What if we call it “Medical Aid in Dying”?

October 31, 2018 • Posted in Blog


A Lesson from History

In the aftermath of WWII, Leo Alexander penned the following as part of an article published in the New England Journal of Medicine:

The Example of Successful Resistance by the Physicians of the Netherlands
There is no doubt that in Germany itself the first and most effective step of propaganda within the medical profession was the propaganda barrage against the useless, incurably sick described above. Similar, even more subtle efforts were made in some of the occupied countries. It is to the everlasting honor of the medical profession of Holland that they recognized the earliest and most subtle phases of this attempt and rejected it. When Sciss-Inquart, Reich Commissar for the Occupied Netherlands Territories, wanted to draw the Dutch physicians into the orbit of the activities of the German medical profession, he did not tell them” You must send your chronic patients to death factories” or “You must give lethal injections at Government request in your offices,” but he couched his order in most careful and superficially acceptable terms. One of the paragraphs in the order of the Reich Commissar of the Netherlands Territories concerning the Netherlands doctors of 19 December 1941 reads as follows: “It is the duty of the doctor, through advice and effort, conscientiously and to his best ability, to assist as helper the person entrusted to his care in the maintenance, improvement and re-establishment of his vitality, physical efficiency and health. The accomplishment of this duty is a public task.”[16] The physicians of Holland rejected this order unanimously because they saw what it actually meant—namely, the concentration of their efforts on mere rehabilitation of the sick for useful labor, and abolition of medical secrecy. Although on the surface the new order appeared not too grossly unacceptable, the Dutch physicians decided that it is the first, although slight, step away from principle that is the most important one. The Dutch physicians declared that they would not obey this order. When Sciss-Inquart threatened them with revocation of their licenses, they returned their licenses, removed their shingles and, while seeing their own patients secretly, no longer wrote death or birth certificates. Sciss-Inquart retraced his steps and tried to cajole them—still to no effect. Then he arrested 100 Dutch physicians and sent them to concentration camps. The medical profession remained adamant and quietly took care of their widows and orphans, but would not give in. Thus it came about that not a single euthanasia or non-therapeutic sterilization was recommended or participated in by any Dutch physician. They had the foresight to resist before the first step was taken, and they acted unanimously and won out in the end. It is obvious that if the medical profession of a small nation under the conqueror’s heel could resist so effectively the German medical profession could likewise have resisted had they not taken the fatal first step. It is the first seemingly innocent step away from principle that frequently decides a career of crime. Corrosion begins in microscopic proportions.

Alexander, Leo. “Medical Science Under Dictatorship.” New England Journal of Medicine (July 14, 1949): 39-47. (With subscription; no subscription needed here.)

Editor’s Note: To better understand the underpinnings of the Dutch physicians’ resistance, please see the following, quoted from Robert Jay Lifton’s “German Doctors and the Final Solution,” The New York Times (21 September 1986):

The crucial theoretical work was Die Freigabe der Vernichtung lebensunwerten Lebens, or ”The Permission to Destroy Life Unworthy of Life.” Published in 1920, it was written jointly by two distinguished German professors, the jurist Karl Binding, retired after 40 years at the University of Leipzig, and Alfred Hoche, professor of psychiatry at the University of Freiburg.

Hoche argued in the book that a policy of killing was compassionate and consistent with medical ethics. He pointed to situations where doctors were obliged to destroy life – interrupting a pregnancy to save the mother, for example. He went on to claim that various forms of psychiatric disturbance, brain damage and retardation indicated that the patients were already ”mentally dead.” He characterized these people as ”human ballast” and ”empty shells of human beings” – terms that would later reverberate in Nazi Germany. Putting such people to death, Hoche wrote, ”is not to be equated with other types of killing.” It is, he wrote, ”an allowable, useful act.”

For more about Leo Alexander, read here.


Physician-Assisted Suicide
Medical Aid in Dying

D. Joy Riley, M.D., M.A.
Executive Director

On 9 October 2018, the American Academy of Family Physicians (AAFP) Congress of Delegates (COD) voted for a major change—one which differs from the Code of Ethics of the American Medical Association. The AAFP elected to “adopt a position of ‘engaged neutrality’ toward medical aid in dying as a personal end-of-life decision in the context of the physician-patient relationship.” From this position, the AAFP will be able to argue for similar changes at upcoming AMA meetings. The resolution approved by the AAFP-COD also rejected the terms, “physician-assisted suicide” and “assisted suicide,” preferring to use the euphemism, “medical aid in dying” instead. Dr. Michael Munger, AAFP President, said, “Through our ongoing and continuous relationship with our patients, family physicians are well-positioned to counsel patients on end-of-life care, and we are engaged in creating change in the best interest of our patients.”

I don’t think I have to wonder what the late Leo Alexander would have had to say about this development, or about whether or not this was “in the best interest” of patients. I do think, though, that if my physician were a member of the AAFP, I would be letting him or her know that “corrosion begins in microscopic proportions,” and that respect for human life should not end with a difficult or devastating diagnosis. If my physician thought that he or she would be acting in my best interest by providing “medical aid in dying,” I would “engage in creating change” by changing physicians.


Tracy Grant, deputy managing editor at The Washington Post, describes lessons learned while caring for her dying husband
(click image to view video)