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Judging from its unfortunate title, A Merciful End: The Euthanasia Movement in Modern America would appear to be just another in the dreary collection of recent books extolling assisted suicide as a curative to the tyranny of modern medical paternalism and a necessary adjunct to the right of personal autonomy. But, as the old saying goes, one should not judge a book by its cover. Rather than being an apologia, University of Prince Edward Island history professor Ian Dowbiggin’s approach is utterly fair and evenhanded. Instead of arguing the issue pro or con, he provides an exhaustively researched and objective history of euthanasia advocacy in the United States.

Dowbiggin demonstrates that euthanasia advocacy in America is not a recent phenomenon. The drive to legalize mercy killing actually began in the late nineteenth century, a natural byproduct of the popularization of eugenics. Indeed, Charles Darwin’s warning in The Descent of Man that hospitals, asylums, and therapeutic medicine interfered with natural selection by permitting weak members of society to survive and reproduce”which would imply euthanasia as a curative”helped lead his cousin, Francis Galton, to the idea that society could improve the gene pool by controlling human procreation. This was to be accomplished both by encouraging “good stock” to reproduce in larger numbers and to prevent “bad stock” from procreating at all.

It didn’t take long for these attitudes to spread beyond deciding who should not be born to the presumption that society could decide who among the living should die. For many believers in eugenics, killing was not just seen as a rational means of ending suffering when life was no longer worth living because of pain or despair, but also had the potential to be an effective method of social control. Thus, in 1900, one of the euthanasia movement’s pioneers, physician William Duncan McKim, advocated a “gentle, painless death” as the solution to problems he saw caused by America’s drunkards, criminals, and people with disabilities.

In the first half of the twentieth century eugenics and euthanasia were symbiotically connected. Many among the American elite came to embrace euthanasia as part of the same enterprise. Among these were utilitarian philosopher Robert G. Ingersoll, biologist and early eugenics heavyweight Charles Davenport, Food and Drug Administrator Harvey Wiley, Margaret Sanger, Helen Keller, and civil rights lawyer Clarence Darrow, who advocated in 1915 that it was just to “chloroform unfit children . . . [and] show them the same mercy that is shown beasts that are no longer fit to live.”

From the 1920s through the late 1930s, euthanasia continued to grow in public popularity. Indeed, as World War II loomed, public opinion polls showed popular support for legalization, and the leaders of the now fifty-year-old movement enthusiastically”and not unrealistically”predicted imminent legislative success. But the time, it turned out, was not ripe at all. The public’s revulsion to the euthanasia pogrom against disabled infants and adults by doctors in Nazi Germany soon forced American euthanasia advocacy into the shadows, where it remained for the better part of the next forty years.

Dowbiggin’s history provides a fascinating study in how little the movement and its tactics have actually changed over the years. Indeed, the book’s narrative discloses a remarkably clear and consistent pattern, both in the strategy and substance of euthanasia advocacy, from its inception to today.

Then (and now), euthanasia advocates manipulated language in order to gain public acceptance of their agenda. Indeed, the first example of this tactic was the movement’s successful co-opting of the word “euthanasia” itself, which was originally understood as referring to the “relief of pain for the dying as the best way to ensure an ‘easy death’””a notion akin to the current understanding of the word “hospice.” More recently, euthanasia has evolved into the euphemistic “death with dignity” and “aid in dying.”

Then (and now), supporters of legalizing euthanasia thought of themselves as free thinkers with the courage and vision to break outdated religious “taboos” about the sanctity of human life for the sake of reforming society based on the truths of science and the values of secularism. Dowbiggin notes that the first activists viewed euthanasia as one part of a broader agenda of “kindred causes” that included eugenics, population control, and sexual equality”to which modern-day euthanasia enthusiasts would add abortion.

Then (and now), euthanasia advocates despised the Catholic Church and (to a lesser degree) evangelical Protestants for their alleged interference with individual freedom and the implementation of “enlightened” social policies. Then (and now), euthanasia advocacy was widespread among members of the Unitarian Church. Not surprisingly, some of the most enthusiastic supporters were (and are) secular humanists, whose “faith in man” rather than in God is deemed the ultimate creed. Indeed, according to Dowbiggin, Charles Francis Potter, the founder of the Humanist Society of New York, supported euthanasia as the “the quintessential Humanist cause,” a position that many humanists still espouse.

Then (and now), the movement depended upon moral outlawry to move its agenda forward. Jack Kevorkian wasn’t the first of these rogues and undoubtedly he won’t be the last to thumb his nose at the law and social convention by defiantly carrying out mercy killings while daring society to stop him. In 1915, a physician named Harry Haiselden convinced the parents of a disabled infant not to have surgery performed that would have saved their child’s life. Like Kevorkian and others of his ilk, Haiselden sought fame for his deed. And, like Kevorkian in our day, by his very defiance he “got more Americans than ever before talking about euthanasia” and “also won endorsements [for legalization] from prominent figures.”

For 162 pages, Dowbiggin’s straightforward narrative traces the ins and outs, the ups and downs, of euthanasia advocacy: the creation of organizations, their changes of name to expand their popular appeal, the vagaries of public popularity, the impact of the Holocaust, the movement’s infighting over tactics, the stridency and eccentricities of its leaders. It is all very interesting and informative. But then, for no reason that I can see, the author’s narrative peters out as he approaches the present.

Despite the 1990s being the most dramatic and, unfortunately, successful decade in the history of American euthanasia advocacy, Dowbiggin devotes a mere fourteen pages to recent history. This makes it less likely that readers will pick up on the strong philosophical ties between the early movement and contemporary euthanasia advocacy. Consider the following recent developments, which receive far too little”or no”attention.

Oregon voters legalized assisted suicide for those diagnosed as terminally ill in 1992. While this is briefly discussed in the book, a fuller description of the events leading to the 1992 campaign is a tale well worth telling. Not only was the legalization campaign explicitly anti-Catholic, but a fuller account of why it was narrower than previously failed efforts to legalize euthanasia would have helped the reader understand that permitting doctors to write lethal prescriptions for terminally ill patients is seen by advocates as merely the proverbial foot in the door that will open society to a much broader mercy-killing license.

Then, in 1997, in two conjoined opinions, the United States Supreme Court refused to issue an assisted suicide Roe v. Wade decision that would have legalized the act throughout the country. Yes, the Supreme Court cases are mentioned. But there is no meaningful exploration of the theories advocated by euthanasia advocates that proved sufficiently persuasive in lower courts, requiring the Supreme Court to take up the issue. This failure allows important facts to go undisclosed. The Ninth Circuit Court of Appeals, for example, would have imposed a broad euthanasia license through judicial fiat. Had Dowbiggin analyzed this radical decision, readers would have learned that it would have expanded the putative right to assisted suicide far beyond the terminally ill, to the disabled, the elderly, and even to those worried about being a financial burden on their families. Moreover, had the Ninth Circuit’s decision gone into effect, doctors would not only have been granted a constitutional right to kill patients who asked to die, but to kill at the request of family members when patients were incapable of making their own decisions.

And lastly, despite being the most successful advocacy effort in the history of the euthanasia movement, Jack Kevorkian’s eight-year crime spree is all but overlooked. Between 1990 and 1998, Kevorkian assisted the suicides of more than 130 people, was acquitted by several juries despite admitting his participation in several assisted suicide deaths, and, in an ultimate act of crass utilitarianism, harvested the kidneys of one of his victims for use in organ transplantation. Most of Kevorkian’s victims were not terminally ill. Indeed, based upon their autopsies, five weren’t even sick. Moreover, Kevorkian’s amoral mindset”going so far as to advocate conducting medical experiments upon people being euthanized”is strikingly similar to the thinking of the originators of the euthanasia movement. Considering the attention and detail paid to far more obscure and less consequential euthanasia advocates, Dowbiggin’s short shrift of the Kevorkian debacle is inexplicable.

Despite his scanting of recent developments, Dowbiggin has performed a valuable public service by writing A Merciful End . He concludes his history on a sobering and chilling note:

Talk of a right to die raises troubling questions: once legalized for the dying, who can be denied such a right? The chronically ill, but not the dying? Pain-free patients who nonetheless feel their medical conditions leave them with no quality of life? Depressed teenagers? The mentally ill? Handicapped children whose parents wish them to be dead? Infants with severe disabilities? Where does the freedom to die end and the duty to die begin? The history of euthanasia in America reminds us that despite a century of intensive debate and passionate political battles, these questions remain largely unanswered.

There is a reason. If these questions were ever answered candidly, it would soon become clear to all that the modern movement, like a looping audio tape, would soon take us right back to where it all began”the quicksand of eugenics. Should society come to that realization, it would soon mark the end of euthanasia as a respectable social movement.

Wesley J. Smith is a senior fellow at the Discovery Institute and an attorney for the International Task Force on Assisted Suicide and Euthanasia. He is the author of Culture of Death: The Assault on Medical Ethics in America.