"The Humane Holocaust," by Malcolm Muggeridge first appeared in The Human Life Review, Winter, 1980.
One of the most curious encounters I ever had in a television studio was participating in a BBC program set up when the South African surgeon, Dr. Christiaan Barnard, had just carried out his first heart-transplant operation in the Groote Schuur Hospital in Pretoria. The program was billed as "Dr. Barnard Faces His Critics," which, as I well knew, was BBC-ese for "Dr. Barnard Faces His Adulators," as, indeed, proved to be the case. One of the great contributions of television to preparing the way for the collectivist-authoritarian way of life towards which all western countries are, in their different ways, sleep-walking, is its capacity to present consensus in terms of ostensible controversy.
The studio was packed with medical practitioners of one sort and another, including distinguished figures like Lord Platt, all of whom were in a state of euphoria about Dr. Barnard's achievement. As befitting such an occasion, the Church was represented, in the person of the appropriately named Dr. Slack, who on its behalf gave full approval, not just to the particular transplant operation that was being celebrated, but to transplants in general as and when required, whatever the organ concerned. In the event, I found myself pretty well the lone representative of the critics Dr. Barnard had been billed as meeting.
When the time came for me to put a question, one shaped itself insistently in my mind. Was Dr. Barnard, I asked him, the first surgeon to chance his arm with a heart-transplant operation, whereas elsewhere there were still qualms and hesitations, because in South Africa the doctrine of apartheid had devalued human flesh, reducing it from something God had deigned to put on, to a mere carcass?
The question, when I put it, was extremely ill-received. Some of the doctors present went so far as to manifest their displeasure by hissing, while Lord Platt rose to apologize to Dr. Barnard, pointing out that I represented no one but myself, and that he, and he was sure all the others in the studio, would wish to dissociate themselves from my insulting question. Dr. Barnard himself, I should imagine deliberately, misunderstood what I had asked, assuming that what troubled me was a fear lest he had transplanted a black African's heart in a white African's body. In fact, the donor was a white girl.
As Dr. Barnard made no serious effort to answer my question, I persisted, to the further displeasure of the doctors, pointing out that his and their attitude showed little sense of the sanctity of life, which, in the Hippocratic oath they had all presumably taken, they had sworn to respect. As a Christian, I said, I worshipped a God who, according to the New Testament, could not see a sparrow fall to the ground without concern, and quoted Blake's beautiful couplet in the same sense:
A Robin Redbreast in a Cage
Puts all Heaven in a Rage.
This caused a titter of amusement, and I lapsed into silence. It is the usual practice after such programs for all the participants to make for the hospitality room, there to continue the discussion over a drink. For once, I just made off, having no taste for any further contact with Lord Platt, Dr. Slack and the others. It was comforting subsequently to receive a letter from a doctor who had once worked at Groote Schuur Hospital but had left, he explained, because he found the attitude there to surgery to be more veterinary than medical.
Dr. Barnard's own attitude to his surgery is well conveyed in his autobiography, One Life. His account of his first post-mortem is almost lascivious; as are his first essays with animals, whose snug little abattoir, he tells us, "smelt of guinea pigs, rabbits and hundreds of mice. Yet it was like heaven, and even today those odours excite me with memories of our first days, so filled with hope and dreams." One of his dreams was to "take a baboon and cool him down, wash out his blood with water, then fill him up with human blood"; another, to graft a second head on a dog, as has allegedly - though I don't believe it - been done in the USSR.
All this was but a prelude to the great moment when the two hearts - the donor's lively one and the recipient's failing one - were ready, and all was set for the first heart-transplant operation. "This isn't a dog," Dr. Barnard reflected exultantly. "It's a man!" and then a doubt seized him; was he, after all, entitled to experiment with a human being? His hesitation lasted only for a few seconds, though; the excitement of the occasion, with, as it seemed, the whole world looking on, restored his confidence, and he got to work with his knife.
As it happened, there was one other moment of, if not doubt, then wonderment. The donor, Denise Darvall, was in a respirator; it would be necessary to stop the respirator, and take her heart, which was still beating. Another doctor, de Klerk, was participating in the operation; he wanted Denise's kidneys, but Dr. Barnard made it quite clear what were the priorities. His instructions were to "cut for the heart and let de Klerk worry about his kidneys afterwards." In the event, having stopped the respirator, they waited for the heart to stop beating before transferring it to the recipient, Washkansky. "What intermingling of mythology and ritual," Dr. Barnard asks himself, "prevented us from touching a heart in a body which had been declared clinically dead?" and, like Pontius Pilate on another dramatic occasion, does not wait for an answer.
Washkansky received Denise's heart, and, presumably, de Klerk her kidneys. The heart worked, and the patient, in a manner of speaking, lived. Congratulatory messages came pouring in; the television camera rolled - exclusive TV rights had been disposed of, resulting in unseemly scenes in the hospital. Washkansky, but not Denise, was brought into the act; the arc lights shown on him, a meeting with his loving relatives was set up, and he succeeded in uttering a few cheerful words into a specially sterilized microphone. At the end of eighteen days, he thankfully expired. "They're killing me," he managed to get out before he died. "I can't sleep, I can't eat, I can't do anything. They're at me all the time with pins and needles ... All day and all night. It's driving me crazy."
Washkansky's successor, Dr. Philip Bleiberg, a dentist, managed to survive for two years, though his private account of how he fared roughly coincided with his predecessor's. In the published version - these rights, too, had been disposed of - he was obliged to put on a brave face, and only three weeks after he had received his new heart, he was able to tell an expectant world that he had succeeded in having sexual intercourse. It was the twentieth century certification of being fully alive: copulo ergo sum. Behind the mania about the transplant operations, lies the mad hope that in due course genital transplants may become possible - new ballocks in old crotches - so that sated lechers can begin all over again.
The Barnard experience stayed in my mind, and as I thought about it, I realized that it amounted to a sort of parable illustrating a basic dilemma of our time, as between the sanctity of life as conceived through the Christian centuries, and the quality of life as conceived in a materialistic society. Those doctors in the BBC studio rejoicing in the new possibilities in surgery that Dr. Bernard seemed to have opened up, saw human beings as bodies merely, and so capable of constant improvement, until at last perfection was achieved.
No more sick or misshapen bodies, no more disturbed or twisted minds, no more hereditary idiots or mongoloid children. Babies not up to scratch would be destroyed, before or after birth, as would also the old beyond repair. With the developing skills of modern medicine, the human race could be pruned and carefully tended until only the perfect blooms - the beauty queens, the mensas I.Q.'s, the athletes - remained. Then at last, with rigid population control to prevent the good work being ruined by excessive numbers, affliction would be ended, and maybe death itself abolished, and men become, not just like gods, but in their perfect mortality, very God.
Against this vision of life without tears in a fleshly paradise, stands the Christian vision of mankind as a family whose loving father is God. Here, the symbol is not the perfected body, the pruned vine, the weeded garden, but a stricken body nailed to a cross, signifying affliction, not as the enemy of life, but as its greatest enhancement and teacher. In an army preparing for battle the unfit are indeed discarded, but in a Christian family the handicapped are particularly cherished, and give special joy to those who cherish them.
Which vision are we for? On the one hand, as the pattern of our collective existence, the broiler house or factory-farm, in which the concern is solely for the physical well-being of the livestock and the financial well-being of the enterprise; on the other, mankind as a family, all of whose members, whatever physical or mental qualities or deficiencies they may have, are equally deserving of consideration in the eyes of their creator, and whose existence has validity, not just in itself, nor just in relation to history, but in relation to a destiny reaching beyond time and into eternity. Or, in simple terms, on the one hand, the quality of life; on the other, the sanctity of life.
The sanctity of life is, of course, a religious or transcendental concept, and has no meaning otherwise; if there is no God, life cannot have sanctity. By the same token, the quality of life is an earthly or worldly concept, and can only be expressed legalistically, and in materialistic terms; the soul does not come into it. Thus a child conceived in conditions of penury, or with a poor heredity, or against its mother's wishes, or otherwise potentially handicapped, may be considered as lacking the requisite quality of life prospects, and so should not be born. Equally, it follows, at the other end of our life span, that geriatrics unable any longer to appreciate what this world has to offer in the way of aesthetic, carnal and egotistic satisfaction, in other words, by virtue of their years losing out on quality of life, should be subjected to euthanasia or mercy-killing, and discreetly murdered.
On this basis, for instance, Beethoven would scarcely have been allowed to be born; his heredity and family circumstances were atrocious, a case history of syphilis, deafness and insanity. Today, his mother's pregnancy would be considered irresponsible, and as requiring to be terminated. Dr. Johnson, when he was born, was scrofulous, and already showed signs of the nervous disorders which plagued him all his life. He, too, under present conditions, would probably not have been allowed to survive. Indeed, a good number of the more notable contributors to the sanctity of life, like Dr. Johnson, would have failed to make the grade on qualify of life, the supreme example being the founder of the Christian religion. Imagine a young girl, unmarried and pregnant, who insists that the Holy Ghost is responsible for her pregnancy, and that its outcome, according to a vision she has been vouchsafed, would be the birth of a long-awaited Messiah. Not much quality of life potential there, I fancy, and it wouldn't take the pregnancy and family-planning pundits long to decide that our Saviour, while still at the fetus stage, should be thrown away with the hospital waste.
These are hypothetical cases; near at hand, we have been accorded, for those that have eyes to see, an object lesson in what the quest for quality without reference to sanctity of life, can involve. Ironically enough, this has been provided by none other than the great Nazi holocaust, whose TV presentation has lately been harrowing viewers throughout the Western world. In this televised version, an essential consideration has been left out - namely, that the origins of the holocaust lay, not in Nazi terrorism and anti-semitism, but in pre-Nazi Weimar Germany's acceptance of euthanasia and mercy-killing as humane and estimable. And by one of those sick jokes which haunt our human story, just when the penitential holocaust was being shown on American, and then on German and other Western European TV screens, a humane holocaust was getting under way, this time in the countries that had defeated Hitler's Third Reich, and, at the Nuremberg War Crimes Tribunal, condemned as a war crime the very propositions and practices with which the Nazi holocaust had originated, and on which the humane one was likewise based.
No one could have put the matter more cogently and authoritatively than has Dr. Leo Alexander, who worked with the Chief American Counsel at the Nuremberg Tribunal:
Whatever proportion these crimes finally assumed, it became evident to all who investigated them that they had started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitudes of the physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as life not worthy to be lived. This attitude in its early stages concerned itself merely with the severely and chronically sick. Gradually, the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted, and finally all non-Germans. But it is important to realize that the infinitely small wedged-in lever from which the entire trend of mind received its impetus was the attitude towards the non-rehabilitable sick [my italics].
Surely some future Gibbon surveying our times will note sardonically that it took no more than three decades to transfer a war crime into an act of compassion, thereby enabling the victors in the way against Nazi-ism to adopt the very practices for which the Nazis had been solemnly condemned at Nuremberg. Then they could mount their own humane holocaust, which in its range and in the number of its victims may soon far surpass the Nazi one. Nor need we marvel that, whereas the Nazi holocaust received lavish TV and film coverage, the humane one just goes rolling along, largely unnoticed by the media.
It all began in the early twenties, in the decadent years in the post 1914-18 war Germany which have been so glorified by writers like Christopher Isherwood, but which, as I remember them at first hand, were full of sinister portent for the future. All the most horrible and disgusting aspects of the decades of the twentieth century - the pornography, the sadism, the violence, the moral and spiritual vacuum - were already in evidence there.
In this sick environment, the notion of mercy-killing was put forward in 1920 in a book entitled The Release of the Destruction of Life Devoid of Value by Alfred Hoche, a reputable psychiatrist, and Karl Binding, a jurist. The authors advocated killing off "absolutely worthless human beings," pointing out that the money spent on keeping them alive thus saved could be used to better purpose - for instance, on helping a young married couple to set up house. Frederick Wertham, in his scholarly and deeply disturbing book, A Sign for Cain, says that the Hocke-Binding book influenced, or at least crystalized, the thinking of a whole generation.
From these beginnings, a program of mercy-killing developed which was initiated, directed and supported by doctors and psychiatrists, some of them of considerable eminence - all this when the Nazi movement was still at an embryonic stage, and Hitler had barely been heard of. Initially, the holocaust was aimed, not against Jews or Slavs, but against handicapped Aryan Germans, and was justified, not by racial theories, but by Hegelian utilitarianism, whereby what is useful is per se good, without any consideration being given to Judeo-Christian values, or, indeed to any concept whatsoever of Good and Evil. Subsequently, of course, the number of the killed rose to astronomical figures, and the medical basis for their slaughter grew ever flimsier; but is should never be forgotten that it was the euthanasia program first organized under the Weimar Republic by the medical profession, which led to and merged into the genocide program of 1941-45. "Technical experience gained first with killing psychiatric patients," Wertham writes, "was utilized later for the destruction of millions. The psychiatric murders came first."
Can this sort of thing happen in countries like Canada and England and the United States? In my opinion, yes; in fact, it is already happening. Abortion on demand has come to be part of our way of life; in the world as a whole there are estimated to have been last year something in the neighborhood of fifty million abortions - an appalling figure, which, however, with media help, did not loom very large, or throw any kind of shadow over 1979 as the Year of the Child. To quieten any qualms Christians might have about it, an Anglican bishop has devised an appropriate prayer for use on the occasion of an abortion which received the approval of the Archbishop of Canterbury. It runs, "Into Thy hands we commit in trust the developing life we have cut short," though whether with the idea of God's continuing the interrupted development elsewhere, or of extinguishing in Heaven the life that was never born on earth, is not clear. In the case of euthanasia, a hymn may seem more in keeping with the occasion - "The life Thou gavest, Lord, we've ended. ..."
Euthanasia, it is true, has not yet been legalized except in some American states, but notoriously it is being practiced on an ever-increasing scale. Already among old people there is reluctance to go into government institutions for fear of being done away with. As for governments - hard-pressed financially as they all now are, and unable to economize on defense expenditure for fear of laying themselves open to the charge of jeopardizing national security, or on welfare expenditure for fear of losing votes - will they not look ever more longingly at the possibility of making substantial savings by the simple expedient of mercy-killing off the inmates of institutes for the incurably sick, the senile old, the mentally deranged and other such? With abortions and family-planning ensuring a zero population growth rate, and euthanasia disposing of useless mouths among the debilitated old, besides mopping up intervening freaks, the pursuit of happiness should be assured of at any rate financial viability.
In Christian terms, of course, all this is quite indefensible. Our Lord healed the sick, raised Lazarus from the dead, gave back sanity to the deranged, but never did He practice or envisage killing as part of the mercy that held possession of His heart. His true followers cannot but follow His guidance here. For instance, Mother Teresa, who, in Calcutta, goes to great trouble to have brought into her Home for Dying Derelicts, cast-aways left to die in the streets. They may survive for no more than a quarter of an hour, but in that quarter of an hour, instead of feeling themselves rejected and abandoned, they meet with Christian love and care. From a purely humanitarian point of view, the effort involved in this ministry of love could be put to some more useful purpose, and the derelicts left to die in the streets, or even helped to die there by being given the requisite injection. Such calculations do not come into Mother Teresa's way of looking at things; her love and compassion reach out to the afflicted without any other consideration than their immediate need, just as our Lord does when He tells us to feed the hungry, shelter the homeless, clothe the naked. She gives all she has to give at once, and then finds she has more to give. As between Mother Teresa's holocaust of love and the humane holocaust, I am for hers.
There is an episode in my own life which, though it happened long ago, provides, as I consider, a powerful elucidation of the whole issue of euthanasia - a study, as it were, in mercy-living in contradiction to mercy-killing. Some forty years ago, shortly before the outbreak of the 1939-45 war, the person whom I have most loved in this world, my wife Kitty, was desperately ill, and, as I was informed by the doctor attending her, had only an outside chance of surviving. The medical details are unimportant; probably today, with the great advances that have taken place in curative medicine, her state would not be so serious. But as the situation presented itself then, she was hovering between life and death, though, needless to say, there was no voice, as there might well be nowadays, to suggest that it might be better to let her go.
The doctor explained that an emergency operation was essential, and, in honesty, felt bound to tell me that it would be something of a gamble. Her blood, it appeared, was so thin as a result of a long spell of jaundice that before he operated a blood-transfusion was desperately needed - this was before the days of plasma. As he said this, an incredible happiness amounting to ecstasy surged up inside me. If I could be the donor! My blood-count was taken, and found to be suitable; the necessary gear was brought in, very primitive by contemporary standards - just a glass tube one end of which was inserted in her arm and the other end in mine, with a pump in the middle drawing out my blood and sending it into her. I would watch the flow, shouting out absurdly to the doctor: "Don't stint yourself, take all you want!" and noting delightedly the immediate effect in bringing back life into her face that before had seemed grey and lifeless. It was the turning point; from that moment she began to mend.
At no point in our long relationship has there been a more ecstatic moment than when I thus saw my life-blood pouring into hers to revivify it. We were at one, blood to blood, as no other kind of union could make us. To give life - this was what love was for; to give it in all circumstances and eventualities; whether God creating the universe, or a male and female creating another human being; whereas to destroy life, be it in a fertilized ovum one second after conception, or in some octogenarian or sufferer from a fatal illness, was the denial of life and so the antithesis of love. In life-denying terms, as we have seen, compassion easily becomes a holocaust; garden suburbs and gulags derive from the same quest for quality of life, and the surgeon's knife can equally be used to sustain and extinguish life. Dostoevski makes the same point: "Love toward men, but love without belief in God, very naturally leads to the greatest coercion over men, and turns their lives completely into hell on earth." We should never forget that if ever there was a killing without mercy, a death without dignity, it was on Golgotha. Yet from that killing, what a pouring out of mercy through the subsequent centuries! From that death, what a stupendous enhancement of human dignity!
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