Suicide, euthanasia and medicine: reflections ancient and modern

Abstract

In this paper I explore just a few of the issues that are raised by what seem to be some rather serious shifts presently occurring in the modern order of death. My main focus is on the particular disturbances caused by the recently renewed demand for the legalisation of assisted suicide and euthanasia in much of the West; disturbances which I attempt to put into some kind of historical perspective. I argue that aspects of a new order of death are emerging around, and through, these debates: aspects that look back to the distant past as much as they look forward.

Keywords:

• suicide
• euthanasia
• death
• medicine
• historical perspectives

Notes

Rebecca Flemming is lecturer in ancient history in the Department of Classics of King's College London. She is the author of Medicine and the Making of Roman Women (Oxford University Press, 2000), and a number of articles and essays on gender and medicine in the ancient world, both separately and together. She is currently working on medicine and empire in the Roman world.

A search for ‘assisted suicide’ on the Gateway service of the US National Library for Medicine (http://gateway.nlm.nih.gov/gw/Cmd) produced (on 15 December 2004), for example, almost 5000 items of bibliography (all but a handful published since 1990) and ‘euthanasia’ over 22,000 items, though that includes duplicates and a rather surprising (at least to a non-medic) number of articles about laboratory animals. The service makes no claims to complete coverage.

The Dutch ‘Termination of Life on Request and Assisted Suicide (Review Procedures) Act, Article 293’, 2000, formally, and comprehensively, legalized euthanasia in the Netherlands, though the courts had, as part of a wider social debate, already effectively decriminalized these activities. The Belgian ‘Law relating to Euthanasia’ became law in September 2002. The ‘Death with Dignity Act’ was first passed by Oregon voters in 1994, but then delayed by legal proceedings until 1997, when Oregon voters also chose not to repeal the measure (by a considerably greater margin than it had initially passed by). Though attempts to overturn the legislation are still ongoing (Charatan 2004), none has been successful so far, and physician-assisted suicide has now been available to Oregon residents for just over seven years. In Switzerland, assisting a suicide for humane reasons, and with no chance of personal gain, has been explicitly legal since 1941, and this legal opening has been systematically made use of by several organizations (such as EXIT and, more controversially, Dignitas). Very recent legislation in France falls far short of legalizing assistance in suicide or euthanasia, despite some claims to the contrary (Spurgeon 2004).

The ‘active’ in this formulation distinguishes this kind of activity from what some would call ‘passive’ euthanasia, that is letting people die, or withdrawing life-sustaining treatment, which is legally permissible in certain circumstances. Whether the ‘passive’/‘active’ distinction is, again, a valid one and whether passive euthanasia is ‘euthanasia’ are two more hotly disputed topics.

See Mason et al. (2002: 530–47) for a survey of British case law in this area, including comments about the situation in Scotland (where the Suicide Act never applied). There have been relevant cases since (such as that of the woman allowed to travel to Switzerland to be assisted in committing suicide: see, e.g., Dyer 2004), though nothing has changed radically.

It is worth noting that Durkheim struggles in terms of current developments more generally. For him, the suicide of those ‘stricken with sickness’ was a form of ‘altruistic suicide’ common among ‘primitive peoples’ where individuation was ‘too rudimentary’ to enable the individual to escape the duty of death society laid upon him; whereas, in his contemporary, more individuated, world, such deaths were restricted to a few ‘isolated and exceptional cases’, with complete extinction projected (2002 [1897]: 178–86). It seems that the reverse is in fact the case, though the present return of the suicide of the stricken is conceived more in terms of an individual's right of self-determination, rather than a social duty (despite fears of a slippery slope from right to duty).

Non-voluntary euthanasia is, therefore, to be distinguished from the involuntary variety, as incapacity is different from absence of a request, or indeed refusal, from the capable. It also worth noting that the Swiss permit only assisting in suicide, strictly construed.

This debate, as noted by Kaufman Osborn (2002: 196–7), has a number of parallels/overlaps with that about PAS and euthanasia, and more with some of the Roman material I will discuss later, but time prevents a fuller exploration of these issues.

This is to take the Oregon ‘Death with Dignity Act’ as an example, but the point is a more generally valid one also.

Criticisms of Durkheim have also been made from within sociology, of course, with those of Douglas (1967) and Atkinson (1978) of most relevance here. As for the arguments of Hill about the Roman world, his anti-Durkheimian thesis also includes particular attention to the specificities of the Roman relationship between ethics and the self which I do not have time to discuss here.

Suetonius’ Lives of the Poets does not survive intact, but versions of some of the individual lives are transmitted in a number of manuscripts of the works of the poets in question, such as Lucan's Civil War. These are collected in Rostagni (1944).

Tacitus Annals (15.56) also has Lucan naming his mother (after initial resistance); the Life is clear that it is the fact that Nero murdered his mother that prompts Lucan to adopt this particular course.

All translations are my own; there are alternative narratives of Lucan's death provided by Tacitus and Dio.

I have rendered the (ambiguous) Latin accordingly in the passages above, supplying ‘his’ with ‘physician’ in translating the Latin ‘medicus’. Nero is alleged by Suetonius (Nero 37) to have sent in his own gang of medici to do the business in cases where those he had condemned were tarrying, but there is no suggestion that this is the case in either instance here (whether or not Suetonius is to be believed more broadly).

Pain was rather an ambivalent factor in this, for, if it could be overcome and things still proceed calmly, then that might make the death even more heroic.

This is an implicit, rather than explicit essentialism, and a range of other arguments are also deployed, for example those concerned with the importance of maintaining trust between patient and doctor, without much attempt to reconcile or order them.

The Japanese courts have paved the way for physicians to assist in their patients’ suicides (Hall 1996), but there has been no actual legislation forthcoming, which appears to be what the profession would need to overcome their reluctance: they do not wish to be seen to take the lead in the matter. This is to say that there are various hierarchy and authority issues at stake here, which are also reflected in the survey results referred to earlier: this was a piece of research aimed mainly at investigating the differential weights placed on the actual wishes of the patient (and indeed on providing the patient with the information required to make various important decisions) and on the view of their family in medical circles in the US and Japan (Ruhnke et al. 2000).

Quite apart from the fictionality of the story, and the particular requirements of its dramatic development, it should be said that the medicus provides a powerful sleeping draught rather than a poison, and is sometimes suggested to have claimed that providing poison is contrary to his profession, though (within the narrative) this is a rule that applies only to cases where he thinks wicked crimes are planned, not (presumably) straightforward euthanasia.

The cases of baby Charlotte and baby Luke cited above also illustrate the problematic relationship between doctors, harm and death.

For Scribonius’ biography, see, e.g., Baldwin (1992); for discussions of his ethics, see, e.g., Deichgräber (1950), Edelstein (1956) and Nutton (1993).

Indeed Claudius was allegedly poisoned by his (third) wife, Agrippina, with mushrooms (see, e.g., Suetonius, Life of Claudius 44) and, according to Tacitus, also with the help of his doctor Xenophon (Annals 12.67).

Godfrey (2004). These comments were made during discussion of Lord Joffe's ‘Assisted Dying for the Terminally Ill Bill’ in a Lords Select Committee, a Bill which, interestingly, does not distinguish between assisted suicide and active euthanasia.

Additional information

Notes on contributors

Rebecca Flemming

Rebecca Flemming is lecturer in ancient history in the Department of Classics of King's College London. She is the author of Medicine and the Making of Roman Women (Oxford University Press, 2000), and a number of articles and essays on gender and medicine in the ancient world, both separately and together. She is currently working on medicine and empire in the Roman world.