Thou shalt not kill; but need’st not strive
Officiously to keep alive.
—Arthur Hugh Clough
For every hundred people who know the most famous couplet in all medical ethics, I doubt that one among them knows that its author intended it as an attack on what he saw as the hypocrisy of Victorian religiosity.
The lines come from his satirical poem The Latest Decalogue. The irony is evident in the opening rhyme:
Thou shalt have one God only; who
Would be at the expense of two?
The other commandments are likewise recommended on strictly prudential or utilitarian grounds, in terms reminiscent of (and possibly inspirational to) Hilaire Belloc’s Cautionary Verses:
Do not adultery commit;
Advantage rarely comes of it.
Nevertheless, no ninety-eight-year-old man with bronchopneumonia has ever had antibiotics withheld from him on the grounds that it would be cruel to save his life only for him to suffer further without someone quoting these lines of Florence Nightingale’s right-hand man, Arthur Hugh Clough, at least once. Far from being a plea for patient autonomy in the intensive care unit, the famous couplet (intended by Clough as an admonition) is the forerunner of the ethical theory, much in favor these days, that to refrain from saving a life when it is at all possibleto do so is as bad, morally speaking, as actually bringing that death about: A man who fails to devote his disposable income
