Hippocrates Would Be Proud

A topic revisited…

On September 22 1996, Dr. Philip Nitchke assisted at the world’s first legal doctor-aided suicide,* made possible by the Northern Territories (Australia) enactment of a voluntary euthanasia law that became effective on July 1. At the Darwin, Australia, home of Bob Dent, Nitchke connected up the retired carpenter, who suffered from advanced prostate cancer, to a computer-controlled “death machine.” Dent answered a series of questions on the computer keyboard, until it asked the penultimate one, whether he understood that a yes answer to the final question would, after 15 seconds, inject him with a lethal mixture of barbiturates and muscle relaxants. It then asked him simply, “Are you ready to die?” Dent answered yes, and died with his wife at his side.

*The Australian Northern Territories  outlawed physician-assisted suicide within before 1999.
At present, several U.S. states, and several countries around the world legally  allow either passive euthanasia (refusing/withholding life-extending treatment) or physician-assisted suicide (“death with dignity”). Oregon’s statistics, the first U.S. state with such a law, record fewer than 250 persons per year making use of this choice.

Euthanasia Is Witchcraft?

The controversial law that made this event possible is hedged with precautions: it is only available to those terminally ill, they must be evaluated by two doctors and a psychiatrist, and patients must wait nine days after evaluation before an injection can be administered. Nonetheless, the usual suspects are mustering in opposition. Clerics along with conservative doctors are mounting an effort to create national legislation outlawing the practice. Some aboriginal leaders join in because they believe euthanasia is a form of witchcraft. The belief seems to stem from an aboriginal concept that is the flip side of the Asian belief that if you save someone’s life you are responsible for it. In the same vein, according to sources familiar with aboriginal ideas, if you take someone’s life, you have taken control of his soul—and that’s witchcraft, by their lights.

Thou Shalt Do No Murder

Let’s look at that: the taboo against murder is very nearly universal among humankind. That doesn’t stop humans from killing each other in all sorts of other ways: self-defense, war, plain old accidents. Causing someone’s death directly without their permission or knowledge is taking control of them, certainly, and heinous…but what about with their permission? at their request? Curing someone is taking control, too, you see. That’s why so many Pagan belief systems teach that a patient must give permission for any healing beforehand. Requiring permission leaves control of a person’s own being in the hands of that individual.

So, are we then responsible for the soul of someone who slips—and breaks a neck—on the banana peel that missed the compost heap? That scarce commodity “common” sense, I think, would say no; you didn’t mean to, it wasn’t intentional. Intent is the key. You planned to kill him, you meant to kill him, youdid kill him; that’s first degree murder. You didn’t plan to kill him, but in a moment’s fury or despair or misery or terror, you acted and did kill him, that’s still murder, but second degree—except in self-defense. You didn’t plan to, didn’t intend to, but your actions caused his death, that’s not murder, that’s manslaughter. Thus embedded in our statutes is the belief that intent counts. It’s what you mean to do that matters.

First of All, Do No Harm

Among the initiatory mystery traditions of ancient Greece are the spiritual Eleusinian mysteries, the mathematical Pythagorean mysteries, and the medical Hippocratic mysteries. Yes, Hippocrates founded an initiatory tradition of physicians, who all swore, as M.D.’s today still swear, to “first of all, do no harm.” The traditional Hippocratic oath includes a promise not to provide “a deadly drug.” I note that there exists very nearly no drug, pharmaceutical or herbal, which can be defined as not being at least potential toxic!

That command is uncannily like the Rede—the nearest thing to an ethical “law” among witches and magic users. And their decisions and actions must, like those of magic-workers, take into account relative degrees of harm. For, if pain itself were harm, then no doctor in all of history could in good conscience cause the pain of setting a broken leg, excavating a bullet or arrow, lancing a boil, stitching a gash. Yet the consequences of such inaction will be predictably worse for the patient; so they harm the fewest the least, and go ahead with the procedure.

Heroic Measures

That same rationale, however, is applied today in cases where the outcome is no better than a crap shoot. Using toxic compounds and near-lethal radiation, doctors try to make the human (host) environment fatal to a deadly parasitical growth, no matter how much suffering the treatment causes the patient. It’s an approach similar to that of the body’s own immune reactions, when the fever, histamine, and swelling, produced to kill off some invading bug, go on to create miseries and even life-threatening conditions of their own. The question usually becomes, is the host human strong enough to survive the prescribed treatment?

In these cases, we’re at the edge of Hippocratic territory—are we doing no harm?—yet such medical action is routine today, the world over. Doctors bump heads with Hippocrates every time they provide resuscitation treatment to a patient who has documented a wish not to receive it. The reason, for it’s more than an excuse, is the law. Not taking action to preserve any scrap of life, regardless of human or dollar cost, has become more hazardous to a doctor’s livelihood than taking action. Hence, between bureaucracy and statute, doctors are squeezed into a pattern that’s only now being broken up—by too many tales of medicine gone mad.

Brain-dead hulks “live” for decades with machine and hand-tending, vacuuming up precious medial and financial resources. Experienced physicians know the system so well that they’ll have tattooed on their sternum the words “no code”—hospital slang for “do not resuscitate, the patient has signed the papers”—only to awaken attached to machines, with broken ribs and a week-long life expectancy, because “it’s not a legal document.” No wonder the world fears medicine—the prospect of surviving can be infinitely more terrifying than the prospect of death.

Punishing the Dead

Christianity judges everyone, even the dead. It is from Christian medieval teachings that some of our weirder laws spring, such as the law that makes it a crime to commit suicide (Christianity is built around a final judgment). Medieval suicides were denied Christian burial for committing the mortal sin of self-murder…unless they did so while insane. This heartless practice—for denying religious services undoubtedly hurt the surviving family, while damage to the deceased is debatable—led to the routine practice of declaring suicides to have taken action while “of unsound mind”—a euphemistic convention that allowed for funeral and burial according to local custom. Some 19th-century wit said that suicides were deemed “of unsound mind” because any other conclusion would cast doubt on the soundness of mind of those who choose to remain among the living.

Limiting Choices

Modern psychiatry would have it that suicide attempts are commonly cries for help; but what of the successes? What of the 88-year-old man and his 85-year-old wife who quietly take a “Final Exit” rather than be forced by infirmity, bureaucracy, and insolvency out of their 35-year home? What of an advanced AIDS patient whose disfigurement and disability has cost him his assets, his home, and his friends? What of the young pregnant girl, cast off by a “God-fearing” family to the mercy of the streets? What of the cancer patient, untreatable beyond continuing toxics and pain-killers, unable to pursue the activities that make life life? What of social pariahs who, like Socrates, choose a cup of hemlock over exile from their life’s meaning? And what of society’s prisoners, who face that most personal of violent crimes, rape, while imprisoned; is it societal concern, or vindictiveness, that dictates such elaborate precautions against inmate suicide?

Control and Consent

These questions all relate to the issue of controlling one’s destiny. Regardless of my belief of what is right for you, I should not dictate—nor should society. Mr. Dent of Darwin chose to exit peacefully, with assistance, maintaining control of his life and his death. My late uncle chose to go on living as long as it worked; yet, in the end, he, too, chose “no heroic measures.” For a man afraid of death, as my uncle was—who might have lived months longer, medicated and hospital-bound, periodically losing parts to surgery—was this suicide? Perhaps. He died naturally the night before his transfer to a hospice; after less than a week in hospital. Yet we learned that he had refrained from using prescribed morphine for a year before he died. What pain one may survive with fortitude, another may find unendurable. But each—Mr. Dent and my uncle—made his choice, kept control, and gave consent.

To Relieve Suffering

In September 1996, Dr. Nitchke told the press that Bob Dent sought to end his suffering by dying, and that his role as doctor was to listen to the patient, and to try to act to relieve that suffering. In the end, Nitchke made Dent’s suicide possible. So did the person who wrote the controlling software program. So did the people who passed that law, the first to be put to use.

Hippocrates would be proud.

This blog entry originally appeared in the Pagan Muse & World Report Winter 1997 issue as the column “Conversations Over the Forge.” Slightly updated, it remains largely as written.