An entire culture is unraveling because its underlying philosophy is defective. As a part of this philosophy, a new ethics has replaced our traditional medical ethics, and the core values of Western Civilization --- the worth of the individual and the sanctity of human life --- have been rejected, along with the tradition of Hippocrates, religious values, and the very idea of objective right and wrong. There is nothing special in being human, killing is beneficent, suicide is rational, and caring for the elderly is a burden that wastes our financial resources.(1) This is what Wesley J. Smith documents in his shocking book, Culture of Death --- the Assault on Medical Ethics in America. Smith, an attorney for the International Anti-Euthanasia Task Force and author of the 1997 book, Forced Exit --- the Slippery Slope from Assisted Suicide to Legalized Murder, (see Medical Sentinel, Vol. 4 No. 6, p. 228) ties the development of this Culture of Death directly to the new field of bioethics, which he describes as a 30-year-old faith-based social movement.
Bioethics originated in the 1960s from discussions about how "justly" to distribute medical treatments. In the 1970s its patriarch, Utilitarian philosopher Joseph Fletcher, created "situational ethics," an ethical version of "anything goes," which rejected individual rights.(2) Fletcher used subjective terms such as "humanhood --- and he advocated killing disabled children. He stated, "...it is better to be dead than to suffer too much or to endure too many deficits of human function."(3) Other bioethicists, several of whom have written popular medical ethics textbooks, include Tom Beauchamp, James Childress, Ronald Dworkin, Edmund Pellegrino, David Thomasma, Daniel Callahan, Albert Jonsen, John Rawls, John Harris, Peter Singer, Tom Regan, Robert Veatch, and John Hardwig. These egalitarians are members of what some have called the "priesthood of death." They believe that individual rights do not apply equally to all people. In addition to following an unworkable Utilitarian philosophy with its population-based ethics relying on altruism, bioethicists promote their views by the subversion of language --- for example, using terms such as "nonhuman animals" and "speciesism." They blur the distinction between animals and humans by ignoring the uniqueness of man's rational faculty. They also trivialize evil, for example, by comparing slavery and the Holocaust with animal husbandry and eating meat.(4)
Bioethics has promoted the development of the "Georgetown mantra," assisted suicide and euthanasia, the animal rights movement, "futile care theory," health care rationing, the "duty-to-die ethic," and killing by dehydration. Bridging the change from fee-for-service medicine to managed care, it sees the sickest patients as "...unwanted ballast who burden the health care system."(5) According to egalitarian bioethicists, determining the criteria of "personhood" identifies "those sorts of individuals who have the highest moral value or importance." Death is inflicted on those who fall short in order to achieve "distributive" justice.
Bioethics promotes hatred between different classes of citizens, but its most alarming influence has been on the education of our college, medical and postgraduate students who now associate ethics with the four failed principles of the "Georgetown mantra" which, as Smith points out, merely are outcome determinants.
The "mantra," from the first, emphasized patient autonomy. Physician paternalism was the bogeyman. The "mantra's" four "principles" are autonomy, beneficence, non-maleficence, and justice ("distributive" or "social" justice). As Smith notes, since these are not anchored in morality, they often conflict and they can justify any outcome. For example, euthanasia, which fulfills the patient's wishes (autonomy), is seen as a "healing act" (beneficence) and saves resources for other societal needs ("distributive" justice).(6)
Respect for "autonomy" soon led to the abandonment of the seriously-ill patient and promoted the assisted-suicide movement since "rational suicide" must be respected in order to prevent paternalism. (Suicide is only wrong if it is irrational.) In Holland, where assisted suicide and euthanasia have been practiced for many years, the slippery slope already is reality. The 1991 Remmelink Report revealed that 6,000 patients --- nearly 5 percent of all deaths for 1990 --- were killed involuntarily by Dutch physicians.(7) This figure by now likely is much larger.
Assisted suicide has been legal in Oregon since 1997, but none of the 43 persons who underwent assisted suicide during its first two years were experiencing "severe, unrelenting and intolerable" suffering so that in Oregon, assisted suicide simply replaced medical treatment. Unfortunately, assisted suicide now is presented favorably by Hollywood and the major news media --- Mike Wallace, Larry King, and Tom Cruise all are fans of Jack Kevorkian.
The group PETA (People For the Ethical Treatment of Animals) uses the same ethics as that found with the "Georgetown mantra." PETA wants to end all use of animals by humans. But as Smith points out, not using animals in research would be an act of cruelty to humans. According to PETA founder Ingrid Newkirk, humans and animals are equal, and humans have no special rights. She states, "A rat, is a pig, is a dog, is a boy. They're all mammals."(8) Irrational ideas like this today are accepted and promoted by the molders of our popular culture in the universities and in the entertainment industry.
"Futile care theory," another result of the bioethics movement, was popular during the 1990s. It authorizes doctors to terminate wanted life-extending treatments and leads to rationing based on discrimination. Both the Society of Critical Care Medicine and the American Thoracic Society support it, the latter stating in 1991, a "...health care institution has the right to limit a life-sustaining intervention without consent"(9) Ethics committees of the Houston area hospitals already have established "futility protocols" to allow "professional integrity and institutional integrity" to overcome patient autonomy in the unilateral decision to terminate "inappropriate care."(10) These committees, with almost no checks or balances, have become medical star chambers working in secret. Since "futility" is a subjective value judgment and not a medical determination, decisions about it involve an arrogant paternalism, a deadly game of "Doctor Knows Best." This is exactly what the "Georgetown mantra's" principle of autonomy was designed to prevent in the first place.
Another rationing scheme, the Oregon health rationing plan, is a failed experiment. Its rationing is medical discrimination which benefits the politically correct, victimizes the weak, and pits different groups of citizens against each other. Still another scheme is the "duty to die ethic" which was proposed in 1984 by the governor of Colorado, Richard Lamm. He asserted that "...old people have a duty to die and get out of the way."(11) Today's premier advocate of the "duty to die" ethic is East Tennessee State University philosophy professor John Hardwig, a Utilitarian who asserts that "...it is sometimes the moral thing to do for a physician to sacrifice the interests of her patient to those of non-patients..."(12)
Bioethics also has given us killing by dehydration, an agonizing death which takes 10 to 14 days and which now is legal in all 50 states. Several years ago withdrawing a feeding tube was considered unethical and possibly a criminal act, but bioethicists needed a solution for the disabled and frail elderly people who were being kept alive too long. In 1983, Daniel Callahan noted that "...a denial of nutrition may...become the only effective way to make certain that a large number of biologically tenacious patients actually die."(13) In its 1986 opinion, the AMA, undermining the very foundation of medicine, paved the way to legalizing death by dehydration by listing "artificially supplied...nutrition and hydration" as a form of medical treatment instead of a basic requirement for life.(14) Soon we read of the death of Nancy Cruzan in 1990, a watershed event which marked a major change in public policy. From the permanently-unconscious the bioethicists next moved to include brain-damaged conscious persons. Marjorie Nighbert was slowly dehydrated to death in 1995 while asking for food and water. As Mr. Smith notes, in the United States today animals receive greater protection from being dehydrated than do cognitively-disabled humans.
After carefully documenting these disastrous consequences of bioethics, the author tells us how we can respond in his last chapter titled, "Towards a Human Rights Bioethics." But here the author fumbles. He asserts that bioethics concerns "ultimates: the meaning of life, the challenges of mortality, the rights and responsibilities that flow from being a member of the human family." He says (using bioethics terminology) that it allows us when we become older to be "filled with unquestionable personhood"(15) We should oppose it both through a policy of containment and by creating a better bioethics. We must reject assisted suicide and euthanasia, by using a program called "medicaring' (which appears to be the same as private medical care). We must expose the dangers of "futile care theory" by educating the public, must limit dehydration by insisting on written advance directives, and must reject the quality-of-life ethic because it makes our love for each other conditional. Finally we need not restore the old order but instead must "...move confidently forward..." to create a "vibrant robust and influential school of bioethics...based on life's inherent equality."(16) So we are to fight the evil bioethics movement, which doesn't work, by using an improved version of the bioethics movement.
But as Culture of Death shows beyond doubt bioethics is bad "ethics" which can't work. It won't work even when its proponents claim to be smarter than the rest of us and have the best of intentions. After only 30 years, bioethics has reached the end of its blind alley. Being the perversion of medical ethics, it should be called "bio-suicide," and its elite cadre of arrogant gurus labeled the "priesthood of death." Jack Kevorkian is in jail for doing what the bioethics movement promulgates every day.
An unworkable, subjective utilitarian philosophy with its situational ethics has led an entire culture to the abyss. As the author notes, bad ideas do indeed hurt real people. But more bad ideas are not the antidote. The core values of Western Civilization are not the "equal moral worth" of humans and "life's inherent equality," but instead are the worth of the individual and the sanctity of the individual's life. Human rights under bioethics does not mean individual rights. And our individual rights do not flow from each of us being a member of the "human family," which, at any rate, now has been dehumanized by the bioethics movement. Finally, in contrast to Mr. Smith's complex definition of bioethics, ethics is that branch of philosophy which identifies a code of values which we use to separate good from evil in order to prolong our lives and enhance our (long-term) happiness. An objective ethics based on reality, with its standard of value the life of the individual, for us is not just an option but a metaphysical necessity.(17) As noted years ago by the Objectivist philosopher Ayn Rand, no individual ever need be the means to the ends or to the welfare of others, and the human good does not ever require the sacrifice of another.
In short, Culture of Death is the most important book on medical ethics to appear in many years, and Wesley J. Smith is a modern-day hero for exposing the dehumanizing, anti-life policies of the bioethics movement. Americans, when they read the book, will demand an end to the promotion of bioethics by educational institutions and religious groups. By adopting a more objective philosophy with an ethics whose standard of value is the life of the individual, we will be able to return to that gold standard of medical ethics, the Oath of Hippocrates, which has been respected by physicians and surgeons of every race and creed for over 2000 years. Then the Georgetown mantra, futile care theory, the duty to die ethic, assisted suicide and euthanasia, and killing by dehydration will be remembered as a sordid chapter from our past.
1. Smith WJ. Culture of Death: The Assault on Medical Ethics in America. San Francisco, CA, Encounter Books, 2000, p. xiii.
2. Ibid., p. 14.
3. Ibid., p. 57.
4. Ibid., p. 191.
5. Ibid., p. 92.
6. Ibid., p. 30.
7. Ibid., p. 111.
8. Ibid., p. 195.
9. Ibid., p. 126.
10. Ibid., p. 132.
11. Ibid., p. 150.
12. Ibid., p. 152.
13. Ibid., p. 66.
14. ibid., P. 67.
15. Ibid., p. 242.
16. Ibid., p. 238-9.
17. Rand A. The Virtue of Selfishness. New York, NY, Signet Books, 1970, p. 13.
Dr. Jerome C. Arnett, Jr., is a member of the Editorial Board of the Medical Sentinel, a medical ethicist, and a practicing pulmonologist in Elkins, West Virginia.
Originally published in the Medical Sentinel. This article may be cited as: Arnett JC. The Bioethics Movement — An Emerging culture of Death. Medical Sentinel. 2002;7(2):48-49, 57.
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