While the Nazis goals were fundamentally corrupt, the basis of our medically assisted dying program are compassion, personal dignity and autonomy.
A recent article in Policy Options by the disability rights activist Catharine Frazee claims that in current discussions surrounding end-of-life care, “the history of [Nazi] euthanasia and questions arising from the darkest corners of that history must not be out of bounds.” The topic is certainly important, but, as the oncologist Harvey Schipper reminds us, “Context is everything.” A nuanced debate should also highlight the clear differences between the mentality driving Nazi euthanasia and the motives underlying medical assistance in dying (MAID) in Canada.
In the late 19th and early 20th centuries, the eugenics movement had gained widespread appeal in Germany. Alfred Ploetz, the founding father of the German eugenics movement, advocated for “racial hygiene,” believing that the “superior” individuals had a greater right to life than the physically and mentally “inferior.”
Adolf Hitler used the concept of racial hygiene as a justification for ethnic cleansing. As Timothy Snyder explains in Black Earth: The Holocaust as History and Warning, Hitler viewed human races as “species,” with the higher races evolving from the lower. Hitler concluded that certain individuals’ bioracial characteristics were a direct threat to the racial health of the German volk (people).
Since “defectives” — physically and mentally handicapped people — were considered an impediment to building a stronger race, these negatively valued beings could be sacrificed to further the nation’s goals. Under the Nazi Aktion T4 euthanasia program, not only was consent irrelevant, but persons targeted did not have to be suffering or have an incurable disease.
In contrast, Canada’s medical assistance in dying legislation, Bill C-14, emphasizes autonomy, compassion and personal dignity. For instance, to qualify for MAID, the individual adult in question must provide consent. Further, the person must have an incurable illness, disease or disability and be in an advanced state of irreversible decline. As well, the physical or psychological suffering must be considered intolerable from the patient’s perspective. Finally, death must be reasonably foreseeable.
The logic of the slippery slope does not apply to the Canadian context because, in contrast to the program of Nazi Germany, there is nothing remotely reckless about the process that led to the decriminalization of assisted suicide. After examining the evidence surrounding possible abuses, the Supreme Court of Canada in 2015 voted unanimously to strike down the ban on assisted suicide in Carter v. Canada (Attorney General).
Referencing statistics from Oregon and the Netherlands, the Supreme Court noted how “a system can be designed to protect the socially vulnerable.” Furthermore, expert evidence had established that the “predicted abuse and disproportionate impact on vulnerable populations has not materialized” in these jurisdictions. When discussing the efficacy of safeguards, the Court recognized that they work well in “protecting patients from abuse while allowing competent patients to choose the timing of their deaths.” In other words, there is no open season on disabled people.
Therefore, comparing those who are terminally ill, who are suffering grievously and who consent to assisted suicide to those who are not terminally ill or suffering but then have a death-hastening procedure forced upon them is misleading. In the words of the Holocaust historian Lucy Dawidowicz: “I do not think we can usefully apply the Nazi experience to gain insight or clarity to help us resolve our problems and dilemmas. There has been a lot of shoddy thinking and writing, making such facile comparisons.”
The Nazi analogy is misleading for two reasons. First, the Nazis did not progress from voluntary euthanasia (ending a life with consent) to involuntary euthanasia (killing against consent); they started with the latter. Second, the Nazis did not begin with noble goals (compassion for the terminally ill) that were eventually corrupted (the “mercy” killing of mentally and physically handicapped people). The Nazi Aktion T4 program specifically targeted mentally and physically handicapped people and was corrupt from its inception.
The moral failure of Nazi euthanasia is that it denied countless individuals compassion, personal dignity and autonomy, traits that are foundational to Canada’s MAID program. If we are to learn from the past, we need to address the obvious differences in motivation between Nazi euthanasia and end-of-life care practices in Canada. Only then can we understand that our values and those of Nazi Germany remain diametrically opposed.
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