Bioethics — Part 2: Is it compassion, personal autonomy, or ulterior utilitarian motives at heart?

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Following the publication of the first part of this article dealing with bioethics and infanticide,[1] I received correspondence from a former colleague, Dr. Richard L. Elliot, Director of Medical Ethics at Mercer University, contending there is little difference among medical and biomedical ethicists; that my characterization of bioethicists as utilitarian moralists (useful agents of the State) may not be accurate; and that autonomy (and personal choice) is given “high priority” by bioethicists.[2] I beg to differ on all counts.

I have served as a chief medical editor in four medical publications, the Journal of the Medical Association of Georgia (1993-1995), the Medical Sentinel (1996-2003), Surgical Neurology (2004-2010), and Surgical Neurology International (SNI; 2010-present). In all four of these journals there were considerable discussions about ethics and the nuances of tenets between traditional medical ethicists who follow Hippocratic teachings and biomedical ethicists who follow utilitarian precepts, and articles to that effect were published in them, as well as in the Journal of the American Medical Association (JAMA); at least four articles and/or letters on the subject were published in the last two years in SNI revolving around this subject.

As far as disagreeing with my characterization of bioethicists and their alleged prioritizing for autonomy, below are telling remarks, not by death-obsessed crackpots but by leading lights of the bioethics movement:

1. Dr. Daniel Callahan, Professor of Bioethics and former Director, now President Emeritus, of the Hastings Center: “Denial of nutrition, may, in the long run, become the only effective way to make certain that a large number of biologically tenacious patients actually die.”[3]

2. Dr. Peter Singer, Professor of Bioethics at Princeton University: “Fetuses like newborns lack the essential characteristics of personhood — ‘rationality, autonomy, and self-consciousness’ and therefore ‘killing a newborn baby is never equivalent to killing a person, that is, a being who wants to go on living.”[4,5]

3. Dr. John Hardwig, Professor of Ethics at the University of Tennessee has repeatedly affirmed that elderly patients, who have lived a full life as well as those citizens whose lives have become not worth living because of chronic disease, have a “duty to die” for the good of society and the proper utilization of societal health resources. Moreover, he has gone farther than most pointedly admitting denial of individual autonomy by asserting there is a “responsibility to end one’s life in the absence of any terminal illness…a duty to die when one would prefer to live…even those who want to live can face a duty to die.[6]

4. Dr. Ezekiel Emanuel, Director of the Clinical Bioethics Department at the U.S National Institute of Health and one of the architects of Obamacare has proposed that we should all die by age 75 because “we are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic.” Dr. Emanuel claims he is not advocating euthanasia at age 75 “in order to save resources, ration health care, or address public-policy issues,” but that is exactly what he is inferring and in fact later he makes utilitarian proposals to redistribute health resources from the old and infirm to the younger generation.[7]

In reference to my previous article in which I referred to the bioethicists call for newborn infanticide, I received inquiries as to why not adopt, instead of killing these babies. Here is how the bioethicists responded:

“On this perspective, the interests of the actual people involved matter, and among these interests, we also need to consider the interests of the mother who might suffer psychological distress from giving her child up for adoption. Birthmothers are often reported to experience serious psychological problems due to the inability to elaborate their loss and to cope with their grief… those who grieve a death must accept the irreversibility of the loss, but natural mothers often dream that their child will return to them. This makes it difficult to accept the reality of the loss because they can never be quite sure whether or not it is irreversible.”[8]

Thus according to the bioethicists, ostensibly adoption would be too traumatic, more so than the killing of the newborn infant. At this juncture, we must pause and ponder whether we have here a pathologic inversion of priorities due to some sort of convoluted compassion, or plain, deliberate and deceitful casuistry!

It is no wonder, then that with all this obsession to push society towards “a duty to die” mindset and euthanasia for the most vulnerable in our society — not necessarily respecting individual autonomy, as it is claimed by some as “the right to die,” but really for utilitarian reasons, the conservation and redistribution of resources — moral philosopher Wesley Smith has pointedly called the bioethics movement a “culture of death.”[9]

References

1. Faria MA. Bioethics — Should they encourage the killing of unwanted newborn infants? HaciendaPublishing.com, July 12, 2015. Available from:  http://haciendapub.com/articles/bioethics-%E2%80%94-should-they-encourage-killing-unwanted-newborn-infants

2. Elliot, Richard L. Bioethics and Infanticide. Hacienda Publishing.com, July 22, 2015. Available from: http://haciendapub.com/articles/bioethics-%E2%80%94-should-they-encourage-killing-unwanted-newborn-infants#comment-1360

3. Callahan, Daniel. “On Feeding the Dying,” Hastings Center Report 1983;13(5):22. Much more can be found in Daniel Callahan’s book, Setting Limits — Medical Goals in an Aging Society. New York: Simon and Schuster, 1988. A recent article encapsulates the views of Dr. Callahan which have not changed since the publication of his book. Available from: http://khn.org/daniel-callahan-limits-on-health-care/

4. Singer, Peter. FAQ. III: The Sanctity of Human Life. Princeton University, March 2009. Available from: http://www.utilitarian.net/singer/by/200509–.htm

5. Singer, Peter. “An Interview” in Writings on an Ethical Life. 2001, p. 319–329. 

6. Hardwig, John. Is there a duty to die? Hastings Center Report 1997;27(2):34-42. In this comprehensive article, Hardwig goes to great lengths to defend his rationalization for “the duty to die” and enumerates all of the criteria for death, “even for those individuals who would prefer to live.”  Available from: http://web.utk.edu/~jhardwig/dutydie.htm

7. Emanuel, EJ. Why I Hope to Die at 75: An argument that society and families — and you — will be better off if nature takes its course swiftly and promptly. The Atlantic, September 17, 2014.  Available from: http://www.theatlantic.com/magazine/archive/2014/10/why-i-hope-to-die-at-75/379329/ 

8. Giubilini A, Minerva F. After birth abortion: why should the baby live?  J Med Ethics (2012). doi:10.1136/medethics-2011-100411. Available from: http://jme.bmj.com/content/early/2012/03/01/medethics-2011-100411.full

9. Smith, WJ. Culture of Death — The Assault on Medical Ethics in America. San Francisco, CA: Encounter Books, 2000. Book Review available from: http://www.haciendapub.com/medicalsentinel/bioethics-movement-emerging-culture-death

Additional Reading

10. Faria MA. Bioethics — The Life and Death Issue. HaciendaPublishing.com, October 24, 2012.

11. Faria MA. Euthanasia, Medical Science, and the Road to Genocide. Medical Sentinel 1998;3(3):79-83.

12. Faria MA. Slouching Towards a Duty to Die. Medical Sentinel 1999;4(6):208-210.

13. Faria MA. The road being paved to neuroethics: A path leading to bioethics or to neuroscience medical ethics? Surg Neurol Int 2014;5:146.

14. Faria MA. Bioethics and why I hope to live beyond age 75 attaining wisdom!: A rebuttal to Dr. Ezekiel Emanuel’s 75 age limit. Surg Neurol Int 2015;6:35.

Written by Dr. Miguel Faria

Miguel A. Faria, Jr., M.D., is an Associate Editor-in-Chief and a World Affairs Editor of Surgical Neurology International; Clinical Professor of Surgery (Neurosurgery, ret.) and Adjunct Professor of Medical History (ret.) Mercer University School of Medicine. He served under President George W. Bush as member of the Injury Research Grant Review Committee of the Centers for Disease Control and Prevention (CDC; 2002-05); His website is https://haciendapublishing.com

An edited version of this article (due to space constraints unreferenced) appeared in the Macon Telegraph, August 30, 2015 under the title: “Opinion — Bioethicists versus medical ethicists.” The full version here is fully annotated and the reader is invited to avail themselves of these references to find out the reality of the bioethics movement.

This article may be cited as: Faria MA. Bioethics — Part 2: Is it compassion, personal autonomy, or ulterior utilitarian motives at heart? HaciendaPublishing.com, August 24, 2015. Available from: https://haciendapublishing.com/bioethics-part-2-is-it-compassion-personal-autonomy-or-ulterior-utilitarian-motives-at-heart/(opens in a new tab)

Copyright ©2015 Miguel A. Faria, Jr., M.D.

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