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Thou shalt not kill
Thou shalt not kill JOHN CONLEY, MD, New York, New York
T h e matchless position of life has been a focus of wonderment from the beginning of time. It has been protected by religious law and, more recently, by secular law relating to our system of justice. There is a recognized sanctity about the living phenomenon that gives it distinction from all other experiences. It is unique, it is holy, it is us, and it has woven itself into every aspect of our existence. It is the most important feature of our agenda. Anything of this magnitude will be a dominant force in society, will create rules and regulations unto itself, and will establish axiomatic positions relative to conduct, to feeling, and to belief. Most of these positions have been discussed and worked out in our society, but there are constant questions and readjustments that are necessary and timely. Hippocrates stated categorically that he would not give a "fatal draft to anyone even if asked, nor will I suggest such a thing." He obviously believed it better not to become involved in the killing process, regardless of the circumstances. Killing in warfare, in religion, and in love and rage has been the habit of human beings since the beginning of time. Some of these killings were endorsed and even sanctified. Some were rewarded, some were punished, and some were ignored. Some were planned, some were spontaneous, some occurred in cold blood, and some occurred in passion. The psychological reasons for this act cover the gamut of human emotions. Accountability was measured from a religious, political, social, community, and more recently, psychological point of view. There was never a completely satisfactory explanation of the killing process, except, perhaps, in self-defense. The results are always associated with sadness, despair, relief, and jubilation by those affected. There is almost always a set of human scars that are never completely cured. From the John Conley Foundation for Ethics and Philosophy in Medicine, Inc. Reprint requests: John Conley,MD, the John Conley Foundation for Ethics and Philosophy in Medicine, Inc., 211 Central Park West, New York,NY 10024. OtolaryngolHead Neck Surg 1997;116:3. Copyright © 1997 by the American Academy of OtolaryngologyHead and Neck SurgeryFoundation, Inc. 0194-5998/97/$5.00 + 0 23/39/57677
I have only touched in outline form on the emotions of human killing. There is another killing that goes on in the animal kingdom that is considered to be perfectly normal. That relates to the instinct and the necessity of survival. The acquisition of food by killing the object of nourishment has certain rules and regulations that have organized the food chain throughout the world. There are, of course, some "black holes," but agriculture, farming, harvesting, herdsmanship, and fishing on a business and randomized basis are functioning fairly well for us. There are some regulations and some famines, but no one ever questions the right of human beings and animals to eat and survive. Our question in medicine is whether a physician has the right to kill a patient when there is a sufficient medical reason and when the patient's advocate has requested that it be done. As doctors, we all know of instances when this would be justified. Some of the germane factors that might support this proposition would be pain, misery, depletion of the quality of life, and low survival level. I have intentionally omitted economic factors, availability of resources, physical and medical services, and community support. These factors are essential but are at a periphery of such an important medical question as killing. The whole idea seems repugnant to me. I believe it would be better for things to go on as they are with necessary adjustments made as the situations demand, rather than the imposition of another bureaucratic system. A new system of euthanasia would certainly create problems with management and bureaucratic objectivity. There is certainly a place for a specialist in dying as well as for a specialist in living. The patient or the general medical doctor who attends the patient's family, the knowledgeable internist, and the surgeon should be able to ameliorate this problem as a team or individually. It is a question of caring, dignity, relief of pain, human contact, and appropriate medical substitutes. Heroic life-saving measures at the end of what is left of a life, when hope and quality are gone, are emotional gestures in temporary futility. It is ardently wished that a sensitive doctor could handle this problem in a humane fashion that will proclaim professionality and caring. There is no great need to disagree with Hippocrates in this respect.
T h e matchless position of life has been a focus of wonderment from the beginning of time. It has been protected by religious law and, more recently, by secular law relating to our system of justice. There is a recognized sanctity about the living phenomenon that gives it distinction from all other experiences. It is unique, it is holy, it is us, and it has woven itself into every aspect of our existence. It is the most important feature of our agenda. Anything of this magnitude will be a dominant force in society, will create rules and regulations unto itself, and will establish axiomatic positions relative to conduct, to feeling, and to belief. Most of these positions have been discussed and worked out in our society, but there are constant questions and readjustments that are necessary and timely. Hippocrates stated categorically that he would not give a "fatal draft to anyone even if asked, nor will I suggest such a thing." He obviously believed it better not to become involved in the killing process, regardless of the circumstances. Killing in warfare, in religion, and in love and rage has been the habit of human beings since the beginning of time. Some of these killings were endorsed and even sanctified. Some were rewarded, some were punished, and some were ignored. Some were planned, some were spontaneous, some occurred in cold blood, and some occurred in passion. The psychological reasons for this act cover the gamut of human emotions. Accountability was measured from a religious, political, social, community, and more recently, psychological point of view. There was never a completely satisfactory explanation of the killing process, except, perhaps, in self-defense. The results are always associated with sadness, despair, relief, and jubilation by those affected. There is almost always a set of human scars that are never completely cured. From the John Conley Foundation for Ethics and Philosophy in Medicine, Inc. Reprint requests: John Conley,MD, the John Conley Foundation for Ethics and Philosophy in Medicine, Inc., 211 Central Park West, New York,NY 10024. OtolaryngolHead Neck Surg 1997;116:3. Copyright © 1997 by the American Academy of OtolaryngologyHead and Neck SurgeryFoundation, Inc. 0194-5998/97/$5.00 + 0 23/39/57677
I have only touched in outline form on the emotions of human killing. There is another killing that goes on in the animal kingdom that is considered to be perfectly normal. That relates to the instinct and the necessity of survival. The acquisition of food by killing the object of nourishment has certain rules and regulations that have organized the food chain throughout the world. There are, of course, some "black holes," but agriculture, farming, harvesting, herdsmanship, and fishing on a business and randomized basis are functioning fairly well for us. There are some regulations and some famines, but no one ever questions the right of human beings and animals to eat and survive. Our question in medicine is whether a physician has the right to kill a patient when there is a sufficient medical reason and when the patient's advocate has requested that it be done. As doctors, we all know of instances when this would be justified. Some of the germane factors that might support this proposition would be pain, misery, depletion of the quality of life, and low survival level. I have intentionally omitted economic factors, availability of resources, physical and medical services, and community support. These factors are essential but are at a periphery of such an important medical question as killing. The whole idea seems repugnant to me. I believe it would be better for things to go on as they are with necessary adjustments made as the situations demand, rather than the imposition of another bureaucratic system. A new system of euthanasia would certainly create problems with management and bureaucratic objectivity. There is certainly a place for a specialist in dying as well as for a specialist in living. The patient or the general medical doctor who attends the patient's family, the knowledgeable internist, and the surgeon should be able to ameliorate this problem as a team or individually. It is a question of caring, dignity, relief of pain, human contact, and appropriate medical substitutes. Heroic life-saving measures at the end of what is left of a life, when hope and quality are gone, are emotional gestures in temporary futility. It is ardently wished that a sensitive doctor could handle this problem in a humane fashion that will proclaim professionality and caring. There is no great need to disagree with Hippocrates in this respect.