Wednesday, November 2, 2016

'Permitting the Destruction of Life Unworthy of Life': Brief Excerpts and Remarks on Scale and Scope

Binding and Hoche's book was a seminal work. It placed the question of life and death in proper scientific, legal, and political context. But the concept of 'life unworthy of life' is a normative concept, both broader and deeper than the medical context to which their book applied it. Its extension and expansion by the NSDAP and the SS to cases not mentioned by Binding and Hoche, as a reflection of its scale and scope, was legitimate.

Binding and Hoche's book, Permitting the Destruction of Life Unworthy of Life, published in 1920 following Binding's death, examines the theoretical, legal, and medical contexts of the question: "When is the state justifiably engaged in the ending of life?" Their answer: When it involves life unworthy of the name. The forfeiture of a will to life that is coupled with a grave medical affliction or condition and concomitant burden on family and state. In such cases, to end life is justifiable and praiseworthy. The state must assume the burden of making the killing of such life feasible.

The book was published following the end of World War I. That context reveals itself in the examples that are found in the book. The reader is asked to envision battlefields where a healthy soldier dies in a dysgenic war while the unhealthy, back home, sap the vitality of an already burdened state in its medical facilities.

Binding and Hoche's restriction of the concept of 'life unworthy of life' to medical contexts in general, but specifically cases of terminal illness, were broadened by the NSDAP and the SS to include other groups besides the terminally ill. These included larger segments of the population, including not just the terminally ill, the feeble minded, and those for whom life is a greater burden than blessing, but also racial and ethnic groups. Hoche was later critical of this expansion, and Anglo-American writers have constantly attacked it. A typical example is "Binding and Hoche's 'Life Unworthy of Life': An Historical Analysis," by Howard Brody and M. Wayne Cooper.

The concept of 'life unworthy of life,' however, is a normative concept, not a political, medical or scientific concept. Even Binding and Hoche acknowledge, in their last paragraph, that it is a concept that existed even in the ancient world. Constant proximity to death meant that the concept was accepted without question:
There was a time, now considered barbaric, in which eliminating those who were born unfit for life, or who later became so, was taken for granted.
The NSDAP and the SS's expansion and broadening of the concept was legitimate, as were their determinations about the groups of people to whom the concept was applied. Every people inevitably frames answers to the question that was posed above: "When is the state justifiably engaged in the ending of life?" An extensive catalog of deaths that resulted from the policies of nations before, during, and after World War II would provide a revealing view of how pervasive some variant of an answer manifests itself among different peoples. We must come to accept that not everyone is deserving of life and relearn how to devalue human detritus.

Source: K. Binding und A. Hoche, Die Freigabe der Vernichtung lebensunwerten Lebens (Leipzig, Felix Meiner Verlag: 1920). German here. [1]

Dr. Karl Binding (1841-1920)

Dr. Alfred Hoche (1865-1943)

... Should permissible taking of life be restricted, except in emergency situations, to an individual's act of suicide as it is in current law, or should it be legally extended to the killing of fellow human beings, and under what conditions?


To what extent, then, is killing humans allowed today, again apart from emergency situations, and what is to be understood by this? Recognizing a right to kill would be the opposite of "allowing."

[...]

Are there human lives which have so completely lost the attribute of legal status that their continuation has permanently lost all value, both for the bearer of that life and for society?

Merely asking this question is enough to raise an uneasy feeling in anyone who is accustomed to assessing the value of individual life for the bearer and for the social whole. It hurts him to see how we handle the most valuable of lives (filled with and sustained by the strongest will to live and the greatest vital power), and how much labor, power, patience, and capital investment we squander (often totally uselessly) just to preserve lives not worth living - until nature, often pitilessly late, removes the last possibility of their continuation.

Reflect simultaneously on a battlefield strewn with thousands of dead youths, or a mine in which methane gas has trapped hundreds of energetic workers; compare this with our mental hospitals, with their caring for their living inmates. One will be deeply shaken by the strident clash of the sacrifice of the finest flower of humanity in its full measure on the one side, and by the meticulous care shown to existences which are not just absolutely worthless, but even of negative value on the other.

It is impossible to doubt that there are living people to whom death would be a release, and whose death would simultaneously free society and the state from carrying a burden which serves no conceivable purpose, except that of providing an examples of the greatest unselfishness. And because there actually are human lives, in whose preservation no rational being could ever again take any interest, the legal order is now confronted by the fateful question: Is it our duty actively to advocate for this life's asocial continuance (particularly by the fullest application of criminal law) or to permit its destruction under specific conditions? One could also state the question legislatively, like this: Does the energetic preservation of such life deserve preference, as an example of the general unassailability of life? Or does permitting its termination, which frees everyone involved, seem the lesser evil?

[...]

But I cannot find the least reason - legally, socially, ethically, or religiously - not to permit those requested to do so to kill such hopeless cases who urgently demand death.

[...]

Despite everything, this new question allows only a very slowly unfolding process of change and adjustment. The consciousness of the meaninglessness of merely individual existence when compared with the interests of the whole; the feeling of one's absolute obligation for integrating every available power and discarding all useless tasks; the feeling of being a totally responsible participate in a difficult and painful undertaking: these must all become part of the common understanding to a much greater extent than today before any of the ideas presented here can receive complete recognition.

[...]

... Goethe originated the model for how important human questions evolve. He saw them as a spiral. The core of this model is the fact that at regular intervals a spiral line rising in a particular direction perpetually returns to the same position relative to the axis crossing it but each time a step higher.

Eventually, this image will be apparent even in connection with the cultural question we have been discussing. There was a time, now considered barbaric, in which eliminating those who were born unfit for life, or who later became so, was taken for granted. Then came the phrase, continuing into the present, in which, finally, preserving every existence, no matter how worthless, stood as the highest moral value. A new age will arrive - operating with a higher morality and with great sacrifice - which will actually give up the requirements of an exaggerated humanism and overvaluation of mere existence. ...

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[1] The English excerpts that I include in this post are cross-referenced with the translation of the National Legal Center for the Medically Dependent & Disabled, published in Issues in Law & Medicine, Vol. 8, No. 2, 1992: 231-265.