To the Editor
Léon Daudet (1862–1942) was a prolific author known for his nationalist friendships. He attended medical school. When he failed to secure an internship, he decided not to write the medical thesis required for his diploma. Instead, he wrote Les Morticoles, a caustic satire condemning French medicine, which was reviewed in the Lancet in 1894.1 In this novel, a young man in search of adventure finds himself in the country of Morticoles, wherein was established a despotic society entirely devoted to medicine. The doctors formed an oligarchy that exploited the rich, as well as the poor, according to their therapeutic fantasies. In this world without mercy, suicide was not only tolerated but encouraged. Persons there who were delinquent could apply, without discrimination as to age, gender, or social status, to the ad hoc staff in a “house of suicide” managed by a Mr Florimol. Several modus operandi were possible, but the host particularly liked chloroform: “It is very rare that my practical lessons do not benefit at short term. Chloroform is a delightful and nuanced issue. I imagined a device that distilled the precious liquid drop by drop on a cone of tulle or fine baptiste put on the face. Lying on the bed, the person has only to press a button and remain motionless. It’s a matter of a few minutes. One thus disappears without realizing it, the imagination sown with smiling faces. Today I have ten students. Tomorrow there will be eight left.” Before this novel appeared, Horace Wells, one of the unfortunate fathers of anesthesia, inhaled chloroform before sectioning his femoral artery.2,3 Medically assisted suicide is more recent, with relative tolerance in Western countries, such as Switzerland, the Netherlands, and Canada, and in a few American states, including Oregon, Washington, Montana, and California. Very recently, the Supreme Court of Canada, by its decision of February 6, 2015, authorized “terminally ill people to seek medical assistance to die.” The Canadian Anesthesia Society therefore considered that Canadian anesthesiologists, through their specialized knowledge of pharmacology, could be called upon to develop protocols for the administration of drugs adapted to a request for assisted suicide.4 In the United States, the American Medical Association and the American Board of Anesthesiology do not accept this. In France, where therapeutic limitations are admitted, the French Society of Anesthesiology and Intensive Care does not support the idea of advanced suicide assisted by a physician considering that physicians are committed to provide care or comfort to their patients but not to help them to die.5
Marc E. Gentili, MD, PhD
Department of Anesthesia and Intensive Care
Centre Hospitalier Privé Saint-Grégoire
Saint-Grégoire, France
[email protected]
REFERENCES
1. “Les Morticoles.” Lancet. 1894;144:1360.
2. Aponte-Feliciano A, Desai SP, Desai MS. Sites and artifacts related to Horace Wells in Hartford, Connecticut. Anesth Analg. 2013;117:500–506.
3. Aljohani S, Bustillo M, Pisklakov S. Horace Wells and His House on 120 Chambers St in New York City. J Anesth Hist. 2016;2:28–29.
4. Mottiar M, Grant C, McVey MJ. Physician-assisted death and the anesthesiologist. Can J Anaesth. 2016;63:326–329.
5. Beydon L, Pelluchon C, Beloucif S, et al.; Sfar. [Euthanasia, assisted suicide and palliative care: a review by the Ethics Committee of the French Society of Anaesthesia and Intensive Care]. Ann Fr Anesth Reanim. 2012;31:694–703.
