The Bioethics of Killing & Letting Die

There has never been a shortage of poor philosophers at the disposal of big business. The case of hospital bioethicists is no exception. And as a sure sign that they are poor philosophers, they are almost never financially wanting.

Bioethicists are a select group of co-affirming free thinkers who are hired, at good price, by the healthcare industry (hospitals, pharmaceutical companies, government departments) in order to sell hard policies. Bioethicists are proficient at manufacturing “ethical” arguments for previously unethical practices that promise to save their employers lots of money.

“Anyone familiar with medical research knows that ethics committees are indispensable – they have the important job of wringing their hands and furrowing their brows before writing the permission slips to cross lines that heretofore were thought impermissible to cross.” more

One current battlefield is the area of withholding and withdrawing treatment at the end of life. Physicians in intensive care units face death and dying on a daily basis. They are regularly an intimate part of the life and death decisions that face dying patients and their families. It is often the physician who counsels the patient and family, and inevitably the physician who implements the decision that has been reached.

Bioethicists, out to save their employers money, are trying to convince doctors not to save their patients. It is happening in hospitals everywhere in the “developed” nations, and it is becoming less and less subtle. Under the guise of “Futile Care Theory,” hospitals are putting in place procedural protocols which allow them to refuse treatment to sick patients, whether they want it or not, if the patient is deemed incurable or terminal. Treatment doesn’t just refer to new and expensive therapies; it extends to life-sustaining food, water and basic hygiene.

On the basis of “futile care theory,” Leslie Burke, age 44, is suing his hospital in the UK for the right to remain alive. Doctors there have refused (in advance) to provide him food or water when is condition deteriorates to the point of needing a feeding tube.

The parents of David Glass were shocked to find the same attitude from their doctors at St. Mary’s Hospital in Portsmouth. In 1998, at age 12, David suffered respiratory failure. Not only did doctors refuse to treat his life, but they sought to administer a “palliative” agent to David in order to hasten his death. They reasoned that David’s profound developmental and physical disabilities made his life not worth living, and therefore not worth saving.

And healthcare boards across North America are quietly implementing similar policies. Physicians, the final common pathway in the withholding and withdrawing that will bring lives to their end, are either unaware or don’t care. But those who don’t care have to be taught to overcome their intuitive instinct that killing is wrong. Enter the bioethicists. Some killing is okay. Some letting die is okay too. In fact, anything is okay given the right motivation, intention, circumstances and societal context.
Here are some delightful selections from my professor’s bioethics notes for tomorrow’s lecture on withholding and withdrawing treatment. She is also our hospital bioethicist. We’ll face-off at 8:30am EST tomorrow.

On Moral Intuition: “Often people will intuitively believe that while it is appropriate in certain instances to withhold treatment, it is never right to withdraw treatment.”

Intuition, however, is usually a sign of what is right for the most part. If the patient refuses an IV line, I won’t put it in. If his only source of food and water is his IV line, I won’t take it out. To do so would be to starve him, and removal of the line would mean death.

On Conscience: “It is important to keep in mind that because something “feels” right or wrong is not definitive in terms of deciding morality.”

But the exception of an ignorant or malformed conscience proves the rule that conscience is generally a good guide to moral action.

On Killing and Letting Die: “Is killing always wrong? Certainly murder is always wrong… it is wrong by definition. It is defined as the wrongful killing of one human being by another. But killing non-humans (animals) is largely accepted by most societies for food, clothes, some research, etc. Killing humans is largely accepted by most societies in certain instances like self defense and war. So, there are instances where we say killing is justified… To argue that something is wrong, a priori, simply because it is killing cannot be done successfully.”

Murder is properly defined as the taking of an innocent human life, to distinguish it from killing in self defense, for instance. The reason it is wrong is because it offends against the infinite dignity of the human person, a being capable of reason and free choice.

On Life after Death: “It may be that death is nothingness and nothingness has no positive or negative value. It is nothing… it may be that not being alive is arguably better than being alive.”

Somewhere in my remote past I learned what I already had known since I first knew anything: being is better than non-being. Something is better than nothing. It is true that suffering can be so intense that it makes us want to die to make it end. But avoidance of suffering is not the same as seeking death. It is precisely in these moments that a suffering patient needs comfort, relief and support. In the darkness of suffering, a physician can snuff out the flame of hope, or affirm, respect (and treat) the dignity of both human suffering and personhood.