to death, protests that this "…attacks the very foundation of medicine as a profession."

To me, this is a crucial problem. To others, it may be an advantage to have physicians become "double agents." If physicians are no longer independent professionals, exercising their best judgment for the patient’s benefit, but become mere employees of HMOs or the state, surely there will be fewer problems for administrators – regardless of what they are administering.

Does this seem paranoid? Note the case of a man brain-damaged in an auto accident, but able to maneuver his wheelchair down a corridor. His wife wanted to dehydrate him to death. The case reached the California Court of Appeals, which ruled, "…there should be no presumption in favor of continued existence." Accused murderers are presumed innocent until proved guilty, but the disabled must have their "continued existence" argued from a neutral standpoint.

Death ceases to be a tragedy, and becomes just a matter of opinion.

But think of the money we’ll save by killing the disabled! Note that the university president who appointed Singer is an economist. Interestingly, in America only 15 percent of those who die have hospice care, while in Britain, where hospice care is free, 65 percent do so.

In Britain only one request for euthanasia was received from about 1800 AIDS patients in a hospice. Polls show that 40 percent of Americans would hasten their own deaths to avoid being a burden on others, but only 14 percent would do so to end their own pain. If we can’t do as well as the underfunded British National Health Service, but respond to fear of being a burden by killing the patient, what does that say about us?

Cicely Saunders – a devout Christian – is a British physician. She cared for a Polish Jew who had survived the Holocaust but lay dying in a London hospital. Saunders identified with him, despite their different backgrounds, then extended this empathy to all those in need. She inspired the hospice movement. For her work she was knighted by Queen Elizabeth.

Peter Singer – an atheist – learned that his grandfather had been murdered in the Holocaust. Rather than identifying with his own relative, he identified with the strong. He went on to justify killing imperfect babies and brain-damaged adults. For his work he was appointed a professor at Princeton.

What people learn from life’s events reveals more about the people than about the events. Whom we select to honor reveals a lot about us.

To the irreligious, life has no meaning beyond itself, so loss of life or health is terrifying. In a culture that worships youth, beauty and physical fitness, the elderly, the unbeautiful and the disabled may be seen as disgusting.

Physicians are as afraid as other people of death and disability, as shown by their rating disabled patients’ quality of life lower than the patients themselves rate it. Doctors’ urge to be in control is threatened by death, the final proof that we are not in control.

These repressed fears may be projected onto patients, making it unclear whether we wish to hasten their deaths in order to relieve their suffering or our own uneasiness. We must recognize that a patient’s expressed wish to die need not be taken literally. It may really be a complaint about inadequate care, or an appeal for reassurance that we still value his or her life.

The young and healthy may say that they would rather be dead than old, blind or paralyzed. The old, blind or paralyzed often feel differently. The healthy are poor judges of what is unbearable.

Everyone has a worst fear, but mine may be different from yours. To an athlete or construction worker, physical disability may be terrifying. To a bioethicist or physician, cognitive disability may be the worst thing imaginable. But it is egocentric to assume that patients feel the same way.

I recall a patient I had years ago. He was senile and undergoing therapy for cancer. But he spent most of the day chuckling at cartoons on TV. As a young doctor, I surely didn’t want to be like him, but I had enough insight to realize that he might be happier than I was. Egocentrism is a poor qualification for an ethicist.

Peter Singer defines a "person" as one who is rational and anticipates the future. A good test of rationality is the ability to learn from experience.

• Have we learned anything from 2400 years of medical tradition?

• Have we learned anything from psychology about repressed fears and projection?

• Have we learned anything from the hospice movement about adequate palliative care?

• Have we learned anything from the Netherlands, where over 1000 patients are "euthanized" annually without their consent, and where psychiatric illness is now an acceptable cause for euthanasia?

• Have we learned anything from the Holocaust, the most terrible lesson of all?

Can’t we see where the current culture of death may be heading? If not, can we claim to be rational and to anticipate the future? By Singer’s criteria, do we qualify as "persons"? Does Singer himself? What good is commemorating the liberation of Auschwitz, if we again hold human life in contempt? 

When I graduated from medical school years ago, "physician-assisted death" meant a concerned doctor committed to caring for the patient until the end. That it now means the opposite is not a source of pride. President Bush’s "culture of life" may be controversial, but it surely is better than a culture of death.

Over 3000 years ago, the Bible told us, "…I have set before you life and death, blessings and curses. Now choose life, so that you and your children may live…" We would do well to heed this lesson, rather than the teachings of "ethicists" who can’t distinguish human babies from fish.

A prior version of this article appeared in New Oxford Review. Dr. Stolinsky writes on political and social issues. He may be contacted at dstol@prodigy.net.

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