Death Therapy

The Euthanasia of Hippocratic Medicine

In its earliest ethical expression, the practice of medicine was governed by the Hippocratic Oath. Physicians swore not to administer deadly substances, even when requested by the patient. The physician’s role was to heal, not to harm, and to serve life, not to extinguish it. At its foundation, the oath placed the sanctity of individual life above all other considerations.

That vision has not endured.

In many developed nations, physicians now administer lethal substances to patients who are neither dying nor in physical pain. They terminate pregnancies not due to danger or illness but because the child is predicted to experience poverty, instability, or other perceived deficiencies in quality of life. These actions are undertaken within a framework that purports to be therapeutic. What is increasingly evident, however, is that death itself has come to be viewed as a form of care.

This is a natural consequence of a system that has shifted its allegiance from the individual to the collective. In a healthcare structure dominated by bureaucratic incentives, actuarial reasoning, and population-level outcomes, human beings are no longer regarded as ends in themselves. They are increasingly treated as variables within larger equations of public health, population management, efficiency, equity, and cost. When a person becomes a problem to manage rather than a life to protect, ending that life may begin to appear rational, even humane.

Suicide as Medicine

In Canada, the Medical Assistance in Dying (MAID) program was initially introduced with strict criteria.¹ It has since undergone substantial expansion. As of 2021, Canadian law no longer requires a patient’s natural death to be reasonably foreseeable in order to qualify for euthanasia.² As a result, individuals suffering from chronic illnesses, psychiatric disorders, and even economic hardship may now be deemed eligible for physician-assisted death. Some have requested MAID due to homelessness, loneliness, or the absence of adequate medical or social services.³

Supporters of the policy often cite autonomy and dignity as guiding principles. Yet the moral weight of such a decision cannot be understood apart from the cultural transformation that surrounds it. Physicians once saw it as their duty to meet despair with resistance, not agreement. When a patient expressed a desire to die, the physician did not affirm the sentiment. He sought instead to uncover its source, to alleviate suffering where possible, and to restore, however imperfectly, the patient’s sense that life remained worth living.

Today, that ethic has been displaced by a culture of affirmation. Rather than confront pathological thoughts, we validate them. If a patient believes he is female, we no longer consider the possibility that this belief reflects psychological distress or disordered perception. We instead modify the body to match the delusion, removing those features that serve as reminders of reality. Likewise, when a patient believes that death is preferable to life, we no longer try to dissuade him. We simply agree, and begin arranging the means to make his death both clinical and legal.

The physician’s role has thus shifted from healer to facilitator. In this new moral landscape, the desire to die is no longer treated as a symptom. Death is now regarded not as the ultimate failure of medicine, but as its final and most definitive therapy, for the disease we have come to see as most unbearable: life itself.

Abortion and Economics

Public discourse surrounding abortion has undergone a similar transformation. What was once presented as a tragic but sometimes necessary intervention is now described as routine healthcare. The prevailing justification has shifted toward economic and social considerations. A significant proportion of abortions in the United States are performed for women living below the poverty line.⁴ These decisions are frequently framed as pragmatic. Advocates argue that a child born into poverty, instability, or emotional unpreparedness is likely to suffer, and therefore termination is not only permissible but responsible.⁵

This reasoning reflects a deeper cultural shift. It suggests that the value of life is contingent upon the projected quality of that life. It presumes that hardship justifies nonexistence. The argument implies, however indirectly, that it is better for some not to be born than to live lives marked by difficulty or disadvantage.

This view is not only morally precarious but socially corrosive. It allows death to be reimagined as a preventative solution. It transforms medicine from a discipline grounded in service to the vulnerable into a mechanism for reducing the presence of those whose needs may exceed the system’s capacity or willingness to respond.

The Cultural Reevaluation of Life

Yet the forces at work are not merely economic. They are civilizational. A society that no longer values life cannot sustain a medicine that protects it. The decline of religious belief, the erosion of familial and communal bonds, and the ascendance of hedonistic individualism have together produced a culture in which life is increasingly regarded as purposeless. Purpose, duty, and hope have given way to Nietzschean nihilism, in which life is not a gift but a burden, not a calling but an accident. Many no longer see themselves as participants in a moral or spiritual project that transcends their own desires and stretches beyond their own mortality. They do not view their own lives as having trajectory or meaning. They do not regard the future beyond their own deaths as something for which they are responsible. They do not bear children because they see nothing worth passing on. They seek death out of the quiet despair that comes from believing there is no reason to endure.

The physician's role has shifted to align with this culture. Medicine no longer exists to uphold the intrinsic worth of life, but to facilitate its conclusion when life ceases to be subjectively satisfying.

Once the value of life is undermined at this foundational level of belief and expectation, systems evolve to reflect that reality. Healthcare institutions, which once operated on the basis of a sacred covenant between an individual doctor and an individual patient, rooted in the presumption that every life was worth saving, now function within a framework that takes disposability for granted, subjugating individual needs to the perceived interests of the collective. Where medicine once sought to serve persons, it now manages populations. The moral language of duty and care has been displaced by the administrative logic of tradeoffs and thresholds.

In this environment, medicine becomes an instrument of triage. Care is no longer guided by the question, What does this patient need? but rather, What use of resources is most efficient for the system as a whole? Increasingly throughout the developed world, treatment is reserved for those most likely to improve, and resources are withheld from those unlikely to recover. Death, then, is quietly reframed as a form of relief, not for the patient alone, but for the institution. Collectivist medicine becomes the logical outgrowth of a culture that has ceased to believe in the irreducible value of the individual.

How Systems Normalize Death as Care

Modern healthcare systems are deeply influenced by utilitarian frameworks. Policymakers speak of outcomes, risk-adjusted metrics, and resource allocation. Such language is often presented as neutral and scientific, but it masks a profound moral transition. The more medicine is directed by population-level goals, the more it loses sight of the individual patient as the primary object of care.

Within this paradigm, the value of treatment is increasingly assessed through the lenses of cost-efficiency and statistical utility. Patients with poor prognoses, complex social burdens, or diminished functional status are routinely deprioritized. In systems where the payer is not the patient but a distant insurer or state agency, death becomes financially preferable to prolonged care. Relief achieved through surrender to oblivion is less costly and more expedient than the long and uncertain labor of rehabilitation. Under such conditions, the impetus to reframe killing as compassion is irresistible.

How Physicians Learn to Participate

Most physicians do not enter medicine with the intention of hastening death. They see themselves as healers, not as agents of withdrawal or extinction. Yet modern medical training, particularly in hospital settings, exposes clinicians to the constant management of life-and-death decisions. Physicians must decide which patients receive aggressive intervention and which receive palliative care. They grow accustomed to determining when to intubate, when to extubate, when to resuscitate, and when to allow a natural death.

These decisions, though ethically necessary, are inherently desensitizing. Over time, they alter the physician’s perception of mortality. The transition from curative intent to comfort care becomes familiar. It becomes clinical. Within this context, the act of euthanasia may appear not as a radical departure, but as a minor extension of what the physician already does. A telling recent example is the case of Ohio ICU physician Dr. William Husel, who was criminally charged for ordering exceptionally high doses of fentanyl during palliative extubation.⁶ Although the doses he administered were in truth extremely large, an anomaly that prompted legal scrutiny and drew allegations of murder, his eventual acquittal reveals just how indistinct the moral boundary between palliation and euthanasia has become.

Physicians like Dr. Husel, and those physicians who participate in MAID or who perform abortion, often do what they do not because they are indifferent, but because they believe they are relieving suffering. They rely on protocols, institutional guidelines, and most of all, peer norms and the modern culture of medicine. In doing so, they may come to believe that their actions are both necessary and compassionate. Without the grounding influence of moral absolutes such as the Hippocratic principle to do no harm, even good physicians may gradually adopt practices they would once have found unthinkable.

The Case for Restoring Individual-Centered Care

The only viable safeguard against this trajectory is a return to a system in which the physician is accountable first and foremost to the patient, not to an algorithm or a bureaucracy. Such a system requires the protection of individual liberty and the reestablishment of the doctor-patient relationship as the central unit of medical ethics.

Markets, though imperfect, create incentives that support this relationship. When physicians work directly for their patients rather than for third-party payers or government agencies, they are more likely to resist pressures that treat life as a cost center or death as an expedient remedy. In a market system, the doctor is not an agent of the state or a contractor of the insurer. He is a fiduciary of the patient. His incentives are aligned not with institutional throughput but with individual survival.

Yet while systemic reform is necessary, it will not be sufficient. Markets can restore accountability, but they cannot alone restore reverence. The deeper crisis is cultural. A society that treats life as disposable will produce a medicine that reflects that view, regardless of how its services are financed. We will not build a medical system that cherishes life unless we first become a people who do.

That renewal cannot be imposed from above. It begins with private virtue: with families who regard children not as burdens but as blessings, with communities that offer solidarity rather than isolation, and with individuals who live as though life is inherently meaningful. It begins when physicians recover the moral clarity to say no, not just to bureaucrats, but to despair.

The Hippocratic Oath may be ancient, but its relevance has not diminished. It articulates a vision of medicine in which the physician pledges never to harm and never to kill. That vision must be preserved, not as a nostalgic ideal, but as a bulwark against the moral erosion that has come to define so much of modern medical policy. If medicine is to have a future worth defending, it must begin by remembering what it exists to protect: not systems, not outcomes, but persons, each one unique, unrepeatable, and worthy of life.

1. Euthanasia in Canada. Wikipedia. May 2025. https://en.wikipedia.org/wiki/Euthanasia_in_Canada

2. Government of Canada. Canada’s new medical assistance in dying (MAID) law. Justice Canada. March 17, 2021. https://www.justice.gc.ca/eng/cj-jp/ad-am/bk-di.html

3. Pitter J. Canadians with non-terminal conditions sought assisted dying for social reasons. The Guardian. October 17, 2024. https://www.theguardian.com/world/2024/oct/17/canada-nonterminal-maid-assisted-death

4. Guttmacher Institute. Abortion in the lives of women struggling financially. Guttmacher Policy Review. July 2016. https://www.guttmacher.org/gpr/2016/07/abortion-lives-women-struggling-financially-why-insurance-coverage-matters

5. Institute for Women’s Policy Research. The economic fallout of reproductive rights restrictions on women’s futures. May 2025. https://iwpr.org/the-economic-fallout-of-reproductive-rights-restrictions-on-womens-futures

6. Tanner L. Doctor acquitted in 14 hospital patient deaths. Medscape Medical News. April 20, 2022. https://www.medscape.com/viewarticle/972525