Secondhand Smoke

Steven Pinker's Stupid Tantrum

2008-05-14T21:42:00.000-07:00

I just read a ridiculous screed by Steven Pinker in the New Republic that is beyond ludicrous. His primary purpose seems to be to attack Leon Kass, who agree or disagree with him, is a very serious thinker. A secondary point seems to be that the President's Council on Bioethics is pushing a Catholic agenda. The third point is that human dignity is no basis for crafting public policy and bioethical principles.

It might help his case if Pinker could get his facts straight. Case in point: Pinker writes that Kass was appointed to head the President's Council on Bioethics, "a position from which he convinced the president to outlaw federally funded research that used new stem-cell lines." But that is exceedingly strange since, 1) the Council did not exist when the president's policy was made and, indeed, was only created in the aftermath of that decision, 2) if Kass (who is Jewish) were really pushing the Catholic line, the President would not have permitted any funding of ESCR. You see, the Catholic Church opposed the Bush plan, and 3) as far as I know Kass has never publicly commented upon funding of ESCR nor on it propriety or lack thereof. But what the hey, why let facts ruin a good demagogic jeremiad?

Pinker goes even further off the rails in his blather over the President's Council's focus on human dignity as a basis for bioethical decision making. As I understand the term and its use in bioethical discourse, dignity means the intrinsic value and overarching importance of human life--which apparently Pinker opposes. But he makes a fool of himself by misusing the term as it is used in bioethics debates--to mean something much less. For example, Pinker says that dignity is "fungible." From his rant:

The Council and Vatican treat dignity as a sacred value, never to be compromised. In fact, every one of us voluntarily and repeatedly relinquishes dignity for other goods in life. Getting out of a small car is undignified. Having sex is undignified. Doffing your belt and spread- eagling to allow a security guard to slide a wand up your crotch is undignified. Most pointedly, modern medicine is a gantlet of indignities. Most readers of this article have undergone a pelvic or rectal examination, and many have had the pleasure of a colonoscopy as well. We repeatedly vote with our feet (and other body parts) that dignity is a trivial value, well worth trading off for life, health, and safety.

Pinker is completely missing the point, probably on purpose, by mixing up what we might call capital-D Dignity, e.g. intrinsic worth, value, and importance with small-d dignity, e.g., not being in a humiliating or potentially demeaning circumstance. I didn't lose my intrinsic worth because I had a colonoscopy last summer. But it wasn't something I would want to do in public and yes, it would be embarrassing to have it done in display window. But protecting the importance of human life and the minor "indignities" of being comical whilst getting out of a small car or the ludicrous posturings of hot sex are two totally different concepts.

He also states that dignity is "harmful," again misusing the term totally:

Jean Bethke Elshtain rhetorically asked, "Has anything good ever come from denying or constricting human dignity?" The answer is an emphatic "yes." Every sashed and be-medaled despot reviewing his troops from a lofty platform seeks to command respect through ostentatious displays of dignity. Political and religious repressions are often rationalized as a defense of the dignity of a state, leader, or creed: Just think of the Salman Rushdie fatwa, the Danish cartoon riots, or the British schoolteacher in Sudan who faced flogging and a lynch mob because her class named a teddy bear Mohammed. Indeed, totalitarianism is often the imposition of a leader's conception of dignity on a population, such as the identical uniforms in Maoist China or the burqas of the Taliban.

Wow, that's original: The Left branding someone perceived to be on the Right, as a Taliban. But such name calling is par for the course for a certain mindset, particularly when it comes to Kass: Apparently they can't out argue him philosophically, so they resort to the cheapest name calling.

But back to the point: Surely Pinker--who is after all a Ph.D--knows that the kind of phony dignity to which he refers is not what the term means in the bioethics debate. And indeed, terrible harm does come from denying Capital D human dignity. Slavery is a perfect example. The intrinsic dignity of slaves is denied by their very servitude. Eugenics is another example, in which the equal moral worth of some were denied, leading to mass forced and involuntary sterilization. The list is long.

Pinker's tantrum is emblematic of a certain mindset that fervently desires to pursue an anything goes bioethics and biotechnology and is like phosphorous hitting the air when confronted with a different value system. Pathetic.

Words to Ponder About the Culture of Death

2008-05-14T13:40:00.001-07:00

Recent events have me recalling the best and most succinct description of why we are slowly succumbing to the culture of death. They are from Canadian journalist and commentator, Andrew Coyne, who, reacting to the widespread public support for Robert Latimer, who murdered his daughter Traci because she had cerebral palsy, wrote:

A society that believes in nothing can offer no argument even against death. A culture that has lost its faith in life cannot comprehend why it should be endured.

(Andrew Coyne, "The Slippery Slope That Leads to Death," Globe and Mail, November 21, 1994.)

Yes, I am in a bad mood.

Oregon "Guidelines That Do Not Protect

2008-05-14T08:21:00.000-07:00

We keep hearing that the Oregon law is working without a flaw. The media touts that party line in almost every story about the issue. Of course to do that, contrary information has to be ignored. For example, the Michael Freeland case (reported in the American Journal of Psychiatry) in which a man became psychotic after being prescribed a lethal brew--even though his cancer had probably not reached the terminal stage--but was allowed by his own psychiatrist to keep the prescription "safely at home." Such as the recent study demonstrating that people without serious symptoms of their disease are given lethal prescriptions by doctors anyway.

And here's another media-ignored study, published in the Michigan Law Review by two of the most notable physician experts on this issue in the country, palliative care expert Kathleen M. Foley and psychiatrist Herbert Hendin. "Physician-Assisted Suicide in Oregon: A Medical Perspective" is a long piece and can't be completely reproduced here. (I can't even summarize it adequately in a short post. Sorry.)

First, here is their summarized conclusion (my emphasis):

Drawing on case studies and information provided by doctors, families, and other care givers, it finds that seemingly reasonable safeguards for the care and protection of terminally ill patients written into the Oregon law are being circumvented. The problem lies primarily with the Oregon Public Health Division ("OPHD"), which is charged with monitoring the law. OPHD does not collect the information it would need to effectively monitor the law and in its actions and publications acts as the defender of the law rather than as the protector of the welfare of terminally ill patients.

That's been clear for a very long time, and it is good that these two stellar professionals have now quantified it. They offer examples:

In Oregon, intolerable suffering that cannot be relieved is not a basic requirement of assisted suicide...The unintended consequence of this provision is that it enables physicians to assist in suicide without inquiring into the source of the medical, psychological, social, and existential concerns that usually underlie requests for assisted suicide, even though this type of inquiry produces the kind of discussion that often leads to relief for patients and makes assisted suicide seem unnecessary.

That's the true hospice approach, but assisted suicide is subverting hospice. (I'll have a piece out next week on that issue.) And call me cynical, but I think the absence of an intolerable suffering element in the law is quite intended. The concept of unrelievable suffering is only the selling point.

Several actual case studies are presented in the article. "Helen," the first legal assisted suicide has been discussed before--including in my Forced Exit--and demonstrates abuse from the git go (to use the vernacular), including "doctor shopping" for a willing prescription writer after the patient's own doctor said no, that has marked the Oregon experience from the beginning. Here is another case I knew less about--that of Joan--who had ALS. The reporting here demonstrates what happens when the law gives the state's imprimatur to some suicides and how meaningless referrals for a "consultation" can be:

He [the prescribing death doctor] stated that after talking with attorneys from the Oregon Medical Association and agreeing to help aid Joan in death, he asked Joan to undergo a psychological examination. The doctor reported that..."I elected to get a psychological evaluation because I wanted to cover my ass."

The doctor and the family found a cooperative psychologist who asked Joan to take the Minnesota Multiphasic Inventory, a standard psychological test. Because it was difficult for Joan to travel to the psychologist's office, her children read the true-false questions to her at home. The family found the questions funny, and Joan's daughter described the family as "cracking up"over them. Based on these test results, the psychologist concluded that whatever depression Joan had was directly related to her terminal illness, which he considered a completely normal response... [Me: Can we say "rubber stamp?]

The psychologist's report in Joan's case is particularly disturbing because without taking the trouble to see her, and on the basis of a single questionnaire administered by her family, he was willing to give an opinion that would facilitate ending Joan's life. The physician's attitude toward the consultation surely played a part in his receiving a report that did not meet professional standards.

Well, that and six bits will buy you a cup of coffee, I guess. Nobody cares. She had ALS, she wanted to die. What do professional standards have to do with it?

The entire article reads very much like the collapse of Dutch medical ethics that came along with its euthanasia laws. This is the bottom line: Assisted suicide is abandonment. The crucial question facing the culture of the West is: Do we care enough about each other any more to exercise true compassion, (the root meaning of which is to "suffer with")?

SHS Funnies

2008-05-14T08:16:00.001-07:00

What happened when Swiss wildflowers learned they had the right not to be "decapitated:"

NHS Meltdown: The People Turn Thumb's Down

2008-05-13T18:06:00.000-07:00

A survey of the victims, er ah, the patients served by the NHS in the UK reveals that they know very well how bad things have become. From the story:

A big variation in the performance of NHS trusts across England is revealed today in the health inspectorate's annual survey of patients' experiences. In some hospitals more than three-quarters of inpatients said the standard of care was excellent, compared with less than one quarter in others.

In the best trusts, staff almost invariably helped frail patients to eat, but in the worst nearly half the people who needed assistance at mealtimes said they did not get it.

There was also a wide variation between hospitals in the quality of food, cleanliness, responsiveness to call buttons and the proportion of patients expected to share bathrooms and toilets with members of the opposite sex.

While some individual hospitals clearly scored well, when viewed regionally, no scorecard were 46% receiving excellent care, and the London region's rating was a paltry 38%. And apparently hygiene control, the key to stopping hospital acquired infections, has worsened. Centralized health care does not work.

"Genetically Altered Embryo" Not as Big a Deal as Advertised

2008-05-13T09:35:00.000-07:00

The story of the first supposedly genetically altered human embryo is making headlines around the world. From the story:

The study appears to be the first report of genetically modifying a human embryo. It was presented last fall at a meeting of the American Society for Reproductive Medicine, but didn't draw widespread public attention then. The result was reported over the weekend by The Sunday Times of London, which said British authorities highlighted the work in a recent report.

Rosenwaks and colleagues did the work with an embryo that had extra chromosomes, making it nonviable. Following a standard procedure used in animals, they inserted a gene that acts as a marker that can be easily followed over time. The embryo cells took up the gene, he said.

The goal was to see if a gene introduced into an abnormal embryo could be traced in stem cells that are harvested from the embryo, he said. Such work could help shed light on why abnormal embryos fail to develop, he said. No stem cells were recovered from the human embryo, said Rosenwaks, noting that abnormal embryos frequently don't develop well enough to produce them.

In my view, this isn't quite as big a deal as reporters are making out. First, the embryo was never viable in the first place because it was genetically defective. Nor was it created for the purpose of destroying it--which is the agenda of cloning research, the essential technology for learning how to genetically engineer the human race. Moreover, animal work has already demonstrated that mammalian life can be genetically altered.

Don't get me wrong: I don't like it. I oppose treating human life, even if it is ultimately nonviable, as a mere instrumentality. But it doesn't really move the ball toward human genetic enhancement forward. To do that, as I noted, will require massive quantities of cloned embryos to learn how the genes express, why, and their mutual interrelationships--a monumental task given the sheer complexity of human development.

But this quote from a defender is, overall, hokum:

But an author of the study says the work was focused on stem cells. He notes that the researchers used an abnormal embryo that could never have developed into a baby anyway. "None of us wants to make designer babies," said Dr. Zev Rosenwaks, director of the Center for Reproductive Medicine and Infertility at NewYork-Presbyterian/Weill Cornell Medical Center.

He should speak for himself. There are plenty of people biting at the bit to genetically engineer embryos, and a cadre of bioethicists and lawyers already laying down the intellectual foundation to create a constitutional right to do it. If human cloning can ever be done reliably--a big if--an increasing number of advocates and media will urge the right to genetically engineer, first for health and later for enhancement, based on a supposed absolute right to procreate and to create the baby you want. That is the trajectory they are on, and all you have to do is read the books and bioethics articles already in print to verify it.

But that's okay. Nobody died and made them monarchs. There are plenty of us with the energetic intent to short circuit their plans.

The Ugly Face of Assisted Suicide

2008-05-12T17:22:00.001-07:00

There is a column in The Gurdian that illustrates vividly the ugly reality of assisted suicide. The writer Jon Ronson followed some suicide facilitators around, and found that their "compassion" leaves much to be desired. For example, Susan (a pseudonym), is trained by the euthanasia fanatic George Exoo to assist suicides and travels the world facilitating death. From the column:

Susan flew to New Zealand to help a depressed, non-terminally ill woman she had met on the internet commit suicide. The woman had previously asked a mainstream right-to-die group called Dignity NZ to help her, but they had refused.

"I was of the impression that she needed assistance in living rather than advice on how to end her life," Dignity NZ's founder, Lesley Martin, later explained to me in an email. She added, "I imagine you are developing a good understanding of what an absolute mess the euthanasia underground is. Unfortunately, there are 'gung-ho' individuals involved [she meant Susan] who, in my opinion, treat the matter of assisting someone to die as an exciting relief from the boredom of their own lives and do so completely ill-equipped and dismissive of the responsibility we have of ensuring that people who need mental health assistance receive it, while still working towards humane legislation that addresses the real issues."
I visited Susan and asked her what had been wrong with the New Zealand woman. "She had some sort of breathing disorder," she said, "and the doctors there wouldn't give her the medication that she needed. I happened to take the same medication. I gave her a little bit of mine and she was fine."
"But you helped her commit suicide, even though you helped her breathe better?" I asked. "Yeah," said Susan. "Isn't that ironic?"
"You shouldn't do it," I said. "Somebody's got to pay the bills so you can have some water in that glass you're drinking," she said.

Before you say, "Tut, tut," Wesley: The Susan's are the reason we need legal assisted suicide," realize that money aside, euthanasia fanatics believe that people should be able to receive help any time they want to die--and for any reason. Think, Philip Nitschke. Think Dignitas, the Swiss suicide facilitating organization and that country's Supreme Court decision granting the mentally ill a right to assisted suicide. Think Jack Kevorkian and wide public support even though five of his victims were not even ill and most were certainly not dying. Think about the poor depressed man Gene, partially disabled by a stroke, who was literally murdered by a Hemlock Society suicide facilitator as reported by the pro assisted suicide author Lonny Shavelson in A Chosen Death. who, it should always be noted, just sat and watched the killing even though he could have saved Gene's life. From the book pp. 93-94:

"Stop Sarah," raced through my mind. For whose sake, I thought--Gene's, so intent on killing himself? The weight of unanswered questions kept me glued to my corner. Was Gene's decision for death so wrong? Was this a suicide, Gene's right finally to succeed and die? Or was this a needless death encouraged by Sarah's desire to act? had Gene's decision to have me there, to tell me his story, given me the right to to stop what was happening--or, equally powerful, the responsibility not to interfere? Or, was I obliged, my by very presence as a fellow human being, to jump up and stop the craziness? Was it craziness?

Events suddenly moved faster than my thoughts. Gene's body heaved up and his cry filled the room, "It's cold," he screamed, and his good hand flew up to tear the plastic bag [off his head]. Sarah's hand caught Gene's at the wrist and held it. His body thrust upwards. She pulled his arm away and lay across Gene's shoulders. Sarah rocked back and forth, pinning him down, her fingers twisting the bag to seal it tight at his neck as she repeated, "The light, Gene, go toward the light. Gene's body pushed against Sarah's. Then he stopped moving.

This is where the ideology of the movement--radical individualism and the acceptability of killing as an answer to human suffering, mixed with terminal nonjudgmentalism--ultimately leads: Death on demand, moral paralysis, and the subversion of common human decency.

What the Big Brained Folk Think About the Intrinsic Dignity of Human Life: Not Much

2008-05-12T08:57:00.001-07:00

Ryan T. Anderson has an interesting entry over at the First Things blog about an ethics conference he attended at Princeton. It makes for sobering reading. He begins with a quote from Princeton philosophy professor Elizabeth Harmon. From his column:

"Look, when we think about ending an early human life, this is something that is really bad for the embryo or early fetus that dies, it's losing out tremendously--I agree with that as I already said...I think it's really dangerous to slide from noticing that something is bad for something, to thinking that that gives us a moral reason [not to do the bad thing]. And just to prove that that doesn't follow, think about plants. So lots of things are bad for trees, and plants, and flowers, and often that gives us no reasons whatsoever, certainly no moral reasons. In my view, fetuses that die before they're ever conscious really are a lot like plants: They're living things, but there's nothing about them that would make us think that they count morally in the way that people do."

Harmon has clearly not yet read the Swiss ethics report establishing plant "dignity," but no doubt she will get on board as the plant rights train picks up steam. Beyond that little jibe, note how accepting her anti-human exceptionalism values literally opens the door to using unborn humans as if they were mere natural resources, such as for experimentation, fetal farming, and the like. And that is precisely where many of the biggest brained among us wish to go.

Ryan reports that Peter Singer took his utilitarian thinking even farther, to perhaps permitting not just the killing of supposedly human "non persons" such as infants, but also adult human persons:

"The intrinsic value of Jane's life may be an important reason, or may not be, depending on the circumstances." For example, Jane's life does not produce a net increase of value in the world if "Jane's death is a necessary condition for Helen, who will live a life of even greater value than Jane." This could justify aborting a genetically defective child to conceive a healthy replacement (Singer's own example)--but also justify killing some adults. The relevance of Singer's fourth consideration also varies, since, he argues, some chimpanzees are "certainly more self-aware than some humans, and more self-aware than fetuses or, for that matter, newborn babies."

I have always said, that if moral distinctions can be made between so-called human non persons and persons, why not also within the person category? And that is precisely where Singer seems to have gone in his presentation.

Ryan thinks the discussion was important both to expose the Singer-type advocacy to public scrutiny and to help the church get its act together. He opines that bringing "disagreements" out into the open is a very good thing because it alerts people to the consequences of ideas. That is idealistic and nice, but perhaps this work is making me cynical: I am not sure that most people care.

Beyond that, I am frankly, appalled. These ideas should be rejected out of hand. And indeed, it is a mark of how far the intellectual elites have taken us down the moral abyss already that the propriety of infanticide, fetal experimentation, and killing one adult to benefit another must now be seriously debated.

Or to put it another way: The problem is that this discussion explicitly treats such ideas as if they were legitimate and no different say, from a debate about whether a 20% or 30% capital gains tax would be best. Indeed, Singer was brought to Princeton--our most prestigious university--not in spite of these views, but because of them. Princeton's faculty thus acted shamefully in approving the appointment that they wouldn't someone else with the same academic credentials (Singer doesn't even have a Ph.D) who wasn't so "cutting edge" in his thinking, thereby granting Princeton's imprimatur of respectability to infanticide (which it would never do if Singer were promoting the same agenda only based on racism.)

Disagreement is good. Getting our big brained betters to reveal their true agendas is, alas, now a necessity. But be very clear: The most of the influential institutions of society--perhaps other than the churches which are rapidly losing influence and in some cases cannot be distinguished in their views from those promoted by the big brained--are now controlled by those who utterly reject human exceptionalism. Worse, this isn't just a mind game to them: They want their ideas implemented, a goal they are pursuing come hell or high water. Learned debates will not cause them to pause for a split second.

It will be up to the average folk to thwart the new eugenics that, like Sauron in the Lord of the Rings trilogy, is re-manifesting and threatens to bring much darkness into the world.

SHS Funnies

2008-05-12T08:50:00.000-07:00

In which we learn that Pig moonlights as a Swiss Ethicist:

Kruger Video No Longer Available

2008-05-11T14:40:00.001-07:00

I uploaded a video from YouTube and posted it here at SHS the other day that depicts a fight over the fate of a calf among lions, a crocodile, and the calf's herd of cape buffalo. I have heard from a few readers that it no longer works. I'm not sure why that is. I suspect that is because it was sold, I believe to National Geographic, and thus taking it off of a free viewing site was probably part of the deal. However, I checked the YouTube site and it was working there. Check it out.

Here is a summary in case anyone still wishes to participate in the commentary about it: Two adults and the calf have walked away from the herd. Big mistake. They literally stumble across a small pride of lions! Seeing an easy meal, the lions leap to the chase and zero in on the calf.

The lions violently knock the calf into a river and pounce on it, biting away. The adults run off. The lions try to drag the calf to the land in order to finish it off, when a crocodile grabs it from the rear. There is a tug of war. We can hear shocked reaction of the people taking the video from across the river.

Finally, the calf is dragged out of the water and is soon to be a meal when the herd of buffalo unexpectedly come up. The bulls go after individual lions who, one by one, are chased off the calf. Finally, the calf gets up and rejoins the herd.

It is a happy ending, from our empathetic perspective of rooting for the helpless calf. Whether the calf ultimately survived, of course, is questionable. He was bitten repeatedly and may have much blood or could die of infection. On the other hand, he may be happily chewing cud none the worse for wear. When I was in S. Africa at a game park, I saw a giraffe without a tail. I was told by the game warden that it was bitten off by a lion, who was probably kicked to death by the giraffe, when she bit down on the tail. Life is tough on the savanna.

I would love everyone to jump in on the commentary I wrote to the original post. I think the video illustrates quite well that animal rights don't apply in nature, and hence, are really not a debate about "rights" at all. Rather, the entire controversy is a debate about the scope and depth of human duties toward animals, which arise because of our exceptional natures.

SHS Funnies

2008-05-11T13:36:00.003-07:00

When a vegetarian falls off the wagon:

The latest research sparks more controversy in the evolution debate:

The "Battle at Kruger", Human Exceptionalism, and the Misnomer That is "Animal Rights"

2008-05-10T10:00:00.001-07:00

This remarkable video depicts a desperate fight between a crocodile, a pride of lions, and a herd of cape buffalo over the life of a calf. No "animal rights" here. No "right" not to suffer here. No "cruelty" here, either. This is the tooth and claw struggle of the natural world.

Only humans have managed to partially step beyond this ruthless struggle and bring a level of charity and civilization to life. And we are the only species to have ever done so in the billion years or so that life has existed on the planet. In this, by definition, we are truly exceptional.

Another uniquely human trait is empathy for other species. In this video, we naturally tend to root for the underdog--the helpless calf that the lions want for dinner. We empathize with and cheer on the buffalo herd that charges to the rescue desperate to save their own. In contrast to us, any elephant or zebra looking on the scene would have been utterly indifferent to the fate of the calf. Only people have the capacity to project their emotions into such a dramatic scene and care about the outcome. And that is another thing that makes us truly exceptional.

The crocodile, the lions, and the buffalo captured in the video all acted purely in their own self interest without regard to the effect their behavior would have on the wellbeing of the other animals. No sacrificing by the buffalo for the sake of the lions. No willingness by the crocodile to forego an easy meal, for which it did not have to work, as unsporting. No willingness by the lions defray their own thriving because of the pain the loss of the calf would cause the buffalo's mother.

Altruism, putting others first, self sacrifice--even toward non humans--these are all distinctly and uniquely human traits further illustrating how we are exceptional. (Dogs don't count. They are our intelligently designed creations and have been engineered by us to exhibit attributes toward us that wolves never would. We are the only species capable of such a feat, adding another point to the list of what makes human beings so exceptional.)

Here's the point I am trying to illustrate: Animal "rights" is a misnomer. It is purely a discussion of the extent and scope of human self-imposed duties. We are the only species who could even conceive of pursuing such a course, clearly and self evidently illustrating the exceptional nature of human life.

This all seems beyond dispute to me. Why human exceptionalism is even controversial is beyond me.

SHS Funnies

2008-05-10T08:44:00.003-07:00

An illustration of how modern names evolve:

SHS a True International Community

2008-05-09T09:33:00.001-07:00

I just did a little research on where SHS's 30,000 visits each month (and slowly going up) come from. Most, not surprisingly, come from the good ol' USA. But I am very gratified to learn that people come here literally from all over the world. In the last month, f0r example, 583 visits came from Australia. We had 86 visits from China, 31 from Argentina, 91 from South Africa, 163 from India, 2169 from Canada, and 1 from Kazakhstan. We had 12 visitors from Vietnam, 113 from Brazil, 9 from Nigeria, 205 from France, and 1 from Greenland. In fact, there are only about 20 countries in the world, most in sub Saharan Africa, from where we received no visitors in the last 30 days.

I am most pleased: Danke, gracias, arigato gozaimashita , merci, xie xie, thanks y'all.

University of Washington Medical School Teaches Futile Care Theory as if the Right to Refuse Wanted Life-Sustaining Treatment Already Exists

2008-05-09T08:44:00.000-07:00

An intrepid reader sent me this on-line syllabus from a bioethics course at the University of Washington Medical School. I checked on the link protocol and the author Nancy Jecker, Ph.D presumes that the right to refuse wanted life-sustaining treatment already exists. From the syllabus:

While you will hear colleagues referring to particular cases or interventions as "futile", the technical meaning and moral weight of this term is not always appreciated. As you will make clinical decisions using futility as a criterion, it is important to be clear about the meaning of the concept.

Futilitarians often deny that Futile Care Theory is about money. They deny it is about ideology that presumes some lives not to be worth living. As the following quote shows, it is about both:

The goal of medicine is to help the sick. You have no obligation to offer treatments that do not benefit your patients. Futile interventions are ill advised because they often increase a patient's pain and discomfort in the final days and weeks of life, and because they can expend finite medical resources.

Although the ethical requirement to respect patient autonomy entitles a patient to choose from among medically acceptable treatment options (or to reject all options), it does not entitle patients to receive whatever treatments they ask for. Instead, the obligations of physicians are limited to offering treatments that are consistent with professional standards of care.

Realize that futilitarians are changing the fundamental purpose of medicine to suit their beliefs. One such fundamental purpose is to extend life if that is what the patient wants. Futile Care Theory arrogantly presumes the right to tell a patient and his or her family that their life isn't worth extending--which is to say, that it isn't the treatment being judged "futile," but the patient. And, it apparently presumes the right to censor information a patient or family need to make proper informed consent.

The futilitarians are acting as if they have already won this bioethical controversy. But their agenda is running into strong head winds. As failed attempts to impose medical futility in Texas--where there is a law explicitly permitting it--demonstrate, we the people are not going to just roll over and let ethics committees meeting behind closed doors decide when the time has come for their baby, grandma, or a spouse to die. The more public we make this fight, the better chance we have to stop this ad hoc health care rationing/medical discrimination in its tracks. After all, in this fight "choice" is on our side.

Fighting Back Against Biological Colonialism

2008-05-09T08:28:00.000-07:00

Biological colonialism (as I call it) is a real and growing international problem, in which rich Westerners pay destitute people for kidneys, the use of their wombs, and potentially coming soon to a poor country in Asia or Africa, for eggs to do mass human cloning. I have reported on some of the devastating consequences to the lives of the exploited here at SHS.

Now the Philippines has struck an important blow against the practice by banning foreigners from receiving kidney transplants in the country. From the story:

Foreigners will be permanently banned from receiving kidneys for transplant in the Philippines to prevent the country from becoming a major Asian center in an already thriving black-market trade, health officials announced Tuesday.

Extensive kidney trading involving impoverished Filipinos and prisoners--who sell their organs for paltry sums to syndicates catering mostly to foreign clients--has been reported by the local media in recent years.
A temporary ban was recently imposed on kidney transplants involving foreigners. "Today, the Philippine government asserts its mandate to protect the poorest and most vulnerable sectors of our society," Health Secretary Francisco Duque said in announcing the ban.

Of course the key is enforcement and breaking up the graft that leads to biological colonialism. But this is a good start that should be emulated around the world.

HT: John B.

NHS Meltdown: The Implosion Continues

2008-05-08T18:37:00.000-07:00

What is left of the NHS in the UK is continuing its awful meltdown. Now, the bureaucrats in charge intend radical surgery. From the story:

Scores of hospital departments such as maternity units and cancer clinics will be closed or merged across the country under plans for a radical shake-up of the NHS...

The plans, which appear to have been held back until after last week's local elections, will be released over the next four weeks by the nine Strategic Health Authorities in England. They include setting a local target of reducing the four-hour wait in A&E to two hours, setting up dedicated trauma centres and better co-ordination of out of hours services.
However, in many cases, the changes--which result from Lord Darzi's continuing review of the NHS--will lead to services provided by cottage and district hospitals being moved out of the area.

Needless to say, protests are expected over what looks to be a loss of local care for many conditions. And the moral of the story is that centralized health care simply does not work.

Washington State: Becoming Two-Faced About Suicide

2008-05-08T08:52:00.000-07:00

Why is assisted suicide always treated as if life were lived in a vacuum? Case in point: The suicide statistics in Washington are, according to a newspaper report "terrifying," and yet, many newspapers editorially support legalizing assisted suicide--which at the very least sends a terribly mixed message to the despairing thinking of taking their own lives. From the story:

Suicide statistics are terrifying. In 2005, there were 32,637 reported suicide deaths in the United States - 822 of those were in Washington State. An estimated 19 million Americans suffer from depression. Depression, combined with certain conditions including anxiety, isolation, drug and/or alcohol use or abuse, physical or emotional illness, and feelings of hopelessness or desperation, increases the risk for suicide.

"Ninety percent of people who die by suicide actually have undiagnosed psychiatric disorders," said AFSP Executive Director Robert Gebbia. In addition to depression, those include bipolar disorder, eating disorders and substance abuse. Gebbia believes that by raising awareness through the Out of the Darkness event, the stigma associated with mental illness can be reduced and more people can be helped. "When someone has died by suicide, people think somehow it's the victim's fault," he said. "We don't agree with that. It is a complication of an illness, just the way things go wrong with the heart or liver. When people see it as a complication of illness, we can reduce the stigma."

I don't want to stigmatize anyone, but I do believe that societal disapproval of suicide saves lives. But placing the state's imprimatur on some suicides does the opposite--it says killing yourself can be the right thing to do. And that is like telling someone not to smoke, but if they do use filter cigarettes: It totally dilutes the message.

The story then presents valuable information on what to do if someone you know is suicidal:
All suicide threats and attempts must be taken seriously...
- Take the initiative to ask what is troubling them and persist to overcome any reluctance to talk about it.
- If professional help is indicated, the person you care about is more apt to follow such a recommendation if you have listened to him or her.
- Don't be afraid to ask whether he or she is considering suicide, or even if they have a particular plan or method in mind.
- Do not attempt to argue anyone out of suicide. Rather, let the person know you care and understand, that he or she is not alone, that suicidal feelings are temporary, that depression can be treated and that problems can be solved.
- Encourage the person to see a physician or mental health professional immediately. Go with them if necessary...
- If the above options are unavailable, call your local emergency number or the National Suicide Prevention Lifeline at 1-800-273-TALK.
(Not applicable for residents of Oregon or Washington (if I 1000 passes) and the suicidal person has cancer or ALS. In such cases, get a doctor to prescribe them poison pills.)

SHS Funnies

2008-05-08T08:24:00.000-07:00

A hate crime against a plant! Why Garfield was banned in Switzerland:

Proposition 71: The New Gilded Age

2008-05-07T07:18:00.000-07:00

When the creators of Proposition 71 spent tens of millions buying a constitutional amendment in California to permit human cloning research, they promised CURES! CURES! CURES! And what are people spending hundreds of millions of dollars of borrowed money on? EXPENSIVE FANCY BUILDINGS! EXPENSIVE FANCY BUILDINGS EXPENSIVE FANCY BUILDINGS! From the story in today's San Francisco Chronicle:

The governing board of the California Institute for Regenerative Medicine is expected to give final approval today to a package of grants that will prompt a construction boom at academic campuses throughout the state.

More than three-quarters of a billion dollars in laboratory construction will get under way as early as next month, seeded by $271 million in facilities grants made possible by the passage of Proposition 71.

And not a workable building designed by "The General," that prefab contractor, either. We are talking high end, expensive architect, all the add-ons, type buildings. Example:

At UCSF, planners had to figure out a way to shoehorn a stem cell research center into the space-constrained confines of their hilltop Parnassus Heights campus. So they tapped one of the world's top design firms, Rafael Viñoly Architects, which delivered a striking plan.

The Institute for Regeneration Medicine will be housed in a silver, terraced structure that snakes uphill along the winding curves of Medical Center Way - tucked behind the 16-story towers housing the campus' major research labs.

I would have hoped that at a time when California is literally drowning in a $20 billion in deficit, that some restraint would be shown. But who was I kidding? This is the kind of moral corruption, pigs-feeding-at-the-trough kind of excess that undermines the people's confidence in government and our ruling institutions.

Somebody ought to sue: Hint. Hint.

Texas Representative Garnet Coleman: Installed in Hall of Shame

2008-05-06T13:01:00.001-07:00

I just did an entry on a new Texas futile care lawsuit involving a girl named Sabrina Murray who was apparently threatened with a futile care termination by a Houston hospital, resulting now in litigation. But I had to reserve this entry for a quote from the author of the futile care law, Garnet Coleman (D-Houston). Sabrina's parents believe that the attempt to deny her care was part of a plan to cover up medical malpractice. Of course, I can't take a position on that--although it is certainly not the first time such a scenario seemed possible--but this crass quote Coleman gave to the Houston Press about the matter:

State Representative Garnet Coleman, (D-Houston), who helped author the 1999 act, tends to agree with Fine. When asked if he thinks the law is sometimes used to bury malpractice, he says, "I would hope not, and that's why we have autopsies. I don't think that the law either encourages it and I don't think that it discourages it. As long as you've had an autopsy, then you would find out what was the cause of death and whether there was a medical error."

"That's why we have autopsies:" I thought I had heard it all. Of course, the reason for the autopsy might be Coleman's terrible law.

A New Futile Care Lawsuit: What the "Quality of Life Ethic" Hath Wrought

2008-05-06T12:34:00.000-07:00

Texas is ground zero for Futile Care Theory because of its pernicious law that permits ethics committees to refuse wanted life-sustaining treatment over patient/family objections. Readers of SHS will recall that when such a decision is rendered, families have a mere 10 days to find alternative care, which can lead to desperate situations, as I have reported on several occasions.

Now there is a new case of a teenage girl named Sabrina Murray whose sinus surgery went terribly wrong, leaving her comatose. From the story in the Houston Press (proving once again that the "alternative" newspapers are doing the best journalism today):

Within about three days of the second surgery, [mother Beatrice] Lopez says, doctors "started talking about our options. And we started getting scared, because the options were not good."

Lopez and [step-father Brian] Murray say that doctors and hospital staff began pressuring them to withhold treatment and feeding, which would ultimately starve Sabrina to death. To the parents, this was unacceptable. They wanted their daughter to live. "I was very disappointed with the way Memorial Hermann handled things," Lopez says. "They put it out on the table that we were being selfish."

Murray and Lopez accuse the hospital staff, doctors and nurses of doing everything they could to try to end Sabrina's life during the ensuing six weeks, including:

- Refusing to implement simple procedures such as giving Sabrina feeding and breathing tubes that would have enabled the parents to take their daughter home and care for her themselves,

- Attempting to turn relatives and friends against Lopez and Murray by encouraging them to persuade the parents to withhold treatment, all the while violating federal privacy laws by discussing Sabrina's healthcare information,

- Entering two separate do-not-resuscitate orders against her parents' wishes, and

- Threatening the family with convening the hospital's ethics committee, which under Texas law can overrule the family's wishes and withhold life-support treatment from a patient.

"It was like we were caught in a bad dream," says Murray. "We couldn't believe this was happening."

Happily--and rarely, since usually desperate families in Texas can't get another hospital to take the patient--a new doctor and hospital was found with positive results:

As Lopez and Murray saw it, the hospital and physicians that caused their daughter's condition were now trying to end her life. And it seemed like there was nothing they could do to stop it.

Terrified, Sabrina's parents called the nonprofit organization Texas Right to Life, which referred Lopez and Murray to an attorney. The parents were able to transfer Sabrina to Texas Children's Hospital, where Lopez says Martin received treatment that doctors at Memorial Hermann had refused to give, treatment that saved her life.

This is a long story but very important to read. Sabrina awakened and is now living with her disability and cared for by her parents. And while I can't take a position about this particular case, I can say I hear from such desperate families on a continuing basis from all over the country. Futile care needs to be stopped.

Post Script: Last session, the Texas Legislature was unable to rescind the state's futile care law--in part because of the wrongheaded opposition of the Texas Conference of Catholic Bishops--which I wrote about critically here. Hopefully this case, if the facts are verified in court, will convince the bishops that allowing doctors and ethics committees to impose their ethical views on families is wrong.

More to follow...

"The Dignity of Living Beings With Regard to Plants"

2008-05-06T09:30:00.002-07:00

I found a linkable cite for the Swiss ethics committee report on the "dignity" of plants. So, I thought I'd put a few pithy quotes up that have not appeared in my discussion here at SHS about the study or in my Weekly Standard piece.

Sometimes materialistic Darwinists will state that there really are no species distinctions between humans and animals because we and they share a high number of genes. Whenever that argument has been made in the past, I have joked, "Well, if you really want to get reductionist, carrots are made up of carbon molecules and so are humans. Hence, there is no real distinction to be made between us." Well, the big brains in Switzerland have precisely adopted that "joke" as one of the bases for granting individual plants "dignity." From the report:

Some members were of the opinion that plants are not part of the moral community, because they do not satisfy the conditions for belonging to this community...A further group felt that there were particular situations in which people should refrain from something for the sake of a plant, unless there are sufficient grounds to the contrary. This opinion was justified either by arguing that plants strive after something, which should not be blocked without good reason, or that recent findings in natural science, such as the many commonalities between plants, animals and humans at molecular and cellular level, remove the reasons for excluding plants in principle from the moral community.

You have to be really big brained to take my jest seriously. But some on the committee take that very position. Unbelievable.

Most of the committee either believed that plants are sentient, or could not say that they are not:

The majority of the committee members at least do not rule out the possibility that plants are sentient, and that this is morally relevant. A minority of these members considers it probable that plants are sentient. Another minority assumes that the necessary conditions for the possibility of sentience are present in plants. The presence of these necessary conditions for sentience is considered to be morally relevant. Finally, a minority of the members excludes the possibility of plants having sentience, because in their view there are no good grounds for such an assumption.

Plants are living beings. But sentience means the ability to feel and experience sensation. Plants are not aware in this sense. They are not conscious and cannot by their natures be conscious.

Finally--and I find this very telling--the Swiss ethicists considered and rejected "theocentrism" (being part of God's creation as the root of dignity), "ratiocentrism" (the capacity to reason as the root of mattering for their own sake, e.g. personhood theory), "pathocentrism" (sentience as the basis for moral worth, an animal rights ideology), but did not consider "humancentrism," the idea that being human is what matters the most morally, regardless of the value we convey to other life forms on the planet. Hence, human exceptionalism was not even thought about. The utter rejection of the intrinsic and inherent value of human life against which I have been warning is spreading and does not bode well for the future of the human community and the achievement of universal human rights.

Plants Rights on the Air

2008-05-06T08:44:00.001-07:00

My Weekly Standard piece, "The Silent Scream of the Asparagus," on plant "dignity" piece is getting a lot of attention. For those in the Cincinnati area who may care to listen, I will be doing the Bill Cunningham Show on WLW (AM 700) at 9:15 Pacific Time.

Fox Interview Moved up 10 Minutes

2008-05-06T05:29:00.000-07:00

For anyone up this early and/or who cares, my interview on America's Newsroom on FNC about "plant rights" has been moved up ten minutes. I am mainlining coffee as I prepare--a plant product I might add--that not even the most utilitarian bioethicist would begrudge me.