Medical Journals & the Culture of Death

An acquaintance of mine is about to head off to medical school.  She is apprehensive about Obamacare – and about her loans. She is taking out a special kind of insurance in the event something happens to her over the next several years, before she can start earning back the hundreds of thousands of dollars she’ll be racking up in debt. Nonetheless, she’s eager to develop her talents and to become an instrument of healing.

She is less attuned, however, to the ideological minefield she will have to traverse, likely with little training or support, if she is to recognize the assaults on human life distorting the healing professions from within. A tour of recent issues of the leading medical journals provides a sample of what she will be up against.  The July 11 and 12 editions of the august Lancet, New England Journal of Medicine, and British Medical Journal all (not entirely by chance) published articles sympathetic to expanding the end-of-life killing license.

The Lancet study assessed trends in the practice of physician-assisted euthanasia in the Netherlands since 1990 in order to gauge the impact of its 2002 legalization.  It applauds what it deems the transparency of this transition and states that, at present, “the incidence of euthanasia and physician-assisted suicide is comparable with that in the period before the law.”  In other words:  nothing really to worry about. That was the take-home message the media compliantly touted in turn.

The data themselves point to another conclusion.  Among other troubling trends, the number of euthanasia deaths was 67 percent higher in 2010 than it was in 2005; underreporting also remains an issue, with only 77 percent of euthanasia cases properly classified.

Veteran observer Wesley Smith notes that the study’s own data reveal that physicians trigger about 14 percent of all deaths in the Netherlands today.  It climbs that high when you count the practice known as “terminal sedation,” which in substance amounts to euthanasia on the installment plan:  patients are put into a coma until death comes from starvation or dehydration – not the underlying disease or condition.

In Evangelium Vitae, John Paul II decried this very tendency “to disguise certain crimes against life…by using innocuous medical terms which distract attention from the fact that what is involved is the right to life of an actual human person.”  Those with pricked consciences about the nature of unethical end-of-life practices feel the need to resort to obfuscation. 

But once the premise becomes openly accepted – that the physician may rightly take life – disguise becomes less and less urgent, as is evident from the advent of mobile euthanasia units. There is “unmet need” for euthanasia, you see, so earlier this year the Netherlands began to equip teams to hit the road and go meet that need.  How considerate. Euthanasia prevention advocate Alex Schadenburg reports these units plan to “reach” 1,000 people per year.

Redefining Physicians’ Role in Assisted Dying” is the New England Journal of Medicine’s offering.  It is called a “perspective” piece, but that is precisely what it lacks – a humane one at any rate.  By that, I mean one roughly consistent with essentially universal codes of medical ethics (including many from non-Christian cultures) going back millennium, which do not endorse physicians taking the lives of their patients.

A number of pragmatic objections to the practice of assisted dying, the authors claim, have not come to pass. It’s therefore time to get over any unfounded, lingering qualms. They dismiss the most fundamental objection – that allowing assisted dying undermines the sanctity of life – by writing:

This is a subjective moral question, commonly framed in terms of absolute preservation of life versus respect for personal autonomy — a divide that often falls along religious lines.

It is no such thing.  Not long ago, most people would have recognized that it is objectively wrong to actively take human life just as, I suspect, most still instinctively recoil at the thought of mobile euthanasia units.

How the authors say the issue is commonly framed is also an imprecise mischaracterization. Nowadays, it often eludes those with elite schooling. It now takes a solid “old school” upbringing or a proper, well-rounded education to spot this error – reassigning matters of objective moral truth to the realm of subjective prerogative – responsible for so much of our cultural rot.

Since there is “no clear, objective answer,” the authors maintain, all preferences should be respected.  They point, however, to a pesky obstacle to broader implementation of enlightened euthanasia policies:  most physicians are not keen on killing their patients.  Their solution? Take it out of the hands of the doctors. Establish “a central state or federal mechanism” (uh-oh!) – with appropriate safeguards, of course – whereby patients can get on with ending their lives without having to rely on doctors to lend pro-active support.

A professional ethicist, writing in the British Medical Journal, covers similar ground. He bluntly stresses that a U.K. “Sanctity of life law has gone too far”; it has infringed upon the subjective wishes of various parties and unduly cramped cost considerations. 

Aspiring doctors who suspect the journals they’ve been conditioned to regard as authoritative aren’t repositories of wisdom on such matters might ponder the relevance of these words by Hilaire Belloc:

We sit by and watch the Barbarian, we tolerate him; in the long stretches of peace we are not afraid. We are tickled by his irreverence, his comic inversion of our old certitudes and our fixed creeds refreshes us; we laugh. But as we laugh we are watched by large and awful faces from beyond: and on these faces there is no smile.

We need them to see unsmiling faces any time they are encouraged to think that various forms of life-taking are merely the ineluctable, noble applications of medical science.
Matthew Hanley

Matthew Hanley’s new book, Determining Death by Neurological Criteria: Current Practice and Ethics, is a joint publication of the National Catholic Bioethics Center and Catholic University of America Press.