A Dark Mercy

There have been growing numbers of stories about the heroism of rescuers and medical personnel, such as this one, who risked their lives and personal safety and comfort to rescue, comfort and evacuate often critically-ill patients in New Orleans. But not all the medical care was directed at saving and healing the sick, as this troubling report indicates (HT: Orbusmax):

Doctors working in hurricane-ravaged New Orleans killed critically ill patients rather than leaving them to die in agony as they evacuated hospitals…

With gangs of rapists and looters rampaging through wards in the flooded city, senior doctors took the harrowing decision to give massive overdoses of morphine to those they believed could not make it out alive.

In an extraordinary interview with The Mail on Sunday, one New Orleans doctor told how she ‘prayed for God to have mercy on her soul’ after she ignored every tenet of medical ethics and ended the lives of patients she had earlier fought to save.

Her heart-rending account has been corroborated by a hospital orderly and by local government officials. One emergency official, William ‘Forest’ McQueen, said: “Those who had no chance of making it were given a lot of morphine and lain down in a dark place to die.”

Euthanasia is illegal in Louisiana, and The Mail on Sunday is protecting the identities of the medical staff concerned to prevent them being made scapegoats for the events of last week.

Their families believe their confessions are an indictment of the appalling failure of American authorities to help those in desperate need after Hurricane Katrina flooded the city, claiming thousands of lives and making 500,000 homeless.

‘These people were going to die anyway’

The doctor said: “I didn’t know if I was doing the right thing. But I did not have time. I had to make snap decisions, under the most appalling circumstances, and I did what I thought was right.

“I injected morphine into those patients who were dying and in agony. If the first dose was not enough, I gave a double dose. And at night I prayed to God to have mercy on my soul.”

The doctor, who finally fled her hospital late last week in fear of being murdered by the armed looters, said: “This was not murder, this was compassion. They would have been dead within hours, if not days. We did not put people down. What we did was give comfort to the end.

“I had cancer patients who were in agony. In some cases the drugs may have speeded up the death process.

“We divided patients into three categories: those who were traumatised but medically fit enough to survive, those who needed urgent care, and the dying.

“People would find it impossible to understand the situation. I had to make life-or-death decisions in a split second.

“It came down to giving people the basic human right to die with dignity.

“There were patients with Do Not Resuscitate signs. Under normal circumstances, some could have lasted several days. But when the power went out, we had nothing.

“Some of the very sick became distressed. We tried to make them as comfortable as possible.

“The pharmacy was under lockdown because gangs of armed looters were roaming around looking for their fix. You have to understand these people were going to die anyway.”

Mr McQueen, a utility manager for the town of Abita Springs, half an hour north of New Orleans, told relatives that patients had been ‘put down’, saying: “They injected them, but nurses stayed with them until they died.”

I find this story deeply troubling at any number of levels. I have written before on my concerns about the practice of active euthanasia (here and here), which arise not merely because of my Christian convictions about its morality, but perhaps equally so because of the great potential danger I see in breeching the moral and social levies which protect us from hubris and the creeping progressive tolerance of evil inherent when crossing them. The weariness of great tragedy saps the spirit, making it all to easy to rationalize the repulsive, to move on to the next horrid scene without reflecting on the last. But sometimes we must stop and focus amid the deadening blur of death and suffering. This story demands such a pause.

I am assuming, first of all, that this story is true–although I have seen no independent confirmation elsewhere. The name of the hospital where this occurred is not given, but it makes one wonder if it is the same facility where 45 dead patients were found abandoned. If it proves true, one must wonder whether there will be less outrage over patients euthanized than abandoned to die–somehow I suspect there might be. After all, they were terminated mercifully, rather than just abandoned–which would be oh, so terribly, terribly heartless.

But of course, if they were euthanized they were abandoned–abandoned by their providers and sworn protectors, those whom they trusted to comfort, heal, and protect them. Granted, the circumstances were horrendous: deprived of power, light, medications, and security, threatened by a mob of barbarians bent on drugs, theft, and destruction–one can hardly begin to imagine the terror, the helplessness, the frustration shared by doctors, patients, and nurses alike. It is easy to judge those who were there, sitting as I am dry, safe and secure, far from this hell on earth. It would be foolish to say that–were I there–my behavior would have been different, more noble, more self-sacrificing, more righteous. I would hope so–but I have been known to underestimate my frailties and potential for moral lapses far too often to be smug or self-righteous: I simply do not know how I would have handled this situation, were I there.

But still I must ask: you killed them? Actively, deliberately, methodically? What has occurred here, it seems, steps over a line clearly blurred by the panic, fear, and hopelessness of a terrible storm and its even more horrible aftermath–the opportunism of human evil in the face of Nature’s wrath–into the realm of a darkness far deeper than wind and water and chaos could wreak. Have you not countered evil with evil? “And if Satan cast out Satan, he is divided against himself; how shall then his kingdom stand?”

Could not the morphine you used to end their lives be instead used to ease their pain, their fear, as you stood by their bedside doing what little you could to comfort them? It takes far more morphine to kill than to comfort. Could you not stand and defend them against the looters, the rapists, the thugs–though ill-equipped you might well lose your safety, your well-being, even your life. There is a word for those who act thusly, defending the weak against the strong at the cost of their lives: heroes. Did you not, by actively terminating their lives, avoid the shameful option of abandoning suffering and dying patients to save yourselves? They were condemned to die by their disease, by the untimely fate of a hospital in harm’s way, by social chaos and raging mobs. You are alive today because you expedited their inevitable death. But your life, so secured, is not enobled by this act: you may indeed find forgiveness, but the act remains: a dark mercy, an act of weakness, heinous forever.

The interview in The Mail is redolent with the special pleading and specious arguments so common among those who have compromised principles for expediency, and by those who justify any and all such moral relativism. The paper protects the anonymity of those who so acted “to prevent them being made scapegoats for the events of last week.” Scapegoats? Whose sins are you carrying into the desert, if not your own? What was the proximate cause of their death, if not your syringe?

The doctor informs us: “This was not murder, this was compassion. They would have been dead within hours, if not days. We did not put people down. What we did was give comfort to the end.” Aahh, compassion–I’ll have a double dose, please. Com-passion: “to suffer with”–this is its root, its meaning. To suffer with a patient, to experience their pain while strengthening their spirit–that is compassion. To stand in the breach, between the looter and the lost, to suffer that they may be spared–that is compassion. To stay with a dying patient, when the lights are out and you have no treatment to offer–that is compassion. To stop their breathing with an overdose so that you can escape without abandoning them to die alone may be rational, understandable, defensible, even arguably reasonable–but it is not compassion. Words have meanings: I know what murder means, what compassion involves, what comfort entails–and they are not the same.

The doctor informs us: “It came down to giving people the basic human right to die with dignity.” Death with dignity–is that indeed our right? Who ordains such a right? Who enforces it? What about the bloated bodies floating face down in sewage-laced water, drifting down streets in the company of dead rats and fire ants–is that dignity? Who stole their right to die with dignity? Would you have injected them also to save such an indignity? And how is it we now define “dignity” as the right to die when and where we want–or when our doctor thinks it’s best? Is not dignity instead dying with inner grace, strengthened by those around you, comfortable that your life has been lived with meaning and purpose–though your body be racked by pain–in the presence of others who care? Many died just this way in Katrina–under circumstances just as horrid and terrifying and degrading as the good doctor experienced. They died with dignity–brutally, but with nobility, grace, and courage, saving and protecting family members, pets, friends, strangers.

The doctor informs us: “You have to understand these people were going to die anyway.” Yes, I do understand–and that is true of every living breathing human on this planet. But your patients died early–in your time, not theirs, under your hand, not that of a looter, nor the ravage of a disease, nor the savagery of storm. Your hand, doctor. Who granted you this right, this power?

But someone in this story sees through the hollow rhetoric, the noble talk, the faux compassion: “Mr McQueen … told relatives that patients had been ‘put down’, saying: ‘They injected them, but nurses stayed with them until they died.'” America, meet your new compassion, your new dignity: the nurse will stay by your side after your doctor puts you down.

Now, perhaps this story is a tabloid fabrication. Perhaps–so often the case–the truth of the situation was mangled beyond recognition by truncated quotes, Dowdian ellipses, or the pure fabrication that passes for journalism in our oh-so-enlightened 21st century. And I was not there–would my behavior have been that much different? I don’t know. Tragedy rips the scab–covered by layers of makeup and cheap jewelry–from the deep wounds of the humans spirit. It may reveal bleeding, and pain, and health, and healing–or the putrid aroma of rotting flesh and festering maggots. A white coat does not bestow deity, but bespeaks instead service and sacrifice–and the dark horrors of a dying hospital do not change this simple truth.

Dancing With Death

Dancing with Death

The war rages on. It is a battle with ancient roots, deeply embedded in religion, culture, and the tensions between rich and poor. It is a war of contrasts: high technology and primitive cultural weapons; knowledge versus ignorance; speed and urgency against the methodical slowness of an enemy who knows time is on his side.

It is a war in which enormous strides have been made, with countless victories large and small.

The enemy is death. The avenger is medicine. And the war is going very poorly indeed. In many ways, the gains of modern medicine against death and disease are truly impressive: longer life expectancy; progress and cures against heart disease, cancer, and diabetes; surgical and procedural marvels hard to imagine even 15 or 20 years ago. Yet, it is these very advances which seem to lie at the heart of a growing problem. We are so engaged in the battle, so empowered by our growing capabilities, that we have lost sight of the bigger picture. While pushing back the adversary of death, we are ever so steadily being destroyed by the very battle itself.

Several recent experiences have driven this dichotomy home for me. Last week, I was asked to evaluate a man who had been hospitalized for a over a week. A nursing home resident in his late 80’s, his overall health was fair to poor at best, and he suffered from severe dementia. He was unable to communicate in any way, and could recognize no one — not even his wife of many years, who remained in possession of her full facilities. He was admitted to the hospital with a severe urinary tract infection with a highly resistant bacteria, and septic shock. When he arrived at the ER, the full extent of his dementia was not apparent to the physicians there, and his wife insisted that all measures be engaged to save him. Aggressive medical care was therefore initiated — intensive care unit, one-on-one nursing care, hemodynamic monitoring, drugs to support blood pressure, intravenous nutrition, and costly antibiotics. After nearly two weeks of such intensive therapy, the patient largely recovered from his life-threatening infection — returning to his baseline of profound dementia. Yet the underlying risk factors which led to it — his age, a chronic bladder catheter and bacteria-harboring stones, diabetes, — remained in place, lying in wait for another, inevitable opportunity, in a matter of weeks or months. The cost of his hospitalization was easily in 6 figures.

In another situation, an elderly women presented to the hospital with signs of a serious, life-threatening infection in her abdomen. A healthy widower, she lived independently with her sister prior to her illness. Emergency surgery was performed, and an abscessed kidney removed. Her medical condition deteriorated after surgery, with coma due to stroke and failure of her remaining kidney brought on by the infection.

The patient’s sister and living companion communicated the clear final wishes of the widower: a women of strong faith, she wished no extraordinary measures, such as ventilators or dialysis, to extend her life needlessly. She was comfortable with death, and not afraid. The staff prepared to allow her to die gracefully, comfortably, and in peace.

But such was not to be. There was no living will, and the sister did not have legal authority to make such decisions. But the widower’s daughter, a nurse living out-of-state with little recent contact with her mother, arrived in town demanding that aggressive measures be taken to save her. A nephrologist (kidney specialist) was called in. A superb physician, compassionate and dedicated, he had been successfully sued in a similar case after recommending that dialysis be withheld in a patient with a grim prognosis. This was a mistake he would not make twice: the widower was transferred to another hospital, placed on dialysis, and died 3 weeks — and a quarter of a million dollars — later, in an ICU. She never woke up.

The issues which these two cases bring up are numerous, complex, and defy easy answers. They touch upon the subjective measure of quality-of-life and what it is worth; the finite limit of economic health care resources; the relative responsibilities of physicians, patients, and their families in end-of-life decisions; the pressures placed on the health care system and its practitioners by after-the-fact second-guessing in an aggressive tort environment; and a host of others greater or lesser in weight and substance, up to and including the meaning of life itself.

All the players bear responsibility in this passion play. Physicians excel at grasping what they can accomplish, but are woefully inadequate for the task of deciding whether such things should be done. In the urgency of acute care, delay to consider the ramifications of a decision to treat may cost an opportunity to save a patient for whom such treatment is desirable; better always to err on the side of salvage. Pressured by family, potential litigation, or instinct, the path of least resistance is to follow your training and use your skills. And physicians themselves are uncomfortable with death, though inundated in its ubiquity.

Family members naturally resist the agonal separation of their loved ones, often harboring unrealistic hopes and expectations of recovery in the face of inevitable death. A curious dance of denial often ensues between physician and family, as each, unwilling to face the unpleasantness of the inevitable, avoids the topic at all costs. The physician hides behind intellect, speaking of blood counts, medications, and ventilators, or at best tiptoeing around the core issue with sterile terms like “prognosis.” Family members hesitate to ask questions whose answers they already know. Too rarely are the physician and family willing to place the subject squarely on the table, in all its ugliness and fearfulness. Decisions which need to be made are put off, unspoken and deferred. The clock ticks on, the meter is running, and only the outcome is not in doubt.

The tort system provides a ready outlet for the anguish and anger of death of a loved one. In such a period of intense emotional turmoil, the real or perceived indifference of physicians (often a mechanism of detachment by which doctors deal with the horrors of death and illness); the parade of unfamiliar medical faces as no-name consultants come and go during the final days; the compounding burden of crushing financial load from the extraordinary costs of intensive terminal medicine; the Monday-morning quarterbacking by the tort system of complex, often agonizingly difficult medical decisions in critically-ill patients: all present a toxic and intoxicating brew which impels the health care system forward to leave no avenue untravelled, no dollar unspent in prolonging life beyond its proper and respectful end.

This march of madness is not without resistors. Seizing on the high costs, the futility, and especially the lack of personal control fostered by impersonal, highly technical terminal care, the euthanasia movement is maneuvering into the gap. Cloaked in slogans of personal autonomy and “Death with Dignity”, active euthanasia proponents seek to replace the sterile prolongation of a now-meaningless life with the warm embrace of Death herself. Terrified by an out-of-control dying process, an end of a life which embodies all meaning, they seek to control death as their final act of significance. But Death will not be controlled, and those who dance with Death are seduced by her siren. Euthanasia starts with compassionate intent, but ends with termination of the useless. Man does not have the wisdom to control death; The Ring-bearer is corrupted by its power.

Our discomfort with death is our confusion about life. Man is the only species cognizant of his coming demise — who then, in the ultimate paradox, lives his entire life pretending it will not happen. Our Western culture, enriched with a wealth of distractions, allows us to pass our living years without preparing for the inevitable. When the time arrives, we use all the weapons at our disposal — wealth, technology, information, law — to resist the dragon. We drive it back for a time — at enormous cost, personal, financial, physical and emotional. Death always wins — always.

I am not of course yearning for a return to the past, a passive resignation to the inevitable anabasis of disease and death. The benefits of medicine and the forestalling of death are precious and powerful gifts, which have greatly benefited many. But like all such great powers, they are useful for good or ill. When the defeat of death becomes an end in itself, detached from the meaningfulness of life lived, it has great destructive energy.

We must learn how to die. And to learn how to die, we must learn how to live — how to seek the transcendent, the power of love, and sacrifice, and giving which makes life rich and enduring. The selfish, the superficial, the transient all gratify for a time, but when this is all we possess, we grasp desperately to their threadbare fabric when beauty and health give way to weakness, fear and death. All great religions understand this: the meaning of life transcends life. In the Judeo-Christian view, life is an opportunity to draw ourselves and others closer to the light and goodness of God, with the promise of an even greater life and deeper relationship after death. Yet even for the agnostic or secular among us, service to others — personal and social — has the potential to endure long after us. None of us will be remembered for our desperate clinging to life in its waning days, but rather for the lives we touched, the world we made better when we lived.

The Children Whom Reason Scorns

The Children Whom Reason Scorns

You Also Bear the BurdenIn the years following the Great War, a sense of doom and panic settled over Germany. Long concerned about a declining birth rate, the country faced the loss of 2 million of its fine young men in the war, the crushing burden of an economy devastated by war and the Great Depression, further compounded by the economic body blow of reparations and the loss of the German colonies imposed by the Treaty of Versailles. Many worried that the Nordic race itself was threatened with extinction.

The burgeoning new sciences of psychology, genetics, and medicine provided a glimmer of hope in this darkness. An intense fascination developed with strengthening and improving the nation through Volksgesundheit–public health. Many physicians and scientists promoted “racial hygiene” – better known today as eugenics.

The Germans were hardly alone in this interest – 26 states in the U.S. had forced sterilization laws for criminals and the mentally ill during this period; Ohio debated legalized euthanasia in the 20’s; and even Oliver Wendall Holmes, in Buck v. Bell, famously upheld forced sterilization with the quote: “Three generations of imbeciles are enough!” But Germany’s dire circumstances and its robust scientific and university resources proved a most fertile ground for this philosophy.

These novel ideas percolated rapidly through the social and educational systems steeped in Hegelian deterministic philosophy and social Darwinism. Long lines formed to view exhibits on heredity and genetics, and scientific research, conferences, and publication on topics of race and eugenics were legion. The emphasis was often on the great burden which the chronically ill and mentally and physically deformed placed on a struggling society striving to achieve its historical destiny. In a high school biology textbook – pictured above – a muscular German youth bears two such societal misfits on a barbell, with the exhortation, “You Are Sharing the Load!–a hereditarily-ill person costs 50,000 Reichsmarks by the time they reach 60.” Math textbooks tested students on how many new housing units could be built with the money saved by elimination of long-term care needs. Parents often chose euthanasia for their disabled offspring, rather than face the societal scorn and ostracization of raising a mentally or physically impaired child. This widespread public endorsement and pseudo-scientific support for eugenics set the stage for its wholesale adoption — with horrific consequences — when the Nazi party took power.

The Nazis co-opted medicine fully in their pursuit of racial hygiene, even coercing physicians in occupied countries to provide health and racial information on their patients to occupation authorities, and to participate in forced euthanasia. In a remarkably heroic professional stance, the physicians of the Netherlands steadfastly refused to provide this information, forfeiting their medical licenses as a result, and no small number of physicians were deported to concentration camps for their principled stand. As a testimony to their courage and integrity, not a single episode of involuntary euthanasia was performed by Dutch physicians during the Nazi occupation.

Would that it were still so.

The Netherlands is today the only country in the world in which euthanasia and assisted suicide are legally performed, having fully legalized the practice three years ago after several decades of widespread illegal–but universally unpunished–practice. The Dutch have come into the public consciousness periodically over the past 15 years, initially with the consideration of assisted suicide laws in Oregon, Washington, Michigan and elsewhere in the early 90’s, and again with their formal legalization of physician-assisted suicide and euthanasia in 2001. Once again they are on the ethical radar, with the disclosure last week of the Groningen Protocol for involuntary euthanasia of infants and children.

The Groningen Protocol is not a government regulation or legislation, but rather a set of hospital guidelines for involuntary euthanasia of children up to age 12:
The Groningen Protocol, as the hospital’s guidelines have come to be known, would create a legal framework for permitting doctors to actively end the life of newborns deemed to be in similar pain from incurable disease or extreme deformities.

The guideline says euthanasia is acceptable when the child’s medical team and independent doctors agree the pain cannot be eased and there is no prospect for improvement, and when parents think it’s best.

Examples include extremely premature births, where children suffer brain damage from bleeding and convulsions; and diseases where a child could only survive on life support for the rest of its life, such as severe cases of spina bifida and epidermosis bullosa, a rare blistering illness.

The hospital revealed last month it carried out four such mercy killings in 2003, and reported all cases to government prosecutors. There have been no legal proceedings against the hospital or the doctors.
While some are shocked and outraged at this policy of medical termination of sick or deformed children (the story has been widely ignored by the mainstream media, and has gotten only limited attention on the Internet), it is merely a logical extension of a philosophy of medicine widely practiced and condoned in the Netherlands for many years, much as it was in Germany between world wars. It is a philosophy where the Useful is the Good, whose victims are the children whom Reason scorned.

Euthanasia is the quick fix to man’s ageless struggle with suffering and disease. The Hippocratic Oath — taken in widely varying forms by most physicians at graduation — was originally administered to a minority of physicians in ancient Greece, who swore to prescribe neither euthanasia nor abortion — both common recommendations by healers of the age. The rapid and widespread acceptance of euthanasia in pre-Nazi Germany occurred because it was eminently reasonable and rational. Beaten down by war, economic hardship, and limited resources, logic dictated that those who could not contribute to the betterment of society cease being a drain on its lifeblood. Long before its application to ethnic groups and enemies of the State, it was administered to those who made us most uncomfortable: the mentally ill, the deformed, the retarded, the social misfit. While invariably promoted as a merciful means of terminating suffering, the suffering relieved is far more that of the enabling society than of its victims. “Death with dignity” is the gleaming white shroud on the rotting corpse of societal fear, self-interest and ruthless self-preservation.

It is sobering and puzzling to ponder how the profession of medicine – whose core article of faith is healing and comfort of the sick – could be so effortlessly transformed into a calculating instrument of judgment and death. It is chilling to read the cold scientific language of Nazi medical experiments or Dutch studies on optimal techniques to minimize complications in euthanasia. Yet this devolution of medicine, with some contemplation, is not hard to discern. It is the natural gravity of man detached from higher principles, operating out of the best his reason alone has to offer, with its inevitable disastrous consequences. Contributing to this march toward depravity:

  • The power of detachment and intellectualism: Physicians by training and disposition are intellectualizers. Non-medical people observing surgery are invariably squeamish, personalizing the experience and often repulsed by the apparent trauma to the patient. Physicians overcome this natural response by detaching themselves from the personal, and transforming the experience into a study in technique, stepwise logical processes, and fascination with disease and anatomy. Indeed, it takes some effort to overcome this training to develop empathy and compassion. It is therefore a relatively small step with such training to turn even killing into another process to be mastered.

  • The dilution of personal responsibility: In Germany, the euthanasia of children was performed with an injection of Luminal, a barbiturate also used for seizures and sedation of the agitated. As a result, it was difficult to determine who was personally responsible for the deed: was it the nurse, who gave too much? The doctor, who ordered too large a dose? Was the patient overly sensitive to the drug? Was the child merely sedated, or in a terminal coma? Of course, all the participants knew what was going on, but responsibility was diluted, giving rationalization and justification full reign. The societal endorsement and widespread practice of euthanasia provided additional cover. When all are culpable, no one is culpable.

  • Compartmentalization: an individual involved in the de-Baathification of Iraq said the following:
    There is a duality in Baathists. You can find a Baathist who is a killer, but at home he’s completely normal. It’s like they split their day into two twelve-hour blocks. When people say about someone I know to be a Baathist criminal, ‘No, he’s a good neighbor!’, I believe him.
    Humans have the remarkable ability to utterly separate disparate parts of their lives, to accommodate cognitive dissonance. Indeed, there is probably no other way to maintain sanity in the face of enormous personal evil.

  • The banality of evil: Great evil springs in countless small steps from lesser evil. Jesus Christ was doubtless not the first innocent man Pilate condemned to death; soft porn came before child porn, snuff films, and rape videos; in the childhood of the serial killer lies cruelty to animals. Small evils harden the heart, making greater evil easier, more routine, less chilling. We marvel at the hideousness of the final act, but the descent to depravity is a gentle slope downwards.

  • The false optimism of expediency: Solve the problem today, deny any future consequences. We are nearsighted creatures in the extreme, seeing only the benefits of our current actions while dismissing the potential for unknown, disastrous ramifications. When Baby Knauer, an infant with blindness, mental retardation and physical deformities, became the first child euthanized in Germany, who could foresee the horrors of Auschwitz and Dachau? We are blind to the horrendous consequences of our wrong decisions, but see infinite visions of hope for their benefits. As a child I watched television shows touting peaceful nuclear energy as the solution to all the world’s problems, little imagining the fears of the Cuban missile crisis, Chernobyl and Three Mile Island, the minutes before midnight of the Cold War, and the current ogre of nuclear terrorism.

    Reason of itself is morally neutral; it can kill children or discover cures for their suffering and disease. Reason tempered by humility, faith, and guidance by higher moral principles has enormous potential for good – and without such restraints, enormous potential for evil.

    The desire to end human suffering is morally good. Despite popular misconception, the Judeo-Christian tradition does not view suffering as something good, but rather something evil which exists, but which may be transformed and redeemed by God and grace, to ultimately produce a greater good. This is a difficult sell to a materialistic, secular world, which does not accept the transformational power of God or the existence of spiritual consequences, or principles higher than human reason.

    Yet the benefits of suffering, subtle though they may be, can be discerned in many instances even by the unskilled eye. What are the chances that Dutch doctors will find a cure for the late stage cancer or early childhood disease, when they now so quickly and “compassionately” dispense of their sufferers with a lethal injection? Who will teach us patience, compassion, unselfish love, endurance, tenderness, and tolerance, if not those who provide us with the opportunity through their suffering, or mental or physical disability? These are character traits not easily learned, though enormously beneficial to society as well as individuals. How will we learn them if we liquidate our teachers?

    Higher moral principles position roadblocks to our behavior, warning us that grave danger lies beyond. When in our hubris and unenlightened reason we crash through them, we do so at great peril, for we do not know what evil lies beyond. The Netherlands will not be another Nazi Germany, as frightening as the parallels may be. It will be different, but it will be evil in some unpredictable way, impossible to foresee when rationalism took the first step across that boundary to kill a patient in mercy.