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ORIGINAL ARTICLE

Early European attitudes towards ‘‘good death’’: Eugenios

Voulgaris, Treatise on euthanasia, St Petersburg, 1804
E Galanakis, I D K Dimoliatis
...................................................................................................................................

J Med Ethics; Medical Humanities 2007;33:1–4. doi: 10.1136/jmh.2006.000247

Eugenios Voulgaris (Corfu, Greece, 1716; St Petersburg, THE AUTHOR

Eugenios Voulgaris (fig 1), also transliterated as
Russia, 1806) was an eminent theologian and scholar, and Eugenius Bulgaris, was born in Corfu, Greece, in
bishop of Kherson, Ukraine. He copiously wrote treatises in 1716 and died in St Petersburg, Russia, in 1806.6–8
theology, philosophy and sciences, greatly influenced the (In this article, we preferred to keep the former
development of modern Greek thought, and contributed to the transliteration as it comes closer to the Greek
spelling and is in accordance with prevailing
perception of Western thought throughout the Eastern Christian Library of Congress usage, see Batalden.7) Having
world. In his Treatise on euthanasia (1804), Voulgaris tried to received a brilliant education in his childhood, he
moderate the fear of death by exalting the power of faith and studied philosophy and theology at the University
trust in the divine providence, and by presenting death as a of Padua, Padua, Italy. He taught for about
20 years in centres of revitalised Greek educational
universal necessity, a curative physician and a safe harbour. life, including Ioannina, Kozani, the Athonian
Voulgaris presented his views in the form of a consoling Academy and the Great Patriarchal School of
sermon, abundantly enriched with references to classical texts, Constantinople. Confronted with faction and
the Bible and the Church Fathers, as well as to secular sources, strife, in 1763 he left what might be called
metropolitan Greece7 8 and moved to Bucharest
including vital statistics from his contemporary England and and eventually to Leipzig, where his learning won
France. Besides euthanasia, he introduced terms such as the admiration of Frederick II the Great, king of
dysthanasia, etoimothanasia and prothanasia.The Treatise on Prussia, to whom he was introduced by Voltaire.
Subsequently, he was appointed librarian in St
euthanasia is one of the first books, if not the very first, devoted Petersburg by the empress Catherine II of Russia,
to euthanasia in modern European thought and a remarkable and became a prominent figure in the Russian
text for the study of the very early European attitudes towards court, ecclesiastical and literary circles of the later
‘‘good death’’. In the Treatise, euthanasia is clearly meant as a 18th century.7 8 In 1776, he was accepted as an
honorary member of the Russian Academy of
spiritual preparation and reconciliation with dying rather than a Sciences. In the same year, he was named bishop
physician-related mercy killing, as the term progressed to mean of Kherson and Slaviansk in the Ukraine, but
during the 19th and the 20th centuries. This early text is worthy renounced his pastoral responsibilities in 17797 8
of study not only for the historian of medical ethics or of and ultimately retired to the monastery of St
Alexander Nevsky near Novgorod.
religious ethics, but for everybody who is trying to courageously Eugenios Voulgaris was one of those 18th
confront death, either in private or in professional settings. century Enlightenment figures with a very wide
............................................................................. range of interests and expertise ranging from
Aristotelian logic and Newtonian physics, mathe-
matics and astronomy to critical study of the Greek
and Latin classics, Byzantine and later Greek

E
uthanasia (from the Greek eu, good; thanatos, Church history, Biblical exegesis and contempor-
death) has nowadays both the meaning of the ary politics.7 He wrote copiously until his very last
gentle and easy death and of the intentional days. His works included translations of Voltaire,
putting to death a person with an incurable or Locke and Wolff, Virgil and St Augustine, revisions
painful disease.1–3 The concept of good death is of classical literature, Greek treatises in philoso-
very old in human thought, but mercy killing has phy, theology and sciences and even tracts on
See end of article for only very recently become a major ethical issue, logic, metaphysics and astronomy. He chose to
authors’ affiliations driven by changes in both medicine and society. write in Attic Greek, expressing ‘‘new ideas in an
........................
A consensus on good death has been very hard old language’’.8 His main works were Logic (1766),
Correspondence to: to achieve, although this question has long Orthodox confession (1767), Treatise on tolerance
E Galanakis, Department of tantalised doctors and philosophers, including (1768), Dogmatic theology (1800) and History of the
Paediatrics, University of
Crete, POB 2208, Hippocrates and Plato themselves.4 The study of Christian Church in the first century (1805).
Heraklion 710 03, Crete, the evolution of the concept of euthanasia is Although Eugenios Voulgaris is overlooked in
Greece; egalanak@ generally focused on, and limited to, the Western the West and rarely mentioned outside Greece and
med.uoc.gr European and American attitudes.5 We present the Russia, he has been a central figure in the
Accepted 19 February
Treatise on euthanasia by Eugenios Voulgaris, an awakening Greek response to the Enlightenment
2007 eminent Greek Orthodox bishop and scholar, of the 18th century.7 By combining traditional
........................ published as early as 1804. Orthodox piety, adaptation of Western philosophy

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Med Humanities: first published as 10.1136/jmh.2006.000247 on 1 June 2007. Downloaded from http://mh.bmj.com/ on 14 October 2018 by guest. Protected by copyright.
Paris), the history of China and the history of the Ottoman
Empire.
In the Treatise on euthanasia, the fear of death was acknowl-
edged as an intrinsic human feature, and a penalty that Adam
bequeathed to manhood. Jesus Christ himself had felt sorrow
when confronting death. Paraphrasing an argument by
Aristotle, Eugenios Voulgaris suggests that indifference to
death would only be ‘‘either divine or bestial’’ (pages 1–2).
Accordingly, he rejected both the Stoic apathy and teachings
favouring suicide, such as those by Hegesias the Cyrenaic, and
sharply distinguished martyrdom and self-sacrifice from
suicide. Suicide is definitely condemned by him, as ‘‘the
preservation of one’s existence consists an inseparable con-
sequence of the divine law of nature’’, a law which ‘‘was read
and acknowledged even by the best among the philosophers,
who lived in the darkness of the pagan misbelief’’, a law which
‘‘is comprehensible by both wise men and laymen and
acknowledged either voluntarily or involuntarily’’ (pages 7–8).
Trying to resolve the tension between acknowledging fear of
death and advocating that death should be welcomed, Eugenios
subsequently focused on moderating the fear of death, and on
emphasising the misery of life and the power of faith and trust
in the divine providence. Voulgaris referred to the Delphic
know thyself and to both Homer and the Psalms comparing
Figure 1 Eugenios Voulgaris (1716–1806), chalcography. human life to a single leaf in an endless forest. Without this
inevitable passage from life to death, life would be impossible,
and teaching activity, he initiated the first phase in the as earth would not suffice for feeding everybody. He kept
renaissance of modern Greek thought, what many now call emphasising the sufferings and the sins of the mortals and
the neo-Hellenic Enlightenment.7 An influential theologian and suggesting that men in advanced age, such as himself, ought to
liberal arts scholar, Eugenios Voulgaris contributed to the welcome death as a curative physician, a friend rather than a
perception of Western thought throughout the Eastern foe, a deep sleep and a calm anchorage against the stormy sea
Christian world. of the protracted suffering and the misery of a longlasting
illness or a tantalised life.
Eugenios Voulgaris supported his consoling views by argu-
THE TREATISE ON EUTHANASIA
ments used by Socrates and Diogenes the Cynic and by the
The Treatise on euthanasia (Diatrivē peri euthanasias) was
beliefs of past societies, including ancient tribes in Thrace and
published in Greek at the Press of the Russian Academy of
Caucasus who were said to celebrate death. He emphasised the
Sciences, St Petersburg, in 1804 (fig 2). The Greek edition was
belief that ‘‘those whom the gods love, die young’’, presented
republished in Athens in 1846,7 and an edition in modern Greek
classical examples of blessed death in young age such as of
was very recently published.9 Soon after the initial publication
Kleobis and Biton, or of Amphiaraos, and compared the
in 1804, the Treatise on euthanasia was translated into Russian by
Spartan heroic disdain of death with the Sybaritic outrageous
Semën Platonov, a student at the Moscow Theological Academy
love of life. After recalling the absurdity of all human efforts to
and published by Moscow University Press in 1806.7 No other
achieve immortality, including alchemy and the then first blood
translations into Latin or into any modern language have
transfusion attempts, he presented the teachings of the Church
followed since then. Unlike other works by Eugenios Voulgaris,
Fathers against the fear of death, quoted Plato in that the whole
this book has been almost forgotten during the following two
philosophy is merely a study on death, and based on Augustine,
centuries.
made conclusions underlying the continuous circle of death–
In the year of publication, the author was 88 years old.
life–death (mors vitalis, et vita mortalis).
However, according to his own testimony, he started working
on the Treatise in his late 50s (1776) and finished in his late 80s
(1804). The treatise is written in the form of an answer to the GOOD DEATH, EUTHANASIA AND EUGENIOS
question how might somebody behave courageously when VOULGARIS
confronting death. Indeed, in his own list of works he indicated The nowadays common term euthanasia seems to have been
that the Treatise was written in response to a question by Prince rather unusual in the classical texts. When in use, this term or
Stephan Michaēl Rakovitsa of Transylvania.7 The Treatise was similar words, such as euthanatos, referred to the death after,
165 pages long and consisted of a single chapter and a two-page or preferably during, a ‘‘good’’ life, a good end after a good life,
corrigendum. A total of 117 footnotes appeared at the bottom of rather than to the release from a miserable one.4 10 This classical
the pages (fig 3). meaning of gentleness survives, although rarely, in English
The arguments are often presented as a consoling sermon, texts during the 17th and 18th centuries, including Francis
which, as is usual in Voulgaris’ scholarly writings,7 is Bacon (1561–1625).1 11–13 Consequently, the term progressed to
abundantly enriched by references to classical sources (includ- include the means of bringing about a gentle and easy death
ing Homer, Plato, Aristotle, Plutarch, Stoics, Cicero, Seneca and and, starting from the late 1800s, the action of inducing this
Stobaeus), the Bible and the Church Fathers (including desirable death.1 It is uncertain whether Eugenios Voulgaris
Tertullian, Jerome, Augustine, Basil the Great and Gregory of used the term under the classical meaning, whether he was
Nazianzus). Secular sources were not overlooked, including influenced by the advances in the European thought or whether
17th century vital statistics from England (John Graunt, he himself coined it for his Treatise. Most possibly, he revived
Natural and political observations made upon the Bills of Mortality, the classical meaning. The term was familiar to the early
London, 1682) and France (Comte de Buffon, Histoire naturelle, Church Fathers, whom Voulgaris had studied deeply. In any

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Early European attitudes towards ‘‘good death’’ 3

Med Humanities: first published as 10.1136/jmh.2006.000247 on 1 June 2007. Downloaded from http://mh.bmj.com/ on 14 October 2018 by guest. Protected by copyright.
Figure 2 The cover page of the first edition of Eugenios Voulgaris’
Diatrivē peri euthanasias, St Petersburg, 1804. An English version of the Figure 3 Eugenios Voulgaris, Treatise on euthanasia, the first page of the
title would be: ‘‘Treatise on euthanasia/TO THE ONE WHO ASKS:/How first edition; the footnote at the bottom of the page refers to Aristotle’s
someone could courageously confront death, either his own or his friends’ Politics.
and fellow beings’?/ANSWER/Written by the Archbishop Eugenios
Voulgaris in lay language, and published with conscientious expenditure
by the four honourable ZOSIMADES brothers, ANASTASIOS, and
NIKOLAOS and ZOIS, and MICHAIL/SAINT PETERSBURG/In the Press of Voulgaris’ Treatise on euthanasia. The author’s advanced age
the Royal Academy of Sciences in the year 1804’’. might have influenced his attitudes, resembling the ‘‘Lord, now
you dismiss your servant’’21; however, his arguments principally
remain those of a Christian theologian. In his view, there is no
case, he clearly understood euthanasia as the peaceful death place for doctors, and in this Voulgaris seems to agree with the
after a pious life, thus continuing to express the classical classical tradition and Thomas More.10 Although the Church
attitude of ‘‘good’’ death. Besides euthanasia, Voulgaris used Fathers had been, in general, supportive of secular medicine,22
terms of analogous origin, such as dysthanasia (bad death), Voulgaris himself did not seem to value any medical heroics in
etoimothanasia (readiness to die) and prothanasia (dying an old man’s passage to death. Death is the curative physician.
before the right time). His consoling parallelism of death to dormancy is already
The term euthanasia still extends to a variety of meanings present in Homer, and was respected by early Christianity.22 23
nowadays, including ending the lives of the unwanted, The consoling reminder of the bitterness, afflictions, chagrins,
inducing death for sufferers, letting people die and caring for cares, temptations and perils of the life as well as the
the dying.12 Among them, mercy killing is the most prevalent. parallelism of death to a harbour of rest for the just can be
Doctors, legislators and philosophers have occasionally pro- found in Ambrose’s ‘‘Death as good’’ (4th century AD).
posed induced death for the severely ill,4 but negative attitudes Voulgaris, however, did not conclude with Ambrose’s exclama-
towards euthanasia were equally present in the Pythagorean tion ‘‘Let us therefore hasten to die’’.24 25 His concept of death
teachings and a clear prohibition seemed to exist in the resembles the ‘‘tamed death’’ that prevailed in mediaeval
Hippocratic Oath. Although the exact meaning of this passage Europe rather than the ‘‘forbidden death’’ that is currently
is still disputed by scholars,10 these prohibitive decorum dominant.26 The Treatise on euthanasia somehow echoes the
guidelines, strongly reinforced by the Judaeo-Christian princi- mediaeval manuals on Ars moriendi, the ‘‘art of dying’’,23 and
ple of the sanctity of human life, were adopted early by the euthanasia is not discussed in its modern sense at all.
Christian Church.11 13–15 Interestingly, the shift promoting The Treatise on euthanasia is clearly not a text devoted to
euthanasia did not have its origins in the medical profession. medical ethics. Only a few treatises on euthanasia by non-
Rather, the first text clearly favouring euthanasia is considered physicians followed during the 19th century, including a thesis
to be Utopia (1516) by the canonised saint Sir Thomas More,11 on medical euthanasia27 and an essay on old age.28 Interestingly,
where the role of the doctor is not discussed at all. Utopia was it was almost simultaneously with Eugenios Voulgaris’ Treatise
not included among the references in Treatise on euthanasia. that Dr Thomas Percival’s ‘‘Medical ethics; or, a code of institutes
Nowadays, discussion on euthanasia focuses on promoting and precepts adapted to the professional conduct of physicians and
death and on alleviating pain and does not emphasise that the surgeons’’ was published in the very opposite point of Europe,
incurably ill can be greatly assisted by preparation to face death. London, in 1803.15 This title is considered to be the debut of the
This preparation has been emphasised unilaterally by religious term medical ethics and the book became highly influential in
ethics,13 16–19 and both the Eastern and the Western Christian the English-speaking world, mainly in the USA.15 During the
Church underline the importance of supporting the dying same year, a code of honour was released by the French
patient.19 20 This preparation forms the starting point for Medical Society.15 The 19th century was crucial for the

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Med Humanities: first published as 10.1136/jmh.2006.000247 on 1 June 2007. Downloaded from http://mh.bmj.com/ on 14 October 2018 by guest. Protected by copyright.
development of medical ethics, and it was during this century Competing interests: None.
that the meaning of euthanasia irreversibly progressed from the
‘‘spiritual’’ preparation to death to the ‘‘active’’ help to die.11
Eugenios Voulgaris, a theologian and a bishop, defended the REFERENCES
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