Euthanasia in Persons with Mental Retardation: More Than in the Wind (1993)

By Dallas Denny

For Dr. Paul Alberto

In Partial Fulfillment of the Requirements for EXC 725

 Georgia State University

Spring, 1994

The Nazis considered persons with mental retardation to be “useless eaters” and sent them to the death camps before any other group (Hollander, 1989a). It was a classic example of Pastor Niemoeller’s oft-quoted “First they came for the Communists…,” but for one thing—those with mental retardation were literally unable to speak up. Today, Germany is virtually bereft of retarded persons more than 50 years of age (Wolfensberger, 1981). The Nazis came for them first.

Despite self-advocacy associations like People First (an organization whose logo should be a 1960s Happy Face), individuals with mental retardation are still for the most part unable to speak for themselves. Their voices lie in their advocates—individual parents and organizations like The Association for the Severely Handicapped and The American Association on Mental Retardation (AAMR), which were formed by and consist largely of professionals [in fact, AAMR was once called The Association of Medical Officers of American Institutions for Idiotic and Feeble-minded Persons (Hollander, 1989a)]. Local, state, and national governments exist to protect them, and to some extent do with dollars and with legislation, but government is as susceptible to trends and pressures as is the fashion industry, and is often indifferent to the needs of its retarded, non-voting constituency.

As we approach the Millennium, euthanasia is officially outlawed in the United States (Lusthaus, 1985), but it is a frequent topic in professional and philosophical journals, just as happened in pre-World War II Germany (Wolfensberger, 1981). The Germans “thought the unthinkable” a decade or more before actually beginning to do it. If we are not currently thinking the unthinkable, we have at least been discussing it in our professional journals for the last decade and more (Cohen, 1981; Elks, 1993; Heifetz; Hollander, 1989a, 1989b; Lusthaus, 1985; Powell, et al., 1982; Wolfensberger, 1980, 1981, 1989).

Hollander (1989a) has pointed out that there has been discussion of euthanasia of persons with severe and profound handicaps for nearly a century: “The fact is that the idea of killing feeble-minded people was in the wind in the late 19th and early 20th centuries…” Heifetz (1989) disputed this, but his argument was weak, and new evidence provided by Elks (1993) makes it clear that a number of professionals gave serious consideration to euthanasia for this population.

In 1980, Wolfensberger warned of a new wave of “deathmaking” that would affect persons with handicaps. Just as happened in Nazi Germany, physicians would be the harbingers of this “new wave” of “mercy killing” (Lifton, 1986; Wolfensberger, 1980).

If retarded persons are a marginalized group, profoundly handicapped infants are even more marginalized. They are not only unable to speak for themselves, they are generally unable to protest nonverbally. Even normally developing newborn males are unable to do more than evidence generalized distress when parts of their body are cut away without anesthesia during circumcision. Profoundly handicapped infants are in no position to argue issues of quality of life, the economic burden they place upon society, whether they lack “humanness,” their right to live versus the rights of their parents to end their life, or the legality of making them dead (Cohen, 1981).

It is hardly surprising, then, that euthanasia is “in the wind” in the late twentieth century United States. And it is more than just in the wind. Since the early 1970s, infants with profound disabilities have been “made dead” (Wolfensberger, 1980). And as Wolfensberger predicted, physicians are the perpetrators, with parents and lawmakers as their accomplices.

Powell et al. (1982) note that euthanasia is often carried out covertly. But “Baby Doe” cases, far from being covert, have made headlines. The first reported case, in 1915, resulted in the imprisonment of the responsible physician (Hollander, 1989a), but later cases have not resulted in sanction. Lusthaus (1985) points out that typically the infant is allowed to die of malnutrition and dehydration by the withholding of food and water. By defining sustenance as “treatment” and then withholding it, the infant is made dead.

If the word euthanasia is itself a euphemism (Lusthaus, 1985), “assisting” an infant to die by starvation and dehydration is positively Machiavellian. And yet it has been allowed to occur.

The mid-1980s saw the rise of the Animal Rights movement. Radical factions broke into a number of laboratories to document mistreatment of animals and sometimes to kidnap them (Holden, 1986, Landers, 1986). This resulted in a passionate defense of animal research from Neal Miller (1985) and others, who believed almost anything a human being could do to a non-human animal in the name of science was justifiable, in an era in which scientists had already been rethinking the exploitative relationship between human and nonhuman animals (cf Burghardt & Herzog, 1980). More importantly, perhaps, it led to regulations for the housing and experimental treatment of non-human animals by the American Psychological Association and the Animal Behavior Society (1985).

The Guidelines for Ethical Conduct in the Care and Use of Animals of the APA require euthanasia of nonhuman animals be carried out in a humane manner, and in such a way as to ensure immediate death (p. 5). They furthermore require animals at all times be provided with food and water (p. 2), that the animals’ welfare must be considered at all times (p. 2), that pain and discomfort of the animal is to be avoided (p. 3), that the animal be anesthetized if it is likely to experience distress (p. 3), that an animal in severe stress or pain which cannot be immediately alleviated should be euthanized immediately (p. 3), that only minimal levels of food and water deprivation are allowable (p. 3), and that food and water deprivation should not be used if there are other ways to accomplish the task at hand (p. 3).

Clearly, it would be highly unethical to treat a nonhuman animal in the way that led to its slow death by starvation and dehydration (Denny, 1987). Not only would a scientist who devised such an experiment be subject to raids by the Animal Liberation Front, but he or she would be severely censured by his or her colleagues.

Why, then, it is allowable to starve and dehydrate a severely or profoundly handicapped human? I would argue it is not because the infant is defined as “not-human,” a justification which humans often use to kill other humans (Lusthaus, 1985). Doing so would allow the infant to receive a rather more decisive form of “deathmaking.” If, on the other hand, the infant is defined as human, it would be necessary to undergo linguistic manipulations of the sort which are actually being used, circumventing the euthanasia laws by defining substances necessary for life as “treatment” and then witholding them. The same sort of linguistic manipulation could be used in the euthanasia of cats and dogs, which are commonly killed by evacuating the air from a “lethal chamber,” if oxygen is defined as “treatment.” But we need not do that with household pets, for they, unlike Baby Does, are in no danger of being considered human.

There is a great deal of controversy about the issue of euthanasia in the United States (Cohen, 1981; Elks, 1993; Heifetz; Hollander, 1989a, 1989b; Lusthaus, 1985; Powell, et al., 1982; Wolfensberger, 1980, 1981, 1989). Perhaps it would be best that the talking be over before the killing starts.

References

American Psychological Association. (1985). Guidelines for ethical conduct in the care and use of animals. Washington, DC: American Psychological Association.

Burghardt, G.M., & Herzog, H.A., Jr. (1980). Beyond conspecifics: Is Brer Rabbit our brother? BioScience, 30(11), 763-768.

Cohen, L. (1981). Ethical issues in withholding care from severely handicapped infants. Journal of the Association for the Severely Handicapped, 6(3), 65-67.

Denny, D. (1987). New regulations for the treatment of animals in behavioral research: Their significance for the treatment of individuals with handicaps. Unpublished paper, Vanderbilt University.

Elks, M.A. (1993). The “lethal chamber”: Further evidence for the euthanasia option. Mental Retardation, 31(4), 201-207.

Heifetz, L.J. (1989). From Munchausen to Cassandra: A critique of Hollander’s “Euthanasia and mental retardation.” Mental Retardation, 27, 53-61.

Holden, C. (1986). A pivotal year for lab animal welfare. Science, 232, 147-150.

Hollander, R. (1989a). Euthanasia and mental retardation: Suggesting the unthinkable. Mental Retardation, 27, 53-61.

Hollander, R. (1989b). Response to Wolfensberger and Heifetz. Mental Retardation, 27, 71-74.

Landers, S. (1986, September). NIH moves 15 monkeys. APA Monitor, 6-7.

Lifton, R.J. (1986). The Nazi doctors: Medical killing and the psychology of genocide. New York: Basic Books.

Lusthaus, E. (1985). “Euthanasia” of persons with severe handicaps: Refuting the rationalizations. Journal of the Association for Persons with Severe Handicaps, 10(2), 87-94.

Miller, N. (1985). The value of behavioral research on animals. American Psychologist, 40(5), 423-440.

Powell, T.H., Aiken, J.M., & Smylie, M.A. (1982). Treatment or involuntary euthanasia for severely handicapped newborns: Issues of philosophy and public policy. Journal of the Association for Persons with Severe Handicaps, 6(3), 3-10).

Wolfensberger, W. (1980). A call to wake up to the beginning of a new wave of “euthanasia” of severely impaired people. Education and Training of the Mentally Retarded, 15, 171-173.

Wolfensberger, W. (1981). The extermination of handicapped people in World War II Germany. Mental Retardation, 19, 1-7.

Wolfensberger, W. (1989). The killing thought in the eugenic era and today: A commentary on Hollander’s essay. Mental Retardation, 27(2), 63-65.