Wesley J Smith
The denouement of the case of Herman Krausz, who died in 1998 at the Jewish General Hospital in Montreal after his respirator was removed over the objections of his family, brings into focus the growing importance of bioethics in Western medicine.
The coroner’s report in the case recommended that “independent mediators” be appointed when, as in the Krausz matter, families wish to continue life-sustaining treatment and physicians wish to call it quits. That sounds good but there is a potential problem: These mediators are likely to be trained in the philosophy of mainstream bioethics, a field that is undergirded by moral values that are at odds with those of most of the population.
Bioethics began as a multidisciplinary philosophical discourse among theologians and philosophers about 30 years ago. At first, participants in the intellectual discussions held differing points of view. Some were wholehearted believers in the sanctity of human life, while others took an explicit or implicit utilitarian approach. Over time, the adherents to the sanctity of human life steadily lost influence to the point where the predominant thinking in the field crystallized into what can be fairly called an ideology. Thus, while every “bioethicist” may not necessarily ascribe to every aspect of the prevailing bioethics belief system, the values inculcated by bioethics education generally reflect the ideology of the mainstream bioethics movement.
Bioethics values and those of most “real” people differ in crucial respects. Most people want their doctors to take the Hippocratic Oath. Bioethics rejects Hippocratic medicine as “paternalistic.” Most people, whether or not they are religious, believe in the sanctity/ equality of human life, i.e., that all human beings have equal inherent moral worth and therefore must be treated with equal dignity. What matters in bioethics, however, is the “quality of life” and whether one has sufficient cognitive capabilities to be a “person,” a designation that does not extend to every human but which some bioethicists, such as Princeton University’s Peter Singer, believe should include many animals.
The criteria used to to distinguish between persons and non-persons are still being debated in bioethics journals and books and at academic symposia. But the categories of human beings who mainstream bioethics ideology holds are probably not persons are pretty much established. “The unprotected,” writes Tom L. Beauchamp, an influential bioethicist from Georgetown University, “would presumably include foetuses, newborns, psychopaths, severely brain-damaged patients, and various demented patients.” The consequences of being stripped of personhood? Beauchamp suggests that humans who are not “moral persons” could be exploited in some of the ways animals are now. “If this conclusion is defensible,” Beauchamp writes, “we will need to rethink our traditional view that these unlucky humans cannot be treated in the ways we treat relevantly similar nonhumans. For example, they might be aggressively used in human research subjects and sources of organs.”
The values of mainstream bioethics—epitomized by personhood theory—are not merely theoretical. They are increasingly applied in hospital corridors and nursing home wards, and are spread through continuing medical education classes given to physicians, nurses, social workers, and others—the very people likely to assume the mantle of “mediators” in health-care delivery disputes.
This is precisely what befell the Krausz family. Herman Krausz fell victim to “futile care theory” that many bioethicists assert permits doctors to unilaterally refuse desired treatment when they perceive that the quality of the patient’s life isn’t worth the investment of resources; financial or emotional. Indeed, despite the Krausz coroner’s finding that doctors should have obtained consent before shutting off Herman’s respirator, the hospital spokesperson defiantly claimed that the report held they should have removed the respirator sooner.
Such hubris reflects a fundamental disagreement that extends far deeper than details of the care of one patient. It was the very value of Herman Krausz’s life that the family and doctors disagreed about, which played out in the dispute over his treatment. If the mediators that the coroner hopes will defuse similar future disputes are trained in the values of bioethics, there is the danger that they will not be neutral communication facilitators as the coroner envisions but parties to the iron-vise pressure increasingly placed on families to bend to the will of the “new medicine.”
In theory, ethics mediators can be helpful in achieving true family/doctor consensus when they and physicians struggle in good faith through difficult medical decisions. Indeed, there are many stories of successful mediations that satisfied all concerned. However, there is the danger that the deck will be stacked. That means beleaguered families must stand ready to fight for the lives of their loved ones—with lawyers if necessary. Bioethics theory is one thing: but the love of a family should not take a back seat to the philosophy of strangers.
[This article was originally published in National Post (February 25, 2000) and has been reprinted with the kind permission of the author,Wesley J. Smith, an attorney for the International Anti-Euthanasia Task Force and the author of Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder. His next book, Culture of Death: The Destruction of Medical Ethics in America, will be published this year.]