Discardable Patients

0 Comments | Insight on the News, May 28, 2001 | by Robert Stacy McCain

Some critics fear that bioethlcs may be undermining the sanctity of human life.

The Hippocratic oath may be on its deathbed, succumbing to a fatal disease called bioethics, according to Wesley J. Smith, a lawyer and antieuthanasia activist. Smith fears bioethics' leading theorists increasingly emphasize "quality of life instead of sanctity of life," meaning that some patients are viewed as "discardable." He thinks doctors and other healthcare providers are refusing lifesaving treatment to patients -- often the elderly and disabled -- whose lives are judged not worth preserving.

A former associate of consumer advocate Ralph Nader, Smith began exploring the field of bioethics, after writing a 1997 book, Forced Exit, about the assisted-suicide movement. He was shocked to discover that views he regarded as extreme -- such as those of Princeton University bioethics professor Peter Singer, who has claimed some human lives are less valuable than the lives of chimpanzees -- were widely accepted among bioethicists.

"Peter Singer, I thought, was on the fringes of bioethics. It turns out he's in the mainstream," says Smith, whose new book, Culture of Death: The Assault on Medical Ethics in America, explores the real-life consequences of bioethics theories. "One of those theories is called futile-care theory or medical futility, in which doctors are giving themselves the right to say no to wanted, life-extending medical treatment based on the doctor's judgment of the patient's quality of life."

Such a theory "does away with the Hippocratic oath -- which few doctors take anymore -- and leads us to a place where the weakest and most vulnerable among us, in essence, become discardable," Smith says. Bioethicists view the deaths of such patients as answers to their own problems, "as answers to the problems of their families as caregivers, as answers to issues of better distribution of medical resources, which has put our medical system in a transition where the right to die quickly becomes the duty to die."

In his book, Smith chronicles how these theories are turned into actual medical practice. Examples abound:

John Campbell's teen-age son, Christopher, had been in a coma for three weeks because of brain damage suffered in an auto accident. When Christopher developed a 107-degree temperature, a doctor refused to order treatment, saying the boy's life was "effectively over" and there was no point in treating the fever, according to Christopher's father. The doctor, fearing legal consequences, finally relented in the face of Campbell's angry insistence. Christopher survived and slowly has begun recovering from his injury.

* In 1997, a top Cleveland neurologist was accused of taking part in a conspiracy to "commit homicide so as to obtain organs" for transplant operations. The doctor had proposed new treatment protocols that allowed organs to be surgically removed after heartbeat and respiration stopped, but before patients were declared "brain-dead." Although the case led to a report on CBS' 60 Minutes, similar policies long had been in effect -- and still are in effect -- at other hospitals.

* Between 1977 and 1982, 69 babies born with a severe birth defect called spina bifida were used in an experiment in which 36 received aggressive treatment and 33 were to get "supportive care." All the treated children lived; nearly all the rest died, most in less than two months. But four of those who were recommended for "supportive care" survived -- only because their parents refused to accept the doctors' recommendations and sought treatment.

Smith says such "horror stories" as he calls them, are reminiscent of Nazi Germany, where the diseased and disabled were deemed "unworthy of life." Despite his own long history of liberal activism with Nader -- "He taught me how to be a citizen advocate.... I think of myself like Paul Revere," Smith says -- he acknowledges that conservatives seem much more concerned about problems in bioethics.

"The liberal groups, which I perceive as being about protecting vulnerable and defenseless people, seem to have difficulty looking this issue square in the eye," he says. "Many right-to-life groups have come to appreciate the bioethics issues. I think there is an anti-intellectual streak among some liberals that says if right-to-life people think one thing, they are duty-bound to think another."

That's one reason Smith avoids the abortion issue. "I don't want to lose half my audience," he says. But according to Smith, the bioethics debate provides an opportunity for those on both sides of the abortion debate to come together to support the sanctity and equality of all human life. "Indeed, some of the most effective opponents of the bioethics movement are disability-rights activists, who tend to be liberal, secular and pro-choice," Smith says. "Yet, disability-rights activists work shoulder-to-shoulder with activists who tend to be conservative, religious and pro-life because they have found common ground on these issues and have stood together on the equality of human life."