Thread by Dr. Brian Kopp.
July 16, 2012 (LifeSiteNews.com) The courts should not interfere with doctors who want to dehydrate to death incapacitated patients who are a drain on scarce financial resources, according to an editorial in this weeks edition of the prestigious British Medical Journal.
Raanan Gillon, emeritus professor of medical ethics and former chairman of the Institute of Medical Ethics governing body, wrote that a ruling last year by the High Court against dehydrating an incapacitated patient to death was profoundly disturbing because it took the life and death decision-making power out of the hands of doctors and required that the principle of the sanctity of life take precedence over other considerations.
The judgment, he said, threaten[s] to skew the delivery of severely resource-limited healthcare services towards providing non-beneficial or minimally beneficial life prolonging treatments including artificial nutrition and hydration to thousands of severely demented patients whose families and friends believe they would not have wanted such treatment.
He complained that the ruling required that, under the stringent Mental Capacity Act, in order to remove life prolonging treatment like a feeding and hydration tube, the patient himself must have left a legally binding advance decision in writing, and that previous casual or unrecorded statements to relatives were not sufficient grounds.
The editorial, titled, Sanctity of life law has gone too far, said that unless it is overturned, the court ruling will gradually and detrimentally distort healthcare provision, healthcare values, and common sense.
Its logical implication, Gillon wrote, is that doctors should no longer decide, in consultation with those who know their incapacitated patients, whether life prolonging treatment including artificial nutrition and hydration will be in their patients best interests.
Furthermore, he said, the ruling logically means that those patients in a higher than minimal state of consciousness must be similarly protected.
The court ruling in question was that in the M Case, in which the family of a 52-year-old woman who was found to be in a minimally conscious state and who was otherwise clinically stable, were petitioning the court to have her feeding and hydration tube removed. The Court of Protection ruled that all patients in such a state must be referred individually to the Court of Protection if life prolonging treatment by artificial nutrition and hydration is to be withheld or withdrawn.
Mr. Justice Baker said in the September 2011 decision, The factor which does carry substantial weight, in my judgment, is the preservation of life. Although not an absolute rule, the law regards the preservation of life as a fundamental principle.
Justice Baker wrote that the courts should not attach significant weight to the patients previous statements unless they had been expressed in a way that could stand up to legal scrutiny. As in the case of Terri Schiavo in the U.S., Ms family had argued that her alleged previous statements indicated that she would not want to be dependent on such care.
Baker responded to this by ruling, [Given] the importance of the sanctity of life, and the fatal consequences of withdrawing treatment, and the absence of an advance decision that complied with the requirements previously specified by the common law and now under statute, it would in my judgment be wrong to attach significant weight to those statements made prior to her collapse.
Anthony Ozimic, communications manager for the Society for the Protection of Unborn Children, said that the ideology being espoused by Gillon and the British Medical Journal is indistinguishable from the materialist utilitarian ethic that led to the elimination of the unfit by eugenicists in the early 20th century, including in pre-World War II Germany.
What is particularly disturbing about Professor Gillons opinions is that he is judging certain disabled people as having lives unworthy of life, balancing those lives against the needs of other patients and seeking to justify killing the disabled on the grounds of rationing, Ozimic told LifeSiteNews.com.
Such a utilitarian calculus is in substance no difference to the calculus made during World War II by the German authorities: that the disabled should die so that wounded soldiers could live. In any case, assisted food and fluids are basic nursing care, not futile medical treatments.
As shocking as such pronouncements are to the general public, the idea that disabled patients should be euthanized, either directly or by the removal of food and hydration, is actually a mainstream of thought among many of the western worlds medical ethicists. Gillon himself is a major voice in the field as a former editor of the Journal of Medical Ethics and the author of the 1985 book Philosophical Medical Ethics.
Classical medical ethics, that held as paramount the principle Do no harm, has in large part been set aside in favor of the new utilitarian-based Bioethics, a formal or normative branch of ethical philosophy that seeks the greatest good for the greatest number according to the principles of justice, beneficence and autonomy.
Thread by me.
If you want to see what direction health care is going, just read the July 12 issue of The New England Journal of Medicine (NEJM).
Of course, reading a medical journal isnt on most peoples to do lists. Even medical professionals who do read journal articles rarely do so to gain insight into the latest shifts in the cultural or political winds.
Thats a mistake. These days, radical trial balloons are often launched from such venerable publications which is especially disturbing because the imprimatur of the medical intelligentsia provides respectability to ideas that otherwise would be dismissed out of hand. The mere fact that an idea appears in what The New York Times describes as perhaps the most influential medical publication in the world, places that concept firmly within the realm of respectable debate.
Which brings us back to the NEJM.
On its pages, the NEJM has long featured articles favoring euthanasia and assisted suicide as well as health care rationing. Indeed, two of its former editors, Dr. Arnold Relman and Dr. Marcia Angell, are vocal advocates of eliminating the private health system and replacing it with a single-payer, government-controlled health system. And both are among the 14 subscribing petitioners on a doctor-prescribed suicide initiative that will appear on the November 2012 ballot in Massachusetts.
Angell is so enamored with the concept of assisted suicide that, in a 2004 article, she decried the fact that too few people were availing themselves of Oregons doctor-prescribed suicide law. She expressed concern that the law was too restrictive.
Now, the NEJM has given a platform for Dr. Lisa Lehmann, director of the Center for Bioethics at Brigham and Womens Hospital in Boston, and researcher Julian Prokopetz to lay out a proposal for facilitating what they call assisted dying. In their article, Redefining Physicians Role in Assisted Dying, the authors address what they see as a real problem: There arent enough doctors willing to participate in assisted suicide.
As the authors state, Many medical professionals are uncomfortable with the idea of physicians playing an active role in ending patients lives. Furthermore, they explain that the American Medical Association and various state medical groups oppose legalization.
It should be noted that when Washington and Oregon changed their laws to permit assisted suicide, they did not make all assisted suicide legal. For example, ones mechanic, plumber, attorney, professor, or spouse is not given the authority to assist suicide. Essentially, what was made legal in those states and what is funded by state and private insurance is one type of assisted suicide: doctor-prescribed suicide.
It is the necessity of a doctor who will prescribe the deadly dose which presents a stumbling block that Lehmann and Prokopetz seek to address. As they explain, We believe there is a compelling case for legalizing assisted dying, but assisted dying need not be physician-assisted.
And how do they suggest that this hurdle between diagnosis and prescription be overcome?
Take the doctor out of doctor-prescribed suicide by setting up a government-facilitated process that will make it easier for patients to cross the River Styx. As they explain:
We envision the development of a central state or federal mechanism to confirm the authenticity and eligibility of patients requests, dispense medication, and monitor demand and use. Such a mechanism would obviate physician involvement beyond usual care.
They see this as a way of overcoming the reluctance of most doctors to assist in suicide, while they remain oblivious (or indifferent) to protecting the lives of vulnerable patients.
As they accurately explain, under Oregons and Washingtons laws, the patients doctor confirms the prognosis, explains alternatives for treatment and care to the patient, and then writes the lethal suicide prescription. In their plan, the doctor would bow out of the process before writing the prescription: Prognosis and treatment options are part of standard clinical discussions, so if a physician certifies that information in writing, patients could conceivable go to an independent authority to obtain the prescription. At that point, the patient could simply go to a suicide-prescribing clinic. Patients could also provide an independent authority with their medical record as proof of their prognosis.
Could this work?
Yes, without question.
Many states already permit nurse-practitioners to prescribe barbiturates (the same drugs prescribed in intentionally lethal amounts for suicide in Washington and Oregon). Removing the requirement that the prescription for suicide be doctor-prescribed would certainly be possible.
While there might be initial objections to leaving the doctor out a crucial step in the process, it should be noted that state-issued annual reports in both Washington and Oregon indicate that reported assisted-suicide cases do not involve the close doctor-patient relationship that advocates of the practice promised would occur.
For example, in Oregon, the length of time for the doctor-patient relationship before writing the lethal prescription has been under one week in some reported cases. Even in cases where the patient has been in the care of the prescribing doctor, once the prescription is written, the doctor may have no further contact with the patient. Prescribing doctors have been present at the time of the patients death from the prescribed overdose in fewer than seven percent of reported cases.
Details of how the newly proposed system would work were revealed by Dr. Lehmann in an interview with ABC News. She explained that doctors would only be responsible for making the diagnosis of a terminal illness. Then, the patient should be able to pick up the lethal drugs from a government-authorized, all-purpose location where a government bureaucrat would determine the patients eligibility for a death prescription.
In addition to soothing the sensibilities and deadening the consciences of doctors, moving physicians into the background would have another effect. It would increase the number of assisted suicides.
Lets consider this for a moment. Do we really think that a government that is constantly looking for ways to contain health care costs will be likely to deny death eligibility? Do we think that government death-control officials will do the right thing or the cheap thing?
Take this proposal, coupled with government-run health care, and you have death panels on steroids.
Like we said, if you want to see what direction things are going in health care, just read the professional journals.
"We will not be silent.
We are your bad conscience.
The White Rose will give you no rest."