Two Pioneers of Euthanasia around 1800

Abstract

In his autobiographical Apologie, the famous French surgeon Ambroise Pare recalled how in 1536, he witnessed remarkable case of mercy killing. On entering conquered city, he encountered three fatally wounded soldiers. They were leaning their backs against the wall of horse stable, next to four others who were already dead. An old soldier approached Pare and asked him whether there was any hope for the three who were still alive. When Pare indicated there was none, the old soldier, to the surgeon's great dismay, calmly proceeded to cut their throats knife. (1) Pare's story is just an anecdote, but it has important implications. It shows that active euthanasia was clearly not beyond imagination in the early modern period. This conclusion is confirmed not only by the famous fictional account of active euthanasia in Thomas More's Utopia, published in 1516, but also by reports of popular customs like pulling the legs of hanged but still living criminals or suffocating dying patients cushions to end their suffering. (2) Western, Christian physicians, however, are generally thought to have unanimously rejected active euthanasia until the late nineteenth century. It was only then, historians of medical ethics have found, that individual physicians joined the ranks of those who, from the 1870s onwards, publicly advocated active euthanasia. (3) As W.B. Fye has argued, various developments in late nineteenth-century medicine and society made it feasible to propose a concept as radical as 'active euthanasia.' These developments were spectacular growth of sophistication in medical diagnosis and prognosis that made it possible to judge patient's condition as incurable with reasonable accuracy; the development of anesthesia and other new, powerful means for the relief of pain and suffering; and the decline of religiously motivated resistance. (4) This standard account of the rise of the modern medical debate on active euthanasia needs to be revised in one important respect, however. It is undoubtedly true that active euthanasia moved into the center of lively controversial debate only in the late nineteenth and early twentieth centuries. But at least two well-known German physicians already publicly endorsed active euthanasia around 1800. Their stance must be understood within the rather special context of German medicine and society at that time. A Radical Break In the year 1800, Carl Georg Theodor Kortum (1765-1824), physician in the town of Stolberg near Aachen, published series of short essays in the leading German medical periodical, Hufelands Journal der practischen Arzneykunde. In one of these essays, Kortum reported various cases of advanced consumption. The patients, he explained, sometimes went through the most horrendous agony, the mere sight of which was difficult for witnesses to bear. As they approached the end, for period of some days they could hardly expectorate or even swallow, until they gradually lost their senses. Yet patient would sometimes live on for another forty-eight hours beyond that, an incessant death-rattle emanating from his or her chest. In such cases, according to Kortum, the only thing one could desire was that gentle death end the patient's suffering. His counsel was clear and explicit: a moderate dose of poppy juice, e.g., 20 drops of Laudanum liq., shortens such agony, by extinguishing the weak vital flame entirely, and it is, in my opinion, morally permitted in such cases. (5) For all we know, Kortum may well have been the first physician in the Christian West who publicly justified and indeed advised active euthanasia on terminally ill patients. And although Kortum did not explicitly state that he himself had acted in this manner, his comment about what dose of laudanum was infallibly successful implies concrete practical if not personal experience. A year later, Christian Ludwig Mursinna (1744-1823), professor of surgery and head surgeon at the Charite hospital in Berlin, was even more explicit in this respect. …