The Ethics of Medical Homicide and Mutilation. Austin O'Malley

primary act is illicit in itself, and an accidental death follows from this act, the agent may be guilty of homicide, provided the first act in itself is naturally likely to cause homicide. Should the first act be always dangerous, such that death commonly follows from it, like rocking a row-boat, aiming a supposedly unloaded gun at a person and pulling the trigger, striking a pregnant woman, drinking whiskey and then overlying an infant in the bed, throwing building material from a roof to a street, racing an automobile through a crowded thoroughfare, sending a crew out in a rotten ship, and so on, the accidental homicide that follows is imputable to the agent no matter how much precaution he may say he has used to avert such a death.

      Suppose, secondly, the original act of the agent is illicit but such that accidental death rarely follows from it; then if he takes due precaution he is not ordinarily guilty of homicide. He has, say, stolen an automobile, and is going along the street leisurely, when a careless child runs off the sidewalk under the machine and is killed.

      1. No person, then, may hasten his own death or permit any one else to hasten it.

      2. No physician may in any possible condition kill a patient merely to effect euthanasia.

      3. The state has no more right than the physician to permit the killing of patients to bring about euthanasia.

      Were such permission given to physicians it would immediately be abused by men with even the best intentions. In all countries and in the largest cities the medical profession is swarming with quacks. What is done in crass ignorance by licensed physicians and specialists every day in the name of medicine is appalling. Professor Orth of the Pathologic Institute in Berlin makes the statement that of all the appendices that have been submitted to him for microscopic examination after removal by conservative and supposedly skilled physicians, 17 per cent. showed no disease at all, and should not have been removed. In this country the percentage of normal appendices removed because of vague abdominal pains is much larger.

      The Journal of the American Medical Association (June 7, 1913) gave a list of post-mortem examinations where the diagnosis made by men with a reputation for fair work had been correct in only the following ratios:

	Diagnosis	Diagnosis
	correct.	incorrect.
	Per cent.	Per cent.
Diabetes Mellitus	95	5
Typhoid Fever	92	8
Aortic Regurgitation	84	16
Cancer of Colon	74	26
Lobar Pneumonia	74	26
Chronic Glomerular Nephritis	74	26
Cerebral Tumor	72.8	27.2
Tuberculous Meningitis	72	28
Gastric Cancer	72	28
Mitral Stenosis	69	31
Brain Hemorrhage	67	33
Septic Meningitis	64	36
Aortic Stenosis	61	39
Phthisis, Active	59	41
Miliary Tuberculosis	52	48
Chronic Interstitial Nephritis	50	50
Thoracic Aneurism	50	50
Hepatic Cirrhosis	39	61
Acute Endocarditis	39	61
Peptic Ulcer	36	64
Suppurative Nephritis	35	65
Renal Tuberculosis	33.3	66.7
Bronchopneumonia	33	66
Vertebral Tuberculosis	23	77
Chronic Myocarditis	22	78
Hepatic Abscess	20	80
Acute Pericarditis	20	80
Acute Nephritis	16	84

      Pneumonia is a very common disease, extremely dangerous, and by skilful treatment it is very often cured, yet of these 100 cases 66 were not diagnosed. I recently saw a severe case of double pneumonia which a physician was treating as "indigestion," and he was giving pepsin tablets for the supposed indigestion. There is such a thing as extraordinary scientific precision in medical work, but it is rare; the ordinary physician treats