The Modern Art of Dying: A History of Euthanasia in the United States available in Paperback, eBook
The Modern Art of Dying: A History of Euthanasia in the United States
- ISBN-10:
- 0691133905
- ISBN-13:
- 9780691133904
- Pub. Date:
- 11/18/2007
- Publisher:
- Princeton University Press
- ISBN-10:
- 0691133905
- ISBN-13:
- 9780691133904
- Pub. Date:
- 11/18/2007
- Publisher:
- Princeton University Press
The Modern Art of Dying: A History of Euthanasia in the United States
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Overview
Lavi begins with the historical meaning of euthanasia as signifying an "easeful death." Over time, he shows, the term came to mean a death blessed by the grace of God, and later, medical hastening of death. Lavi illustrates these changes with compelling accounts of changes at the deathbed. He takes us from early nineteenth-century deathbeds governed by religion through the medicalization of death with the physician presiding over the deathbed, to the legalization of physician-assisted suicide.
Unlike previous books, which have focused on law and technique as explanations for the rise of euthanasia, this book asks why law and technique have come to play such a central role in the way we die. What is at stake in the modern way of dying is not human progress, but rather a fundamental change in the way we experience life in the face of death, Lavi argues. In attempting to gain control over death, he maintains, we may unintentionally have ceded control to policy makers and bio-scientific enterprises.
Product Details
| ISBN-13: | 9780691133904 |
|---|---|
| Publisher: | Princeton University Press |
| Publication date: | 11/18/2007 |
| Edition description: | New Edition |
| Pages: | 240 |
| Product dimensions: | 6.00(w) x 9.00(h) x (d) |
About the Author
Read an Excerpt
The Modern Art of Dying A History of Euthanasia in the United States
By Shai J. Lavi Princeton University Press
Copyright © 2005 Princeton University Press
All right reserved.
ISBN: 978-0-691-13390-4
Introduction THE ETHICS OF THE DEATHBED: EUTHANASIA FROM ART TO TECHNIQUE
The year was 1818, and the Howe family had just moved to Brandon, Vermont, when the young mother fell ill. Hannah was thirty years old and suffered from consumption. Lying on her sickbed, and knowing her days were numbered, she turned to her husband with a weighty question: "Do you doubt of my being prepared to die?" The question of how to die well occupied Hannah's thoughts long before she fell ill. Imagining her deathbed, she had often wished that "she might die shouting, and have an easy passage over the Jordan of death."
As her day of departure approached, she continued to grow weaker in body and could not converse much. But when she heard talk of the happy death of a certain person she smilingly began waving her hand. Her husband then asked if she felt as though she could shout. "Yes," said she, and still waving her hand, she cried "Glory! Glory! Glory!"
The final day came. Through the course of the day, she appeared as usual and her mind was clear and serene. She was surrounded by friends and supported by her husband who documented her last hour. "I took her by the hand and asked her if her confidence held out? If Jesus was precious? And if she had a prospect of heaven? She pressed my hand,and said, 'yes,' and fell asleep in the arms of Jesus without a struggle or a groan."
Early nineteenth-century Americans named this triumphant passage to death "euthanasia." For them, the word signified a pious death blessed by the grace of God.
At a young age, Dr. Arthur E. Hertzler's daughter came down with a terminal illness, most likely typhoid fever. "In the saddest hour of my life, at the deathbed of my daughter," the nineteenth-century physician recalled, "on one side was the magnificent and always faithful Carrie the nurse, on the other side the incomparable Dr. Dampbell, calmly applying measures of resuscitation which he and I knew were utterly futile."
Futile though it was, the efforts of these professionals gave him an indescribable measure of comfort. "I know that my last conscious moments will picture that scene: nurse on one side of the bed, doctor on the other. Though scientifically futile, if my presence in a similar situation ever brought an equal amount of comfort to anyone I am sure it was more worth while than anything else I have ever done. Our mission in life is to lessen human suffering as much as we can."
"The ministers of the old days," wrote the doctor, "had an idea that something notable should take place at the moment of dissolution and seemed to think I should provide pabulum for their discourses." But quite to the contrary, Dr. Hertzler believed that "saints and sinners died alike," and that at the time of death, whatever might have been the antecedents, there was no pain.
For mid-nineteenth-century physicians, "euthanasia" meant a painless death accompanied by physician assistance.
In June 1887, Dr. Edward Thwing received a telegram summoning him to a distant city to tend to a relative stricken with apoplexy and hemiplegia. Given the age of the patient-a sixty-six-year-old widow-and the severity of the attack, death was assured within a day or two. She lingered, however, for five days, speechless and comatose. Her vigorous constitution succumbed slowly. Automatic movements, such as pulling at clothes, lifting her hand to her head, and other signs of restlessness continued until near the end.
The attending physician had left the case in Dr. Thwing's hands forty-eight hours earlier, believing that the patient's life would soon be over. Recalling the case Dr. Thwing noted: "The reality of suffering I could not admit, but the appearance of it in actions, purely reflex, was painful to me. As her only surviving kinsman, I took the responsibility of administering a mild anaesthetic, moistening a handkerchief at intervals from a vial containing two drachms of chloroform and six drachms of sulphuric ether." He held the handkerchief near the nostrils, but not too close so as to facilitate the free admixture of atmospheric air, and carefully studied the facial expression of the unconscious sufferer. After two or three minutes the stertor ceased. The spasmodic actions of the arm were arrested. Respiration became easier and there was a general repose. "Euthanasia," the physician reported, "was gained and an apparently painful dissolution avoided. Fifteen minutes after withdrawing the anaesthetic, the final breath came, without the slightest spasm of the glottis or respiratory muscles, without any other physical struggle or sound."
At the autopsy, one of the five physicians present described a case where, at the request of the parents, he had administered ether to a child suffocating in membranous croup and produced euthanasia, "not less to the relief of the parents than to that of the patient."
Only during the late nineteenth century did euthanasia gain its familiar meaning: the use of anaesthetics to guarantee a swift and painless death. Soon after, attempts were made to legalize euthanasia. The first pro-euthanasia organization in the United States, the Euthanasia Society of America, was founded in 1938. Today, proposals to legalize euthanasia are still being debated throughout the country, and one form of medically hastened death, physician-assisted suicide, is already legally practiced in Oregon.
This is a study of the history of euthanasia in the United States. The question before us is, How did the notion of euthanasia as the medical hastening of death emerge as a characteristically modern way of dying? To ask how euthanasia became possible is not to seek a simple causal explanation but rather to search for the deeper historic significance of this phenomenon. Reversing Rilke's question "What kind of beings are they then, who finally must be scared away by poison?" we may ask, Who is this modern man, for whom medical euthanasia has become a compelling way of dying? The answer lies in nineteenth-century changes in the ethics governing the deathbed, changes that still inform the way we die today.
What makes the medical hastening of death a modern way of dying is not simply that the time of death, in addition to the manner of dying, is determined by human will. That would make the medical hastening of death no different from suicide. Suicide is always an extraordinary act performed under extraordinary circumstances, whereas the medical hastening of death is meant to be a routinized response to a problem we all know we may face, the onset of a fatal illness. Attempts to institutionalize the medical hastening of death and legalize the practice are thus a significant aspect of the modern idea of euthanasia.
The first proposal to legalize medical euthanasia dates back to 1870, and it bears a striking resemblance to similar proposals made over a century later. These later proposals require that euthanasia be performed only by a professional physician and characteristically limit its scope to patients who are both hopelessly ill and suffering. History, to be sure, records "euthanasia" proposals prior to the nineteenth century. But these earlier proposals, made by Thomas More and Francis Bacon, differ in several important ways from those of the late nineteenth century. Most notably, More's proposal does not mention physicians at all, and Bacon's does not endorse active killing. Furthermore, the earlier proposals emerged in the philosophical and imaginary genre of utopias. The nineteenth-century proposals were the first to endorse the medical practice of euthanasia as an actual matter of a public policy.
It is common to think of the current euthanasia debate in relation to mid-twentieth-century advances in medical technique. But the modern problem of dying, namely the condition of hopeless suffering for which euthanasia is one proposed solution, predates the technical advances that are so commonly associated with it, such as life-support systems and advanced surgery. This study, in seeking euthanasia's deeper origins and significance, begins at the turn of the nineteenth century, when the modern problem of dying and the framework for its solution first emerged. It ends precisely where most scholarship on the topic begins-in the 1960s-and shows how most of what took place in the latter half of the twentieth century can be traced back to these earlier developments. This little-known story of euthanasia is the focus of the present study.
The origins of medical euthanasia, I will argue, lie in a movement of dying from the domain of religion through that of medicine and finally into the jurisdiction of positive law and public policy. It is a movement that itself is driven, following Heidegger, by what I refer to as the rise of technique and the decline of art in our world. The story of euthanasia must be understood at three different levels. First, we must know the bare facts, the tale of the individuals and the movements that promoted the legalization of euthanasia in the late nineteenth and early twentieth centuries. Second, we must trace the emergence of euthanasia as a modern way of dying by following the gradual transformation of the ethics governing the deathbed. Finally, at a higher level of significance, we should reflect on the expanding technical search for mastery over death and the gradual shift of dying from a work of art to a product of technique. While the first level of analysis requires no further elaboration at this point, a brief discussion of the two other levels may shed light on the structure of the study as a whole.
The Changing Ethics of the Deathbed
In less than two centuries, the meaning of "euthanasia" has changed several times, and in radical ways. Though my interest lies more in the cultural history of practices than in the history of words and ideas, the history of deathbed practices can be told by tracking the unfolding definitions of "euthanasia" itself. These semantic changes capture the historic shifts in the ethics of the deathbed-understood broadly as the rules governing the conduct of dying, including religious, medical, and legal codes of conduct.
The literal meaning of "euthanasia" is quite removed from its contemporary usage. "Euthanasia" is a compound of two Greek words-eu and thanatos, which together signify a "good death" or an "easy death." For centuries, this literal sense was the only one conveyed by the word. An eighteenth-century medical definition of euthanasia is "a soft easy Passage out of the World, without Convulsions or Pain." This image of a good death is not foreign to the modern sensibility. But "good death" as "easy death" was exclusively a matter of divine providence or good fortune, and beyond human control. Euthanasia, in its original sense, was a death one could hope for but never be assured of.
For centuries, the deathbed in the Christian world was governed by religion, and euthanasia signified a death blessed by the grace of God. The dying person was encouraged to follow a certain course of behavior on his deathbed, which would constitute a holy way of dying and exemplify a holy way of living. These rules of conduct governing the last hour of life were put in writing and published in short manuals, known as ars moriendi, or "the art of dying." This mainly Protestant tradition was highly popular through the eighteenth century. In the United States, it made its final public appearance in the early nineteenth century, when the art of dying itself entered its terminal stage.
In order to understand the rise of medical euthanasia in the United States, it is crucial to comprehend this moment of transition, when the ars moriendi tradition finally faded from view. To explore its significance, the first chapter of this study examines the way in which Methodists, the largest organized religious community in early nineteenth century America, taught Americans how to die. More than any other religious group, Methodists were concerned throughout life with forming the proper disposition regarding death. They would gather around the deathbeds of neighbors and relatives to view the final departure and to meticulously document the hour of death. The final hour was a time of great exultation, in which the dying person, surrounded by family and friends, would approach the end like a fearless soldier ready to die a triumphant death. It is precisely this way of dying that the most celebrated of all New England Puritans, Cotton Mather, termed "euthanasia."
The Methodist ethic of dying contrasted most strikingly with traditional Catholic notions of death. For Catholics, dying constituted the passing over a bridge between this world and the world to come. Deathbed rituals were a rite de passage, preparing those who were dying for their final journey into a better world. For Methodists, however, dying belonged to this world and signified the culmination of life, which subsequently lost its unique transformative power. The art of dying became an art of holy living, and dying became a problem of life proper. It is at this turning point in the history of dying that our story begins.
In the course of the nineteenth century, a relatively short span of time, both the sense of euthanasia and the law governing the deathbed changed. The decline of the art of holy dying was captured in an 1861 edition of the Sick Man's Passing Bell, an ars moriendi book first published early in the seventeenth century. The edition has a melancholy tone and especially laments the fact that when a man is dying, both the physician and the lawyer are sent for, but the "physician of the soul stands outside the door."
A new way of dying was emerging, and its most visible sign was the increasingly dominant presence of the physician at the bedside. While physicians did attend the deathbed in earlier centuries, it was only in the nineteenth century that treatment of the dying, as such, became a medical concern and medically regulated. Whereas in previous centuries the medical doctor would leave the bedside when it was clear that the patient was hopelessly ill, a new ethic developed in which the physician was expected to remain present at the deathbed. The law of the deathbed had shifted from religion to medicine.
The idea of euthanasia changed accordingly. Euthanasia now stood for the new task of the medical profession-to assist dying patients in their last hours, short of hastening death. Euthanasia no longer meant a good death but rather signified the actions taken by physicians to achieve such a death.
The second chapter attempts to understand the new role of the physician at the deathbed and how this role opened the way for a claim that physicians should not merely help the patient to die an easy death but also actively hasten death. Why, until the present day, is the task of hastening death put in the hands of physicians, whose duty and expertise are precisely its opposite-to prolong life?
This new competence of the medical profession emerged neither from new scientific knowledge nor from technical advances in medicine. On the contrary, the physician's role at the deathbed was secured long before he had any medical treatment to offer the dying patient. It is precisely because physicians did not have the means to cure dying patients but nevertheless felt obliged to care for them that medical euthanasia emerged as a possible solution to the problem of dying. The second chapter shows the logic of these developments, in which euthanasia lost its benign sense of easing death and acquired a much more controversial meaning as a way to bring about death.
(Continues...)
Excerpted from The Modern Art of Dying by Shai J. Lavi
Copyright © 2005 by Princeton University Press. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
Acknowledgments ixIntroduction: The Ethics of the Deathbed: Euthanasia from Art to Technique 1
Chapter One: The Holy Craft of Dying: The Birth of the Modern Art of Dying 14
Chapter Two: Medical Euthanasia: From Aiding the Dying to Hastening Death 41
Chapter Three: Legalizing Euthanasia: The Role of Law and the Rule of Technique 75
Chapter Four: Euthanasia as Public Policy: The Euthanasia Society of America 99
Chapter Five: Lethal Dosing: Technique beyond the Law 126
Chapter Six: Mercy Killing: The Limits of Technique 144
Epilogue: Art and Technique, Death and Freedom 163
Appendix: Mercy Killing: Case History 173
Notes 181
Bibliography 211
Index 223
What People are Saying About This
This is an outstanding book-beautifully crafted, extremely thoughtful, exceptionally well-organized and argued, and highly original. It's an important story and Lavi has organized it in a compelling, highly readable manner.
— Sharon Kaufman, University of California, San Francisco.
Shai Lavi has written a timely, insightful, and valuable book. Even those who have agitated for or against euthanasia and physician-assisted suicide rarely know the long history behind our current arguments. He does the necessary and invaluable work of a sociologist and historian: showing us the roots of our present debates. We are deeply influenced by them to this day.
— Daniel Callahan, Director of International Programs, The Hastings Center
This book presents a subtle, nuanced investigation of the practice of euthanasia. It is a thoroughly researched study, relying on a variety of primary sources as well as keen historical instincts to tell a compelling, textured, and insightful story.
— Gary Laderman, Emory College
"Shai Lavi has enormously deepened the current argument over euthanasia by putting it in a perspective that has seldom entered the discussion, namely, its history. The genealogy of the idea and practices that have turned the art of dying into the technique of dying does not solve the current debate, but it does allow us to see it not just as an argument between ethicists, but as one about the cultural meaning of death. This book is essential for anyone who is concerned about euthanasia and has the potential of changing the very terms of the discussion."—Robert N. Bellah, University of California, Berkeley, coauthor of Habits of the Heart and The Good Society."How do we die? What do our ways of dying tell us about who we are and what kind of society we live in? Using the controversy over euthanasia to address these questions, Shai Lavi has written a theoretically sophisticated and persuasive book. Deftly combining historical argument and legal analysis, The Modern Art of Dying speaks to important ethical issues with great sensitivity and unusual subtlety. It exemplifies the best in interdisciplinary scholarship."—Austin Sarat, Amherst College, author of the forthcoming Mercy on Trial (Princeton)"This book presents a subtle, nuanced investigation of the practice of euthanasia. It is a thoroughly researched study, relying on a variety of primary sources as well as keen historical instincts to tell a compelling, textured, and insightful story."—Gary Laderman, Emory College"This is an outstanding book-beautifully crafted, extremely thoughtful, exceptionally well-organized and argued, and highly original. It's an important story and Lavi has organized it in a compelling, highly readable manner."—Sharon Kaufman, University of California, San Francisco."Shai Lavi has written a timely, insightful, and valuable book. Even those who have agitated for or against euthanasia and physician-assisted suicide rarely know the long history behind our current arguments. He does the necessary and invaluable work of a sociologist and historian: showing us the roots of our present debates. We are deeply influenced by them to this day."—Daniel Callahan, Director of International Programs, The Hastings Center
How do we die? What do our ways of dying tell us about who we are and what kind of society we live in? Using the controversy over euthanasia to address these questions, Shai Lavi has written a theoretically sophisticated and persuasive book. Deftly combining historical argument and legal analysis, The Modern Art of Dying speaks to important ethical issues with great sensitivity and unusual subtlety. It exemplifies the best in interdisciplinary scholarship.
— Austin Sarat, Amherst College, author of the forthcoming "Mercy on Trial" (Princeton)
Shai Lavi has enormously deepened the current argument over euthanasia by putting it in a perspective that has seldom entered the discussion, namely, its history. The genealogy of the idea and practices that have turned the art of dying into the technique of dying does not solve the current debate, but it does allow us to see it not just as an argument between ethicists, but as one about the cultural meaning of death. This book is essential for anyone who is concerned about euthanasia and has the potential of changing the very terms of the discussion.
— Robert N. Bellah, University of California, Berkeley, coauthor of "Habits of the Heart and The Good Society".