Involuntary euthanasia

Involuntary euthanasia occurs when euthanasia is performed on a person who would be able to provide informed consent, but does not, either because they do not want to die, or because they were not asked.^[1]

Involuntary euthanasia is contrasted with voluntary euthanasia (euthanasia performed with the patient's consent) and non-voluntary euthanasia (when the patient is unable to give informed consent, for example when a patient is comatose or a child). Involuntary euthanasia is widely opposed and is regarded as a crime in all legal jurisdictions. Reference to it or fear of it is sometimes used as a reason for not changing laws relating to other forms of euthanasia.^[2][3]

History of involuntary euthanasia

United States

Euthanasia became a subject of public discussion in the United States at the turn of the 20th century. Felix Adler, a prominent educator and scholar, issued the first authoritative call in 1891 for the provision of lethal drugs to terminally ill patients who requested to die. In 1906, Ohio considered a law to legalize such a form of euthanasia, but it did not make it out of committee. While much of the debate focused on voluntary euthanasia, other calls for involuntary euthanasia were vocalized as well. In 1900, W. Duncan McKim, a New York physician and author published a book titled “Heredity and Human Progress.” This book suggested that people with severe inherited defects, including mentally handicapped people, epileptics, habitual drunks and criminals, should be given a quick and painless death by carbonic gas.^[4]

In January 1938, the National Society for the Legalization of Euthanasia was formed, and was renamed the Euthanasia Society of America (ESA) later that year. It advocated for the legalization of euthanasia in the United States, primarily by lobbying state legislators. Many prominent ESA members advocated for involuntary euthanasia of people with mental disabilities, including Ann Mitchell, a former asylum patient and main financial supporter of the ESA until her suicide in 1942. Ann Mitchell is also credited with structuring the ESA as a eugenics project. ESA’s first president was Charles Potter, an ex-Baptist minister who advocated for coercive eugenic sterilization and involuntary euthanasia to eliminate undesirable defective people from society.^[5]

The ESA initially advocated for both voluntary and involuntary euthanasia of people with severe disabilities. The organization soon realized that involuntary euthanasia had negative connotations, particularly its association with the Nazis' euthanasia program, and began advocating for voluntary euthanasia exclusively.^[5] The ESA continues to exist today.^[4]

World War II Germany

Gas chamber in Hadamar killing center

Adolf Hitler enacted the Aktion T4 program in October 1939 to euthanize “incurably ill, physically or mentally disabled, emotionally distraught, and elderly people.” The Aktion T4 program was also designed to euthanize those who were deemed "inferior and threatening to the well being of the Aryan race." This program was also designed as part of a larger, “Final Solution” eugenics program. Within months of enactment, the Nazis expanded its definition of who could be euthanized to include those who were of a certain ethnicity as well as economic level. Many people who did not want to be euthanized by this enacted program were murdered anyway against their will. Six killing centers were constructed after T4’s enactment, with one of the most notable being the Hadamar killing center. At these centers, people deemed handicapped or “unfit” by “medical experts” were put to death in gruesome ways. For example, gas chambers were disguised to look like showers, and some were starved to death. Often at these centers, mass euthanasia via gas chambers took place.^[6] The meticulous research undertaken by the Nazis after the deceased was euthanized ultimately was used as a prototype for much larger euthanasia institutions for larger death camps such as Auschwitz and Treblinka, implemented later on in the war.^[7]

Approximately 200,000 people were killed over a six year span due to the T4 program. The T4 euthanasia institutions were shut down by Allied troops in 1945.^[6]

References

1. Jackson, Jennifer (2006). Ethics in medicine. Polity. p. 137. ISBN 0-7456-2569-X.
2. Harris, NM. (Oct 2001). "The euthanasia debate.". J R Army Med Corps 147 (3): 367–70. doi:10.1136/jramc-147-03-22. PMID 11766225. It is the occurrence of involuntary euthanasia which forms one of the main arguments against legalisation.
3. Chapple, A.; Ziebland, S.; McPherson, A.; Herxheimer, A. (Dec 2006). "What people close to death say about euthanasia and assisted suicide: a qualitative study". J Med Ethics 32 (12): 706–10. doi:10.1136/jme.2006.015883. PMC 2563356. PMID 17145910.
4. Cheyfitz, Kirk (1999–2000). "Who Decides? The Connecting Thread of Euthanasia, Eugenics, and Doctor-Assisted Suicide". Omega 40 (1): 5–16. doi:10.2190/djfu-aawp-m3l4-4alp.
5. Dowbiggin, Ian (2002). ""A Rational Coalition": Euthanasia, Eugenics, and Birth Control in America, 1940-1970". The Journal of Policy History 14 (3): 223–260. doi:10.1353/jph.2002.0017.
6. Strous, Rael D. (Jan 2006). "Nazi Euthanasia of the Mentally Ill at Hadamar". American Journal of Psychiatry 163 (1): 27. doi:10.1176/appi.ajp.163.1.27. PMID 16390885.
7. Young, Rachel. ""The "Euthanasia" of People with Disabilities in Nazi Germany: Harbinger of the "Final Solution""".