Recently in Bioethics (EOL) Category

In a recent TCS article on the Terri Schiavo case, Elizabeth Whelan, president of The American Council on Science and Health, says we should call "call tripe when tripe is served." I wholeheartedly agree which is why I believe we should start by calling Ms. Whelan on the tripe -- and the liberal ladling of ad hominem -- that she has served. I realize that the media often calls upon Ms. Wheldan precisely because she is known for giving colorful misrepresentations of her ideological enemies. But such nonsense directed toward the respected neurologist Dr. William P. Cheshire Jr. should not go unchallenged.

Ms. Whelan begins by claiming to know the "harsh facts" of Terri Schiavo's brain state, yet appears to be confused about the difference between a "permanent vegetative state" and a persistent vegetative state in which a patient may be minimally conscious. As Dr. Cheshire correctly notes in his affidavit, actions taken against a minimally conscious patient may be "unintentionally neglectful." Because a misdiagnosis of her condition could lead to cruel and unethical treatment, it is imperative to make as accurate an estimation of her condition as is possible. The record shows, however, that some of the most basic neurological tests have not been used in making the diagnosis.

I was in Okinawa when I got the call. "Mom's not expected to live much longer," my younger brother said. "You might want to come home." I had just arrived on the island a few days before and had to fly back to mainland Japan. As I waited another three days for the next plane back to the States and began to wonder if I'd make it home in time.

Two years earlier, when my mother was diagnosed with breast cancer, my brother built a room onto his house so that she could live with him and his family. The time had been difficult but the past few months had been especially hard on them. On the ride home it was made clear that the prodigal son would be expected to take his turn shouldering the burden.

The cancer had taken a toll. I was shocked by seeing my mother so gaunt, bald, and weak. I'd sit on her bed at night and prepare her medicines, swabbing the shunt in her chest with rubbing alcohol. It seemed absurd to worry about an infection when the tumors were destroying her from within. But I didn't say anything and performed the task as if it were making a difference. She often drift in and out of sleep as I fumbled clumsily with the syringe.

I'd load the needle with morphine and feel a strange impulse, similar to the urge to jump that overcomes you when you stand on the edge of a bridge. All it would take is an extra dose, I thought. My family would wake in the morning to a sense of guilty relief and damned up grief. No one would know. There'd be no questions. There'd be no autopsy. The waiting and the pain and the dying would be over.

But the longer I sat watching her labored breathing the more I realized how precious was life, even in the midst of such suffering. I carefully measured out the correct amount, sometimes slightly less just to be safe. I stayed for three weeks, giving the shots, attempting to make her comfortable. We made it through Thanksgiving before it became obvious that she wasn't finished living. I had to return to Japan. Mom held on for several more weeks before passing away peacefully in her sleep.

Over the past few weeks, the events related to Terri Schiavo have generated thousands of posts throughout the blogosphere. Unfortunately, many of the discussions -- on both sides of the issue -- reveal a complete ignorance about the actual facts in the case. As happens all too often in the blogosphere, people are ready to form an opinion without bothering to understand the essential elements in a story.

But while these ill-informed blogs provide little insight into this particular incident, they have performed the invaluable function of shedding light on the practical ethics of the average blogger. Many bloggers, for instance, appear to believe that human worth is based on functional criteria – specifically mental functions. One of the more representative and revealing remarks was made by Andy from The World Wide Rant:

If [Schiavo’s] brain damage has resulted in her being forever incapable of having a rich inner life, that ability to converse internally and appreciate the now and remember and dream that seems to make us distinctly human, then there is nothing immoral in ending her life now.

If she is capable of having "a life," as opposed to simply "being alive," then to end her life would be immoral.

That said, if the goal is to end unnecessary suffering, then to allow her to starve to death strikes me as immoral. If the decision is that her "life" is over, and that she is merely "alive," then there's no rational reason not to actively move to end her biological life through lethal injection or the like.

Similar sentiments are echoed by Michelle Catalano, Radley Balko, Sissy Willis, and Mike Ditto. Andy and Ditto even complain that religious people are standing in the way of allowing this “mercy killing.” Their posts reminded me of a earlier comment made about opposition to voluntary euthanasia:

Today the starving of Theresa Marie Schiavo will begin. Upon the order of the Probate Division of the Circuit Court of Pinellas County, Florida, an innocent disabled woman will have all nutrition and hydration removed in order that she may be killed by the excruciating method of starvation.

Although Schiavo has been incapacitated for fifteen years, the circumstances of her death were forshadowed eight years before her collapse. In 1982, an infant, referred to as "Baby Doe", was born with Down Syndrome and esophageal atresia. A simple, relatively safe surgery could easily have rectified this child's esophagus problem, allowing the child to continue living. Both the parents and their physician, however, agreed that because of the potential "suffering" this child would endure, it would be better to forego surgery and allow the boy to die. Although the decision was challenged, it was upheld by the courts. Baby Doe suffered from starvation and thirst for six days before he finally died.

The Constitution forbids such criminals as child murderers from being subjected to such “cruel and unusual punishment.” Yet over the past twenty-five years, other children have been starved to death and today the inhumane action will be taken against a helpless young woman. The question Christians and all other people of conscience must ask themselves is why do we allow this to happen?

Such ethical questions often lead to the examination of hypothetical situations in which we ask what we would do under similar circumstances. For example, what would we do to prevent a handicapped Jewish child or woman from being starved by the Nazis? How far would we go to prevent such an injustice? Would we resist such evil? Would we stand up for those who do?

After a three-year investigation, the Royal Dutch Medical Association has concluded that Dutch doctors ought to be able to kill patients who are not ill but who are judged to be "suffering through living." The report, which contradicts a Dutch Supreme Court ruling that euthanasia should be allowed only if a patient has a "classifiable physical or mental condition", argues that no reason can be given to exclude situations of such suffering from a doctor’s area of competence.

Jos Dijkhuis, the emeritus professor of clinical psychology who led the inquiry, said that it was "evident to us that Dutch doctors would not consider euthanasia from a patient who is simply ‘tired of, or through with, life,’" (terms used in the original court case). Instead his committee chose the term "suffering through living," where a patient may present a variety of physical and mental complaints.

He said there was "enormous protest" from doctors to the Supreme Court’s ruling. "In more than half of cases we considered, doctors were not confronted with a classifiable disease. In practice the medical domain of doctors is far broader … We see a doctor’s task is to reduce suffering, therefore we can’t exclude these cases in advance. We must now look further to see if we can draw a line and if so where."

The Dutch have conflated reducing suffering with eliminating suffering, pushing them into what the modern Hippocratic Oath calls the trap of “therapeutic nihilism.” While mental and psychological pain can be just as traumatic as physical pain, it may not necessarily be a permanent condition. When doctors choose the short-term elimination of pain rather than long-term maximizing of care, they kill more than their patients.

After a localized trauma or peripheral nerve injury, a person may feel a syndrome of pain and tenderness that can only be relieved by a sympathectomy, the excision of a sympathetic nerve. In a similar way when we see others suffering from psychological pain and trauma we may be tempted to resort to the “excision” provided by euthanasia. But in doing so we are cutting more than the cords of life. By severing the sympathetic nerves that tie us to our fellow human beings, euthanasia performs a sympathectomy on our souls.

The recent news that doctors in the Netherlands have been administering lethal doses of sedatives to terminally ill newborns has received little notice in the U.S. Neither the mainstream media nor the blogosphere seems to have taken much interest in the “Groningen Protocol” – the policy that doctors have the authority to end the child's life if they think a child is suffering unbearably from a terminal condition.

Appalled by this development, Hugh Hewitt wrote:

There are three kinds of people in the world: Those who will react with horror and alarm to this story; those who will applaud it; and those who will shrug it off as of no interest to them. I am uncertain which of the latter two groups is in worse moral condition.

After searching the newspapers and finding no mention of the story, Hugh added:

MSM does not care to cover this. You figure out why. In silence is approval, and in approval, an invitation to proceed.

I must admit that the most surprising aspect of this story is that people find the practice of euthanasia surprising. For the past thirty years almost all Western nations have embraced some form of abortion and in doing so have accepted the premise that human life in not intrinsically valuable. The shift from abortion to active euthanasia of infants does not require tumbling down the slippery slope; it merely requires people to act consistently with their views.

You probably won’t see it mentioned in travel brochures. And your local travel agent isn’t likely to have any package deals available. But Switzerland has become the destination of choice for “suicide tourists.” Since the country is one of only a handful in Europe that allow assisted suicide, a Zurich clinic has been flooded with foreigners expressing their desire to die.

The Swiss government is currently trying to impose new regulations, including one that would require a six-month residency before becoming eligible for assisted suicide. Officials became alarmed when it was discovered that foreigners were spending less than 24 hours in their country before “checking out.” By law, “assisted suicide” clinics are required to check that patients are suffering from incurable illnesses and have repeatedly expressed the desire to die. But a controversy erupted last year when a British couple in their 50’s, neither of whom were known to have had a terminal illness, died in a clinic after receiving an overdose of barbiturates.