The Particular Danger of Socialist Countries with National Health Care Practicing Assisted Suicide and Euthanasia

 Introduction

When suicide is discussed in terms of ‘assisted suicide’, the category of care for the suffering is brought into focus.  One is no longer speaking of suicide in Roman terms as an honourable death.  Nor is one siding with the Greeks in the virtue for medical practice of doing no harm. As we shall see, we are not thinking of suicide in the repulsive, Darwinian sense of eugenics.  We are now casting the matter of killing in terms of care.

Assisted suicide separates ‘killing’ from ‘care’.  Euthanasia involves combining the two: someone else makes the decision—from a sense of caring—and performs the act. When someone insinuates him or herself into another’s suicide, one is not simply offering assistance.  One is actually abandoning medical and other forms of care and becoming complicit in the act.  Coercion from family, friends, medical providers, and/or insurance agencies is also possible, and I would say probable.  Once a practice is established in a culture for suicidal assistance, the culture will develop a narrative that underlies and undergirds the moral convictions, which will become entrench the practice in the culture.  One of the questions that must be asked is, ‘Do we really want to be this sort of people?’, not just, ‘Should this person not be assisted with his or her suicide?’ 

As the culture moves toward accepting assisted suicide, the government can step in to legislate, provide services for, and enforce the practice.  The more centralised and powerful the government, the more it will engage in social engineering to enforce the convictions and remove dissidents.  This is one of the major concerns that those opposed to assisted suicide entertain, especially in socialist countries with national health systems.  A society moves from care to complicity to coercion to enforced convictions. 

In this essay, the relationship between a socialist government’s enforcement of social convictions and euthanasia will be told with respect to Nazi Germany. (I previously presented this account in ‘What is Fascism—and Do We Need to Worry about This in the American Presidential Election?’)  The focus here is on the danger of socialist governments with national health care getting involved in assisted suicide, and the warning is that this could well end in social reengineering with the elimination of unwanted fetuses, undesirable populations, and persons no longer considered useful.  If one imagines for a moment that this is alarmist, I would respond that it is actually a narrative running throughout history.  At times, it emerges in a horrifying manner, as in fascism.  The essay then examines how assisted suicide has developed in our time in the Netherlands.

Eugenics and a Strong, Socialist Government

Plato’s Republic explores the nature of a just society.  The result is a highly regulated, socialist republic.  In this philosophical treatise, Socrates begins discussion by appealing to nature, but most of the work is guided by discussion of ideal virtues, particularly justice.  For our purposes, we should note how the discussion of an ideal state pursuing certain ideal virtues leads to the justification of practices that would otherwise be considered reprehensible.  Socrates says, ‘the best men must cohabit with the best women in as many cases as possible and the worst with the worst in the fewest, [459e] and that the offspring of the one must be reared and that of the other not, if the flock is to be as perfect as possible’ (459d-e).  The powerful, ideologically driven state inevitably turns to social engineering and eugenics.

In the early 20^th century, Fascists interested in establishing a third, great European empire, the Third Reich, embraced the convictions of social Darwinism and racial hygiene.  The socialist state, they believed, could and needed to help in the progressive evolution of the allegedly stronger race, dominate and enslave inferior races, and eliminate any race that undermined this progress.  While for Italian fascists, Ethiopians became the population to dominate in their brutal imperial expansion in northeast Africa, for Germans, the Jews (as well as some other undesirables) were the race to eliminate in Europe.

The term ‘eugenics’ (‘good stock’) was introduced in 1883 by Francis Galton, a brilliant polymath and half-cousin to Charles Darwin.  He was interested in studying hereditary characteristics of humans in order to explore the ‘practicability of supplanting inefficient human stock by better strains’.  He defined it as a system designed to advance ‘the more suitable races or strains of blood’ and as offering ‘a better chance of prevailing speedily over the less suitable’.  His studies led him to advocate ‘eugenic marriages’.

In 1895, Alfred Ploetz wrote Grundlinien einer Rassenhygiene (Racial Hygiene Basics), introducing the language of ‘racial hygiene’. German eugenic practices were systematically implemented in the German colony of South West Africa (Namibia), with tens of thousands of Herero and Nama enslaved, incarcerated, brutalized, and executed in a genocidal programme between 1904 and 1908.  Eugenics featured in this brutality.  The German doctor, Eugen Fischer, examined traits (hair colour, skin colour, and skulls) of mixed-race individuals in Rehoboth, South West Africa.  He also conducted painful experiments on Africans in the concentration camp, measuring skulls (many being sent to Germany for further study), removing body parts, injecting them with arsenic, opium, and other substances, and sterilizing women.  With such ‘scientific’ studies as ‘proof’, Fischer promoted racial purity and opposed intermarriage among races.  Germany outlawed interracial marriage in its colonies from 1912.  (This was also a lasting policy of the Nationalist government’s Apartheid policies in South Africa.)

This concern for racial health led to the 1933 Law for the Prevention of Offspring with Hereditary Diseases.  (The state’s control or heavy-handed involvement in health is still defended in varying degrees in different countries: national control of health insurance that funds abortion of children with Downs Syndrome, transgender surgeries, euthanasia, government control of the population during the Covid pandemic, etc.)  The Swiss psychiatrist, Ernst Rüdin, guided the writing of the 1933 law.  He was the director of the Psychiatric Research Institute of Munich and later, in 1935, the director of the German Society of Neurology and Psychiatry in 1935. This law permitted sterilization for:

1. congenital mental deficiency, 2. schizophrenia, 3. manic-depression, 4. hereditary epilepsy, 5. hereditary St. Vitus dance (Huntington’s chorea), 6. hereditary blindness, 7. hereditary deafness, 8. serious hereditary physical deformity. [9] ... chronic alcoholism (paragraph 2).

The individual, a legal representative, the state physician, or heads of hospitals, nursing homes, and penal institutions could apply to the eugenics court for the sterilization in these cases.  The state physician and police were required to proceed with the court’s decision of sterilization, even against the individual’s will, and were allowed to use force (paragraph 12).  The law was signed by Adolf Hitler, Germany’s Nazi dictator.  Its initial purpose was to sterilize 50,000 Germans per year.  In 1939, Hitler signed permission for a programme that came to be called Aktion T4, which lasted through 1945 (the end of World War II).  T4 authorised the killing of asylum inmates with mental or physical abnormalities.

The concern for racial purity was particularly directed against the Jews in Europe’s political and social turmoil after World War I.  The Nuremburg Laws of 1935 forbade sex and marriage between Jews and Germans and employment of Jewish women under the age of 45 (the Law for the Protection of German Blood and German Honour) and restricted citizenship to Germans and those of related blood (the Reich Citizenship Law). Dr. Gerhard Wagner proposed sterilization of the Jews.  In a short time, the Nazi regime adopted the ‘final solution’ policy of the Holocaust, the genocide against the Jews.  The work of eugenicists went hand in hand with that of the Nazi’s military, paramilitary, and police forces.  Dr. Otmar von Verschauer, head of the Kaiser Wilhelm Institute in Berlin-Dahlem, and Dr. Josef Mengele (the ‘butcher of Auschwitz) collaborated in the study of race, and the latter experimented on, maimed, and killed prisoners in the Auschwitz concentration camp.  Mengele sent eyeballs, heads, and blood samples to von Verschauer.  Dr. Sigmund Rascher performed his own experiments on prisoners at the Daschau concentration camp.  He would expose prisoners to freezing temperatures and then try to revive them.

Adolf Hitler makes his argument for national socialism in his autobiographical manifesto, Mein Kampf, published in two volumes in 1925 and 1926.  In his chapter on ‘People and Race’, his argument begins with the assumed science of eugenics advocated by academics, researchers, and institutes.  Importantly, his argument appeals to ‘Nature’ instead of Communism’s utopian ideals, even though his national socialism is, in fact, a eugenically defined utopia, an Aryan state.

First, he notes, animals mate with their own species.  Any cross-breeding results in an inferior animal.  Second, Nature allows struggle so that the species improves, as the weaker specimens do not survive.  If this did not happen, the worst would outnumber the best.  Moreover, Nature opposes the mating of a higher with a lower race.  Whereas Hitler initially had different species in mind, his thoughts have by this time migrated to consideration of different human races.  This was part of the eugenics research, as we have noted, from the beginning.  He says that any mingling of the superior, Aryan race with others results in the end or inferiority of the civilization.  The superior races’ level of evolution is depressed; it retrogresses physically and intellectually.  He rejects any idea that man or ideas can conquer Nature.  He attributes the erroneous view, which he calls pacifist, to the Jews.  Rather, everything admirable (‘science and art, industry and invention) is the result of ‘a few peoples, and perhaps originally of one race’.  He says, ‘The great civilizations of the past have all been destroyed simply because the originally creative race died out through blood-poisoning.’ He realizes that Japan appears to be an exception, but he claims what is Japanese is only the outward dress of European scientific and technological achievement.  Hitler takes a further step: the superior, Aryan race needed to use lower races to advance; it required the subjugation of other races.  This was also for the good of the conquered, since the superior masters preserved and encouraged civilization.

National Socialism

To implement a eugenics programme for society, the government needs to assume powers associated with socialism.  Just as communism (extreme socialism) requires a strong, militaristic, centralized, one party, dictatorial, and totalitarian government (the Politburo or executive committee, the Vanguard of the People, the Party, the strong leader/dictator) to implement its economic reforms, fascism (extreme nationalism) requires the same for its goal of racial health.  Ideology of either sort justifies centralized power and the use of brutal force. Freedom of speech is rejected and replaced with ideological propaganda.  The government uses military and police force to enforce its will on the people.  Over against liberal democracy, government’s purpose is not held to be to defend the individual against the group, including the government, in matters of speech, ideas, and private property.  It is rather to implement policies of social reengineering.  In the case of national socialism (fascism), these policies are formed, allegedly, for the protection of the nation, and in a eugenic national socialism, the state protects the superior race.  In the case of the Nazis, this was the so-called Aryan race.

Nationalism and socialism arose in Europe as a rejection of monarchies by the population.  With the American and French Revolutions in hindsight, Europe experienced numerous revolutions in 1848-1849.  Earlier, the United States formed more of a federal republic made up of states, whereas in France a more nationalistic movement emerged from its violent revolution.  The United States developed as a nation under God whose rights were said to be God-given, whereas in France, rights were approved by the nation state.  More generally, nationalism identified the nation with the state government, and so a nation might be made up of various ethnicities —as empires had been—but what held them together were their borders, citizenship, language, culture, and laws.  Initial rebellion by the people against the monarchies of Europe was in the interest of greater freedom, better living conditions, economic improvements, and so forth--concerns more associated with liberal democracy.  Yet nationalism also developed as a means to assure these rights and meet these concerns.

Nationalism developed in various regions of Europe.  Following the American and French responses to monarchy at the end of the 18th century, Romanticism contributed significantly to the rise of nationalism throughout Europe.  People developed a love of the fatherland, their history and heritage, the soil from which they sprang, and their native languages.  A political motivation for nationalism was a natural response to a people's domination by another country (as we have recently seen in the break-away of states in former Yugoslavia or now in Ukraine under attack from Russia).  German nationalism developed as a reaction to Napoleon's empirical overreach throughout Europe, including Germanic territories.  Poland had Russia squeezing it to its east and Germany to its West.  Jean-Jacque Rousseau encouraged Poland to stimulate a nationalist identity in response.  Italy's separate states, often under foreign control, felt the need to unify as a nation.  A pan-Slavic movement also gained interest in the Austro-Hungarian Empire. 

Toward the end of the 1800s, German nationalism developed under the guidance of Otto von Bismarck, who wanted to unite the various German kingdoms or duchies (such as Schleswig-Holstein).  This strengthened the ‘nation’ and tended toward an ethnic and cultural national identity.  The political effort toward this end required a stronger, national government.  The significant alternative to such nationalism lay in the development of communism during the same period.  While  nationalism, socialism, and communism emphasised a strong government to attain social reengineering, communism envisioned this in terms of a Marxist, economic reform.  German nationalism first took the form of social democracy.  After the First World War, it took its next steps toward fascism.  It moved step-by-step in the 1920s and 1930s toward a eugenic national socialism as Hitler rose to power.  In each aspect of this, it was fully opposed to Christianity, replacing devotion to God with devotion to the state.

In his ‘People and Race’ chapter in Mein Kampf, Hitler claims that the Aryan’s greatest quality is not in intellect as such but in ‘his readiness to devote all his abilities to the service of the community’.  We have here the combined notions of a superior race and its superior social qualities.  Labour for the community, even at the expense of one’s own happiness, is the first step toward building a truly human culture.  The murderous concentration camps were presented as labour camps; over the entrance to Auschwitz were the words, ‘Arbeit Macht Frei’ (Labour Makes Free).

An even higher ideal, Hitler claimed, is sacrificing one’s life for the community.  This ideal is called Pfichterfellung, the performance of duty in service of the community over against self-satisfaction.  While we might think that this is unnatural—is not self-preservation a basic instinct?—Hitler relates this back to Nature.  Nature ‘recognizes the primacy of power and strength’. This concept was already promoted by Friedrich Nietzsche in Thus Spoke Zarathustra, which promotes the notion of an 'Over-Man' who promotes atheism ('God is dead') and power.  Nietzsche developed Arthur Schopenhauer's concept of the will to live with his own concept of the will to power.

Applied to the evolution or development of a great culture, Nazism promoted the glory of individual sacrifices in one's work and life for the community.  In the previous century, Richard Wagner promoted the national spirit (Volksgeist) in his operatic dramas, claiming in 'Judaism in Music' (1850) that Jews only wanted fame and money in their musical endeavours.  Friedrich Nietzsche (in The Birth of Tragedy) initially (he eventually fell out with Wagner) saw in Wagner's music a return to a Dionysian (becoming) versus Apollonian (being) worldview.  In his notes in 1886, Nietzsche explained this concept:

The word Apollonian' stands for that state of rapt repose in the presence of a visionary world, in the presence of the world of beautiful appearance designed as a deliverance from becoming; the word Dionysos, on the other hand, stands for strenuous becoming, grown self-conscious, in the form of the rampant voluptuousness of the creator, who is also perfectly conscious of the violent anger of the destroyer.

The Dionysiac worldview rejects the rational, status-quo for a passionate, creative will to power.  This spirit was grounded in the nationalistic, Aryan, and romantic naturalism of the Germanic people in which individuals would find their purpose and meaningful self-sacrifice. Nietzsche's 'deep antagonism to Christianity' was because it led to a 'degeneration of the Germanic spirit'.  Hitler presented his anti-individualistic, national, and communal or socialist vision over against what he calls the pacifist’s idealism—and he has in mind particularly the Jews—which he insisted is 'unnatural'.

Hitler then engages in a lengthy tirade against the Jew as the opposite of the Aryan in 'People and Race'.  Among his many assertions, the Jew is accused of supporting Marxism.  Marxism shares much with Nazism, both being socialistic ideologies.  The difference is that Nazism promotes the notion of a national spirit deeply rooted in a mythological history, whereas Marxism promotes an economic vision of the rising of the poorer class against the richer class, an anti-capitalist socialism.  Hitler's opposition to the Jews is partly based in his racism and partly in the historical situation of the early 20th century.  Marxists' attempts at governing in European countries after World War I included a notable element of Jews.  Opposition to Marxists, therefore, included an anti-Semitism.  One might note in Hitler’s argument, then, that, while fascism claims to follow a naturalistic form of idealism (resulting in ethnic nationalism), Marxism follows an unnatural (manmade) idealism (resulting in an economic, international movement).  His rant against the Jews included the delusional notion that there was a Jewish conspiracy to dominate the world.  Underlying anti-Semitism was a hatred of 'the Other'.  (How contradictory today to see social Marxists advocating both a 'multicultural diversity' with 'no borders' and anti-Semitism.)

Apartheid

Apartheid in South Africa bore similarities to the more extreme version of Nazism in Germany.  It forbad the mixing of races and identified the ‘white’ race as the superior race.  It gave whites special privileges to allow them to advance beyond the other races, from access to parks to better schooling to promotion in jobs.  Other races were excluded from the political process.  It used the mechanisms of a powerful, socialist state to control society.  As Hitler advocated, South Africa needed and used the lower races to advance, especially in the mining industry.  Apartheid could be and sometimes was presented as a kind, paternal oversight of the lower races, helping them to develop as long as it was separate development.  The point here is that a strong, socialist government might not include in its social architecture the elimination of unwanted groups as in Nazi Germany, but the very establishment of a strong socialist government overseeing its citizens is full of abusive potential.  Given humanity’s sinfulness, the more centralised its power—as at the tower of Babel—the more dangerous things become.  Throw assisted suicide into the programme of governmental care, and one is soon dealing with institutionally enforced euthanasia.

The Present Situation

The argument put forward here is based in history, but it might also now be followed as an unfolding story in countries that have instituted assisted suicide, like the Netherlands and Canada.  One resource that explores the contemporary challenge of assisted suicide and government involvement in the United Kingdom, the Netherlands, Australia, and elsewhere is that in 2014 by Kieran Beville, an Irish Baptist pastor and lecturer at Badhoeverdorp, Netherlands.  Beville examines how the ‘right to die’ has become a ‘right to kill’ matter in the Netherlands.  The government established guidelines for assisted suicide in 1981, one of which was that the person seeking suicide must be in unbearable pain.  As with abortion, one might note, the initial guideline allowing something easily broadened to include initially excluded cases.  Thus, by 1986, ‘unbearable pain’ was not limited any longer to physical pain but also to ‘psychic suffering’ or ‘potential disfigurement of personality’.  Given the right to terminate a person when the person requests this for virtually any reason, the next development one might expect is the doctor stepping in without the patient’s consent.  In the Netherlands, this is no longer categorized as ‘euthanasia’ but as ‘life-terminating treatment’.  One might note that the practice still fits under the conceptualisation of ‘care’.  Coercion is no longer a concern as the will of the patient is not an issue.

Bellville cites the case of a physician in 1990 who reported putting patients with incurable cancer and suffering into a coma to relieve the pain, then terminating them without their consent.  Then came the Remmelink Report in 1991, a government study of its allowance of euthanasia.  Bellville writes,

According to the Remmelink Report, in 1990, 2,300 people died as a result of doctors killing them upon request (active, voluntary euthanasia).  400 people died as a result of doctors providing them with the means to kill themselves (physician-assisted suicide).  1,040 people (an average of 3 per day) died from involuntary euthanasia, meaning that doctors actively killed these patients without the patients’ knowledge or consent.  14% of these patients were fully competent.  72% had never given any indication that they would want their lives terminated.  In 8% of the cases, doctors performed involuntary euthanasia despite the fact that they believed alternative options were still possible.  In addition, 8,100 patients died as a result of doctors deliberately giving them overdoses of pain medication, not for the primary purpose of controlling pain, but to hasten the patient’s death.  In 61% of these cases (4,941 patients), the intentional overdose was given without the patient’s consent.

Also, in 45% of the cases, families of hospitalised patients who were involuntarily euthanized were not given notice.

Once doctors expand their role from the limitations of the Hippocratic Oath to include what was long specifically rejected, abortion and assisted suicide/euthanasia, they move from fighting to save lives to being empowered to take lives.  Once so empowered, some will simply take the unethical route of falsifying death records, claiming the person died of natural causes.  We can be sure that some will use power in corrupt ways.

Another consequence of legal euthanasia is that palliative care gets less support than it otherwise would have.  In the case of the Netherlands, Bellville points out, only two hospice programmes were operative by the mid-1990s.  Furthermore, euthanasia is easily expanded where the individual in question cannot make decisions for him or herself.  This occurred in Holland when the Dutch Pediatric Association was advised in 1992 that severely handicapped new-borns were better given an early death than allowed to live.  The next year, a court case found that a psychiatrist was acting legally in assisting in the suicide of a depressed client whose marriage broke down and whose two children died.  In other words, the sluice gates of death have been opened in the Holland dykes: self-help programmes for youth wishing to die, lethal injections for elderly patients administered by general practitioners, training in euthanasia in medical schools, weighing of costs in medical treatment, acceptance of euthanasia for treatable diseases like ‘diabetes, rheumatism, multiple sclerosis, AIDS, bronchitis, and accident victims’.

Conclusion

The facts, as presented above by Belleville, regarding Holland’s allowance and practice of euthanasia and assisted suicide provide evidence of how things actually develop once doctors committed to caring for patients are empowered and expected to reinterpret such case to include killing their patients—something the Hippocratic Oath wisely foresaw as deleterious for the entire profession of healing.  Certainly, other examples might be multiplied.  Belleville also warns that, where a national health care is unavailable, as in the USA, and many consequently lack health insurance, the poor may face only one choice: the cheaper solution of suicide.  The examples Belleville has given, however, point to a different problem: the empowerment of a national health system to put people to death, even against their consent.  My argument is that giving power to an institution, the health care profession, in socialist countries is far more dangerous.  An identification of an undesirable class could easily further the use of such power against them.  The quintessential example of this is the National Socialist German Workers’ Party, the Nazis.  Given the sudden resurgence and allowance of anti-Semitic protests, violence, and even policies of some institutions in the West, we should not assume that ‘surely this would never happen again’, whether against the Jews or some other group.