Allegiance to the Hippocratic Oath

`IT is not immoral for a physician to assist in the rational suicide of a terminally ill person,'' said a panel of 12 doctors in the latest New England Journal of Medicine. But history warns us that euthanasia should not be performed by physicians. No matter how pure the sympathetic motives of any physician who does not want to see patients suffer a long and painful death, physicians who freely agree to help with a little killing will not long be able to resist society's demand for more and more killing. For there is no limit to the number of social and human problems that can be ``solved'' by killing. Even today, societies around the world openly practice capital punishment, torture of political dissidents, genocide, and infanticide.

In a provocative explanation of how modern medicine emerged from primitive magic, anthropologist Margaret Mead noted that in all primitive cultures, destructive and protective magic are always associated in the same person. The witch doctor or shaman may come to heal with a potion, or to kill with a poison. The same dual nature of medicine appears in Plato's ``Republic,'' where physicians are expected both to heal society's philosopher guardians and kill defective newborns or maimed athletes.

Only with Hippocrates did healers categorically renounce killing. The disciples of Hippocrates rejected not just some killing, but all killing; no abortion, no assisted suicide, no deadly drug, no killing at all.

The Hippocratic oath finally permitted patients to trust physicians without reservation. And it finally permitted physicians to practice their art without yielding to society's incessant pressure to involve them in lethal but socially useful activities.

A chilling example of what can happen when physicians agree to do a little killing occurred in the 1920s and '30s in Germany, then the most humane and scientifically advanced medical community the world had ever known. At first, German physicians accepted only the thesis expressed in a monograph published in 1920, ``On the Destruction of Life Unworthy to be Lived'': ``Not granting release by gentle death to the incurable who long for it; this is no longer sympathy, but rather its opposite.'' This is the same impulse that many doctors today feel when confronted by a terminally ill patient who wants to be free of suffering.

But German physicians who began to practice euthanasia at their own initiative soon ended up killing at someone else's initiative and under state authority. Eventually, some 200,000 psychiatric and chronic patients were killed, and this euthanasian ethic later lent support to the broader program of social extermination conducted under Nazi auspices.

In prewar Germany, of course, the social and economic pressures were extreme. In contemporary American society, the pressures being applied to medicine - often in the name of cost-containment - are not yet so fearsome; hence, the abuses of euthanasia should, at least initially, be less dramatic. But they will certainly be no less repugnant.

Perhaps more relevant to our situation is the experience of the Netherlands, which has accepted active euthanasia. It seems too early to say what will finally happen there, but Dutch physicians, who first spoke only of peaceful release for a few terminally ill and competent adults, already report non-consenting terminations of patients who cannot make informed decisions.

Pessimists would say that in the United States today, it is no accident that the oath of Hippocrates has quietly disappeared from nearly all medical school graduations. The profession has accepted physician involvement in abortion; it has accepted physician involvement in capital executions; it now wonders whether or not to accept active euthanasia and assisted suicide.

Optimists would say that euthanasia is being openly debated in the courts, at professional conferences, by the public, and by medical panels, so that every potential danger of euthanasia will be deliberately and collectively considered. They believe that by increasing awareness about euthanasia, the medical community moves toward a more enlightened and compassionate future.

A society as diverse as ours may never agree on what an ``enlightened and compassionate future'' would be, and whether it would include the killing of terminally ill patients. But Mead was right about the role of physicians; we should not permit our healers to become killers. So far, history has only confirmed what Hippocrates knew at the outset; if by medicine we mean the practice of an art devoted to life and health, then medicine must reject euthanasia or it will have no future.