This book does not leave you unmoved. A slim volume—113 pages—in pocket format, posing weighty questions with no hedging, presented as an interview. French journalist and essayist Élisabeth Lévy gives Professor Israèl, 83, the chance to restate his views on euthanasia. Strong words from a man with his feet on the ground.
Still a teenager, Israèl joined the Resistance fighting in Nazi-occupied Paris under an assumed name. A pulmonary physician, he would eventually direct the oncology department at Avicenne Hospital in Bobigny for more than twenty years. Israèl traces the evolution—and devolution—of medicine from yesterday to today. "I've often been struck by the casual ease with which patients are abandoned without exploring every possibility, without firing every shot. How can we simply stop caring for a life? In whose name?"
He learned in the field, during terrible years when ninety-five percent of cancer patients died. When he speaks of terminal patients and their suffering, Professor Israèl knows what he is talking about. "I can say with confidence that no matter how the disease ends, when a patient feels that his life matters to the doctor treating him, it changes things enormously."
It is not religion but the practice of judo that sustains Professor Israèl in settings where suffering and death are constant presences—like the oncology ward. Training in martial arts until his fifties taught him to look difficulty in the face and confront it. He recalls a cancer patient with numerous metastases. "He needed treatment with interleukin, and I warned him it would be brutal—weeks of terrible suffering. His answer I will never forget: Doctor, I'll do everything you tell me, because since I've had this tumor, you're the first doctor who's looked me in the eye."
It is crucial to weigh Professor Israèl's words against his long professional experience. Many patients arrived at the hospital in such grave condition that they slipped into semicoma. When pulled from that state by adequate resuscitation, "they would say: 'When can I leave? I'd like to spend a few days on the Côte d'Azur to recover.' Thinking of these patients, I tell myself that if I had been authorized by a 'living will' found by chance in their wallets to actively shorten their lives while they were in semicoma—which happens in the Netherlands—I would have committed a true crime, even if encouraged by their families, by law, and by the Holy League!"
Professor Israèl does not dodge the hardest questions: how families react when a loved one's condition worsens; illness in children; passive euthanasia; active euthanasia.
He speaks with realism and simplicity. "Aggressive medical treatment, especially in oncology, has been heavily condemned, and rightly so." "In other words, many doctors of my generation were guilty of aggressive treatment—by which I mean pursuing therapy that serves no purpose." Yet he clarifies: "I believe that therapeutic persistence—trying everything—has nothing to do with aggressive treatment, and is in fact absolutely commendable. There are thousands of patients who owe their lives, even their recovery, to the persistence of a doctor or surgeon."
He brings equal clarity to the cultural, rather than religious, reasons for opposing euthanasia. Given our genetic heritage, the potential of every human brain, and all the experience and habit that shape us, we can say this: in the entire history of humanity, no two individuals have ever been, or ever will be, identical. "This means every being is absolutely unique," and the physician is in some sense the guardian of that uniqueness. "We must be aware of this miracle. Either the doctor, who serves as shelter from harm during our earthly life, understands this singular, unique status and shows it through care, will, respect, compassion, and guidance—or he refuses to acknowledge that he holds an existence that is unique and irreplaceable, with grave consequences for our cultures and for the very status of homo sapiens sapiens." If doctors accept euthanasia, patients will lose trust in doctors.
"The demand for euthanasia has always been made in the name of dignity. I confess that use of this word makes me particularly furious. For a healthy person, loss of dignity might mean incontinence. But to decide such a thing means ignoring what goes through a sick person's mind. From a position of good health, it is easy to decide that someone has lost so much dignity he deserves to die. For me it is barely conceivable."
But the gravest risk is to society itself: "legalized euthanasia breaks the symbolic bond between generations. Children, grandchildren, and now—as we become a four-generation society—great-grandchildren will know that you can simply dispose of the old." "There is an unsaid that holds a society together; what reveals this unsaid is respect for life and the necessity of extending all our effort to preserve it to the end."
GBB, 2009