From Sander to Schiavo: Morality, Partisan Politics, and America’s Culture War over Euthanasia, 1950–2010

Time magazine called it “the most controversial trial since the 1925 Scopes evolution case.” In March 1950, more than one hundred reporters, photographers, and radio broadcasters from the United States and around the world descended on Manchester, New Hampshire, and filed roughly 1.6 million words while covering the trial of Dr. Hermann Sander, a forty-one-year-old physician from nearby Candia. ¹ Indicted on a charge of killing one of his patients, a fifty-nine-year-old woman dying of cancer, Sander was the first physician in U.S. history to stand trial for mercy killing. His trial ended in an acquittal, but from an historical perspective the significance of Sander’s 1950 court appearance lay in its relevance to the country’s long-standing, divisive debate over euthanasia. This debate was raging as bitterly as ever on March 31, 2005, when in Pinellas Park, Florida, forty-four-year-old Terri Schiavo died after her feeding tube had been removed.

The Sander Trial and the Terri Schiavo saga serve as book ends to a chapter in the history of euthanasia in modern America that witnessed momentous changes to the nation’s moral values surrounding death and dying. Before the twentieth century, euthanasia—taken from the Greek word for “good death”—usually referred to the practice of making dying patients as comfortable and pain-free as possible with a view to preparing them for death. Yet in the period between the Gilded Age and the onset of the Cold War, “euthanasia” became identified with mercy killing, typically the act of a physician administering a lethal injection to a pain-wracked, dying patient who either does or does not request it. Support for the concept of euthanasia by lethal injection came from the growing perception that people were living longer and more and more were dying lingering deaths, as well as the publicity surrounding the increasing medical use of subcutaneous injections with syringes for the relief of pain.

Then, in the post–World War II era, the accepted definition of euthanasia broadened to include the withdrawal of life-prolonging medical treatment for dying adults or infants with severe defects, or physician-assisted suicide (PAS)—the act of providing a terminally ill patient with the drugs to kill himself or herself. These changes reflected sweeping shifts in personal values, as well as a host of demographic, scientific, medical, cultural, and socioeconomic trends, but they were also part and parcel of a protracted struggle waged by opposing constituencies that voiced profoundly different moral positions on the issues of death and dying. The upshot by the dawn of the twenty-first century was that euthanasia in its varying forms had become a highly emotional issue for partisan groups with firmly dissimilar moral viewpoints about the policy future of America.

This article argues that the history of America’s post–World War II debate over euthanasia is rooted in a paradox: on the one hand, the history of euthanasia is a good example of sociologist James Davison Hunter’s thesis that twentieth-century America was wracked by “culture wars,” a hotly-contested “struggle over national identity” whose impact has been felt by “virtually all of the major institutions of American society.” Hunter’s description of the “cleavages at the heart of the contemporary culture war”—“the impulse toward progressivism and the impulse toward orthodoxy”—closely resembles the moral fault line that divides the vocal adversaries in the conflict over euthanasia. ²

On the other hand—and in sharp contrast to hot-button moral issues such as abortion or same-sex marriage—euthanasia has seldom been a significant factor in electoral politics. For example, despite polling that suggests that support for various forms of euthanasia conforms closely to political party allegiance, U.S. candidates for political office are almost never asked their positions on euthanasia, as they often are on abortion. ³ While abortion can draw tens of thousands of Americans to protest marches, euthanasia demonstrations are few and far between and tend to be sparsely attended. As this article shows, the main...