gy of perinatal transmission of HIV. AIDS 1988; 2: S83-S89 4. Halsey N, Boulos R, Holt E et al: Maternal-infant HIV transmission in breastfed Haitian infants [abstr ThC 609]. Presented at Sixth International Conference on AIDS, San Francisco, June 20-24, 1990
Ethics of euthanasia ongratulations are due for C CMAJs consideration of the ethics of euthanasia with the articles "Giving death a helping hand" (144: 358-359), by Mina Gasser Battagin, and "Euthanasia and related taboos" (ibid. 359-360), by Dr. Eike-Henner Kluge, CMA's director of ethics and legal affairs. I recall Dr. Walter C. Mackenzie, the distinguished dean of medicine at the University of Alberta, giving a public lecture sponsored by the University of Calgary on medical euthanasia in which he supported the procedure. He indicated that in no case up to that time (about 1970) had a Canadian court sustained a prosecution against a physician for undertaking a mercy killing. Since disparate opinions may preclude a major consensus statement representing Canadian physicians on conditions justifying euthanasia, it may be appropriate to note the approach of Dutch physicians.' Reasonable cases will not attract the attention of public prosecutors, and in other cases the court decisions will in time provide appropriate guidelines, Morley J. Tuttle, MD PO Box 4563, Stn. C Calgary, Alta.
Reference 1. Horgan J: Death with dignity. Sci Am 199 1; 264 (3): 17
I have observed with interest the explosion of media coverage of active euthanasia. Apparently a 956
CAN MED ASSOC J 1991; 144 (8)
number of groups across Canada are now lobbying for this latest of "human rights." Two of the recurring themes in their arguments are that dying with dignity is synonymous with premature death to avoid suffering and that society today is kinder to our animals than to our human beings. Both themes are brought forth by Ms. Battagin. In the last 12 years I have had the privilege of caring for many terminally ill patients, all of whom, I believe, died with dignity. The courage with which they accepted their suffering was an inspiration to me and to many of their family members. During this final illness I have often seen families drawn closer together and old wounds healed as they provided support for their loved one and each other. It is not easy to watch people suffer during their final days - or at any other time during their lives. To bring a person's life to a premature end, however, robs the person of a truly dignified death. We must be careful not to use euphemisms such as "death with dignity" when we really mean premature death to avoid suffering. I do not believe that the two terms have anything in common. Are we really kinder to our animals than to our fellow human beings? The fact that we may put to death an animal who is suffering and refuse to do the same for a human being has far less to do with kindness to animals than it does with the realization of the dignity of human life. A farmer may shoot his horse when it breaks a leg; however, when his son breaks a leg, rather than shooting him he comes to me for help, not because he lacks compassion for his son but because he recognizes that human life is infinitely more precious than animal life. Likewise, when one of my patients is suffering with an illness, terminal or otherwise, I believe the care given should take
into account the dignity of human life and not be relegated to that reserved for farm animals. Unless we recognize the significance of human life any discussion of death with dignity is futile. Kenneth J. Crowe, MD PO Box 1690 Melfort, Sask.
I composed a rebuttal to Dr. Kluge with 14 points to show that euthanasia makes little sense. I then had to realistically assess the probability of having as good an opportunity to state a very different perspective. While employed as the CMA's ethicist, Kluge is often invited to contribute to CMAJ and encourage the contributions of like-minded people who state his real case for him. Although feigning objectivity - "I am not making a plea for active euthanasia"' - he makes it quite clear where his inclination lies. This is not surprising, because his pro-choice abortion and euthanasia views were well known in this community long before he was appointed by the CMA. A large, possibly the largest, number of physicians would like their patients, politicians and country to know that Kluge does not represent their view of medical ethics. The differences can be aired only so often within the organization, with such futile effects, before ethical physicians begin to champion a separate association. A Canadian Ethical Medical Association (CEMA) would be founded on principles of progressive science and enduring ethics. Its members would always put the best interest of the patient first and insist that neither governmental coercion nor ethicist guile would sway them from basic principles. Because ethics make such a profound impact on every aspect of medical practice, the members of CEMA would probably estabLE 15 AVRIL 1991
Ethics of euthanasia ongratulations are due for C CMAJs consideration of the ethics of euthanasia with the articles "Giving death a helping hand" (144: 358-359), by Mina Gasser Battagin, and "Euthanasia and related taboos" (ibid. 359-360), by Dr. Eike-Henner Kluge, CMA's director of ethics and legal affairs. I recall Dr. Walter C. Mackenzie, the distinguished dean of medicine at the University of Alberta, giving a public lecture sponsored by the University of Calgary on medical euthanasia in which he supported the procedure. He indicated that in no case up to that time (about 1970) had a Canadian court sustained a prosecution against a physician for undertaking a mercy killing. Since disparate opinions may preclude a major consensus statement representing Canadian physicians on conditions justifying euthanasia, it may be appropriate to note the approach of Dutch physicians.' Reasonable cases will not attract the attention of public prosecutors, and in other cases the court decisions will in time provide appropriate guidelines, Morley J. Tuttle, MD PO Box 4563, Stn. C Calgary, Alta.
Reference 1. Horgan J: Death with dignity. Sci Am 199 1; 264 (3): 17
I have observed with interest the explosion of media coverage of active euthanasia. Apparently a 956
CAN MED ASSOC J 1991; 144 (8)
number of groups across Canada are now lobbying for this latest of "human rights." Two of the recurring themes in their arguments are that dying with dignity is synonymous with premature death to avoid suffering and that society today is kinder to our animals than to our human beings. Both themes are brought forth by Ms. Battagin. In the last 12 years I have had the privilege of caring for many terminally ill patients, all of whom, I believe, died with dignity. The courage with which they accepted their suffering was an inspiration to me and to many of their family members. During this final illness I have often seen families drawn closer together and old wounds healed as they provided support for their loved one and each other. It is not easy to watch people suffer during their final days - or at any other time during their lives. To bring a person's life to a premature end, however, robs the person of a truly dignified death. We must be careful not to use euphemisms such as "death with dignity" when we really mean premature death to avoid suffering. I do not believe that the two terms have anything in common. Are we really kinder to our animals than to our fellow human beings? The fact that we may put to death an animal who is suffering and refuse to do the same for a human being has far less to do with kindness to animals than it does with the realization of the dignity of human life. A farmer may shoot his horse when it breaks a leg; however, when his son breaks a leg, rather than shooting him he comes to me for help, not because he lacks compassion for his son but because he recognizes that human life is infinitely more precious than animal life. Likewise, when one of my patients is suffering with an illness, terminal or otherwise, I believe the care given should take
into account the dignity of human life and not be relegated to that reserved for farm animals. Unless we recognize the significance of human life any discussion of death with dignity is futile. Kenneth J. Crowe, MD PO Box 1690 Melfort, Sask.
I composed a rebuttal to Dr. Kluge with 14 points to show that euthanasia makes little sense. I then had to realistically assess the probability of having as good an opportunity to state a very different perspective. While employed as the CMA's ethicist, Kluge is often invited to contribute to CMAJ and encourage the contributions of like-minded people who state his real case for him. Although feigning objectivity - "I am not making a plea for active euthanasia"' - he makes it quite clear where his inclination lies. This is not surprising, because his pro-choice abortion and euthanasia views were well known in this community long before he was appointed by the CMA. A large, possibly the largest, number of physicians would like their patients, politicians and country to know that Kluge does not represent their view of medical ethics. The differences can be aired only so often within the organization, with such futile effects, before ethical physicians begin to champion a separate association. A Canadian Ethical Medical Association (CEMA) would be founded on principles of progressive science and enduring ethics. Its members would always put the best interest of the patient first and insist that neither governmental coercion nor ethicist guile would sway them from basic principles. Because ethics make such a profound impact on every aspect of medical practice, the members of CEMA would probably estabLE 15 AVRIL 1991
