Belgium: The Return of “Useless Eaters”

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English: Skull and crossbones

English: Skull and crossbones (Photo credit: Wikipedia)

At http://www.france24.com/en/20121218-belgium-looks-euthanasia-minors-alzheimers-sufferers is an article on a proposal that will most likely pass Belgium’s legislature that allows euthanasia for minors and for Alzheimer’s patients. Increasingly secular, godless Europe is finally passing laws that reflect the decline of the remnants of Christian ethics that held on for a while after the decline of religious belief. The phrase “useless eaters” was coined by a Nazi doctor who was discussing Nazi Germany’s euthanasia program. It had no problem killing minors and people with senility of whatever cause. With no clear cut behavioral diagnostic difference between Alzheimer’s Disease and senile dementia in general, the new law, when passed, could de facto be applied to some non-Alzheimer’s senile patients.

What are the limits on the age of minors? Apparently none–any minor deemed “too sick to live” by a doctor and by parents or guardians could be killed. The slippery slope that supporters of euthanasia claimed would not happen is already fact. Next door in The Netherlands, voluntary euthanasia quickly led to involuntary euthanasia, and there was, for a time, a proposal on the table to have a “quality of life threshold” below which a person would no longer have the right to live. It may just be a matter of time before the severely mentally retarded will join the list of “useless eaters” and euthanized. A godless society only gives life a utilitarian value. Although Kant tried to set up a secular system that allowed for intrinsic human dignity, his dream died, at least in some European countries, and the remnants of the Christianity that still influenced Kant died away. Now there is no bar to making decisions regarding euthanasia not based on alleged “mercy,” but on a person’s ability to “contribute” to society. The fittest survive; those considered unfit will be eliminated. The most frightening instances of murder are those murders that use mercy to justify them. The only “mercy” involved may be for the family to get a burden off their back and the state to save on medical bills due to fewer patients requiring long-term care.

The United States, for now, has enough residual Christian belief to avoid Europe’s direction for now. However, given the responses of most of my medical ethics students to questions regarding the moral rightness or wrongness of physician assisted suicide, it seems that those supporting PAS will win in the long run. If they do, it will be no surprise if PAS leads the way into voluntary active euthanasia and eventually to involuntary active euthanasia. Society will be at last be in part of a eugenics movement that will make the earlier movement in the first decades of the twentieth century seem like child’s play. God help us all if that happens–and it will happen in Western Europe (and probably in Canada) before it happens in the United States. But with 30% of young people in the U.S. classifying themselves as “irreligious,” the road toward Europe may be wider than one might think.

Atheists forget, when they catalog the crimes of religion, that the mass murderous regimes of the twentieth century were atheistic: Nazi Germany, the Stalinist Soviet Union, Maoist Communist China, North Korea, and Cambodia when it was under the rule of Pol Pot. The sanctity of human life does not make sense in an atheistic framework; the value of human life must be instrumental and not intrinsic in a consistent atheistic system. It is no surprise, then, that Belgium and the Netherlands are going the route toward allowing more and more classes of people to potentially be subject to euthanasia. The Nazi world of alleged “useless eaters,” a world Europe once claimed to eschew for good, is coming back to haunt a godless society. The price paid for such folly will be very high.

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Dr. Jack Kevorkian: Sincerity Does not Negate Moral Evil

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Dr. Jack Kevorkian's cropped image

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My student often with identify sincerity with truth, especially on matters of morality and/or religion. I remind them that Lenin was no doubt sincere in murdering hundreds of thousands of his political opponents. And he was sincere–unlike his successor Josef Stalin, Lenin really did believe in Communism and that killing people may be best for a greater good. Surely his sincerity does not make his actions morally right.

Dr. Jack Kevorkian was a sincere man. I do not believe, despite his rather expressive paintings of gruesome death scenes, that he was a psychopath or sociopath. He was well read in ancient Greek and Roman classics and was well aware that until Christianity came along, the vast majority of Greeks and Romans supported euthanasia–the Hippocratic Oath, based on the Pythagoreans’ high view of life, was the exception rather than the rule. Kevorkian used their arguments about a person dying with honor and dignity, arguments that were later revived by David Hume (1711-1776), to defend physician assisted suicide. Unlike the current Oregon and Washington State laws, which allow a physician to dispense a prescription of a deadly dose of drugs to terminally ill people who gave prior permission, Kevorkian went further. He built his infamous “suicide machine” which the patient could start himself, but Dr. Kevorkian had the set up in terms of inserting IV lines and arranging the correct drugs in each IV bag. The first bag released normal saline; the second a sedative to relax the patient; the third a dose of a deadly drug. Technically a patient could stop the process at any time; whether this always was the case in practice is a disputed point.

Dr. Kevorkian was not insane, but he was really, truly, sincerely wrong. He believed that he was easing the pain of terminally ill patients (although one woman he “assisted” had fibromyalgia, which is not a terminal illness). Error often contains partial truth, and the partial truth in Dr. Kevorkian’s stance is that a doctor’s sole duty involves more than preserving life. Sometimes it is best for a physician to allow the disease process take its course and withhold or withdraw burdensome treatment such as a ventilator or artificial nutrition and hydration. But to go beyond that and allow physicians to actively help a patient kill himself by a deadly drug that is in no sense a treatment for illness violates the fundamental end of medicine to “first, do no harm.” Kevorkian and his defenders might say, “But we euthanize animals who are hurting.” That is true, but animals do not have the level of understanding of the pain they feel compared to human beings. Human beings can understand what is going on and realize why they are in pain–and they can take steps to get medical treatment to stop the pain. Many physicians are not aware that most pain can be controlled with the proper drugs.

My best friend, during the final month of her life, was in hospice, where she received drugs to control pain and nausea. While the drugs were not by any means perfect, she did feel better, and I and her other friends were able to spend precious time with her and say goodbye before she peacefully passed away. If all terminally ill patients in pain received better palliative care, most of the clamor for physician assisted suicide would most likely go away.

Dr. Kevorkian represents the contemporary view that severe pain is the ultimate evil that can happen to a human being. Don’t get me wrong–I hate pain and have a very low pain threshold. I could not imagine the agony of being in constant, severe pain. I would want the best treatment for pain available if I were in severe intractable pain. In an earlier world that began to dissolve in the fourteenth century, pain was not considered to be the worst evil. Dying without salvation was. Today society is secular, and even many Christians are Christians in name only–they never accepted the world view and view of human nature that comes with Christianity. So they go back to the old Stoic view that suicide can be acceptable in some circumstances. Yet even the Stoics believed it was normally best to suffer misfortune and pain; suicide was a last resort to protect one’s honor and dignity. The modern world does not understand fortitude through pain, using illness to draw closer to the transcendent, or using a long, drawn out dying process to adequately prepare for death, both in secular and in spiritual matters. Today people want a quick death–in their sleep, of a sudden stroke or heart attack. There are times I feel that way, too, but when I use my reason, I realize that knowing one is dying, even if it involves great pain, gives one time to prepare, to say goodbye, and to draw closer to God. None of that would have made sense to the atheist Dr. Kevorkian. Yet a secular case can be made against PAS as well.

Not only does PAS violate the fundamental end of medicine, which is to help a person in need, doing no harm, but wide scale legalization would take away the psychological barrier to including more classes of people as candidates for PAS. Professor Margaret Battin once said at a talk I attended that she believed that someone with intractable chronic depression that could not be treated with drugs is a legitimate candidate for PAS. Most of the audience of physicians and philosophers seemed to agree. What about the person with chronic back pain that is not helped by drugs? What about the woman with fibromyalgia? To how many groups of people will PAS be extended.

In the Netherlands, where PAS is legal, thousands of patients have been actively killed by their doctors–without giving prior permission and without a family or friend as proxy giving prior permission. The doctor makes a judgment about the patient’s quality of life–and if the patient’s quality of life does not measure up to the physician’s standards, the physician kills the patient. A recent attempt to formalize a quality of life standard, below which a physician could kill a patient, was defeated in the Netherlands. But with some physicians already crossing that barrier, it may be just a matter of time before the law reflects practice.

Doctors already have a great deal of power over the patient. The patient comes to the doctor for help, and the doctor has the knowledge and the power to diagnose and treat the patient. Given that amount of power, would someone really want to agree with Dr. Kevorkian to give the physician the authority to help a patient kill himself? Once power crosses one barrier, historically it has tended to cross others.

Dr. Kevorkian meant well. But history shows that some of the worst tyrants in history “meant well.” Pol Pot really believed that by killing the educated classes and moving the rest of the urbanized population of Cambodia he could create a classless society. Instead he murdered over a million people. Dr. Kevorkian only was involved in helping a few hundred people kill themselves. But multiply that by hundreds of other Dr. Kevorkian’s along with a racially individualistic society that affirms that a person “has the right to determine the time and manner of one’s death.” Such hubris feeds Dr. Kevorkians and feeds physician power over life and death–and this in turn feeds Death itself. God help us.

Euthanasia: Love or Selfishness?

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The skull and crossbones, a common symbol for ...

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I often listen to books on CD as I drive. Lately I have been listening to classics, the latest of which is D. H. Lawrence’s book, Sons and Lovers. It is a well-written book about two generations of the Morrell family, a mining family living near Nottingham. Near the end of the book, Paul Morrell is deeply disturbed by his mother’s suffering from cancer. He devoutly wishes that she would die. The agony becomes so great for him that he grinds up morphine-based pills and puts it in his mother’s evening milk. She drinks it, her breathing slows, and eventually she dies. Paul is relieved that his mother’s suffering is finally over.

Many readers will be sympathetic to Paul. After all, no one wants a beloved family member to suffer. Didn’t he do the most merciful thing? After all, we put animals down when they are suffering; why not allow human beings to have a similar merciful death?

I would argue that in many cases, including this fictional case, it is more likely that the giver of euthanasia was more concerned with his own pain watching a loved one suffer rather than concern for the loved one’s suffering. In the novel, Paul has put his life on hold during his mother’s illness. I would not deny that the story is meant to be read to show his love for his mother, but it also makes clear that the illness of Paul’s mother inconveniences Paul. There is an element of selfishness in his giving a deadly dose of morphine to his mother. If he had given it to her for the purpose of relieving her pain, knowing that death was a possibility, his actions could be defended under the principle of double effect. But his motive was to kill his mother, and this means that his actions were morally wrong–Paul is a murderer.

Family members who engage in euthanasia need to rationalize their actions, so they say that their action was wholly done out of love for the suffering family member. Perhaps that is true, but knowing human nature, it is easy for a person to rationalize selfish motivations as love to justify an intrinsically evil act. Sick people do inconvenience healthy family members. In American individualistic culture the prevailing ethic tells people to abandon the ill (or kill the ill person) so the survivors can fulfill their own life plans. This is pure selfishness and a grossly wicked attitude to have. We are not isolated individuals but are interconnected from our immediate family to our friends and then to others. Sickness is part of the human condition, and it is part of our duty as moral human beings to support our sick loved ones and not try to get them out of the way in the name of “mercy.” Too often the only “mercy” an euthanizer has is for himself–he gets rid of the source of his pain.

Hospice did not exist in Lawrence’s day; it does today and offers excellent care for the dying. Pain control methods are better, and doctors are now receiving training in pain control. Will this quiet the drive toward euthanasia? I fear that American society is too selfish to avoid the mistakes of the Netherlands in legalizing physician assisted suicide, which in turn has led to both voluntary and involuntary euthanasia. And in Lawrence’s book, Paul’s mother did not want to die; she desired to live as long as she could. Paul killed her against her will. Hopefully people who still believe in human community, the dignity of human beings, and mutual care for the most vulnerable among us will be able to stop any future moves to legalize euthanasia in the United States.

Physician Assisted Suicide and the Ends of Medicine

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When I ask my medical ethics students whether they support physician assisted suicide (in the sense of the physician prescribing a deadly dose of a drug, usually barbituates, for the patient to take when he wishes), the vast majority raise their hands. Even most students in my classes who oppose abortion support physician assisted suicide (PAS). To me this is disturbing, especially since the strongest support for PAS has been in my class of future physician assistants.

What is so wrong, you may ask, about physician assisted suicide? After all, even with ideal pain control, some terminally ill patients either remain in a great deal of pain or have to be totally sedated. Why not allow such patients to “control the time and manner of their own deaths?” Surely PAS will encourage more dignified deaths among patients in intractable pain. And in referendums, Oregon and Washington have passed laws permitting PAS. Shouldn’t this practice spread to other states?

Although PAS sounds attractive, its practice would be a fundamental distortion of the proper goals of medical practice. The internal goods of medicine include restoring a patient to health, and when a patient cannot be restored to health, to make that patient as comfortable as possible. But supporting a patient’s suicide indirectly involves the physician in killing a patient. Physicians have a great deal of power over patients, power which, if misused, can lead to pain, suffering, and death–as the Nazi medical experiments and the Tuskegee Syphillis Experiment revealed. Now a physician can withhold or withdraw medical care that is only prolonging the dying process. The goal is not to hasten death per se, but to relieve the patient’s suffering. But prescribing a deadly dosage of a drug is designed to let the patient hasten his death. One may say that the motive is to relieve suffering, but there is a difference between allowing the disease process to take its course and giving a drug so a patient can actively commit suicide. This abuse of medical power has already spread in the Netherlands, where PAS is legal, to doctors actively killing patients without the patient’s permission or the patient’s family’s permission. Once the line forbidding a physician from assisting in a patient’s death is crossed, it will be difficult to turn back. Doctors participating in PAS will not be practicing medicine, but doing something else entirely–being accessories to suicide.

There is an assumption in the modern world that pain is the worst thing that a person can experience. That was not the view of the premodern world. Socrates was willing to suffer pain and death to keep his integrity. The early Christians suffered excruciating torture via persecution–they believed that they were sharing in the sufferings of Christ. And without modern pain control methods, people suffered far more from diseases than they do today, yet the drive for PAS is a modern movement (David Hume was among the first to defend suicide as an option in a person in great pain). This does not mean that we should not try to stop pain as much as possible short of actively killing the patient or giving the patients the means to suicide. Relieving suffering is a moral obligation of physicians as long as medical power does not cross over the line into aiding a patient in his active demise. Even in this post-Christian world, would secularists really want doctors to cross the line into PAS? Could PAS be controlled once the genie is out of the bottle? I do not believe so–but even if PAS is the only line that is crossed, it remains inimical to the ends of medicine and is wrong.