When discussing a topic, we first should define our terms. This is particularly important when the topic is a matter of life and death like health care. We must not allow those with an agenda to cause the definitions to “creep” – that is, to include more people and more situations – so that we are duped into accepting that agenda without realizing what is happening.
At first this term was an insult. But it came to indicate a person whose whole brain is dead, and who is on a respirator. Such a person is legally dead. His organs can be taken for transplantation, and the respirator turned off. His heart is beating, but almost everyone agrees that no one is home.
Still, it is a bad sign when a cruel insult morphs into a medical and legal term of great significance. It is also a bad sign when the emotional baggage attached to being “brain dead” is transferred to less severe disabilities.
Terri Schiavo was diagnosed by her estranged husband’s doctors as being in a persistent vegetative state. This means that she breathed on her own and showed reflex activities, but was unaware of her surroundings. On the contrary, her family’s doctors reported that she sometimes was aware of her surroundings, and was minimally conscious.
Yet some pundits referred to her as “brain dead.” These people allowed definition creep to set in. They were taking the meaning of “brain dead” – that someone is legally dead – and transferring that meaning to “persistent vegetative state,” and perhaps even to “minimally conscious.”
When I was in medical school years ago, “terminal” meant that the patient was in the actual process of dying. It didn’t mean that he was expected to die sometime in the future – everyone is. It didn’t mean that he was expected to die within some fixed time – no one could be sure. But in recent years, “terminal” has been redefined to mean “expected to die within six months.”
Let me tell you about Fred. He was a young man with a rapidly growing cancer of uncertain origin. When I first saw him as a trainee in medical oncology, his neck and upper body were covered with lumps. My professors had never seen such a rapidly growing cancer, and they expected him to die in days.
Nevertheless, he was begun on large doses of chemotherapy. His tumors began to shrink. Ultimately they disappeared. The microscopic slides were reviewed to be sure it really was a cancer. It was.
Fred went on to finish college, get married, and father a normal child. Yes, his case is unusual. But if we had gone along with our predictions, we would have given up. He would have died, fulfilling our prediction.
It is dangerous to predict a bad outcome, when your prediction leads you do what makes that prediction come true. Then you never realize you made a mistake, so you make the same mistake again.
Doctors are often wrong in their predictions of life expectancy. Yet these imperfect predictions are now the basis of declaring someone “terminal” – and therefore suitable to be killed.
“Removing life support.”
During a discussion of the Schiavo case, a doctor described removing her feeding tube as “removing an impediment to death.” This doctor headed the ethics committee of his hospital. He was used to dealing with patients who were at the point of death, and deciding whether to stop active treatment. Of course, pain medication, food and water, and nursing care continue.
This doctor is a religious man. Yet he allowed definition creep to occur. He was used to withdrawing advanced medical treatment, so it was only a small step to withdraw food and water. He pointed out that unlike Terri Schiavo, we normally take nourishment by eating, not through a tube.
Yes. And we normally breathe unaided. Surely he wouldn’t take an inhaler away from an asthmatic patient. We normally move by walking. Surely he wouldn’t take a wheelchair away from a paraplegic patient. At least we hope he wouldn’t. The opposite of “normal” is “abnormal.” It isn’t “dead.”
Even a thoughtful, religious man can fall victim to definition creep. Even he can fool himself about what he is doing. Terri Schiavo wasn’t on “life support.” She was receiving water and food. Death wasn’t approaching. You can’t “remove an impediment” to what isn’t coming. You can kill her. You can tell yourself you didn’t. But you did.
This term should refer to patients who are near death and want some control over the way they leave this world. The problem arises when we use the expression for people whose lives are not ending.
Articles about Terri Schiavo, and patients like her, refer to “end-of-life” issues. But her life was not ending until someone else decided to end it. We needed to say plainly, “Terri has lived like this for years. Should we allow her to live for more years, or should we kill her now?” That would have been blunt, but it would have been accurate. Instead, we allow ourselves to be misled by shifting, elastic terminology.
Now that ObamaCare has been upheld by the Supreme Court, this problem becomes more pressing. To clarify the situation, we refer to the leading medical journal in the United States, the New England Journal of Medicine. There we find multiple articles advocating nationalized health care, assisted suicide, and euthanasia. But we find no articles, and virtually no letters to the editor, on the other side. Science requires open discussion of opposing views. This isn’t science – it’s political advocacy.
Advocates of an all-powerful central government do not become scientists merely because they put on white coats. There is no independent medical establishment; there is only the leftist establishment. Doctors who disagree are on their own. (See http://docs4patientcare.org/)
The July 12, 2012 issue of the New England Journal contains two relevant articles. One is titled, “Cents and Sensitivity –Teaching Physicians to Think about Costs.” This is a worthwhile objective, but only if the physician is dedicated to the welfare of individual patients, and has not degenerated into a government agent.
To shed light on this question, recall what President Obama replied when asked whether elderly patients should receive pacemakers:
…if we’ve got experts…advising doctors across the board that it will save money. [Emphasis added.]
That is, “experts” in Washington will tell doctors what they can and cannot do for a whole class of patients, with the overall goal of saving money.
To shed further light (or in this case, further darkness), note that the other article in the New England Journal is titled, “Redefining Physicians’ Role in Assisted Dying.” The authors recognize that it is problematic for physicians to be tasked with the contradictory jobs of healing and killing. To avoid this inconvenience, they state:
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. [Emphasis added.]
That is, in addition to telling doctors what treatments they can and cannot give whole groups of patients, these remote, faceless, unelected, unaccountable bureaucrats now would also be empowered to dispense lethal drugs – as they see fit. Note the word “mechanism.” How cold and impersonal. How robotic. How frightening.
Of all professions in Germany, physicians had the highest percentage of Nazi Party members. Today, some leading physicians advocate health-care rationing, nationalized health care, unrestricted abortion, destruction of human embryos for research, assisted suicide, and euthanasia of the severely disabled. So remember not to expect moral leadership from the medical profession. My colleagues failed to provide it in the past, and – with some exceptions – they are failing to provide it now.
Moral leadership must come from us. As Pastor Niemöller taught us, the time to speak out is now, when the “central mechanism” is being planned. When the “central mechanism” is already functioning, it will be too late.
Hadamar Euthanasia Clinic, Nazi Germany, 1941-1945
When I was reading the New England Journal article on the “central mechanism” for assisted dying, I unexpectedly found myself whistling a tune. It took a while to recall, but there it was – an old Wehrmacht marching song. Rousing, isn’t it? A real toe-tapper.
We have a powerful temptation to identify with the strong, and to despise the weak, the elderly, and the disabled. Perhaps it originates from an animal-like survival instinct, but it is fostered and exploited by would-be totalitarians. The only antidote is reverence for all human life, which we derive from religion. I believe that eventually we will all be judged on how well we resist this temptation.
Dr. Stolinsky writes on political and social issues. Contact: email@example.com. You are welcome to publish or post these articles, provided that you cite the author and website.