By Wesley Smith
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| Wesley Smith |
The prestigious New England Journal of Medicine has been among the instigators of this shift. As early as 2005, the journal published (without significant criticism) the so-called Groningen Protocol—a bureaucratic checklist from the Netherlands that instructs Dutch doctors which terminally ill or seriously disabled babies they can lethally inject. In 2010, NEJM published advocacy in favor of an invidious health-care rationing measure known as the QALY (“quality-adjusted life year”), adoption of which has the effect of limiting care to the disabled and disadvantaged whose lives are bureaucratically rated as lower in quality than the lives of others.
In its September 6, 2018, edition though, NEJM has outdone itself. With Belgium and the Netherlands already allowing the conjoining of organ donation and euthanasia, and with Canada debating whether to follow them off that moral cliff, the journal has published a radical proposal that would demolish the ethical foundation of transplant medicine—the “dead donor rule.”
The rule requires that donors be declared dead before vital organs are procured and that the surgical transplant procedure not be the cause of the donor’s death. In their NEJMpiece “Voluntary Euthanasia—Implications for Organ Donation,” Dr. Ian M. Ball and bioethicists Robert Sibbald and Robert D. Truog urge that those rules be loosened in countries where euthanasia is legal:
Bear in mind that legal euthanasia in Belgium and the Netherlands is not limited to the terminally ill. In Canada, the euthanasia patient’s death need only be “foreseeable,” whatever that means, and even that vague limitation is under court attack. And bear in mind, too, that patients requesting euthanasia usually do not receive any suicide counseling services before they are killed.
Conjoining euthanasia with organ donation would thus send the insidious message to vulnerable people that their deaths have greater social value than their lives. For the particularly vulnerable, that could be the point that tips their decisions. Moreover, following the path the authors urge would transform a life-saving medical sector into one that also ends lives, imposing on transplant specialists the dual role of both healer and killer.
The NEJM was once one of the most powerful institutional opponents of medical utilitarianism. In 1949, it published a famous and powerful argument against allowing such values into the practice of medicine. Writing after the revelation of the depraved practices of the Nazi regime’s doctors, who engaged in infanticide, the killing of disabled adults, and many other infamies in the name of science, Leo Alexander, a psychiatrist and medical adviser to the office of chief counsel at the Nuremberg war crimes trials, warned that the utilitarian infection that destroyed German medical ethics could spread:
Physicians have become dangerously close to being mere technicians of rehabilitation. . . . In an increasingly utilitarian society these patients [with chronic or terminal diseases] are being looked down upon with increasing definiteness as unwanted ballast. A certain amount of rather open contempt for the people who cannot be rehabilitated with present knowledge has developed. . . . At this point Americans should remember that the enormity of a euthanasia movement is present in their own midst.
Would today’s NEJM publish Alexander’s powerful anti-utilitarian advocacy? How could it? By running articles openly supportive of infanticide, health-care rationing by “quality” of life, and now of conjoining euthanasia and organ harvesting, the NEJM has become the very wedge against which Alexander so powerfully inveighed.
Perhaps it is time for a name change. I suggest that the New Euthanasia Journal of Medicine more accurately identifies the values it embraces.
Although some patients may want to be sure that organ procurement won’t begin before they are declared dead, others may want not only a rapid, peaceful, and painless death, but also the option of donating as many organs as possible and in the best condition possible. Following the dead donor rule could interfere with the ability of these patients to achieve their goals. In such cases, it may be ethically preferable to procure the patient’s organs in the same way that organs are procured from brain-dead patients (with the use of general anesthesia to ensure the patient’s comfort).In other words, rather than wait for the patient’s heart to stop after lethal injection—as currently is done in the Netherlands and Belgium—the patient could be anesthetized and his organs procured while he is still alive.
Bear in mind that legal euthanasia in Belgium and the Netherlands is not limited to the terminally ill. In Canada, the euthanasia patient’s death need only be “foreseeable,” whatever that means, and even that vague limitation is under court attack. And bear in mind, too, that patients requesting euthanasia usually do not receive any suicide counseling services before they are killed.
Conjoining euthanasia with organ donation would thus send the insidious message to vulnerable people that their deaths have greater social value than their lives. For the particularly vulnerable, that could be the point that tips their decisions. Moreover, following the path the authors urge would transform a life-saving medical sector into one that also ends lives, imposing on transplant specialists the dual role of both healer and killer.
The NEJM was once one of the most powerful institutional opponents of medical utilitarianism. In 1949, it published a famous and powerful argument against allowing such values into the practice of medicine. Writing after the revelation of the depraved practices of the Nazi regime’s doctors, who engaged in infanticide, the killing of disabled adults, and many other infamies in the name of science, Leo Alexander, a psychiatrist and medical adviser to the office of chief counsel at the Nuremberg war crimes trials, warned that the utilitarian infection that destroyed German medical ethics could spread:
Whatever proportions these crimes finally assumed, it became evident to all who investigated them that they had started from small beginnings. The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as life not worthy to be lived.All it took for doctors to be led astray, Alexander warned in “Medical Science Under Dictatorship,” was utilitarian calculation, “the infinitely small wedged-in lever from which this entire trend of mind received its impetus”:
Physicians have become dangerously close to being mere technicians of rehabilitation. . . . In an increasingly utilitarian society these patients [with chronic or terminal diseases] are being looked down upon with increasing definiteness as unwanted ballast. A certain amount of rather open contempt for the people who cannot be rehabilitated with present knowledge has developed. . . . At this point Americans should remember that the enormity of a euthanasia movement is present in their own midst.
Would today’s NEJM publish Alexander’s powerful anti-utilitarian advocacy? How could it? By running articles openly supportive of infanticide, health-care rationing by “quality” of life, and now of conjoining euthanasia and organ harvesting, the NEJM has become the very wedge against which Alexander so powerfully inveighed.
Perhaps it is time for a name change. I suggest that the New Euthanasia Journal of Medicine more accurately identifies the values it embraces.
Fantastic article Wesley, as usual. Very insightful and powerful. Keep up the good work!
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