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.

Anti-Religious Bias in Medical Ethics

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English: Medicine

Image via Wikipedia

A few of my medical ethics students (not by any means the majority) object to my including such a large component of religious ethics in my teaching. Such an attitude is not surprising–it is another instance of religion’s increasing exclusion from public life and debate (Fr. Richard John Neuhaus‘ “naked public square,” but it is nevertheless disturbing. The founders of the great Hippocratic tradition of medicine (and ethics) were Pythagoreans, and their thought cannot be understood apart from Pythagorean mysticism. Roman Catholic scholars were producing texts in medical ethics as early as the seventeenth century, and taught medical ethics as a university course long before the contemporary bioethics revolution began in 1966. Roman Catholic concepts such as the principle of double effect and the ordinary-extraordinary care distinction have become a part of the ethical vocabulary in medicine.

In addition, Protestant scholars, such as Paul Ramsey and James Gustafson, have made important contributions to medical ethics. Jewish scholars, such as Hans Jonas and Leon Kass, have also contributed to the field, with Professor Kass serving as the chairman of the President’s Council on Bioethics during the Bush administration. Muslim scholars are beginning to be published in both mainstream medical and in medical ethics journals. At a practical level, understanding diverse religions is important for any health care provider.

The terms of the debates over key bioethical issues such as abortion and euthanasia cannot be adequately understood without understanding the religious arguments involved in these debates. I am not denying the possibility of a consistent secular ethics; I am saying that, as a matter of fact, de-emphasizing the religious aspect of medical ethics is irresponsible, period, and would be more irresponsible for me from a scholarly/teaching point of view.

What is more disturbing than students’ attitudes, which may be as much due to lack of exposure to alternative views (especially for those students who are “rabidly secular”), is the increasing exclusion of religious points of view from medical ethical debates. This exclusion is not absolute; journals such as the Hastings Center Report occasionally publish articles from a religious perspective, as do some other journals in medical ethics, but this is becoming increasingly rare. The false Enlightenment assumption that religion is only a private, subjective matter is part of the problem. Such a view reveals utter ignorance of the function of religion in personal behavior and in society. As one of my teachers at UGA once said, “I would never be such a damned fool as to claim that religion is only a private matter.” He was a liberal Protestant and not a raging Fundamentalist, but he understood the function of religion to be inherently social. He also understood that religions make claims about reality, and such claims can be broadly tested against human experience in general, although there will always be an element of faith and of mystery in religion.

Increasingly, I find a small group of students who could be called “misotheists”–they hate God or at least the notion that any Creator exists. Since these are mostly science students, I would guess they were encouraged to believe such things by some of their science teachers, as well as by the strict methodological atheism of modern and contemporary science. Far too many science teachers make sweeping metaphysical claims regarding religion being a superstition and claim that such a view is “scientific.” Of course this is really the philosophy of “scientism,” the view that science can explain all reality and that any reality claims that go beyond a mythical “scientific method” are, by their very nature, not part of reality. Such a view needs to be justified by argumentation, but neither the scientists who accept scientism nor students are willing to present arguments–their hostility to religion is palpable. Other students (and atheists and agnostics in general) are angry ex-religious people who have rebelled against, perhaps, a harsh religious background (or maybe they just want to get laid and don’t want any religion to get in their way). Since misotheism is, like scientism, an emotionally-based position, there is no rational way to get most people who hold such views to think them through.

I admit I’m frustrated. It is becoming increasingly difficult to be a religious believer who teaches in a college or university. They follow the logic of the eighteenth century Enlightenment, adopting not only its positive side (toleration for different points of view) but also its negative side (the total secularization of the academy). Even in religious schools, the logic of the Enlightenment leads many faculty be be atheists or agnostics and to minimize the role of religion in public life. It is sad that this attitude has spread to future health care providers.

The Ethics of Psychedelic Research on Human Subjects

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Stanislav Grof, psychologist and psychiatrist

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Is it morally right to do research using psychedelic drugs such as mescaline, LSD, or DMT using human subjects? Much laboratory research has been done using animals already, and someone may argue that there is no need to study these dangerous substances in human beings. I will argue otherwise.

All three of these drugs, as well as other psychedelics, are widely abused–and that is one of the dangers of research–the press will find out about the research, disseminate information about it, and some non-addicts will read about the research and say, “Now that drug seems interesting–I think I’ll try it.” Ergo, we have more addicts than ever. But I would argue that that danger is exaggerated. Knowledge of mescaline and LSD has been public for many years, and DMT has become increasingly known since the 1990s. Mushrooms have been used for centuries, and ketamine has been widely abused since the 1960s. I do not see how human trials could publicize these drugs any more than they already have been–and even if they do, dangerous side effects and bad trips will also be publicized, scaring many people away from trying them.

The main reason I support psychedelic research with select groups of human subjects is that some mental illness is intractable to current treatments. Some cases of schizophrenia, for example, are so severe that current therapy does little or no good. Some researchers, such as Stanislav Grof, have used LSD in the treatment of schizophrenics. Other conditions, such as depression, can be so severe that only electroconvulsive therapy does any good, and the good that is does is only temporary. Plus, ECT carries with it the risk of brain damage. If some psychedelics could be used to treat these intractable cases of schizophrenia and depression more effectively than current treatments, especially if such research is backed up by animal studies, why not try it using select subjects. Now for subjects able to give informed consent, they should be thoroughly warned about the risks of such studies. For subjects who are mentally incompetent, the family member or person with power of attorney should be given sufficient information to give or withhold informed consent based on his interpretation of the patient’s prior wishes. If risks are thoroughly explained, and the patient has not been helped by any other treatment, and informed consent is given, I see no ethical problem with attempting to determine whether a psychedelic drug can help the patient. A critic may reply, “What about the risk of harm, both physical and psychological? What about the risk of future addiction caused by the study?” If current treatments, such as ECT, can harm the patient and only give a temporary reprieve from the illness, a study using psychedlics most likely would not do more harm than prior treatments–and it may help. As far as the risk of addiction, that comes with the territory of any drug that helps a patient feel better. Should we stop research on painkillers because some patients become addicted to them?

The FDA has been very conservative in approving studies with psychedelics. Part of this caution is necessary to prevent harm to human subjects. And no one wants to go back to the days when the U. S. Army and CIA were secretly giving LSD to soldiers–one soldier committed suicide. The FDA has the right to leave no stone unturned–I would not want to be the FDA agent who helped pass a study that ended up harming research subjects. But sometimes regulatory agencies hear the word “psychedelic” and are afraid to support any research involving such drugs, even if they potential to treat intractable mental illness. Hopefully some balance can be found between the absolute necessity of protecting research subjects and the desire to find new drugs to help those who cannot be helped with current therapies.

Ethics and Resuscitation

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CPR training

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Contemporary medicine brings with it ethical problems that human beings have not faced before. With the advent of modern resuscitative techniques, issues arise of when to start and stop cardiopulmonary resuscitation. In the 1950s, doctors in hospitals often carried a scalpel that was used when a patient went into cardiac arrest–the chest would be opened, and the heart massaged directly. This method saved the lives of many surgical patients as well as generally healthy pregnant women who had reactions to the anesthesia then routinely given during labor and delivery. It is still used today on trauma victims and on some heart attack victims. In 1960, William B. Kouwenhoven and his associates published an article in the Journal of the American Medical Association on closed-chest heart massage, which is still taught to the general public in CPR classes today. In the early days, doctors would sometimes work on a patient for over an hour, and some of these patients recovered without significant brain damage. Over the years, many other patients suffered severe, disabling brain damage. As CPR spread beyond drowning victims and victims of cardiac death due to a medical condition (such as a myocardial infarction, a “heart attack,” debates over when to use it intensified. CPR might, for example, bring back briefly a dying cancer patient, but what would be the point (unless the patient was waiting for a family member he wished to see before he died or another personal reason)? “Do-not-resuscitate” forms came into vogue, in which the patient or a proxy could let his wishes be known on whether he should be given CPR. I have had several relatives and friends die in peace because they did not go through CPR and advanced cardiac life support after cardiac arrest.

But what about the following scenario: a young woman collapses while jogging at a marathon. CPR is immediately started, along with advanced cardiac life support by the ambulance crew, and the patient is taken to a hospital. It is twenty minutes after her cardiac arrest. Doctors immediately pronounce her “dead on arrival.” This is an actual case; I am leaving out the names of the marathon, the city, and the hospital. What troubles me is that even today some doctors do not give up after twenty minutes, and patients do recover after an hour of CPR and ACLS. Some of these patients fully recover, physically and mentally. Why pronounce a young woman dead twenty minutes after cardiac arrest–maybe her heart only had an electrical glitch that, with treatment, could be controlled, or she could be given an implantable defibrillator and live for many years. We would not know–but twenty minutes seems so short in a decision that guarantees that the woman is dead.

One reason I feel strongly about death being pronounced so quickly in such a case is that my mother suffered a cardiac arrest. Doctors worked on her over two hours (and she did have some times in which her heart would beat off and on during that time), and eventually put one pacemaker line in that did not work; the second line did. She recovered without neurological effects and received a pacemaker and implantable defibrillator.

It seems that too many CPR decisions, both by paramedics and by hospitals, are more based on triage than on what could help patients (albeit a very small percentage of patients). I once asked a PA student who had worked at a hospital whether doctors would work on a trauma patient in cardiac arrest (which they sometimes do if the patient had signs of life at the scene). He replied it depended on how much time they had. I wonder if this is the same for patients in medical cardiac arrest. Now some of these patients may have had a DNR order that was discovered, so when the newspaper says someone was pronounced dead after a short ride to the hospital the DNR is the real reason. But when I read in the paper about drowning victims who were in the water less than five minutes being pronounced DOA twenty minutes later, this is troublesome. Would not there be a moral obligation, in a life or death situation, to try a bit longer, especially given the existence of some successes in the past? If a fifty-year-old man has his first MI, a witnessed arrest with bystander CPR, is twenty minutes’ effort enough for him? I am sure doctors mean well and are looking at “evidence-based medicine,” and studies that say the success rate of ACLS after 20 minutes is extremely low. Because of such studies, paramedics are calling codes over after 20 minutes of CPR and ACLS in the field. In an unwitnessed arrest, this may be justified. If the arrest is witnessed with no CPR given before the ambulance arrived, it may be justified. I am not so sure if the arrest is witnessed.

In the case of trauma, I know of at least two instances, one in Tennessee, the other in North Carolina, in which paramedics said that a patient was dead–and the patient was not. I can understand triage at a trauma scene; the chance of CPR and resuscitative thoracotomy (opening the chest and massaging the heart directly, which is done with some trauma victims) have such a low chance of success with trauma victims) is almost nil (although, contra most articles, there have been survivors of blunt traumatic arrest who fully recovered–check out Woodbury, Minnesota). So if the number of paramedics is limited and someone else with a pulse and severe injuries needs to be treated, in those cases it is acceptable to consider the person in cardiac arrest dead. Otherwise, outside of severe head injuries with brain matter, obviously broken necks, obvious severe bodily trauma, and clear signs that too much time has passed, why not try CPR? Sometimes trauma victims swallow their tongues or get debris in their mouths, and they arrest due to asphyxiation. What is wrong with clearing the airway, trying CPR for a few minutes, seeing if there is any rhythm on the monitor. If not, what harm does it do? It doesn’t harm the patient. And a life might be saved.

I realize that physicians will say, “You’re not a physician and have no right to say anything about these issues.” No, I am not a physician; I volunteered as an EMT-Basic for eight months, but the knowledge from the training is extremely small compared to a physician’s. But I can read articles in medical journals, I can use a dictionary, and I can interpret the data and cases I read. I do know that there is a difference between someone with a shockable rhythm and someone whose initial rhythm is PEA or asystole, and that death will be pronounced more quickly in the latter situations unless a readily reversible cause of the arrest can be found. But the clincher for me is that my mother would have died if the doctors had given up on her. Thank God for them, and for my brother, who pushed the doctors to continue CPR even after they had considered giving up. It is too bad that other patients do not have such an advocate.