Wednesday 4 May 2011

'Mercy killing', abortion and the Hippocratic Oath

I started to write this blog a couple of weeks ago, then got terribly busy (amid all our UK bank holidays the past two weekends) with an over-running work project, and missed my self-imposed deadline of the end of April. Never mind. Here it is now.

It came to my attention recently that the Hippocratic Oath, which for centuries was seen as the touchstone of medical good practice, and to which all doctors signed up without demur, not only promises that 'I will use my power to help the sick to the best of my ability and judgement; I will abstain from harming or wronging any man by it', but also specifically promises not to practice either euthanasia or abortion.

I feel sure that many people do not realise the extent to which Western medicine has departed from the Oath, nor appreciate the slippery slope on which medical knowledge and practice has now embarked. The activities of Dignitas, the prevalence in the UK and some other countries of abortion thinly veiled by the cloak-all device of 'threat to mental wellbeing of the mother', the sympathy for 'mercy killing' by a relative of a sick person for whom pain or other suffering has removed any joy in living - all these are now a commonplace of so-called 'liberal' thinking. But the question is, should they be?

As fellow-humans it is natural to feel sympathy for the terminally ill person who wishes to die with dignity rather than surrounded by acute patients in an overstretched NHS hospital, or the teenage girl burdened with an unwanted pregnancy from which the baby's father has simply walked away, or the spouse, partner, son or daughter of a disabled person whose perspective has been distorted by living with their incapacity. But where should we divide this sympathy from a recognition that a permissive attitude to these actions actually undermines the respect for life that the Hippocratic Oath was designed to promote and protect, and which we lose at our and our society's peril. For it is a short step from allowing euthanasia and abortion to promoting it - and we are already some way along that path. Sympathy is a great human emotion, but it has to be underpinned by a robust sense of moral values, or it becomes a dangerous thing. Should my sympathy for the young man whose childhood was ruined by his mother's alcoholism lead me to condone his taking out his very understandable anger on the old lady he meets in the street? Should my sympathy for the mother with post-natal depression lead me to allow her to neglect or harm her baby? Most of us would say "no", but in fact these scenarios are not so very different from the actions that we are permitting, sometimes even promoting.

Surely where someone is in trouble, we should seek to get alongside and help them, not stand back and condone or approve of their crazy, destructive, desperate attempts to help themselves. We can help the disabled person whose incapacity takes away all sense of independence to find ways of living a real and useful life, using modern technology, personal carers, their own indomitable spirit - for this is how those disabled people who do manage to live such a life have managed to overcome their problems. That terminally ill patient who fears the process of natural death needs to be put in contact with the hospice movement, or with doctors who specialise in palliative medicine. Not all pain can be removed, but the support makes a big difference, as those who have encountered Macmillan Cancer nurses will agree. The pregnant teenager needs someone she can trust, someone to talk to her parents and teachers, help her with practical and financial support, talk to her about the options for keeping the baby or finding a foster or adoptive parent (and the mess that is called an adoption process in this country will be the subject of another blog!)

This helping is in fact much more demanding than the sympathy-on-the-sidelines approach, and too often is seen by our peers as 'do-gooding' when it is nothing of the kind. The do-gooder seeks to bolster his (or more usually her) own sense of worth, not primarily to get alongside another person and find out what can be done to improve their situation. But does it really matter what other people think of what we do, when something so important is at stake? If we do not reverse this trend towards 'mercy killing' we shall soon have 'killing for convenience', as some abortions already border on, and then perhaps 'killing for a purpose', as the Nazis did. As I said, the slope is slippery, and we would do well to turn round and haul ourselves up to the top again, to the high ground where there is some philosophical and moral safety, before we find ourselves down among the pariahs of history who thought that relative morality made sense, and tailored their ethics to match.