Society's attitude means we are sweeping 'human deformity under the rug'
By: Susan Martinuk

Until recently, we didn't expect our babies to arrive in a nice-looking package with an inspector's approval number stamped on their foreheads, and we couldn't return them if the goods were found to be defective.

But new medical technologies have given us the power to seek out genetic flaws while the baby is still in the womb and suddenly our standards of acceptability have changed. We no longer just question the quality of life that imperfect children can have ­ we also debate whether they should even be born.

Enhanced forms of ultrasound, amniocentesis and prenatal genetic screening, a sophisticated analysis of the foetus' genetic material, have all been fine-tuned to detect the slightest errors in a developing baby's biological machinery. In a small number of cases, this capability allows doctors to treat the condition in utero or as soon as the child is born. But such treatments are rare and in the majority of cases, the predictive technology is more advanced than the treatment options. Cures are in the distant future.

As a result, these diagnostic investigations are often little more than search and-destroy missions to eliminate the imperfect and, in the words of some, a high-tech means of "genetic cleansing."

Over the past month, the public has become privy to the inner details of this aspect of medicine and many people don't like what they are hearing. Disturbing stories of genetic or late-term abortions first began to emerge when devastated nurses from Calgary's Foothills Hospital told the press about viable, but imperfect, foetuses that were left to die. As a storm of controversy threatened to envelop the hospital, officials quickly obtained a publication ban on further stories by Alberta Report, the magazine that reported the news.

But the circumstances of these events ­ babies being left to die, reports that health-care workers violated their consciences to keep their jobs and the publication ban ­ all point to a dire need for an open and reasoned debate about these procedures.

To many, the most repugnant aspect of genetic abortions is that they are often performed late in pregnancy and, therefore, can result in the birth of a live baby. A British Columbia coroner's investigation found that 16 aborted babies had been born alive since 1995, with the largest baby being born at seven months gestation and weighing in at 2.2 kilograms. These babies are denied food, fluids and breathing assistance until they die.

A less emotional, but far more insidious aspect of these procedures, is the very idea that children with genetic defects should be eliminated. Officially, abortions are only performed on babies with lethal abnormalities and are likely to die soon after birth. But, unofficially, any anomaly is fair game, and doctors say that late-term abortions have also been performed on children afflicted with "Down's syndrome, physical disabilities or even sheer unwanted-ness."

This is the real issue that underlies genetic terminations ­ the notion that we can somehow justify the selective killing of less-than-perfect babies. In the words of one physician, we are "using technology to sweep human deformity under the rug." Such attitudes only fuel society's fear of imperfect children. Prenatal screening creates the illusion that we can control our genetic destiny.

Thus, we now expect to have genetically perfect children and feel well within our rights to reject anything less. Reports from medical journals state that 92% of infants diagnosed with Down's syndrome in utero are aborted, while 80% of infants are aborted when any kind of genetic imperfection is found. These are rather frightening statistics when one considers that we all carry at least five genetic defects of some sort. Still more ominous is a report from The Lancet that states that over a five-year period, 174 babies were born healthy ­ even after they had been diagnosed with abnormalities.

For the most part, society allows medical technology to proceed unchallenged by turning a blind eye to the uncomfortable issues that stem from its use. But our rapidly expanding knowledge of the human genetic code will only increase the array of choices that are available to us. Before we settle into accepting the easiest option (aborting the imperfect), we must have an informed public discussion of all the options and issues raised by genetic testing. We've had a peek behind the hospital doors and been exposed to the realities and ethical dilemmas that are associated with prenatal diagnostic procedures. We are using technology to destroy children who are less than perfect. If, as a society, we do not think this is acceptable, then we need to say so.

Susan Martinuk is a Vancouver writer and broadcaster. This article originally appeared in the National Post - May 28, 1999. Reprinted with permission.

Update...

The court order sought by the Calgary Regional Health Authority (CRHA) prohibiting Alberta Report from publishing any information on late-term abortions was finalized July 6. Justice Ged Hawco of Alberta Court of Queen's Bench ruled that news reporters may publish the facts about late-term abortion, but may not reveal the names of those involved, including patients, physicians and health care workers. Alberta Report editor and publisher Link Byfield wrote in a letter to the Globe and Mail that the magazine had no intention of publishing names, stating "This has been and will remain a story about policy, not personalities.. No court ban is necessary."

Documents made public by the CHRA reveal the concerns of nurses who deal with an inherently contradictory situation. They agonize over having to work on a ward where healthy babies are being born at the same time as late-term babies are being left to die; where crying healthy babies "might disturb the women undergoing genetic terminations," and where some nurses feel utterly unable to meet the emotional needs of their patients because of their own moral and ethical values. They lament that pro-life nurses are being weeded out by hiring practices.

According to information released by the hospital, a total of 51 pregnancies were aborted in 1998 for congenital abnormalities, 21 of them involved unborn children 20 weeks and over. In a staff newsletter from Feb. 26, 1999, the unit managers spell out special instructions for genetic abortions: "No one will be excluded from the care of these patients."

In a media release quoted by several newspapers and radio stations, Canadian Physicians for Life condemned the practice of infanticide in Canada and the refusal to protect the conscience of health care workers

A report on the opinions of Canadian physicians about legalized physician-assisted suicide was published by the Royal College of Physicians and Surgeons in June, 1999. The mail-in survey was conducted in 1995 by Dr. T. Douglas Kinsella, University of Calgary bio-ethicist and professor of medicine, and Dr. Marja J. Verhoef, University of Calgary Department of Community Health Sciences associate professor. Physician-assisted suicide was defined in the questionnaire as "the suicide of a competent human being with a terminal illness, usually by means of an overdose of medication obtained from a physician who agrees to aid and abet the person's suicide."

Addition results to those presented in the graph (right) include:

• Statistically significant regional variations were found, with physicians in B.C. (28%) and Quebec (24%) being the most willing to practice legalized assisted suicide, where as those in the other 8 provinces less willing (15% to 18%).
• Those most experienced in terminal care were the most opposed to the legalization of assisted suicide.
• Those most active religiously were the most opposed to personal participation.

Study co-author Dr. Kinsella believes the government should invest in education and financial support for first-rate palliative care. He told the National Post, "Educators should jump on the bandwagon and realize that we are quite deficient, because we have a confused group of physicians in this country with respect to physician assisted suicide." Any attempt to legalize physician-assisted suicide would clearly split the medical community, said Dr. Kinsella.

See reply card to order a copy of the original Annals RCPSC article "Determinants of Canadian Physicians' Opinions about Legalized Physician-Assisted Suicide: A National Survey."

 

New directives from the British Medical Association give doctors in Great Britain the power to decide when to withdraw care, including water and food, to patients who, according to them, have no hope of surviving.

A spokesman for the British Medical Association said they are prepared to face the risk of accusations by the family: "But with these new directives we feel much more protected," he said. To date, such norms could only be applied to patients in deep coma.

Peggy Norris, of the "Alert" group against euthanasia, pointed out that "the doctor's Association is confusing the discontinuation of ineffective treatment with the practice of taking patients' lives. You cannot deny water and food to patients: these are fundamental to life. It is tantamount to killing them."

 

The British Medical Association has launched a new Website to seek public opinion on how a consensus view can be agreed on physician-assisted suicide. The BMA plans to hold a conference next year to formulate a policy on the issue.

"We are looking for common ground on which to hold the debate as a preliminary to the conference next year," a BMA spokesman said. "One of the things we have to settle is the terminology - to get definitions of what is meant by euthanasia, what is meant by physician-assisted suicide."

He stressed that the BMA was not seeking opinions on whether it was right or wrong, rather a consensus opinion on how to progress. He said the association had trawled the web and had found thousands of papers addressing the issue. "But very few of these papers address the issue of consensus - most of them focus on the arguments and conflict. Searching for consensus is something that hasn't really been undertaken before, and certainly hasn't been achieved and we want to use the Website to encourage discussion to take things forward."

"We're going to put some of this literature - from the BMA and others - on the website to allow people to have a look at all this." 

On November 23, 1998 the Saskatchewan Court of Appeal unanimously overturned the Saskatchewan court decision by Justice Ted Noble to shorten Robert Latimer's sentence for the murder of his daughter Tracy.  Robert Latimer has been granted leave to appeal his conviction to the Supreme Court of Canada. The case will likely be heard in March or April 2000.

Donations are needed for Canadian Physicians for Life legal costs as Intervenor to the Supreme Court of Canada in the Latimer case. Contributions are tax deductible. Thank you.

The complex issues surrounding euthanasia and assisted suicide have been increasingly prominent in the public eye, the public conscience, and the law in the last decade. In addition to the Latimer case, the last few years have seen Sue Rodriguez's failed court challenge and mysterious suicide in 1993, the revocation of Dr. Maurice Generoux's medical license earlier this y The public has been witnessing the suffering of the Latimers for over five years ear for assisting suicide, the recent inquiry into Dr. Nancy Morrison's role in the death of a patient, and the recent furor surrounding the "do not resuscitate order" placed involuntarily on and then ordered removed from Mr. Sawatsky. These developments have, of course, provoked calls for legislative action; for Parliament to devote attention to critically evaluating the provisions of the Criminal Code, and to take steps to provide relief for the kind of suffering which has led to individuals committing homicide out of "compassionate" motives.

The Court of Appeal in the Latimer decision has rejected another invitation to change a fundamental cornerstone of our legal system. The Court of Appeal, and the Supreme Court of Canada, recognized that to change the law to excuse killing committed out of "compassion", would be to ignore the impact on dependant individuals who presently benefit from the protection of that law.

As the majority of the Court of Appeal noted in the appeal of Mr. Latimer's first trial, the state has an "interest in the protection and preservation of human life." This is particularly true when the life to be protected is that of a severely handicapped child who is entirely dependant on others. The state's obligation to protect its most vulnerable members is at the heart of the law against intentional killing. The trial judge excused Mr. Latimer's actions without considering their impact on how society views its severely disabled members, or on how the disabled perceive themselves. Justice Noble simply did not address the impact of his decision on the state interest in preserving and enhancing the lives of the severely disabled.

Law reform on such a grave issue can only come after opportunity has been given for thoughtful, reflective debate which hears the needs and concerns of many. The courts cannot, on an ad hoc basis, allow individuals to be stripped of the protection of the law by the actions of even desperate and apparently well-meaning individuals. Even if it is believed that the balance that Parliament has achieved is not the correct one, a change made by a few individuals in the emotionally charged circumstance of the courtroom, without the benefit of hearing from the representatives of many of those affected, is unlikely to be a sound development.

Should there be an additional class of murder to accommodate for compassionate motives? It has long been recognized that "hard cases make bad law". As the Court of Appeal noted, to take such an approach to this case ignores other vitally important considerations. It is telling that the many organizations which advocate the needs of the disabled have opposed the relaxation of the law prohibiting euthanasia or assisted suicide for "compassionate" reasons. The disabled are pressed on all sides by those who accord their lives less worth than others. To grant Robert Latimer a lesser sentence, is to agree that the life of Tracey Latimer was of such a nature that it was not of any value to her, or anyone else. As the first trial judge noted, "[l]ife was not kind to Tracy but it was a life that was hers to make of what she could." This is not sentimentality. Even as her father, he was not entitled to take matters into his own hands and end her life.

And what of those, like Sue Rodriguez, who are capable of making their own decisions about when to die? Consent in such situations is most often superficial. It is well known that many, if not the majority, of patients who request euthanasia do so while suffering from treatable depression. Others, who feel that they are a burden to loved ones, request euthanasia out of feelings of guilt. This is not to say that real consent can never exist. It is just to say that meaningful consent will be exceedingly rare, and that law which can only prevent superficial consent by prohibiting any consent, is entirely justified. This was recognized by the Supreme Court of Canada in Latimer #1: "society, through the operation of the criminal law is entitled to guard against potential abuses in such situations". Safeguards designed to prevent abuses where euthanasia and assisted suicide are not prosecuted, are notoriously ineffective. The abuses which have occurred in the Netherlands are the best documented and most notorious example of this.

The public has been witnessing the suffering of the Latimers for over five years. In contrast, the suffering which they all endured in the previous 12 years was solitary and obscure, with no one tragically focal event which could attract public attention or galvanize public compassion. It's certainly easier to simply allow people to take their own lives, or assist them with it, or to end their lives for them, rather than to address head-on the more complex problem of how to restore as much life quality as possible to suffering people. But to allow people to take the lives of others, and to take their own lives, deflects attention and resources away from where it should be, which is in providing greater community support, and better education for physicians in palliative care. As was clearly pointed out in evidence before Canada's Senate commission on euthanasia and assisted suicide, the lack of training which, in general, physicians have in palliative care is a serious problem, and since now clearly documented calls for wide-spread responses at every level.

The recent inquiry into Dr. Nancy Morrison's role in the death of one of her patients provides an illuminating example (the reason she ultimately will not stand trial is not because her actions, injecting her patient with potassium chloride, were not blameworthy, but because there wasn't sufficient evidence to determine whether the cause of death was her injection). Her motivation in providing a lethal injection was, on one level, altruistic - the patient was suffering horribly. But on the evidence presented at the preliminary hearing, he was also suffering needlessly. The drugs which had provided comfort two days before had no effect, even when their dosages were increased over 100 times the previous effective dosage, and no trace of the drugs were found in the patient's liver. The explanation for this was that the cap of the intravenous line feeding the drugs into the patient must have come loose, thus preventing the drugs from entering the blood stream. The solution ought to have been to fix the intravenous line rather than to inject a syringe of a drug intended to stop the patient's heart.

If compassionate homicide becomes an option, it will deflect expertise, training, and resources away from helping the disabled and dying - which ought to be the essence of good medical practice. "Compassion" after all, means "to suffer with" not to kill, and medicine, devoted to alleviating suffering and pain must adapt with recent dramatic improvements in these areas. In refusing to accept superficially appealing arguments that would weaken respect for the equal treatment of the sick and handicapped, the law is fulfilling one of its functions in society.

Adapted from LEX VIEW - Copyright © 1999 Iain Benson, and Brad Miller. Used with permission. "Lex View" is a publication of the Centre for Renewal in Public Policy

Canadian Physicians for Life endorses the Human Embryonic Stem Cell Project which addresses the experimental process of destroying human embryos in order to harvest embryonic stem cells for scientific research. This coalition of groups and individuals asserts that embryonic stem cell research is scientifically problematic and unethical. They welcome recent advances which suggest that adult stem cell research and other therapies offer an equal or greater potential benefit to treat or heal those suffering from disease and urge support for the development of such alternatives that do not require the destruction of embryonic life.

The coalition released it's Statement on Human Embryos and Stem Cell Research at a press conference in Washington, DC on July 1, 1999. The statement was written and coordinated by many pro-life lawyers, ethicists and scientists.

A web site has been developed with information on this issue including the text of the statement, statement summary, list of signers, and an opportunity for people to show their support for the principles of the statement by signing onto it themselves. The address is: www.stemcellresearch.org      A copy of the statement is available from our office.

It was a Sunday morning in the summer of 1941. Bishop Clements von Galen of Munster, Germany, mounted his pulpit to preach a stirring homily demanding that government officials responsible for the German euthanasia program be charged with murder.

"Once it is allowed," he said, "once it becomes permissible, to put to death 'unproductive' human beings, then we are all of us open to being murdered when we, too, are old and feeble and no longer productive..."

The homily had a profound impact on Hans Scholl, a young medical student who, it is reported, said, "At last, somebody has had the courage to speak out."

The German bishop's homily and the student's response to it are described in the book, A Noble Treason, by Richard Hanser.

But the account doesn't end there. Young Scholl was not content to know that someone else had made a statement and, therefore, the matter was ended. Rather, using the bishop's courageous act - for it was, indeed, courageous to speak out against any government program in Nazi Germany - Scholl and several other students, including his 22-year old sister, Sophie, formed a student resistance group called the White Rose (Weisse Rose), the name chosen because it symbolized everything that was noble and beautiful and opposed evil.

Using a small duplicating machine the students defied the powerful state apparatus, secretly printing and distributing thousands of leaflets denouncing the inhumane programs. Eventually they were arrested. A hasty trial was held. Hans and Sophie Scholl, along with Professor Kurt Huber were sentenced to death.

When confronted by a hostile judge about her activities, Sophie Scholl responded calmly, "Somebody, after all, had to make a start."

cited in the Steubenville Register - 12/25/87 by: Rita Marker

In Germany they came first for the Communists, and I didn't speak up because I wasn't a Communist. Then they came for the Jews, and I didn't speak up because I wasn't a Jew. Then they came for the trade unionists, and I didn't speak up because I wasn't a trade unionist. hen they came for the Catholics, and I didn't speak up because I was a Protestant. Then they came for me, and by that time no one was left to speak up.        

Martin Niemoeller (1892-1984)

What is the impact of eugenic practices on human rights?

A major consequence of eugenic practices on human rights is the emerging reality of an "Animal Farm" philosophy (some are more equal than others). We are pitting one characteristic against another. Many people and organisations argue that to eugenize, to deselect the characteristic female in India and elsewhere is unacceptable, but to eugenize the characteristic disability is acceptable. This sentiment is reflected in a variety of legal/policy documents and statements. More and more statements, oral and written, appear which claim that the search for a gay gene is wrong and tests should never be developed in the case the gay gene is found.

In each of these cases the authors do not denounce the use of predictive testing and selective termination related to the characteristic disability. To the contrary we see arguments developed which try to draw the line between them (gender or sexual orientation ) and the others (disability). And even among disabled people we see a judgment based on a characteristic (my characteristic shouldn't be part of eugenic measures but yours...)

What we have here is the start of a war of the characteristics. Who will win and who will lose? On the surface the first battle line is around perception of characteristics and what remedies should be used for them.

There are three options:

• A eugenic solution (change at the genetic level)
• A euthenic solution (change at the societal level)
• A euphenic solution (change at the personal level)

Obviously women who denounce an eugenic solution for the female characteristic in India still want to help females. Only they think an eugenic solution (getting rid of the person or person-to-be with the characteristic female) is wrong. They advocate for an euthenic solution (changes within the environment women live in), to make society more accepting of women. Gays also denounce an eugenic solution that would destroy them and instead want an euthenic solution. For many gays even the suggestion of an euphenics solution (to cure them of being gay), is an untenable idea since they believe being gay is part of who they are, so to "fix" them shows a disregard for them.

Deaf people, blind people, and dwarves think often in the same way as gays, that both eugenic and euphenic solutions are unacceptable. People who are labeled as disabled have been fighting for a long time for the social model of disability, in which their disability is viewed as a reflection of societal attitudes, the environment they live in. This would allow for euthenic solutions. But the reality is that disabilities are viewed in most countries within the medical model, which allows only for eugenic solutions. Euphenic solutions are NOT available in most cases.

And now the circle is closing: euthenic solutions often involve human rights approaches. Eugenic solutions do not. Being targeted for eugenic solutions and the appearing Animal Farm Philosophy has quite a few consequences. It leads to a weakening of the involvement of any characteristic targeted for eugenics solutions in the human rights movement. And once prebirth eugenic solutions are established for one characteristic, there will be other consequences for this characteristic e.g. only 5% of disabilities in the Western world are determined prior to birth. To deal with disabilities appearing after birth we are establishing after birth eugenic procedures such as infanticide, DNR (Do not resuscitate) and euthanasia.

Summary

1.  Personal negative eugenics is the predominant use of eugenics today.

2.   Many legal and policy documents seem to encourage personal negative eugenic choices through laws where the only restraint is on sex.

3.   By making a distinction between gender and other characteristics, governments in essence tell people that some eugenic choices (elimination of disability) are acceptable and may be even expected, whereas others are not (sex selection). This is in essence the start of social eugenics.

4.  People are often coerced into personal negative eugenic decisions by the lack of support.

5.  There is no such thing as autonomous personal eugenic choice, at least not in most societies today.

6.  We have already established justifications for eugenic practices which do not allow us to draw a line anywhere.

A war of characteristics is on, which will disenfranchise many characteristics from the human rights movement and from equality rights.

This has to stop.

Excerpted from Eugenics,Euthenics, Euphenics by Gregor Wolbring. Used with permission.  For complete text and references, see Dr. Wolbring's web site "Euthanasia and Biotechnology"  Dr. Gregor Wolbring is an Assistant Professor in the Department of Education at the University of Calgary. He is an advisor on bioethic issues to the Council of Canadians with Disabilities.

The following commentary was submitted to various media in response to the debate surrounding federal Health Minister Allan Rock's plan to prohibit abortions for the purpose of gender selection.

The Federal plan to clamp down on sex-selection technologies has radical tax-funded women's groups struggling.  How does one stand for abortion rights but deny access to selective (female) abortion? How can the Canadian Abortion Rights Action League say " choice is choice" but "We don't advocate that there should be gender screening for sex selection"? How can such a specific reason for eliminating one's unborn child be wrong when no reason at all is good enough for true abortion believers?

This schizophrenia came about when we moved from talking about aborting a "fetus" to aborting a "female fetus". This is uncomfortably close to calling the abortus a "girl", which makes us face the discomfiting realization that the unborn individual already exists and is now undeniably human, as any ultrasound can show us. Ordinary people may move from seeing the fetus as a "potential person" to seeing the fetus as a person with a life to lead, if we don't kill her. All prochoice women owe their lives to their mother's admirable lack of interest in lethal sex selection against female fetuses. Yet the most strident of prochoice speakers refuse to place any limits on the killing.

In an odd rationalization, a Planned Parenthood executive defends female-selective abortion for women who would otherwise face "beatings and desertion". This novel surgical approach to sick relationships inadvertently exposes an enduring truth: abortion modifies women to fit a certain kind of victimisation. No wonder the same official says "this whole thing is very difficult".

Selective mothering (not to be confused with elective smothering, one postnatal option for unwanted children) seems to cause confusion all over the feminist camp. "It's profoundly sexist," says an indignant member of the Feminist Alliance on Genetic and Reproductive Technologies. "This is the whole business of treating children as products." Right. Wanted products. All together, sisters: "every child should be a wanted child", remember?

Dr. Patricia Baird wants our government to send a signal that "males and females are equally valued in this country," a chilling thought when you remember where that particular "value" has been ranked ­ way below the raw power of Choice. If sex selection abortions open Pandora's box, it is not simply because the practice is "profoundly sexist". If we think it through, we might see that devaluing females is no different than devaluing all "unwanted" children. And that abortion is, in the cold light of dawn, a genocide of convenience against those unfortunates who live on the wrong side of their birthday

National Post Editorial - July 3, 1999.  Reprinted with permission.

It's tough being a liberal ­ sometimes you just can't keep up with the latest political fashions. Take the recent aboriginal whale-hunt off the coast of Washington state. Which liberal bias is more en vogue? Knee-jerk environmentalism, or the romantic urge to exempt Indians from the laws that bind the rest of us?

Tricky stuff. And it looks like Allan Rock, Canada's Health Minister, has another such liberal dilemma. Mr. Rock has never made a secret of his feminism nor his support for complete sexual liberation ­ in college he hosted a political meeting with John Lennon; last week he mugged for the cameras while marching in Toronto's gay pride parade.

So how does the painstakingly sensitive Mr. Rock balance his belief in sexual freedom with his opposition to Canadian women aborting their babies simply because they don't want girls? On the one hand, liberalism demands that women should be granted access to abortion on demand ­ no medical reason necessary. An unblinking acceptance of multiculturalism makes it difficult to condemn un-Canadian ideas ­ such as valuing boys over girls.

On the other hand, the fact that girls are being aborted because they are girls pushes Mr. Rock's feminist buttons. Certainly, he supports abortion on demand, abortion without question, abortion paid for by taxpayers.  But these foetuses are female!

Confused and conflicted, Mr. Rock accidentally indulged in some pro-life rhetoric. This is the statement his department cobbled together: "Health Canada views sex-selection for non-medical reasons as a highly discriminatory practice that devalues the female in society . . . This is not viewed as an abortion or choice issue."

Well, bully for Mr. Rock.  But if aborting girls devalues the female, why does aborting humans not devalue human beings? And if sexist abortions ­ rooted in ethnic or religious beliefs ­ can be banned, will Mr. Rock find other motives unacceptable as justification for abortions or their public funding?

And if choice should determine abortions, why should Mr. Rock alone get to choose the grounds for making the choice? And if abortion is a deeply personal human decision ­ as he usually claims ­ who is Mr. Rock to tell a pregnant woman that because she should want a girl, she is going to have one?

A Parliamentary debate on the subject is planned for the fall. That will give Mr. Rock the summer to perform more logistical acrobatics

By Dr. Norman R. Doidge

Anyone who thinks that Kevorkian's sentence for murder will make the issue of euthanasia go away is fooling themselves. There is a change in the Zeitgeist underway.  Prof. Peter Singer, for instance, has just been appointed to a chair in Bioethics at Princeton University's Center for Human Values.  Singer argues both for giving lethal injections to children with incomplete brain function, and some haemophiliacs, and, in his 1975 book Animal Liberation, that raising animals for food or experimentation is as bad as slavery.  Does giving lethal injections to disabled kids and not eating meat, eating radishes but not eggs, make him a vegan or vegetarian?  I always get those mixed up.

Why is this happening now? Until recently, euthanasia has been kept at bay, for the religious and non-religious alike, because of the power of the fundamental Biblical notion: Woman and man were created in the image of God.  The magnificent consequence was that human life was sanctified. One didn't tamper with God's work.

But that notion is no longer sacred for many in a secular world. Even those who believe that life is sacred, and the extension of life a blessing, are bedeviled by the fact that the methods that allow us to extend our lives can simultaneously desacralize our view of it, by mixing man-made technologies with the sacred design. In doing so we have doubled our average life span from 40 years in 1850, to 80 years in 1999. Each new success influences our psychology. But these successes have made us not so much invincible, but rather, more squeamish.

Now euthanasia would seem a farthest remove from squeamishness.  Those who support it, seem willing to face, head on, the inevitability of death; those against, seem willing to face the inevitability of some suffering attending death.  Yet our squeamishness seeps into both sides of the euthanasia debate. One can support euthanasia out of compassion for those who are dying excruciating deaths, coupled with a squeamishness about their suffering. One can oppose euthanasia out of squeamishness, too, by conveniently averting one's gaze from how agonizing death can be, refusing to recognize that for some there is a moment when pain is so intense it overwhelms even the wish to survive, never mind obey the law. Others, watching a family member who is suffering an agonizing terminal illness, do nothing, not out of a sense of the sacredness of life, but out of a guilty squeamishness about taking responsibility for an irrevocable decision.

True, there are relatively "good deaths" now. Palliative care and pain control have made significant progress in recent years. But one of the reasons that there are "good deaths" is that in hospitals today there are doctors who oversee them. Generally, these doctors walk a tightrope, waiting till the moment ­ when death is as certain as can be ­ to give patients pain medication that not only stifles their agony but slows their breathing so that they die peacefully.

Unlike Dr. Death, they have not made dying, hitherto a sad fact of life, a morbid legal right. By quietly "letting nature take its course" without fanfare, they do not open up a dangerous Pandora's box ­ the cult of death ­ which is a perpetual dark temptation, a strangely contagious ideal, about which we would know more were we not so squeamish. The cult of death was raised to a virtue by the ancient Romans, the Japanese, the ecstatic Dionysians, and even those Inuit who idealize noble suicide of the aged. But thus far, most liberal democracies, under the shadow of the Bible, have developed, instead, an esoteric practice of mercy, which restrains the cult of death and lets nature take its course without letting nature needlessly ravage a helpless soul. We do not dismiss the doctor who has tended his patient in sickness, asking him to suddenly disappear and take his medicines with him the moment it becomes clear the patient is dying. Health care includes care for the dying; but care for the dying is not murder.

This system has had many protections built into it. Aware that many who are ill become demoralized, depressed, and suicidal, psychiatrists are routinely called in to treat the depression. Studies have shown that, in the overwhelming majority of cases, those medically ill and suicidal patients who are seen by clinicians, end up, after treatment, opting for life. The role of the psychiatrist in this system has been clear. Psychiatrists have been against suicide.

But even that is now being threatened. A 50-year-old Dutch woman, in good physical health, became depressed following the death of her only child and wanted to be put to death. Her lawyers argued successfully that since depression is an illness, the state, in denying her the right to die, was discriminating against her because she was mentally ill. Now, in the Netherlands, when you tell your doctor or psychiatrist you want to kill yourself, instead of interpreting this as a cry for help, the doctor is expected to help you explore the pros and cons. This change will transform and corrupt psychiatry as we know it. Imagine the message the state, by sanctioning this, is giving to a suicidal, impulsive adolescent.

If euthanasia is legalized, many in the medical profession will refuse to go along. No doubt there will be talk of creating a group of death professionals to handle this grim task. One can only guess at how disturbed the psychological profiles of such people would be. Ironically, we are better served in the current situation: It is doctors whose very identities are based upon keeping people alive, who become the de facto reluctant gatekeepers of death. Their very reluctance to play the role make them most suitable for it, and provides a safeguard against abuse.

But now the debate is shifting into the courts, and the subtle shades of death and dying, of mercy and murder, are at risk of being turned into black and white, as lawyers argue, in an adversarial way, for "rights" to die. The system we have now is not totally satisfactory; but it could be worse by being made artificially simpler than it is. That artificial simplicity is exactly what excites Kevorkian.

"Have a nice trip," he told Janet Adkins, an Oregon woman with Alzheimer's, as he injected her. He didn't treat her pain, or care for her. He just killed her.

Condensed from 4/2/99 column - with permission.    Dr. Doidge is a research psychiatrist and psychoanalyst in Toronto. His column on human nature appears every other Wednesday in the National Post