“It is a physician’s mission to cure disease and alleviate suffering,”
says Dr. Nehemiah Nickerson. “There is a point beyond which he can not
cure disease; after that it is his duty to alleviate suffering.”
A mission implies a mandate; a mandate an authority superior to that of
the missionary. I do not know from what higher authority a physician
derives his own, nor who has the right to lay down the lines within
which his activity must lie. Within the civil and the moral law he is
a free agent—free to observe or disregard the customs of his trade, as
conscience may determine. He has no mandate, no mission.
It is true, however, that to cure disease and to alleviate suffering
are purposes commonly recognized as important among those belonging
to the practice of medicine. Having failed to accomplish the first,
how far may a physician go in accomplishing the second?—that is a
question that finds no answer in any imaginary mandate. It is not even
answered by the Decalogue, for the commandment “Thou shalt not kill”
has so many obvious and necessary limitations that its value as a
guide to conduct is virtually nothing. Dr. Nickerson believes he may go
so far as to kill the patient he can not cure. Moreover, he candidly
affirms his habit of doing so. I am told that he is a distinguished
physician; there is apparently nothing in his frank avowal to lessen
his distinction. It would not surprise, indeed, if his fame should take
attention from even the officers of the law. To make himself an object
of lively interest in quarters where the several kinds of distinction
in his profession are commonly overlooked he has only to descend from
generals to particulars, naming the patients whom he has turned out of
the frying-pan of physical pain into whatever state awaited them, and
the means (under Providence) which he employed to that end.
A man may be the best judge of what he is for, but by laymen unskilled
in physic it is usually held that a physician’s business is not only
to cure disease and alleviate suffering, but to prolong life—to
save it altogether being impossible, for all must eventually die.
But laymen have no mandate always to be right; now and again they
have been in error. The righteousness and expediency of releasing an
incurable sufferer from the horrors of life should not be clouded and
discredited by an erring advocacy.
When a horse or a dog incurs the mischance of a broken back no question
is raised as to the propriety of “putting it out of its misery.” Unable
to cure it, we kill it, and in doing so feel a comfortable sense of
benevolence, a consciousness of having performed a disagreeable duty,
of having discharged an obligation inseparable from our dominion over
the beasts of the field. It may be said that in the instance of a human
being similarly incurable the dominion is lacking. But that does not
go to the root of the matter, and is, moreover, untrue; for a helpless
man is as much subject to our power as a helpless animal, and as much
a charge upon our good will. And in many cases he is as little capable
of deciding wisely what is good for him. A wounded bird or squirrel
will manifest a strong indisposition to be “put out of misery,” by
struggling to escape into the bush; a man will sometimes beg for death,
even when he does not know himself incurable. If there should be a
difference in the treatment of the two in respect of the matter in hand
it would seem that the beast should be spared and the man killed.
But Dr. Nickerson’s critics think that a different rule should hold,
because the man is an immortal soul, whereas the beast is a thing of
to-day, divinely ordained to “perish.” To this it may be said in reply:
All the stronger reason for a reversal of our practice, for in putting
the man out of his misery you would not really kill, but only change,
him; but the animal having only one life, in taking that you make him
“poor indeed,” depriving him of all that he has.
That the man is an immortal soul is, however, a proposition which,
after centuries of discussion, remains unsettled; and those who hold
Dr. Nickerson’s view must in conscience forego the advantage of the
argument which their generous opponents try to thrust upon them. If
we actually knew human beings to be immortal many of the current
popular objections to killing them would disappear, and not only
soldiers but physicians and assassins could work at their trades with
a comparatively free hand, along lines of usefulness not always and
entirely divergent. Surely there could be no great wrong in “removing”
a good Christian, whether he were ill at ease or not: to translate
him to the shining altitudes of Paradise is distinctly to augment the
sum of human happiness. For that matter, it would not be difficult to
demonstrate logically the proposition that any Christian may rightly
slay any other Christian upon whom he can lay his hands. True, he is
forbidden by his religion to do so. All the more noble and generous
of him to invite eternal punishment in order to abridge his brother’s
season of earthly trial, insure him against backsliding and usher him
at once into the Kingdom of Delights. In point of mere expediency a
general observance of this high duty is open to the objection that
it would somewhat reduce the church militant in point of numerical
strength. But this is perhaps a digression.
It is urged that not knowing the purposes of the Creator in creating
and giving us life, we should endure (and make our helpless friends
endure) whatever ills befall, lest by death we ignorantly frustrate the
divine plan. Merely pausing to remark that the plan of an omnipotent
Deity is not easily frustrated, I should like to point out that in
this very ignorance of the purpose of existence lies a justification
of putting an end to it. I did not ask for existence; it was thrust
upon me without my assent. As He who gave it has permitted it to become
an affliction to me, and has not apprised me of its advantages to
others or to Himself, I am not bound to assume that it has any such
advantages. If when in my despair I ask why I ought to continue a
life of suffering I am uncivilly denied an answer, I am not bound to
believe, and in lack of light may be unable to believe, that the answer
if given would satisfy me. So the game having gone against me and the
dice appearing to be loaded, I may rightly and reasonably quit.
That is the way that a logical patient would probably reason if
incurable and in great pain. I confess my inability to discern the
fallacy of his argument. Indeed, it seems to me that so far as concerns
baffling the divine purpose the patient who calls in a physician and
tries to recover is more obviously guilty of attempting to do that than
the patient who tries to die. To an understanding that accepts life as
a gift from God, illness might very naturally seem a divine intimation
of God’s altered mind. To one thinking after that fashion voluntary
death would necessarily appear as cheerful submission to the divine
will, and the taking of medicine as impious rebellion.
The right of suicide implies and carries with it the right to put to
death a sufferer incurably ill; for the relief which we claim for
ourselves we cannot righteously deny to those in our care. We would
naturally expect a medical advocate of suicide to kill a patient
occasionally, as humanity may suggest and opportunity serve. Dr.
Nickerson’s frankness is shocking, but on a survey of the entire
question it seems a good deal easier to point out his infractions of
the law than his disloyalty to reason and the higher sentiments which
distinguish us from the priests that perish.
1899.