The Right to Live or the Obligation to Die
This article was written at the time of the proposed legislation in California (SB 840) which related to health care. It seemed relevant to quote from a book that I had written many years ago, even thought it was at some points outdated.
“The atrocities of Hitler's Third Reich originated in philosophies and practices extending back into the nineteenth century. The precipitating factor, however, was Germany's poverty resulting in part from the Versailles treaty ending World War I. Economic considerations were involved in the killing. Then, as today, the bottom line—money—determined policy. How much does society want to pay in order to help the poor and the physically unfit?
“Robert Proctor writes of a document found in a castle used as one of the six euthanasia institutions equipped with gas chambers. This document cited the following savings resulting from the involuntary euthanasia—or murder—of 70,273 persons:
Bread: 4,781,339.72 kg.
Marmalade: 239,067.02 kg.
Margarine:174,719.23 kg.
Schmalz: 5,311.40 kg.
Coffee substitute: 79,671.38 kg.
Sugar: 185,952.86 kg.
Flour: 156,952.86 kg.
Meats and sausage: 653,516.96 kg.
Potatoes: 19,754,325.27 kg.
Butter: 50,458.49 kg.
“The euthanasia operation had saved Germany an average of 88,543,980 reichsmarks per year and by the end of 1941, 93,541 hospital beds' were available due to the mass killings.
“Actually, Germany began cutting back budgets for medical care as early as 1933, the first year of Nazi government: medical insurance companies paid 10 million reichsmarks less for the care of invalids in 1933 than in 1932, when Germany had been in the depths of the recession. Many homes for the elderly were closed. The total number of working nurses taking care of the ill dropped from 111,700 in 1933 to 88,900 in 1934; the number of hospitals and healthcare institutions decreased from 3,987 in 1931 to 3,219 in 1935; and the number of hospital beds per thousand people went in the same time period from 5.7 to 4.5.
“A good summary statement of Germany's official attitude toward caring for the ill during the early years of the Third Reich was this: ‘From time immemorial, the nation has always eliminated the weak to make way for the healthy. A hard, but healthy and effective law to which we must once again give credence. The primary task of the physician is to discover for whom health care at government expense will be worth the cost.’
“. . . While millions were being slaughtered by the Nazis, the United States was not free from danger. Perhaps our gradual realization of Hitler's extremes slowed down the processes that could have led to our own disregard for human life.
“In 1935 the French-American Nobel Prize winner Alexis Carrel, who ironically helped prepare the way for the transplant technology that has saved so many lives, suggested in his book Man, the Unknown that criminals and the insane should be ‘humanely and economically disposed of in small euthanasia institutions supplied with proper gasses.’
“In a 1938 speech to Harvard's Phi Beta Kappa chapter, W. G. Lennox stated that saving lives ‘adds a load to the back of society.’ He wanted physicians to recognize ‘the privilege of death for the congenitally mindless and for the incurable sick who wish to die; the boon of not being born for the unfit.’
“And a 1937 Gallup poll showed that 45 percent of the American population favored euthanasia for defective infants. America was, indeed, well on her way then toward a disregard for human life; and she is well on her way once again.
“Today, in a frightening manner, the idea of choosing who shall live and who shall die has been reappearing in both the United States and Europe. There is talk about rationing health care, limiting the amount of such care available to the poor, the chronically ill, or the aged. According to a front-page article in the March 27, 1989, New York Times:
The State of Oregon and Alameda County in California have become the first governments in the nation to plan explicit rationing of health care for the poor.
In both places, agonizing choices are being made and lists drawn up, ranking medical procedures from the most effective to the least, according to which save the most lives and improve the quality of life for the most people.
“The article goes on to say that officials in both Oregon and California
hope to provide a model for rationing of care for the middle class by Federal Government and by employers and insurance companies, which have been tightening restrictions on health coverage.
“In a May 15, 1989, article in Time, the comment is made that
many doctors readily admit that applicants for new high-tech operations have to pass a “green screen” or “wallet biopsy”—meaning those who can pay get first crack at the operations.
“According to Time, Dr. Marye L. Thomas, Alameda County's director of mental health, herself a member of a committee of experts designated to decide what treatments shall be available to the county's uninsured poor, commented:
As a physician, I was trained to give the best possible care to anyone, period. Back when I was in medical school, I never thought I would be discussing this.
“In a November 25, 1991, article in Time, Oregon's plan is discussed in more detail.
The newest and broadest attempt to improve access and contain costs is taking place in Oregon . . . The centerpiece and most controversial feature of the plan is a list of 709 medical conditions and their treatments, ranked according to their seriousness and the likelihood that treatment will restore the patient to long-term good health. Actuaries estimate that state and federal Medicaid money will pay for treatment of everyone suffering from the first 587 conditions on the list.
In effect, Oregon is promising to provide universal coverage in exchange for a system of financial triage. A child will get a liver transplant; a chronic alcoholic will not. An AIDS sufferer will get treatment in the early stages of his illness, but in the terminal stages will get only 'comfort care.' The plan would not pay for so-called heroic measures, such as expensive life support for babies born after less than 23 weeks of gestation and weighing less than 500 g (1.1 lbs.). Nor will it pay for self-curing ailments - now covered - like the common cold, food poisoning, sprains and simple diaper rash. And, of course, the patient who needs spinal disc surgery, No. 588 on the list, may be out of luck.
“Oregon’s rationing proposal is only a sample of what is being tried and will be used in the future. The potential variables are frightening. What happens to those who live in pain and face being crippled because spinal disc surgery is number 588 instead of number 587? What happens to the elderly, the weak, or the very young if the common cold remains untreated and complications develop? Food poisoning can kill—is it really ‘self-curing’?. . .
“If we wait until death becomes mandatory at seventy or dialysis is refused at fifty-five or death is prescribed for Alzheimer's or mental retardation or AIDS; if we wait until there are mandatory abortions for the poor or the ‘genetically unsound,’ whoever they may be; if we wait until organs are taken from live bodies warehoused in a perfectly controlled environment; if we wait until others tell us what we may do with our own bodies—we will have waited too long for anything but the collapse of our entire society to save us. We will truly have lost the right to choose.”
— from Life on the Line, by Elizabeth R. Skoglund
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For more of Elizabeth Skoglund’s writing, please visit her Books page.