Chapter 3

So far we have chiefly considered murder as a violation of man's right to his life. We must now turn our attention to God's right, which the murderer violates. It may indeed happen that a man willingly resigns his right to live, that he is tired of life, and longs and implores for some one to take it away. Can you then do it? You cannot. His life does not belong to him alone, but to God also, and to God principally; if you destroy it, you violate God's right, and you will have to settle with Him. God wills this man to live and serve Him, if it were only by patient endurance of his sufferings.

For a man may be much ennobled and perfected by the practice of patience under pain and agony. Some of the noblest characters of history are most glorious for such endurance. The suicide rejects this greatness; he robs God of service and glory, he rebels against his Creator. Even Plato of old understood the baseness of suicide, when he wrote in his dialogue called "Phædon" that a man in this world is like a soldier stationed on guard; he must hold his post as long as his commander requires it; to desert it is cowardice and treachery; thus, he says, suicide is a grievous crime.

This being so, can a Doctor, or any other man, ever presume to contribute his share to the shortening of a person's life by aiding him to commit suicide? We must emphatically say No, even though the patient should desire death: the Doctor cannot, in any case, lend his assistance to violate the right and the law of the Creator: "Thou shalt not kill."

I have no doubt, gentlemen, that some of you have been saying to yourselves, Why does the lecturer insist so long upon a point which is so clear? Of course, none of us doubts that we can in no case aid a patient to commit suicide. My reason for thus insisting on this matter is that here again we are dealing with a living issue. There are to-day physicians and others who deny this truth, not in their secret practice only, but, of late, to justify their conduct, they have boldly formulated the thesis that present apparent expediency can lawfully be preferred to any higher consideration. Here is the fact. At a Medico-Legal Congress, held in the summer of 1895, Dr. Bach, one of its leading lights, openly maintained it as his opinion that "Physicians have the moral right to end life when the disease is incurable, painful, and agonizing."

What his arguments were in support of his startling proposition, I have not been able to learn. But I know that a cry of horror and indignation has gone up from many a heart. Many have protested in print; but unless, on an occasion like this, moralists raise their voice against it with all the influence which sound principles command, the saying of Dr. Bach may at least shake the convictions of the rising generation of physicians. The only argument for Dr. Bach's assertion that I can imagine--and it is one proceeding from the heart rather than the head--is that it is cruel to let a poor man suffer when there is no longer hope of recovery. It is not the Physician that makes him suffer; it is God who controls the case, and God is never cruel.

He knows His own business, and forbids you to thwart His designs. If the sufferer be virtuous, God has an eternity to reward his patient endurance; if guilty, the Lord often punishes in this world that He may spare in the next. Let Him have His way, if you are wise; His command to all is clear, "Thou shalt not kill."

One rash utterance, like that of Dr. Bach, can do an incalculable amount of harm. Why, gentlemen, just think what consequences must follow if his principle were, admitted! For the only reason that could give it any plausibility would be that the patient's life is become useless and insupportable. If that were a reason for taking human life away, then it would follow that, whenever a man considers his life as useless and no longer supportable, he could end it, he could commit suicide. That reasoning would practically justify almost all suicides. For, when people kill themselves, it is, in almost all cases, because they consider their lives useless and insupportable. Whether it results from physical or from moral causes that they consider their life a burden, cannot, it seems to me, make any material difference; grief, shame, despair are as terrible sufferings as bodily pains. If, then, we accept Dr. Bach's principle, we must be prepared for all its baneful consequences.

IV. But are there no exceptions to the general law, "Thou shalt not kill"? Are there no cases in which it is allowed to take another's life? What about justifiable homicide? There are three cases of this nature, gentlemen; namely, self-defence, capital punishment inflicted by the state, and active warfare. With only one of these can a physician, as such be concerned or think himself concerned. He is not a public hangman executing a sentence of a criminal court; nor is he acting as a soldier proceeding by public authority against a public foe. As to the plea of self-defence, it must be correctly understood, lest he usurp a power which neither human nor divine law has conferred upon him.

1. _Self-defence._ It is a dictate of common-sense, already quoted by Cicero as a universally received maxim of Jurisprudence in his day, that it is justifiable to repel violence by violence, even if the death of our unjust assailant should result. In such a case, let us consider what really takes place. A ruffian attempts to take away my life; I have a right to my life. I may, therefore, protect it against him; and, for that purpose, I may use all lawful means. A lawful means is one that violates no law, one that I may use without giving any one reasonable ground of complaint. Suppose I have no other means to protect my life than by shooting my aggressor; has he a right to complain of my conduct if I try to do so? No, because he forces me to the act; he forces me to choose between my life and his. Good order is not violated if I prefer my own life: well-ordered charity begins at home. But is not God's right violated? It is; for God has a right to my life and to that of my assailant. The ruffian who compels me to shoot him is to blame for bringing both our lives into danger; he is responsible for it to God. But the Creator will not blame me for defending my life by the only means in my power, and that when compelled by an unjust assailant, who cannot reasonably find fault with my conduct.

But it may be objected that no evil act may be done to procure a good result, that a good end does not justify a bad means. That is a correct principle, and we will consider it carefully some other day. But my act of necessary self-defence is not evil, and therefore needs no justification; for the means I employ are, under the circumstances, well-ordered and lawful means, which violate no one's rights, as has just been shown. Of course the harm I do to the aggressor is just only in as far as it is strictly necessary to defend the inalienable right I have to life or limb or very valuable property. Hence I must keep within the just limits of self-defence. To shoot an assailant, when I am in no serious danger, or when I can free myself some other way, or when I act through malice, would not be self-defence, but unjustifiable violence on my part.

2. The principles that make it lawful for a man to defend his own life with violence against an unjust assailant will also justify a parent in thus defending his children, a guardian his wards; and in fact any one may forcibly defend any other human being against unjust violence. A parent or guardian not only can, but he is in duty bound to, defend those under his charge by all lawful means. Similarly the physician would be obliged to defend his patient by the exercise of his profession in his behalf.

Now the only case in which the need of medical treatment against unjust aggression could become a matter for discussion in Jurisprudence is the case of a mother with child. Is the child under those circumstances really an unjust aggressor? Let us study that important case with the closest attention. Let all the rays of light we have gathered so far be focussed on this particular point. Can a physician ever be justified in destroying the life of a child, before or during its birth, by craniotomy or in any other manner, in order to save its mother's life, on the plea that the child is an unjust assailant of the life of its mother? Put the case in a definite shape before you. Here is a mother in the pangs of parturition. An organic defect, no matter in what shape or form, prevents deliverance by the ordinary channels. All that medical skill can do to assist nature has been done. The case is desperate. Other physicians have been called in for consultation, as the civil law requires before it will tolerate extreme measures. All agree that, if no surgical operation is performed, both mother and child must die. There are the Cæsarian section, the Porro operation, laparotomy, symphysiotomy, all approved by science and the moral law. But we will suppose an extreme case; namely, the circumstances are so unfavorable for any of these operations--whether owing to want of skill in the Doctors present, or for any other reason--that none can safely be attempted; any of them would be fatal to the mother.

In this extreme case of necessity, can the Doctor break the cranium of the living child, or in any way destroy its life with a view to save the mother? If three consulting physicians agree that this is the only way to save her, he will not be molested by the law courts for performing the murderous operation. But will the law of nature and of nature's God approve or allow his conduct? This is the precise question under our consideration. We have seen that the infant, a true human being, has a right to live, as well as its mother. "All men are created equal, and have an equal right to life," declares the first principle of our liberty. The Creator, too, as reason teaches, has a clear right to the child's life; that child may answer a very special purpose of Providence. But whether it will or not, God is the supreme and the only Master of life and death, and He has laid down the strict prohibition, "Thou shalt not kill."

Now comes the plea of self-defence against an unjust aggressor. If the child is such, if it _unjustly_ attacks its mother's life, then she can destroy it to save herself, and her physician can aid the innocent against the guilty party. But can it be proved that the infant is an unjust aggressor in the case? There can be no intentional or _formal_ guilt in the little innocent babe. But can we argue that the actual situation of the child is an unjust act, unconsciously done, yet _materially_ unjust, unlawful? Thus, if a madman would rush at me with a sharp sword, evidently intent on killing me, he may be called an unjust aggressor; though, being a raving maniac, he does not know what crime he is committing, and is _formally_ innocent of murderous intent. _Materially_ considered, the act is unjust, and I can defend myself lawfully as against any other unjust assailant. Such is the common teaching of moralists. But can the innocent babe be classed in the same category with the raving maniac? Why should it? It is doing nothing; it is merely passive in the whole process of parturition.

Will any one object that the infant has no right to be there at all? Who put it there? The only human agents in the matter were its parents. The mother is more accountable for the unfortunate situation than the child. Certainly you could not, to save the child, directly kill the mother, treating her as an unjust assailant of her child's life? Still less can you treat the infant as an unjust assailant of its mother's life.

The plea of self-defence against unjust aggression being thus ruled out of court in all such cases, and no other plea remaining for the craniotomist, we have established, on the clearest principles of Ethics and Jurisprudence, that it is never allowed directly to kill a child as a means to save its mother's life. It would be a bad means, morally evil; and no moral evil can ever be done that good may come of it; the end cannot justify an evil means. In theory all good men agree with us that the end can never justify the means. But in practice it seems to be different with some of the medical profession. Of late, however, the practice of craniotomy and all equivalent operations upon living subjects has gone almost entirely out of fashion among the better class of physicians.

Allow me, gentlemen, to conclude this lecture with the reading of two extracts from articles of medical writers on the present state of craniotomy in their profession. You will find them in accord with the conclusions at which we have arrived by reasoning upon the principles of Jurisprudence.

Dr. W. H. Parish writes ("Am. Eccles. Review," November, 1893, p. 364): "The operations of craniotomy and embryotomy are to-day of relatively infrequent occurrence, and many obstetricians of large experience have never performed them. Advanced obstetricians advocate the performance of the Cesarian section or its modification--the Porro operation--in preference to craniotomy, because nearly all the children are saved, and the unavoidable mortality among mothers is not much higher than that which attends craniotomy. Of one hundred women on whom Cesarian section is performed under _favorable conditions_ and with _attainable_ skill, about ninety-five mothers should recover and fully the same number of children. Of one hundred craniotomies, ninety-five mothers or possibly a larger number will recover, and of course none of the children. The problem resolves itself into this: Which shall we choose--Cesarian section with one hundred and ninety living beings as the result, or craniotomy with about ninety-five living beings?"

Even if a liberal deduction be made for unfavorable circumstances and deficient skill, the results, gentlemen, will still leave a wide margin in favor of Cesarian section. My second extract is from an article of Dr. M. O'Hara, and it is supported by the very highest authorities (ib. p. 361): "Recently [August 1, 1893] the British Medical Association, the most authoritative medical body in Great Britain, at its sixty-first annual meeting, held at Newcastle-upon-Tyne, definitely discussed the subject before us. In the address delivered at the opening of the section of Obstetric Medicine and Gynecology, an assertion was put forth which I regard as very remarkable, my recollection not taking in any similar pronouncement made in any like representative medical body. The authoritative value of this statement, accepted as undisputed by the members of the association, which counts about fifteen thousand practitioners, need not be emphasized.

"Dr. James Murphy ('British Medical Journal,' August 26, 1893), of the University of Durham, made the presidential address. He first alluded to the perfection to which the forceps had reached for pelves narrowed at the brim, and the means of correcting faulty position of the fœtus during labor. He then stated: 'In cases of great deformity of the pelvis, it has long been the ambition of the obstetrician, where it has been impossible to deliver a living child _per vias naturales_, to find some means by which that child could be born alive with comparative safety to the mother; and that time has now arrived. It is not for me to decide,' he says, 'whether the modern Cesarian section, Porro's operation, symphysiotomy, ischiopubotomy, or other operation is the safest or most suitable, nor yet is there sufficient material for this question to be decided; but when such splendid and successful results have been achieved by Porro, Leopold, Saenger, and by our own Murdoch Cameron, I say it deliberately and with whatever authority I possess, and I urge it with all the force I can master, that we are not now justified in destroying a living child; and while there may be some things I look back upon with pleasure in my professional career, that which gives me the greatest satisfaction is that I have never done a craniotomy on a living child.'"

You will please notice, gentlemen, that when this distinguished Doctor said, "We are not _now_ justified in destroying a living child," he was speaking from a medical standpoint, and meant to say that such destruction is now scientifically unjustifiable, is a blunder in surgery. From a moral point of view it is not only now, but it was always, unjustifiable to slay a child as a means to save the mother's life; a good end cannot justify an evil means, is a truth that cannot be too emphatically inculcated. This is one of the most important subjects on which Medical Jurisprudence has been improved, and most of its text-books are deficient. The improvement is explained with much scientific detail in an address of the President, Samuel C. Busey, M.D., before the Washington Obstetrical and Gynecological Society ("Am. Journal of Obstetrics and Diseases of Women and Children," vol. xvii. n. 2).

LECTURE III.

ABORTION.

Abortion, gentlemen, is the theme of my present lecture.

I. An important point to be determined is the precise time when the human embryo is first animated by its own specific principle of life, its human soul. It is interesting to read what various conjectures have been ventured on this subject by the learned of former ages. They were totally at sea. Though gifted with keen minds, they had not the proper data to reason from. And yet some of those sages made very shrewd guesses. For instance, as early as the fourth century of our era, St. Gregory of Nyssa taught the true doctrine, which modern science has now universally accepted. He taught that the rational soul is created by Almighty God and infused into the embryo at the very moment of conception. Still, as St. Gregory could not prove the certainty of his doctrine, it was opposed by the majority of the learned.

The Schoolmen of the Middle Ages, while condemning abortion from the time of conception, preferred the opinion of Aristotle, that the rational soul is not infused till the fœtus is sufficiently developed to receive it. The embryo lived first, they taught, with a vegetable life; after a few days an animal soul replaced the vegetative principle; the human soul was not infused into the tiny body till the fortieth day for a male, and the eightieth day for a female child. All this sounds very foolish now; and yet we should not sneer at their ignorance; had we lived in their times, we could probably have done no better than they.

It was not till 1620 that Fienus, a physician of Louvain, in Belgium, published the first book of modern times that came near the truth. He maintained that the human soul was created and infused into the embryo three days after conception. Nearly forty years later, in 1658, a religious priest, called Florentinius, wrote a book in which he taught that, for all we know, the soul may be intellectual or human from the first moment of conception; and the Pope's physician Zachias soon after maintained the thesis as a certainty that the human embryo has from the very beginning a human soul.

Great writers applauded Fienus and his successors; universities favored their views; the Benedictines, the Dominicans, and the Jesuits supported them. Modern science claims to have proved beyond all doubt that the same soul animates the man that animated the fœtus from the very moment of conception. The "Medical Jurisprudence" of Wharton and Stillé quotes Dr. Hodge of the Pennsylvania University as follows (p. 11): "In a most mysterious manner brought into existence, how wonderful its formation! Imperfect in the first instance, nay, even invisible to the naked eye, the embryo is nevertheless endowed, at once, with the principles of vitality; and although retained in the system of its mother, it has, in a strict sense, an independent existence. It immediately manifests all the phenomena of _organic_ life; it forms its own fluids and circulates them; it is nourished and developed; and, very rapidly from being a _rudis indigestaque moles_, apparently an inorganic drop of fluid, its organs are generated and its form perfected. It daily gains strength and grows; and, while still within the organ of its mother, manifests some of the phenomena of animal life, especially as regards mobility. After the fourth month its motions are perceptible to the mother, and in a short period can be perceived by other individuals on close investigation.

"The usual impression," the authors add, "and one which is probably still maintained by the mass of the community, is that the embryo is perfected at the period of quickening--say the one hundred and twelfth or one hundred and twentieth day. When the mother first perceives motion, is considered the period when the fœtus becomes animated--when it receives its spiritual nature into union with its corporeal.

"These and similar suppositions are, as has been already shown, contrary to all fact, and, if it were not for the high authorities--medical, legal, and theological--in opposition, we might add, to common-sense."

At present, gentlemen, there seems to be no longer any authority to the contrary. But many people, and some Doctors, seem to be several generations behind the times; for they still act and reason as if in the first weeks of pregnancy no immortal or human soul were in question.

Physicians worthy of their noble profession should strive to remove such gross and mischievous ignorance. In many of the United States the law casts its protection around an unborn infant from its first stage of ascertainable existence; no matter whether "quickening" has taken place or not, and consequently no matter what may be the stage of gestation, an indictment lies for its wilful destruction (Wharton and Stillé, p. 861). "Where there has been as yet no judicial settlement of the immediate question, it may be reasonably contended that to make the criminality of the offence depend upon the fact of quickening is as repugnant to sound morals as it is to enlightened physiology" (ib.). "That it is inconsistent with the analogies of the law is shown by the fact that an infant, born even at the extreme limit of gestation after its father's death, is capable of taking by descent, and being appointed executor" (ib.). Dr. Hodge adds this sensible remark: "It is _then_ only [at conception] the father can in any way exert an influence over his offspring; it is _then_ only the female germ is in direct union with the mother--the connection afterwards is indirect and imperfect" (ib.). The fact, therefore, is now scientifically established that the embryo from the first moment of conception or fecundation is a human being, having a human immortal soul.