A MERCIFUL END: THE EUTHANASIA MOVEMENT IN MODERN AMERICA

by Ian Dowbiggin

Oxford University Press, 2003 272 pages, $28

Do not be thrown by the off-putting title. Professor Ian Dowbiggin's book is not only a carefully researched and scrupulously fair-minded treatise, but it's also a highly engaging read. It functions as both a social-science lesson and as a cautionary tale of what happens when “reformers” convince themselves they've discovered a formula for pure utopian bliss.

Though short, A Merciful End comprehensively traces the twists and turns primarily of the Euthanasia Society of America. While euthanasia proponents often trimmed their sails to the prevailing winds, the destination for many, if not most, has remained constant: active euthanasia for the willing and in certain circumstances, the unwilling. (The “distinction” to many euthanasia supporters, Dowbiggin writes ominously, “was incidental.”) The book explodes the myth “that the modern euthanasia movement began only in the 1960s and 1970s with the introduction of life-prolonging medical technology, the decline of the doctor-patient relationship, the rise of the ‘rights culture,’ medicine's inept handling of end-of-life care and the AIDS epidemic.”

In fact its roots go back to the late 19th and early 20th centuries. Support for euthanasia was frequently a package deal for members of the avant garde. In Dowbiggin's words, euthanasia “was a critical component of a broad reform agenda designed to emancipate society from anachronistic and ultimately unhealthy ideas about sex, birth and death.” We forget how many prominent Americans were supporters of euthanasia and (frequently) its ideological twin sister, eugenics. “Progressives” all, they believed passionately that death would be the “last taboo to fall in the struggle to free Americans from what birth control activist Margaret Sanger, herself an ESA member, called ‘biological slavery.’”

Greasing the skids for euthanasia was the embrace of eugenics — “evolution in a hurry” to many supporters. With a childlike faith in science and technocratic expertise, eugenicists were supremely confident the human race could be perfected through selective sterilization and euthanasia. The idea of “improving the race” served the interests of the euthanasia movement well until discredited by the Nazis. And while Dowbiggin cautions about “playing the Nazi card,” the similarities in language can be striking.

Until recently, the center of gravity for the euthanasia movement in the United States was Manhattan. Elitist to the core, its membership strongly supported active euthanasia: direct killing and physician-assisted suicide. But the Euthanasia Society of America and kindred organizations made minimal headway until retooling and softening their message in the late '60s. By repacking their pitch as a “right to die” issue, they capitalized on our culture's obsession with individual rights and “choice,” which first took hold in that decade. Rejecting “unwanted treatment” combined an appeal to individual decision making with a fear of an insensitive medical bureaucracy.

From the beginning people of faith and, especially the Catholic Church, were seen by the euthanasia movement as primary opponents. Such people, they complained, exerted a “stranglehold of tradition and religious dogma” that, they decided, had to be broken.

A Merciful End offers two explanations for the very limited “success” of the American euthanasia movement. One is a bitter division between the “radicals” and the “moderates” within the euthanasia movement. The other is the rise of a broad-based coalition that came to include the pro-life movement and disability-rights activists. This resistance was aided immeasurably by a 1994 report by the New York State Force on Life and the Law, an out-of-control Jack Kevorkian and a unanimous 1997 Supreme Court decision that found no right to assisted suicide in the Constitution. And in the last decade, there has been a stunning turnaround with far greater attention paid to pain relief, palliative care and hospice treatment.

These much-needed reforms have changed the chemistry of the debate and offer reason for hope. The same might be said of Dowbiggin's book.

Dave Andrusko, editor of National Right to Life News, writes from Washington.