Life or death — a medical dilemma
Dr Julius Hackethal is no stranger to controversy. In the past eight years he has written a number of books exposing “the mistakes and cover-ups" of his colleagues in the West German medical profession. Now, however, the 62-year-old surgeon finds himself at the centre of a storm over what a doctor should do when confronted with an incurable patient, slowly dying in great pain. The debate is particularly intense because of Germany's history: the mass “euthanasia” programme of the Nazis, in which about 70,000 mostly mentally ill people were murdered. It hovers ominously in the background whenever such a subject is raised. In the case of a woman being referred to only as “Hermy E,” Dr Hackethal had no doubt of what he should do. When she requested, just before Easter, a quick and digni-
fied death he provided the means: four grams of cyanide.
His action has been condemned by every medical organisation in the country as a breach of all medical ethics. One doctor has gone so far as to bring a private prosecution. Public reaction is harder to gauge, but Dr Hackethal says that since the facts became public, the telephone at his clinic “has never been quiet,” with only one person registering a protest. Dr Hackethal told the story in an interview with the news magazine "Der Spiegel.” which put him on its cover. The 69-year-old Mrs E. knew she was dying after 13 operations and radiation treatment for skin cancer of the face.
When she arrived at the clinic, on the shores of the Chiemsee about 40 miles south-east of Munich, she weighed about “901 b and was unable to take solid foods.
TONY CATTERALL in Bonn on the doctor who caused a storm by giving a patient suffering from cancer the means by which she ended her life.
The pain was terrible, and she might — at most — have lived another nine months.
“Please help me,” she said. “I can’t continue like this.” In normal cases — and he alleges that many German doctors do it — Dr Hackethal told “Der Spiegel” that he would slowly increase a patient’s dose of morphine, which is in any case necessary as tolerance to the drug builds up, until the last one was deadly. However, Mrs E. wanted to go quickly, and a sudden massive injection of morphine would be murder.
He recalled being told by a law professor, at a congress of the
Society for a Humane Death, that although actually killing someone at their request was against the law, merely helping in a suicide was not.
He checked with his lawyer, who confirmed the opinion, and then provided Mrs E. with cyanide tablets and a glass of water, after which he left the room. A relative of the patient dissolved the tablets and Mrs E. drank the mixture. Within minutes she was dead. Dr Hackethal filled out the death certificate himself: Mrs E. died from “unnatural causes: cynaide poisoning.” In his “Spiegel” interview, the
doctor said he was not seeking publicity in so filling out the death certificate. “I didn’t know the police would give out the information,” he said. “I thought they also had a duty of confidentiality,” although he fully expected a police investigation. The district Public Prosecutor is still awaiting the results of that investigation and until he receives it refuses to comment on whether he might bring any charges. For the medical profession, legality is not the question. According to the president of the German General Medical Council, Dr Karsten Vilmar, Dr Hackethal’s action was simply “unjustifiable.” “To pass on, or even to prepare poison to be passed on by a patient’s relative, contradicts the Geneva Pledge, the Hippocratic Oath, professional principles, and the basic ethics of medicine, which call on a doctor to preserve life
and relieve suffering,” Dr Vilmar says.
“A doctor must not be entitled to administer a deadly substance, or he becomes the lord over life and death. A doctor must not be the judge over life and death.” If a patient could not be “absolutely certain” that a doctor would never administer lethal substances, then the relationship of trust between the two would be destroyed. Dr Hackethal also faces the possibility of being called before the Bavarian General Medical Council to face charges of professional misconduct. But he is unrepentant.
“My goal,” he told “Der Spiegel," “is to have the professional regulations changed so that, in truly special cases, a doctor should have the duty to help a patient die, just as he now has the duty to save life.” Copyright — London Observer Service.
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Press, 17 May 1984, Page 21
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771Life or death — a medical dilemma Press, 17 May 1984, Page 21
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