"When you get older," reflects Dr. Christiaan Barnard, "you get more compassionate." Thus the South African heart surgeon who made headlines in 1967 with the world's first successful heart transplant operation has turned his attention at age 58 to the disturbing consequences of modern medical technology. He is now convinced that too many of his fellow physicians are, by dint of training, so obsessed with preserving life that they are oblivious to its quality. In his eighth and latest book, Good Life/Good Death (Prentice-Hall, $7.95), Barnard makes an impassioned case for euthanasia and even suicide for terminally ill patients. Barnard performs surgery rarely these days, and spends most of his time teaching at the University of Cape Town Medical School or writing at the suburban ranch house he shares with his second wife, Barbara, 30, and their two young sons. On a recent visit to the U.S., he explained his controversial views to Barbara Rowes of PEOPLE.
What led you to reexamine your attitudes toward euthanasia and suicide?
In the last few decades medical research has pushed death back beyond a number of frontiers, with respirators, antibiotics, intravenous infusions and so forth. While I think it would be disastrous for society to restrain medical research, we must take steps to insure that lifesaving techniques are used to enhance life rather than to prolong hopeless suffering and sustain people in vegetative states.
In your book, you differentiate between passive and active euthanasia. What is the distinction?
Morally, of course, it is very hard to distinguish between them, because both bring about what the word euthanasia meant in its original, Greek context: an easy or painless death. Procedurally, however, passive euthanasia is death resulting from the withdrawal of life-support systems or life-sustaining medications. Active euthanasia is death caused by direct intervention, such as administering a lethal drug overdose.
Where do your medical colleagues stand on this?
Passive euthanasia is accepted in general by the profession, although not all doctors will admit it. Active euthanasia is illegal, but I believe it has a place in clinical practice.
When are these measures appropriate?
Life-support mechanisms should not be used when there is no chance the patient will recover; similarly, when the terminally ill patient is suffering from severe pain, it should be relieved by medicines even if those medicines shorten the patient's life. That is my idea of passive euthanasia. The active form is well illustrated by a South African case in which a young doctor gave his dying father a lethal drug overdose. The old man had terminal prostate cancer; his pain was so great not even morphine was relieving it. A court found the doctor guilty of murder but set him free. The Medical Council, however, found him guilty of malpractice and revoked his license.
Do you practice passive euthanasia?
I have for years, and I ask no forgiveness. Indeed, I told the doctor attending my mother in her last illness that she should neither be tube-fed nor given antibiotics. I am convinced that is what she wanted. She was in her 90s then and, after suffering her third stroke, had lost consciousness from pneumonia. During the 11 years following her first stroke, as she lay bedridden with recurring bladder and lung infections, she would sometimes confide to me, "I wish God would come and take me away."
Have you practiced active euthanasia?
Never.
With your views, hasn't restraint often been difficult?
I'll tell you how close I once came. When I was a young doctor, serving a residency in obstetrics and gynecology, I often saw patients with cancer of the cervix and uterus. In severe cases, the cancer invades the nerves at the back of the womb and causes unbelievable pain. One such patient was Maria. Her cancer was too far gone for surgery, and drugs relieved her agony only briefly. During my rounds, I used to sit by her bedside as she wept and begged God to end her suffering. One night I filled a syringe with 12 times the normal dose of morphine and quite calmly brought it to her room. She looked up at me like a lamb awaiting slaughter. I couldn't do it. I turned and squirted the morphine into the sink. Giving her that needle would have been the same as slitting her throat. I went to the wardroom and put my face against the wall. I was shaking all over.
What became of Maria?
A few weeks later I saw her leave the hospital—her husband's arm around her and two small children tugging on her sleeve. Radium therapy had helped bring about a remarkable temporary remission.
Isn't that a chilling illustration of the danger of active euthanasia?
Yes and no. Such a case is truly the exception. What it shows is that humane guidelines for physicians facing that crisis were lacking. In fact, they are still lacking.
What guidelines would you propose?
The most important rule would be that no doctor should make the decision alone, especially a young doctor three months into his residency—as I was. Second, in making their decision, the doctors should be guided not only by the physical condition of the body but also by whether the patient has irretrievably lost what you might call the basic joy of being alive and the desire to keep on living.
Do doctors have the right to take life?
I find society's attitudes on this subject hypocritical and illogical. Man long ago accepted the right of national rulers to send him to war to slaughter others or be slaughtered. In most countries, the so-called defense budget overshadows the amount spent on maintaining health and welfare. We accept the right of a judge to condemn another human being to death for a capital offense. Great care is taken so that the death will be quick and clean. Yet what a furor is raised when a doctor asks for the right to give a terminally ill patient, suffering horribly, a similar quick, clean death.
Is it "playing God"?
If that's so, a doctor plays God just as much when he uses technology to prolong the life of a terminally ill patient. I don't believe the God of mercy and compassion would mind if we mere mortals play God when faced with hopeless irreversible agony.
What is your view of suicide?
I believe it is a fundamental right of any individual who is capable of clearly assessing his situation. It's a right because no one can stop him and no one can punish him for it. Much of the legal proscription has been repealed, but the stigma remains. Yet the self-preservation urge in humans is so strong that I don't think any special safeguards are needed except those already in force regarding addictive or lethal drugs, high-risk surgery and so on. We should not stop a dying individual who sees that his life has deteriorated to utter meaninglessness and chooses to end it.
Under what circumstances would you yourself commit suicide ?
A few years ago my youngest brother, Marius, who is also a heart surgeon, and I stood at the bedside of one of our patients and watched him slowly suffocate from advanced lung cancer. He had been a good and just man, and had accepted his fate without complaint. But in his eyes we saw a plea for help which we knew we could not legally respond to. It was devastating. Walking away, we vowed to each other that if one of us ever finds himself in similar straits the other will leave a fatal drug overdose within reach. If the sufferer is incapable of helping himself, the other will administer the dose.
Is it pain you fear?
No. As a chronic arthritic, I have learned to live with pain. What I fear most is becoming depersonalized—being reduced to a helpless state.
Death itself doesn't frighten you?
In 35 years of practice, I have only once seen a patient who was actually afraid while dying, and he was a young man who had had a massive heart attack. I remember vividly when I was 10 years old my best friend told me his father quoted the Bible in his last words, "Death, where is thy sting?" Those words awed and enthralled me, but now I know such contentment at the moment of death is not unusual.
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