Gentlemen:--In my first lecture I proved to you the existence and the
binding power of a higher law than that of human legislators, namely, of
the eternal law, which, in His wisdom, the Creator, if He created at
all, could not help enacting, and which He is bound by His wisdom and
justice to enforce upon mankind.
We are next to consider what are the duties which that higher law
imposes upon the physician. In this present lecture I will confine
myself to one duty, that of respect for human life.
A duty is a bond imposed on our will. God, as I remarked before, imposes
such bonds, and by them He directs free beings to lead worthy lives. As
He directs matter by irresistible physical laws, so He directs
intelligent and free beings by moral laws, that is, by laying duties or
moral bonds upon them, which they ought to obey, which He must require
them to obey, enforcing His commands by suitable rewards and
punishments. Thus He establishes and enforces the moral order.
Now the duties He lays upon us are of three classes. First, there are
duties of reverence and honor towards Himself as our sovereign Lord and
Master. These are called the duties of Religion, the study of which does
not belong to Medical Jurisprudence. The other classes of duties regard
ourselves and our fellow-men, with these we are to deal in our lectures.
I. Order requires that the meaner species of creatures shall exist for
the benefit of the nobler; the inert clod of earth supports vegetable
life, the vegetable kingdom supplies the wants of animal life, the brute
animal with all inferior things subserves the good of man; while man,
the master of the visible universe, himself exists directly for the
honor and glory of God. In this beautiful order of creation, man can use
all inferior things for his own benefit.
This is what reason teaches concerning our status in this world; and
this teaching of reason is confirmed by the convictions of all nations
and all ages of mankind. The oldest page of literature that has come
down to us, namely, the first chapter of the first book of Holy Writ,
lays down this same law, and no improvement has been made in it during
all subsequent ages. Whether we regard this writing as inspired, as
Christians and Jews have always done, or only as the testimony of the
most remote antiquity, confirmed by the acceptance of all subsequent
generations, it is for every sensible man of the highest authority.
Here is the passage: "God said, Let us make man to our image and
likeness; and let him have dominion over the fishes of the sea, and the
fowls of the air, and the beasts, and the whole earth, and every
creeping creature that creepeth upon the earth." And later on in
history, after the deluge, God more explicitly declared the order thus
established, saying to Noe and his posterity: "Every thing that moveth
and liveth shall be meat for you; even as the green herbs have I
delivered them to you." But He emphatically adds that the lives of men
are not included in this grant; they are directly reserved for His own
disposal. "At the hand of every man," He says, "will I require the life
of man."
All things then are created for man; man is created directly for God,
and is not to be sacrificed for the advantage of a fellow-man. Thus
reason and Revelation in unison proclaim that we can use brute animals
as well as plants for our benefit, taking away their lives when it is
necessary or useful to do so for our own welfare; while no man is ever
allowed to slay his fellow-man for his own use or benefit: "At the hand
of every man will I require the life of man."
II. The first practical application I will make of these general
principles to the conduct of physicians is this: a physician and a
student of medicine can, with a safe conscience, use any brute animal
that has not been appropriated by another man, whether it be bug or bird
or beast, to experiment upon, whatever specious arguments humane
societies may advance to the contrary. Brute animals are for the use of
man, for his food and clothing, his mental and physical improvement, and
even his reasonable recreations. Man can lawfully hunt and fish and
practise his skill at the expense of the brute creation, notwithstanding
the modern fad of sentimentalists. The teacher and the pupil can use
vivisection, and thus to some extent prolong the sufferings of the brute
subject for the sake of science, of mental improvement, and intelligent
observation. But is not this cruelty? and has a man a right to be cruel?
No man has a right to be cruel; cruelty is a vice, it is degrading to
man's noble nature. But vivisection practised for scientific purposes is
not cruel. Cruelty implies the _wanton_ infliction of pain: there are
people who delight in seeing a victim tortured; this is cruelty or
savagery, and is a disgrace to man. Even to inflict pain without
benefit is cruel and wrong; but not when it is inflicted on the brute
creation for the benefit of man, unless the pain should be very great
and the benefit very small. Certainly it is right to cultivate habits of
kindness even to animals; but this matter must not be carried to excess.
The teaching of humane societies condemning all vivisection is due to
the exaggeration of a good sentiment and to ignorance of first
principles. For they suppose that sufferings inflicted on brute animals
are a violation of their rights. Now we maintain that brute animals have
no rights in the true sense of the word. To prove this thesis we must
explain what a right is and how men get to have rights. A _right_ is a
moral claim to a thing, which claim other persons are obliged to
respect. Since every man has a destiny appointed for him by his Creator,
and which he is to work out by his own acts, he must have the means
given him to do so. For to assign a person a task and not to give him
the means of accomplishing it would be absurd. Therefore the Creator
wants him to have those means, and forbids every one to deprive him of
those means. Here is the foundation of rights. Every man, in virtue of
the Creator's will, has certain advantages or claims to advantages
assigned him which no other man may infringe. Those advantages and
claims constitute his rights, guaranteed him by the Creator; and all
other men have the _duty_ imposed on them to respect those rights. Thus
rights and duties are seen to be correlative and inseparable; the rights
lodged in one man beget duties in other men. The same Creator that
assigns rights to one man lays upon all others duties to respect those
rights, that thus every free being may have the means of working out its
Heaven-appointed destiny.
Thus it is apparent that rights and duties suppose free beings, persons;
now an irrational animal is not a person; it is not a free being, having
a destiny to work out by its free acts; it is therefore incapable of
having duties. Duties are matters of conscience; therefore they cannot
belong to the brute animal; for it has no conscience. And, since rights
are given to creatures because of the duties incumbent on them, brute
animals are incapable of having rights. When a brute animal has served
man's purpose, it has reached its destiny.
III. But it is entirely different with man: there is what we may call an
infinite distance between man and brute. Every man is created directly
for the honor and service not of other men, but of God Himself: by
serving God man must work out his own destiny--eternal happiness. In
this respect all men are equal, having the same essence or nature and
the same destiny. The poor child has as much right to attain eternal
happiness as the rich child, the infant as much as the gray-bearded
sire. Every one is only at the beginning of an endless existence, of
which he is to determine the nature by his own free acts. In this
infinite destiny lies the infinite superiority of man over the brute
creation.
That all men are equal in their essential rights is the dictate of
common-sense and of sound philosophy. This truth may not flatter kings
and princes; but it is the charter of human rights, founded deeper and
broader in nature and on the Creator's will than any other claim of
mankind. As order requires the subordination of lower natures to higher,
so it requires equality of essential rights among beings of the same
nature. Now all men are of the same nature, hence they have all the same
essential rights.
If any people on earth must stand by these principles, certainly the
American people must do so; for we have put them as the
foundation-stones of our civil liberty. There is more wisdom than many,
even of its admirers, imagine in the preamble to our Declaration of
Independence; upon it we are to base the most important rights and
duties which belong to Jurisprudence. The words of the preamble read as
follows: "We hold these truths as self-evident, that all men are created
equal; that they are endowed by their Creator with certain inalienable
rights; that among these are life, liberty, and the pursuit of
happiness." I feel convinced, gentlemen, and I will take it for granted
henceforth, unless you bring objections to the contrary, that you all
agree with me on this important point that _every man has a natural
right to his life, a right which all other men are solemnly bound to
respect_. It is his chief earthly right. It is called an _inalienable_
right; by which term the fathers of our liberty meant a right which
under no circumstances can be lawfully disregarded. A man who takes it
upon himself to deprive another of life commits two grievous wrongs: one
towards his victim, whose most important right he violates, and one
towards God, who has a right to the life and service of His creatures.
"Thou shalt not kill" is a precept as deeply engraven on the human heart
by reason itself as it was on the stone tables of the Ten Commandments
by Revelation.
So far we have chiefly considered murder as a violation of man's right
to his life. We must now turn our attention to God's right, which the
murderer violates. It may indeed happen that a man willingly resigns
his right to live, that he is tired of life, and longs and implores for
some one to take it away. Can you then do it? You cannot. His life does
not belong to him alone, but to God also, and to God principally; if you
destroy it, you violate God's right, and you will have to settle with
Him. God wills this man to live and serve Him, if it were only by
patient endurance of his sufferings.
For a man may be much ennobled and perfected by the practice of patience
under pain and agony. Some of the noblest characters of history are most
glorious for such endurance. The suicide rejects this greatness; he robs
God of service and glory, he rebels against his Creator. Even Plato of
old understood the baseness of suicide, when he wrote in his dialogue
called "Phædon" that a man in this world is like a soldier stationed on
guard; he must hold his post as long as his commander requires it; to
desert it is cowardice and treachery; thus, he says, suicide is a
grievous crime.
This being so, can a Doctor, or any other man, ever presume to
contribute his share to the shortening of a person's life by aiding him
to commit suicide? We must emphatically say No, even though the patient
should desire death: the Doctor cannot, in any case, lend his
assistance to violate the right and the law of the Creator: "Thou shalt
not kill."
I have no doubt, gentlemen, that some of you have been saying to
yourselves, Why does the lecturer insist so long upon a point which is
so clear? Of course, none of us doubts that we can in no case aid a
patient to commit suicide. My reason for thus insisting on this matter
is that here again we are dealing with a living issue. There are to-day
physicians and others who deny this truth, not in their secret practice
only, but, of late, to justify their conduct, they have boldly
formulated the thesis that present apparent expediency can lawfully be
preferred to any higher consideration. Here is the fact. At a
Medico-Legal Congress, held in the summer of 1895, Dr. Bach, one of its
leading lights, openly maintained it as his opinion that "Physicians
have the moral right to end life when the disease is incurable, painful,
and agonizing."
What his arguments were in support of his startling proposition, I have
not been able to learn. But I know that a cry of horror and indignation
has gone up from many a heart. Many have protested in print; but unless,
on an occasion like this, moralists raise their voice against it with
all the influence which sound principles command, the saying of
Dr. Bach may at least shake the convictions of the rising generation of
physicians. The only argument for Dr. Bach's assertion that I can
imagine--and it is one proceeding from the heart rather than the
head--is that it is cruel to let a poor man suffer when there is no
longer hope of recovery. It is not the Physician that makes him suffer;
it is God who controls the case, and God is never cruel.
He knows His own business, and forbids you to thwart His designs. If the
sufferer be virtuous, God has an eternity to reward his patient
endurance; if guilty, the Lord often punishes in this world that He may
spare in the next. Let Him have His way, if you are wise; His command to
all is clear, "Thou shalt not kill."
One rash utterance, like that of Dr. Bach, can do an incalculable amount
of harm. Why, gentlemen, just think what consequences must follow if his
principle were, admitted! For the only reason that could give it any
plausibility would be that the patient's life is become useless and
insupportable. If that were a reason for taking human life away, then it
would follow that, whenever a man considers his life as useless and no
longer supportable, he could end it, he could commit suicide. That
reasoning would practically justify almost all suicides. For, when
people kill themselves, it is, in almost all cases, because they
consider their lives useless and insupportable. Whether it results from
physical or from moral causes that they consider their life a burden,
cannot, it seems to me, make any material difference; grief, shame,
despair are as terrible sufferings as bodily pains. If, then, we accept
Dr. Bach's principle, we must be prepared for all its baneful
consequences.
IV. But are there no exceptions to the general law, "Thou shalt not
kill"? Are there no cases in which it is allowed to take another's life?
What about justifiable homicide? There are three cases of this nature,
gentlemen; namely, self-defence, capital punishment inflicted by the
state, and active warfare. With only one of these can a physician, as
such be concerned or think himself concerned. He is not a public hangman
executing a sentence of a criminal court; nor is he acting as a soldier
proceeding by public authority against a public foe. As to the plea of
self-defence, it must be correctly understood, lest he usurp a power
which neither human nor divine law has conferred upon him.
1. _Self-defence._ It is a dictate of common-sense, already quoted by
Cicero as a universally received maxim of Jurisprudence in his day, that
it is justifiable to repel violence by violence, even if the death of
our unjust assailant should result. In such a case, let us consider what
really takes place. A ruffian attempts to take away my life; I have a
right to my life. I may, therefore, protect it against him; and, for
that purpose, I may use all lawful means. A lawful means is one that
violates no law, one that I may use without giving any one reasonable
ground of complaint. Suppose I have no other means to protect my life
than by shooting my aggressor; has he a right to complain of my conduct
if I try to do so? No, because he forces me to the act; he forces me to
choose between my life and his. Good order is not violated if I prefer
my own life: well-ordered charity begins at home. But is not God's right
violated? It is; for God has a right to my life and to that of my
assailant. The ruffian who compels me to shoot him is to blame for
bringing both our lives into danger; he is responsible for it to God.
But the Creator will not blame me for defending my life by the only
means in my power, and that when compelled by an unjust assailant, who
cannot reasonably find fault with my conduct.
But it may be objected that no evil act may be done to procure a good
result, that a good end does not justify a bad means. That is a correct
principle, and we will consider it carefully some other day. But my act
of necessary self-defence is not evil, and therefore needs no
justification; for the means I employ are, under the circumstances,
well-ordered and lawful means, which violate no one's rights, as has
just been shown. Of course the harm I do to the aggressor is just only
in as far as it is strictly necessary to defend the inalienable right I
have to life or limb or very valuable property. Hence I must keep within
the just limits of self-defence. To shoot an assailant, when I am in no
serious danger, or when I can free myself some other way, or when I act
through malice, would not be self-defence, but unjustifiable violence on
my part.
2. The principles that make it lawful for a man to defend his own life
with violence against an unjust assailant will also justify a parent in
thus defending his children, a guardian his wards; and in fact any one
may forcibly defend any other human being against unjust violence. A
parent or guardian not only can, but he is in duty bound to, defend
those under his charge by all lawful means. Similarly the physician
would be obliged to defend his patient by the exercise of his profession
in his behalf.
Now the only case in which the need of medical treatment against unjust
aggression could become a matter for discussion in Jurisprudence is the
case of a mother with child. Is the child under those circumstances
really an unjust aggressor? Let us study that important case with the
closest attention. Let all the rays of light we have gathered so far be
focussed on this particular point. Can a physician ever be justified in
destroying the life of a child, before or during its birth, by
craniotomy or in any other manner, in order to save its mother's life,
on the plea that the child is an unjust assailant of the life of its
mother? Put the case in a definite shape before you. Here is a mother in
the pangs of parturition. An organic defect, no matter in what shape or
form, prevents deliverance by the ordinary channels. All that medical
skill can do to assist nature has been done. The case is desperate.
Other physicians have been called in for consultation, as the civil law
requires before it will tolerate extreme measures. All agree that, if no
surgical operation is performed, both mother and child must die. There
are the Cæsarian section, the Porro operation, laparotomy,
symphysiotomy, all approved by science and the moral law. But we will
suppose an extreme case; namely, the circumstances are so unfavorable
for any of these operations--whether owing to want of skill in the
Doctors present, or for any other reason--that none can safely be
attempted; any of them would be fatal to the mother.
In this extreme case of necessity, can the Doctor break the cranium of
the living child, or in any way destroy its life with a view to save the
mother? If three consulting physicians agree that this is the only way
to save her, he will not be molested by the law courts for performing
the murderous operation. But will the law of nature and of nature's God
approve or allow his conduct? This is the precise question under our
consideration. We have seen that the infant, a true human being, has a
right to live, as well as its mother. "All men are created equal, and
have an equal right to life," declares the first principle of our
liberty. The Creator, too, as reason teaches, has a clear right to the
child's life; that child may answer a very special purpose of
Providence. But whether it will or not, God is the supreme and the only
Master of life and death, and He has laid down the strict prohibition,
"Thou shalt not kill."
Now comes the plea of self-defence against an unjust aggressor. If the
child is such, if it _unjustly_ attacks its mother's life, then she can
destroy it to save herself, and her physician can aid the innocent
against the guilty party. But can it be proved that the infant is an
unjust aggressor in the case? There can be no intentional or _formal_
guilt in the little innocent babe. But can we argue that the actual
situation of the child is an unjust act, unconsciously done, yet
_materially_ unjust, unlawful? Thus, if a madman would rush at me with a
sharp sword, evidently intent on killing me, he may be called an unjust
aggressor; though, being a raving maniac, he does not know what crime he
is committing, and is _formally_ innocent of murderous intent.
_Materially_ considered, the act is unjust, and I can defend myself
lawfully as against any other unjust assailant. Such is the common
teaching of moralists. But can the innocent babe be classed in the same
category with the raving maniac? Why should it? It is doing nothing; it
is merely passive in the whole process of parturition.
Will any one object that the infant has no right to be there at all? Who
put it there? The only human agents in the matter were its parents. The
mother is more accountable for the unfortunate situation than the child.
Certainly you could not, to save the child, directly kill the mother,
treating her as an unjust assailant of her child's life? Still less can
you treat the infant as an unjust assailant of its mother's life.
The plea of self-defence against unjust aggression being thus ruled out
of court in all such cases, and no other plea remaining for the
craniotomist, we have established, on the clearest principles of Ethics
and Jurisprudence, that it is never allowed directly to kill a child as
a means to save its mother's life. It would be a bad means, morally
evil; and no moral evil can ever be done that good may come of it; the
end cannot justify an evil means. In theory all good men agree with us
that the end can never justify the means. But in practice it seems to be
different with some of the medical profession. Of late, however, the
practice of craniotomy and all equivalent operations upon living
subjects has gone almost entirely out of fashion among the better class
of physicians.
Allow me, gentlemen, to conclude this lecture with the reading of two
extracts from articles of medical writers on the present state of
craniotomy in their profession. You will find them in accord with the
conclusions at which we have arrived by reasoning upon the principles of
Jurisprudence.
Dr. W. H. Parish writes ("Am. Eccles. Review," November, 1893, p. 364):
"The operations of craniotomy and embryotomy are to-day of relatively
infrequent occurrence, and many obstetricians of large experience have
never performed them. Advanced obstetricians advocate the performance of
the Cesarian section or its modification--the Porro operation--in
preference to craniotomy, because nearly all the children are saved,
and the unavoidable mortality among mothers is not much higher than that
which attends craniotomy. Of one hundred women on whom Cesarian section
is performed under _favorable conditions_ and with _attainable_ skill,
about ninety-five mothers should recover and fully the same number of
children. Of one hundred craniotomies, ninety-five mothers or possibly a
larger number will recover, and of course none of the children. The
problem resolves itself into this: Which shall we choose--Cesarian
section with one hundred and ninety living beings as the result, or
craniotomy with about ninety-five living beings?"
Even if a liberal deduction be made for unfavorable circumstances and
deficient skill, the results, gentlemen, will still leave a wide margin
in favor of Cesarian section. My second extract is from an article of
Dr. M. O'Hara, and it is supported by the very highest authorities (ib.
p. 361): "Recently [August 1, 1893] the British Medical Association, the
most authoritative medical body in Great Britain, at its sixty-first
annual meeting, held at Newcastle-upon-Tyne, definitely discussed the
subject before us. In the address delivered at the opening of the
section of Obstetric Medicine and Gynecology, an assertion was put forth
which I regard as very remarkable, my recollection not taking in any
similar pronouncement made in any like representative medical body. The
authoritative value of this statement, accepted as undisputed by the
members of the association, which counts about fifteen thousand
practitioners, need not be emphasized.
"Dr. James Murphy ('British Medical Journal,' August 26, 1893), of the
University of Durham, made the presidential address. He first alluded to
the perfection to which the forceps had reached for pelves narrowed at
the brim, and the means of correcting faulty position of the fœtus
during labor. He then stated: 'In cases of great deformity of the
pelvis, it has long been the ambition of the obstetrician, where it has
been impossible to deliver a living child _per vias naturales_, to find
some means by which that child could be born alive with comparative
safety to the mother; and that time has now arrived. It is not for me to
decide,' he says, 'whether the modern Cesarian section, Porro's
operation, symphysiotomy, ischiopubotomy, or other operation is the
safest or most suitable, nor yet is there sufficient material for this
question to be decided; but when such splendid and successful results
have been achieved by Porro, Leopold, Saenger, and by our own Murdoch
Cameron, I say it deliberately and with whatever authority I possess,
and I urge it with all the force I can master, that we are not now
justified in destroying a living child; and while there may be some
things I look back upon with pleasure in my professional career, that
which gives me the greatest satisfaction is that I have never done a
craniotomy on a living child.'"
You will please notice, gentlemen, that when this distinguished Doctor
said, "We are not _now_ justified in destroying a living child," he was
speaking from a medical standpoint, and meant to say that such
destruction is now scientifically unjustifiable, is a blunder in
surgery. From a moral point of view it is not only now, but it was
always, unjustifiable to slay a child as a means to save the mother's
life; a good end cannot justify an evil means, is a truth that cannot be
too emphatically inculcated. This is one of the most important subjects
on which Medical Jurisprudence has been improved, and most of its
text-books are deficient. The improvement is explained with much
scientific detail in an address of the President, Samuel C. Busey, M.D.,
before the Washington Obstetrical and Gynecological Society ("Am.
Journal of Obstetrics and Diseases of Women and Children," vol. xvii.
n. 2).