Via Wesley J. Smith we learn of this article by Dudley Clendinen, a former Times correspondent, who has ALS (aka Lou Gehrig's disease). He is planning his own suicide (unless he happens to die of pneumonia first). But Smith is actually writing about this highly approving load of utterly confused malarky from Times columnist David Brooks on end-of-life issues and on how we can save money by magically making people with Alzheimer's Disease conveniently disappear. Here's how this goes:
If you want to, I'll let you read Clendinen's column for yourself, instead of quoting it. Clendinen is pretty unequivocal: He's planning his suicide. He says he's found a calm and peaceful way (not shooting himself, which he contemplates at the beginning of the column) if it should be "necessary," before he gets to a point he considers too undignified.
Or you can just take my word for it on that point.
Then we come to Brooks. The bottom line is that Brooks doesn't know what he's talking about. He's picked up a few phrases, dreamt up a few more, and mish-mashed them together. He can't even hear himself, realize how illogical and uninformed he is, or face the implications of what he's saying, much less realize how offensive his language about the disabled is. Yet he thinks he's being profound about life and death and a helpful little amateur economist at the same time. A twofer.
Or maybe not.
Let's start with the fact that Brooks doesn't admit that Clendinen is planning to commit suicide, yet Brooks approves of Clendinen's plans, partly quoting him:
Instead of choosing that long, dehumanizing, expensive course, Clendinen has decided to face death as one of life’s “most absorbing thrills and challenges.” He concludes: “When the music stops — when I can’t tie my bow tie, tell a funny story, walk my dog, talk with Whitney, kiss someone special, or tap out lines like this — I’ll know that Life is over. It’s time to be gone.”
Right from the outset this introduces into Brooks's column an ambiguity among various "options" like refusing extraordinary care, refusing ordinary care, and actively killing oneself.
Then we get this bit of pseudo-profundity. David Brooks on the meaning of life:
Clendinen’s article is worth reading for the way he defines what life is. Life is not just breathing and existing as a self-enclosed skin bag. It’s doing the activities with others you were put on earth to do.
Why, thanks, Mr. Brooks. Should I ever be in danger of ending up as merely a "self-enclosed skin bag," I'll be sure to keep that in mind. Right. Got it. Under those circumstances, I'm not really living. That's not living. In fact, if I'm just one of those "self-enclosed skin bags," I might as well be dead. Thanks for driving that home. Perhaps you should go preach on that loving text at the local nursing home: "Hey, all you self-enclosed skin bags! Don't you get it? This isn't life! Life is doing the activities with others you were put on earth to do."
And then there's the strange attempt to drag God into it somehow, without naming Him, of course. (I owe this point to one of Smith's readers.) See, we were "put on earth" to do activities with others. You know. Meaningful activities. Activities like the ones Dudley Clendinen won't be able to do anymore in the later stages of ALS. By golly, if we can't do those activities, we aren't fulfilling the purpose for which we were put on earth. In fact, one might conclude that under those circumstances, we don't even have value to Whoever It Might Be who "put" us here on earth. So, once again boys and girls, repeat after me: Under those circumstances we might as well be dead.
But Brooks isn't done. He's been doing some figgering on the back of an envelope and positively leaps from his musings on the meaning of life into the economic arena:
But it’s also valuable as a backdrop to the current budget mess. This fiscal crisis is about many things, but one of them is our inability to face death — our willingness to spend our nation into bankruptcy to extend life for a few more sickly months.
Actually, Clendinen himself mentioned years of life if he took medications and accepted other medical interventions, and of course didn't kill himself actively. But hey--months, years, what's the difference?
Brooks then quotes the following claim from someone else:
[O]ur main achievements today consist of devising ways to marginally extend the lives of the very sick.
Followed by this, which would be humorous if it weren't so scary:
Others disagree with this pessimistic view of medical progress. But that phrase, “marginally extend the lives of the very sick,” should ring in the ears.
Did you see that? Did you catch that? The statement he just quoted and thinks so important may be false. In fact, there is apparently sufficient evidence against it that Brooks felt himself bound to throw in the disclaimer that others disagree with this "pessimistic view." Nonetheless, who cares whether it's true or not, it's a great phrase, so it should "ring in the ears." Talk about thinking in sound bites! Don't bother me with the facts! This phrase should "ring in the ears."
Then we get to Brooks's next masterpiece of illogic and terrifying ignorance--the attempt to connect the money issue, and the issue of "accepting" death, to people with Alzheimer's:
The fiscal implications are all around. A large share of our health care spending is devoted to ill patients in the last phases of life. This sort of spending is growing fast. Americans spent $91 billion caring for Alzheimer’s patients in 2005. By 2015, according to Callahan and Nuland, the cost of Alzheimer’s will rise to $189 billion and by 2050 it is projected to rise to $1 trillion annually — double what Medicare costs right now.Obviously, we are never going to cut off Alzheimer’s patients and leave them out on a hillside. We are never coercively going to give up on the old and ailing. But it is hard to see us reducing health care inflation seriously unless people and their families are willing to do what Clendinen is doing — confront death and their obligations to the living.
Let's tear this one into tiny little bits, which is more than it deserves. First: A great many Alzheimer's patients are not actively dying. Referring to them as being in "the last phases of life" is highly misleading. They need care because they can't care for themselves. So what in the world is Brooks talking about when he talks about how important it is for Alzheimer's patients to "confront death"? No doubt, Brooks himself doesn't know. He hasn't thought about the matter in such clear terms at all. Hmm, let's see. What exactly do you recommend, David? Suppose Dad has Alzheimer's and is otherwise physically healthy but can't remember things and needs constant care, which is expensive. How, precisely, do you suggest that we (on his behalf, since he can't do so) "confront death"? Is Brooks perhaps under the ignorant assumption that all of that care for Alzheimer's patients is being spent on ventilators or something else that most people would consider "extraordinary care"? Let's face the facts here. It is these patients' lives that are expensive, not their deaths. They require care. Care costs money. They are not dying. So they need to be cared for. Deal with it.
But let's see what else is here. What about that bizarre phrase, "their obligations to the living"? Excuse me, Mr. Brooks, um...Aren't people with Alzheimer's living, too? Oh, you mean the other people who are living? Are you suggesting an obligation to die? Oh, wait a minute: They aren't living (see above), not really living, if they aren't able to do "the activities with others they were put on earth to do." I remember now. So maybe we should just define them as "dead," then. That would be convenient. Then we could leave them out on the hillside after all.
And then, one more: You want Alzheimer's patients and their families to do what Clendinen is doing, right? But Clendinen is planning to commit suicide. So that presumably means that Alzheimer's patients and their families should...Oh, you didn't mean that? So you just weren't thinking, right? So what exactly did you mean?
Ignorant, bigoted, mish-mash.
But there are a couple more little bits to add to the confusion: Brooks approvingly cites Daniel Callahan, who, he says, emphasizes "the social solidarity model — in which death is accepted as a normal part of the human condition and caring is emphasized as much as curing." But, wait a minute: Just a paragraph ago, Brooks was telling us (here, let's find the exact words) that a real budget-breaker is the cost of "caring for Alzheimer’s patients" (emphasis added). Caring for them. Not trying to cure them. Just caring for them. So how, again, does this fit with the approval of a model that emphasizes the importance of "caring"? Brooks doesn't know. He doesn't think.
And finally, at the end of his article, Brooks has the gall to drag in the names of Richard John Neuhaus, Leon Kass, and Gilbert Meilaender (!!) to try to gild his decidedly non-lily heap of nonsensical pseudo-ethics with the gloss of their humane credentials--implying that all he's saying is something these three men have said or would approve of. One can hope that all three of them (Fr. Neuhaus from heaven) would see through Brooks instantly. If it's possible to speak meaningfully of "seeing through" someone whose head is so muddled that he doesn't know the difference between suicide and refusal of extraordinary care, who is ignorant enough to think of all Alzheimer's patients as dying, and who can't see how incredibly bigoted it is to refer to disabled human beings as "self-enclosed skin-bags" who aren't doing "what they were put on earth to do" and should start thinking about the U.S. budget and their obligations to the (really) living.
Brooks's column is a warning: People are muddle-headed, and muddle-headedness is catching. I won't be surprised if there are some people who read my post here, read Brooks's column, and try to tell me that I've misrepresented him, misunderstood him. All anyone is saying here, I may be told, is that there comes a point where we have to accept death, etc., etc. Move along, folks, nothing to see here.
I'm willing to grant, at least on the basis of this column alone, that Brooks doesn't have active ill-will. Brooks's problem is that he is a fool. And that sort of foolishness will be deadly--for many, many helpless people.
Comments (23)
Ceteris paribus, it'd be nice to die on a horse: that's what people used to mean when they talked about "dying with dignity honor." But most people's chances of that are pretty slim. I'll take something that involves the Last Rites and not being offed by some crackpot.
Posted by Titus | July 17, 2011 9:13 PM
Hmm, I can't seem to get the strike tag to work, so my comment above doesn't make as much sense as it was intended to. Apologies.
Posted by Titus | July 17, 2011 9:16 PM
David Brooks wrote:
Following his argument to its logical conclusion, it seems reasonable to assume that in the future, this most absorbing thrill/challenge will be commonplace, that is, regularly practiced. And later, because after all we are concerned about cost, compulsory.
Logan's Run (1976):
Of course, I would expect Mr. Brooks, as well as practically all of the NYT subscribers who read his article, to vehemently deny this conclusion...
Posted by RichB | July 17, 2011 11:14 PM
Sweet holy smokes! He cites Neuhaus, Kass, and Meilaender at the end? Incredible! The one thing I do appreciate about Brooks is that he actually admits that the IPAB is a "death panel," unlike most social medicine supporters. That's the best thing I can say.
Posted by Mark | July 18, 2011 1:09 AM
Oh, ok. On rereading he said those three "offer other perspectives" but then follows with "on why we should accept the finitude of life and the naturalness of death." What a tangled mess of a sentence that kinda makes you think they'd agree with him. If you know they don't (what an understatement,) you can kinda sorta see how he's kinda sorta telegraphing this, but it is all so very irresponsible.
Posted by Mark | July 18, 2011 1:18 AM
Yes, it is a confusing and irresponsible sentence in an article full of confusing and irresponsible sentences sentences. I would have definitely taken that sentence to mean, "These people more or less support what I'm saying; they're just talking about it from a slightly different angle." Which is certainly not true. But it's pretty obvious that he doesn't care about being responsible. He's writing an irresponsible blog post because he had what he thought was a brilliant idea about the connection between this other (pro-suicide) article and the U.S. budget. Now he's telling us all about it. He'll say whatever pops into his head for that purpose. If Kass & Co. have said _something_ about not trying to be immortal, Brooks is happy to co-opt those names for the cache with any more conservative readers he happens to have.
Posted by Lydia | July 18, 2011 8:50 AM
The ugly truth is that if our society were more level-headed, judgmental and intolerant, we'd have plenty of money for the weakest among us like Alzheimer's patients. If we refused to pay for STD treatments, refused to subsidize single mothers, drug addicts, alcoholics, the morbidly obese, feckless white trash that behaves like life is one big Jackass rerun, etc. we'd have plenty of money to cover our veterans, the retarded, the severely handicapped, etc.
An even uglier truth is that the former group and those who would give it public assistance are often willing to throw the truly vulnerable under the bus to enjoy their autonomy at public expense.
Posted by Mike T | July 18, 2011 9:02 AM
That is really quite stunningly bad. I enjoyed your demolition.
That description of welcoming death sounds exactly like the Harry Potter conception of death as a "friend." (By the way, did anyone see the last movie the other day? Me neither. I don't think elephants are allowed in the theater anyway.)
The Elephant
Posted by The Masked Elephant | July 18, 2011 9:39 AM
So, Clendinen has ALS, wants to off himself, and Brooks is his black-robed, scythe-carrying chearleader.
Boo-hoo... Cowards...rationalizing cowards...
I guess the concept of the Cross is lost on these people. Oh, but they will claim to be such caring Christians because they are doing it all, "for their families and the good of society." This is the re-definition of love from liberal Protestants in the 1960s - an act of feeling one with mankind - carried to its extreme. They are, literally, loving themselves to death, is that it?
Cowards, rationalizing cowards, all!
I wish to heaven these people would learn to play the man. They seem to forget that people are more edified by one who resists the urge to despair (which is an act of pride, really) than one who rationalizes and acts on its existence.
True dignity is a sort of morally elevated respect, even self-respect, that one recognizes as the sign of one's station. Now, Clendinen has no self-respect. Indeed, he wants to get rid of his self because it is not the perfect selfish little thing he sees in his own prideful estimation. He recognizes neither his station as someone made in the Imago Dei (which does not depart until the soul does, so what does being able to try your shoes have to do with anything?), nor the respect he owes to that image within. Indeed, he hates that image because he does not understand it. He thinks that image is the image of an all-powerful, functioning God, who can do whatever he pleases. He has yet to realize that it is the image of a lamb thrust through by a fault in the nature of a capricious fallen humanity.
Simply put, he does not realize that suffering has a purpose in life. He is absolutely blind to that fact because he has yet to realize that, as it says in the book of Job: He will lead the afflicted by their affliction. He is blind to that fact because the words, "Take up your cross and follow me," mean nothing to him.
Apparently, for both Clendinen and Brooks, life means the ability to dance. Well, there's a Danse Macabre they are dancing with dead holding the lead. It will leave them, when the music stops, not the dignity of the courageous nor the respect of the masses, but the bitter feeling of flames.
The Chicken
Posted by The Masked Chicken | July 18, 2011 10:43 AM
That description of welcoming death sounds exactly like the Harry Potter conception of death as a "friend."
Oh, death can be a friend. In fact, I think St. Francis called it brother death, but one gets to relate to death in that fashion only if one loves. The problem is that Clendinen really doesn't understand the love that will make death a friend because he does not understand why Christ died.
The Chicken
Posted by The Masked Chicken | July 18, 2011 10:48 AM
Should read:
Well, there's a Danse Macabre they are dancing, with Death holding the lead.
Sheesh...never go for the dramatic ending unless you are a good typist.
The Chicken
Posted by The Masked Chicken | July 18, 2011 10:54 AM
Well, MC, at the risk of alienating an ally (and one who has posted great comments here), I would say that in America 2011, I would hesitate ever to use the phrase, "Death is a friend." St. Francis wasn't battling suicide and assisted suicide advocates; there wasn't a risk of his being misunderstood in his own time.
Especially in a non-Christian context (which M.E. was citing), and especially in a context where suicide has been approved of or is treated as a genuine option, teaching young people that "Death is a friend" gets the insta-creepy award.
In essence, if you divorce the idea of "giving in to death" from a clear moral, and really clear Christian, context, it does rather swiftly just become an acceptance of suicide and euthanasia.
Posted by Lydia | July 18, 2011 2:31 PM
Which, actually, I guess was your point, wasn't it, Chicken? So we agree.
By the way, I think you're bang-on about Clendinen's not loving himself in the proper way. There's a kind of terror in C's article of not looking good, not looking attractive, of being "icky" or unpleasant to be around. At one level, such fear is natural and understandable. At another level, and when not informed by an understanding of the imago dei, it becomes sheer self-loathing--a loathing of one's future or hypothetical future self who looks like _that_ to other people.
Posted by Lydia | July 18, 2011 2:34 PM
The difficult thing about this is there some truth to what he says. Now hear me out before judging what I say.
It is extremely common for physicians to be overly optimistic about what modern medicine can do and treat people in such a way that it just makes miserable our loved one's last days. Well-meaning physicians just trying to do the right thing. I know so many people, and myself included, that say "if only we'd have refused the last treatment(s) the doctor suggested" for a family member. Many of us our haunted by our own participation in such things. Now these people hear Brooks' opinions and they think "Hey, here's a guy that get's it." Or at least that is true for a fairly well-known Christian bioethicist I know. He gets that, and he's right to warn people against this. Modern medicine can be a curse and it to be used with great care. That has nothing to do with what Brooks is advocating, but do you see the nuance required to see the difference? That nuance required to accept one limitation of medical treatment has nothing to do with the . . . um, "limitation" that Brooks is talking about. But what scares me is that the topic of death isn't popular, and the nuance to see the difference between the two things I'm talking about gives such a wide opportunity to push something evil with the appearance of doing good. Brooks in unsubtle, but I know others far more subtle that are very beguiling and persuasive. I wish our churches would be more active on this issue and take a stand on a Christian approach to medical care and dying. See Paul J. Griffiths on this issue here: javascript:popup_window('http://www.baylor.edu/player/index.php?id=126004&gallery_id=5664','770','550')
My only question for Griffiths is whether it is proper to view the "Ars Moriendi" as a normative model, or whether it was just a very old attempt to master death in much the same ways people do today. I'm not sure the answer, but it has occurred to me. In any case, I definitely agree with him that you can't just participate in the entire program and not get burned in the end. I am my wife commonly refuse medications and treatment offered, and I'm openly skeptical of their risk charts and medical prescriptions. A great many docs hand out meds like it was candy, and lead you to believe you aren't really healthy if you're not on it, and I'm not exaggerating. I've heard "oh you're grandfather died of a heart attack, well you need to be on some medication then" line too often. As if there were some better way to die.
Posted by Mark | July 18, 2011 3:38 PM
Exactly. That's what I meant in my last paragraph about muddle-headedness. In fact, I'm not at all sure Brooks himself _realizes_ that he's advocating suicide. Is it possible to advocate suicide without realizing it? I think it is if you're David Brooks and thoughtless enough. You read an article by a guy planning his suicide, and it sounds all noble, and you cover it up with phrases about the meaning of life and real living, mix with a few truths about the dangers of attempting to be immortal, and stir. A nice brew of hemlock.
And as you say, people are more likely to swallow it (pun intended) because they _are_ afraid of having "too much" medical intervention.
Moreover, our medical establishment is exceedingly bizarre in that it will engage in all manner of interventions up to a point and then suddenly--boom!--it's atavin and morphine, npo orders, and easing you out of all your troubles, hoping no one will notice that this wasn't _precisely_ a natural death. And that sort of thing is _constantly_ sold to people as merely "accepting the limitations of medicine."
What I think a lot of people don't understand is this strange dual thrust of the current medical milieu. Some might think that people like me must be _denying_ the drive to over-medicate, to give extremely nasty chemo with extremely dangerous side effects, etc.
But it's just a false dichotomy to say, "Either our medical establishment is doing too much or it's doing too little." Actually, it's simultaneously doing both. In one place you have the person undergoing heart transplant and taking anti-rejection drugs for the rest of his life. In another place there's a lady who had a stroke and is now being dehydrated to death because doctors don't want to engage in the extremely mild intervention of giving her a feeding tube. If they did, she might have to go to a nursing home, and her children have told the doctors she always wanted to avoid a nursing home. So drug her up, give her nothing, wait a couple of weeks, and she'll be gone. Hope you don't suffer too much, Mom.
This strange dual emphasis reminds me quite a bit of the combination of frantic anti-fertility treatments and abortion in our society.
Posted by Lydia | July 18, 2011 4:08 PM
I, in fact, foresee the day (if it hasn't already come) where a person who agrees to a DNR order (or family members who agree to it on his behalf) will automatically be assumed a) not to want nutrition and hydration and b) to be just fine with, shall we say, questionable doses of morphine or other similar drugs at the end of life.
In other words, the middle way may simply be ruled out by medical practice. Perhaps not officially, but by such iron custom that family members find it impossible to get medical personnel to believe that, "Mom signed a DNR" does _not_ mean, "Mom wants to be dehydrated to death."
Posted by Lydia | July 18, 2011 5:03 PM
Yes. I agree. I just wish our churches were more in the forefront on this, but it seems to me they can be as confused as the general public. At least the Evangelical church seems content to leave it up to the doctors and bioethicists.
Yes, I think so. I get that sense too. It isn't true of course. Many things in life require steering between two extremes. Avoiding one and crashing recklessly into the other doesn't count.
Absolutely agree it's a false dichotomy. I think your example is too true also.
Posted by Mark | July 18, 2011 8:21 PM
I, in fact, foresee the day (if it hasn't already come) where a person who agrees to a DNR order (or family members who agree to it on his behalf) will automatically be assumed a) not to want nutrition and hydration and b) to be just fine with, shall we say, questionable doses of morphine or other similar drugs at the end of life.
In other words, the middle way may simply be ruled out by medical practice. Perhaps not officially, but by such iron custom that family members find it impossible to get medical personnel to believe that, "Mom signed a DNR" does _not_ mean, "Mom wants to be dehydrated to death."
There is a lot of testimony that the middle way is getting increasingly difficult to justify to many. I don't know how much stock to put into one person's testimony, but if you haven't seen this from a few months ago it is interesting. http://www.freerepublic.com/focus/f-bloggers/2678028/posts
Posted by Mark | July 18, 2011 8:27 PM
Oops. Sorry for forgetting the tags. The top two paragraphs are Lydia's of course.
Posted by Mark | July 18, 2011 8:28 PM
I hadn't seen it, Mark. That's very, very disturbing. Notice that all these patients were able to eat by mouth. The nurses and doctors were _very deliberately_ killing them by withholding even food by mouth and deliberately dosing them into unconsciousness with morphine. Horrifying. Enough to make anyone refuse ever, ever to go to hospice. And that's not what hospice was supposed to be.
I also note that advance directives usually (at least used to usually) refer to _artificial_ nutrition and hydration. Unless the blogger is just misremembering, the one Larry signed referred to _any_ nutrition and hydration, and that, in fact, was how this was all enforced: Even patients who could eat by mouth were put on npo orders, explicitly so that they would die.
Bless the Filipino orderlies--sneaking around to feed dying people a little applesauce.
Posted by Lydia | July 18, 2011 8:46 PM
Yes, it is deeply disturbing. Somehow it seems to have the ring of truth to it. It isn't what hospice was supposed to be.
Posted by Mark | July 18, 2011 9:34 PM
The Filipino orderlies represent what hospice was supposed to be (as does the Catholic atmosphere, I suspect). The hard-boiled nurse and doctor represent what it apparently has become. That's partly why the story seems to be obviously true.
Posted by Lydia | July 19, 2011 7:44 AM
I for see a time when people wanting to kill themselves will be rewarded by the state as heroes. Coming to a demented country, near you...
The Chicken
Posted by The Masked Chicken | July 19, 2011 8:23 AM