A Concise History of Euthanasia: Life, Death, God, and Medicine (review)

This compact volume offers a comprehensive distillation of the history of euthanasia, contextualized in terms of the struggle between organized religion and secular advocacy groups. Unfortunately, when Ian Dowbiggin (an expert on American euthanasia-advocacy groups) treats subjects beyond the range of his earlier scholarship, he often introduces distortions that undermine the value of the book. 


Consider Dowbiggin's presentation of the origins of the modern concept of euthanasia. In 1605 Francis Bacon introduced the expression "outward Euthanasia" to designate what we would today characterize as end-of-life palliative care. Having correctly noted this point, Dowbiggin misreads a line from Bacon, interpreting the statement that seventeenth-century physicians "make a kind of scruple and religion to stay with the patient after he is given up" (p. 23) as asserting that "physicians . . . tended to stay with their patients until the bitter end" (p. 23). "To make a scruple," however, is to refrain from doing something for reasons of conscience: Bacon was asserting that seventeenth-century physicians did not treat dying patients, fearing that they would be accused of collecting fees for ineffective cures—a breach of the canons of medical propriety. Bacon wanted to change this practice, so he created a new deathbed role for the physician that would parallel the role of the priest. Priests, in Bacon's view, offered the dying person "inward Euthanasia," a good death for the soul; physicians, however, could offer "outward Euthanasia," a pain-free death for the body. Eventually physicians explored and accepted Bacon's proposed deathbed role, practicing what in the nineteenth century was called "euthanasia"—today's "palliative care." By misreading the text and asserting that physicians played this role before Bacon proposed the new practice of "outward Euthanasia," Dowbiggin misrepresents the modern origins of the subject of his book.


Fortunately, Dowbiggin does a better job in tracing the late nineteenth-century transformation of the meaning of "euthanasia" from palliative care to "mercy killing." Unfortunately, however, he misrepresents other key transitions. Consider another example. On 26 August 1952, the Danish anesthesiologist Bjorn Ibsen saved a suffocating polio patient by inventing the machine that came to be known as the artificial ventilator. Quite inadvertently, Ibsen thereby initiated a debate about the propriety of disconnecting patients from ventilators, allowing them to suffocate. Fellow anesthesiologists petitioned Pope Pius XII for guidance on this subject. In 1957 Pius XII responded, declaring that patients are not obligated to undergo ventilation since these "treatments go beyond the ordinary means to which one is bound"; just as importantly, he also declared that consensual disconnection of a ventilator "is not . . . euthanasia in any way."¹ Here is how Dowbiggin represents Pius XII's declaration: "For millions around the world [the pope's] comments redefined euthanasia as a process whereby it was morally permissible to withhold unwanted, unnecessary treatment as long as it was clearly the patient's wish" (p. 116). This inverts the import of the pope's statement: after the proclamation, Catholics did not characterize disconnecting ventilators as "euthanasia." Thus a Catholic couple from New Jersey, Joseph and Julia Quinlan, with a clear conscience and the support of their priest, petitioned the courts for permission to disconnect the ventilator of their daughter Karen Ann (In re Quinlan, 1976); the courts, the media, and the public followed the Catholics' lead in considering this not to be a form of "euthanasia." To suggest otherwise is to distort the history of euthanasia.


Ultimately, numerous small but significant errors make this book painful for the expert to peruse, and too unreliable for the public to use. It is a pity.