A Medical Millstone

Cast Off the Cloak of Conscience?

David C. Stolinsky, MD
April 16, 2009

No, that is not a spelling error. I meant millstone, not milestone. I meant something that drags us down, not something that marks our progress along the road.

I just received my copy of the New England Journal of Medicine, the most widely quoted medical journal in America. And there was the latest millstone:

Federal laws may make room for the rights of conscience, but health care providers − and all those whose jobs affect patient care − should cast off the cloak of conscience when patients’ needs demand it. [Emphasis added.]
− New England Journal of Medicine, April 9, 2009

The only “cloak” is the word needs. No one is refusing needed medical care because of conscience. The journal is talking about abortion, assisted suicide, euthanasia and similarly questionable procedures. The problem isn’t needs, it’s wants:

·         The only women who need an abortion are those whose health is seriously threatened. Many abortions are performed because of convenience, including interference with work schedules, vacation plans and the ability to attract new boyfriends. The real need is that of babies to be born and adopted by the loving married couples who are lined up waiting for them, even if they are handicapped.

·         No one needs to be helped to kill herself, or to be killed. If the problem is depression, the need is for psychotherapy and antidepressants. If the problem is disability, the need is for reassurance that we do not consider the person a useless burden. If the problem is pain, the need is for adequate pain control. If the problem is brain damage, the need is for care. Terri Schiavo didn’t need to die. Her estranged husband wanted to get rid of her so he could marry his girlfriend. She needed the care her parents wanted to give her. And we wanted to stop seeing her on TV and watch more sitcoms.

·         No one needs to give birth to eight babies, especially when she already has six small children. The “octomom” wanted to fulfill some narcissistic desire, and the fertility doctor wanted to perform the procedure because he could. That may be the real motivation for much research on cloning of human embryos − we want to see how godlike we can become, when in fact we are becoming the opposite.

When I was a medical student years ago, I read the New England Journal. I learned facts, but I also learned how to think like a physician. The journal had a weekly case discussion. A patient was presented, and an expert discussed possible diagnoses. When he finished, others joined in, either backing up the discussant or offering a different diagnosis. Then the correct diagnosis was given. I learned that even experts from prestigious universities can be mistaken.

This lesson was reinforced in my classes. I recall a guest lecturer who was shown a patient with a terrible-looking chest x-ray. The man was an expert in chest diseases. He diagnosed advanced lung cancer and criticized our doctors for putting the patient through more tests. He concluded that the patient should be left to die. There was only one problem − the patient had tuberculosis, a curable disease.

Between that expert and the journal discussions, I came to realize that even the best physicians are fallible, so we should err on the side of diagnosing treatable diseases and not give up hope prematurely. Of course, back then the thought of “euthanizing” a patient would never have occurred to us.

But times change. Like most organizations, medicine − especially academic medicine − has been taken over by leftists. They advocate state-controlled health care, as well as assisted suicide, euthanasia, and abortion on demand.

These positions, which we call “liberal” but which are profoundly illiberal, are all advocated by the New England Journal. In addition to scientific articles, the journal also publishes “perspectives,” which are what newspapers call opinion pieces.

But newspapers are known to be biased, while scientific journals are assumed to be scientific. When the New England Journal publishes a “perspective,” it is backed by the journal’s distinguished history, as well as the prestige of Harvard Medical School.

So when “perspectives” advocate socialized medicine, abortion on demand, assisted suicide and euthanasia, these topics take on the aura of science. But in fact they are merely personal opinions.

After reading another article advocating assisted suicide and euthanasia, I wrote a letter to the editor, pointing out that these practices contravene the Hippocratic Oath as well as the teachings of all major religions. My letter was not published. The editor wrote that the journal published only “reasoned argument,” not an “appeal to authority.”

This attitude is appropriate for scientific articles, where one points to evidence. But it is inappropriate for articles dealing with ethical matters. The Nazi scientists who developed drugs and gasses to murder the physically and mentally handicapped were just as scientific as the British scientists who developed penicillin. But the Nazi scientists were unethical.

“Reasoned argument” was used to justify eliminating the disabled, who were a “drain on the Fatherland.” But an “appeal to authority” − the Hippocratic Oath and the Bible − condemned what the Nazis were doing. Only a fool or someone ignorant of history could deny these facts.

The editors of the New England Journal are neither fools nor ignoramuses. What’s their excuse? Is their liberal lust for “change” so strong that they risk knocking the ethical underpinnings out from under medicine? Is their elitist urge for centralized control so powerful that they are leading us over an ethical cliff?

The latest millstone is a “perspective” written by someone with both medical and legal degrees − a real “expert.” The article urges President Obama to reverse a regulation promulgated under President Bush. Bush allowed physicians and other health-care providers to refuse to participate in procedures that violate their deepest beliefs.

If Bush’s regulation is reversed, as seems likely, physicians, nurses and technicians will be forced to participate in abortion, assisted suicide, euthanasia, destroying human embryos for their spare parts, implanting eight embryos into a woman − or whatever. Obama has already declared that scientists should be guided by “facts,” not “ideology” − that is, ethical considerations.

But could this provision work in reverse as well? Could physicians also be punished for giving care when rationing of health care is enacted? If unelected, unaccountable federal bureaucrats can tell physicians what patients “need,” they can also tell physicians what patients “don’t need” − and enforce their orders.

If you think physicians’ freedom to use their best judgment for their patients is restricted by insurance companies and HMOs, try government bureaucrats. Financial pressures are bad enough; threats of punishment are even worse. Think of the Department of Motor Vehicles − not just intrusive meddlers, but heavy-handed bullies.

The article goes so far as to advise doctors to “cast off the cloak of conscience.” “Cloak”? What lies beneath the “cloak”? Do we really want to discover that beneath the “cloak,” there might lurk a Dr. Mengele?

Mengele earned both an M.D. and a Ph.D. from the prestigious University of Heidelberg. He was an “expert.” He was a scientist guided by “facts,” not ethical considerations. He was a man who listened to “reasoned argument” and rejected “appeal to authority” such as the Hippocratic Oath and the Bible. He “cast off the cloak of conscience.”

So he was ideally suited to become deputy chief physician at Auschwitz. He performed experiments on unanesthetized prisoners. He took his turn at “selection,” where physicians evaluated new prisoners to decide who was strong enough to work, and who went straight to the gas chambers and crematoria.

Don’t the editors of the New England Journal know that our conscience is a precious gift from God? Don’t they know it is what distinguishes us from lower animals? If I cast it off, what am I? Someone with a medical degree on the wall, perhaps, but not a truly human being.

You want a doctor who “cast off the cloak of conscience”? I wish you good luck and good health. You’ll need both.

Dr. Stolinsky writes on political and social issues. He can be contacted at dstol@prodigy.net.

www.stolinsky.com