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Choice devours itself: Explicit in South Australia

Many of us who follow the biomedical scene with regard to right to life issues have long believed that the "right to choose" is really a one-way street. We hear all the time about the "right to choose" not to receive treatment, resuscitation, or "life-extending measures," but all the rhetoric suggests that the people shouting "choice" would be singing a different tune if the choice were to receive the measures they obviously disdain. In such discussions the life-sustaining measures are almost always negatively portrayed as "being hooked up to machines" (even when this is false and there are no machines), "being hooked up to tubes" (aka, receiving food and water by tube feeding), and "being kept alive." As we saw here, "being kept alive" is now even used to refer to a person suffering from dementia who is apparently willingly receiving mere spoon feeding. And then, of course, there are all the extremely derogatory ways of referring to the disabled patient himself.

So is choice really the important thing, or is the really important agenda making sure people make the "right" choice, the "rational" choice (to die)? Is "freedom to choose" just a fraud, intended to lure people to their deaths? Many of us have thought so for a long time.

Let me pause for a moment to explain again the "choice devours itself" phenomenon. Choice devours itself when someone touts the need to make some choice available, allegedly for the benefit of some identifiable group who needs to choose that outcome. Then, however, we find that some of the very people who were to be benefited are actually being forced into the so-called "choice," but the original advocates of choice as the greatest good either don't care, actively approve of the coercion, or are in denial about its occurrence. So their love of choice turns out to have been a sham.

This happens with regard to coerced and forced abortions, human sex trafficking, and, of course, death.

Now, South Australia has amended its medical laws so that they expressly affirm that the only choice allowed is the choice for death and that a choice for life need not be honored. The Advance Care Directives Act 2013 reads,

(2) A medical practitioner responsible for the treatment or care of a patient in the terminal phase of a terminal illness, or a person participating in the treatment or care of the patient under the medical practitioner's supervision—

(a) is under no duty to use, or to continue to use, life sustaining measures in treating the patient if the effect of doing so would be merely to prolong life in a moribund state without any real prospect of recovery or in a persistent vegetative state (whether or not the patient or the patient's representative has requested that such measures be used or continued); and

(b) must, if the patient or the patient's representative so directs, withdraw life sustaining measures from the patient. (emphasis added)

It doesn't get much more explicit than that, does it? The article which reports this amendment (in a postscript) says that this removes a previous "confusion" in the law as to whether doctors have to provide what they deem to be "futile" care for patients. Well, thanks for clearing that up, folks. Now we know that futile care theory reigns. If you choose death, then choice is sacrosanct and the doctor must respect that choice. If you choose life, even where this simply means continuing to receive sustenance, the medical profession can refuse.

Notice that this would apply even if the patient had an advance directive (as some of us do) which expressly says that we do wish to receive, say, tube feeding if necessary. Remember all that talk about how we should all avoid these agonizing end-of-life debates by running right out and "making our wishes known" in an advance directive? Yes, well, in South Australia they're making it quite clear that it was all a lie. Eventually the lie becomes unnecessary.

As Wesley J. Smith says (from whose blog I got the story):

For those who take comfort because they don’t live in South Australia, understand that these laws are as catching as a virus.

That's an important point. Let's not fool ourselves. The ethical "professionals" in the United States are committed to the same worldview that lies behind this law in South Australia. There is not some kind of deep cultural divide there. The world is a very small place, especially when it comes to sub-fields like bioethics. There is no question but that the ethics committees in hospitals in the United States believe that they should have the unilateral power to do what this Australian law describes--to refuse to honor what they regard as "irrational" decisions to remain alive in a state they deem unworthy of life. Nor, as this case shows, is this always about money or "demanding things for which one has no ability to pay," though money often does come into play and will do so even more as America moves more and more into a socialized medical situation. But in young Zach's case, his family had medical insurance. No, it's about power. And it's about thinking that people who want to live or who want their loved ones to continue to live "like that" are irrational.

It's about choice devouring itself.

Comments (10)

Nor, as this case shows, is this always about money or "demanding things for which one has no ability to pay," though money often does come into play and will do so even more as America moves more and more into a socialized medical situation.

Right. Given the way Obamacare takes over medical decisions generally, it's not surprising if they take over deciding whether to give you medical care for "cost effective" reasons. But deciding to take a person home from the hospital to feed her at home isn't a cost problem for anyone in the system, so refusing to allow that cannot be based on any sort of medical determination - they just WANT PEOPLE DEAD. Their "choice" is a disguised stand-in for "death", and they are having trouble with the disguise anymore. N.I.C.E. coming to a neighborhood near you.

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Nor, as this case shows, is this always about money or "demanding things for which one has no ability to pay," though money often does come into play and will do so even more as America moves more and more into a socialized medical situation.
end

Are you sure that this life-indifferent trend correlates directly with the increasing government interventions in the system? As I see it, even if the government had done nothing, does do nothing, the precedent toward looking at life and limb only in terms of profit and cost saving would have persisted and even grown any way. I don't disagree, but I think your view of the problem is too narrow; you've been watching too much news.
The explanation is not in the socialization of medicine, but in the general cultural breakdown and moral paralysis of the society involved. Because there is no standard of right and wrong with respect to medical practice and the preservation of life, considerations of competition and efficiency are all that concern health care merchants and their accountant-facilitators.
Amorality is the curtain for great evil in this society; it is this more profound disease that makes medicine more death-friendly in theory and practice.

My very point in the sentence you quote is that this _isn't_ first and foremost about saving money. I simply say that in fact it will happen *more often* as the system is further socialized. As an empirical fact, I believe that that is quite true. Canada went this direction, where the family and the person himself had no say-so, faster than the U.S. And even yet in the U.S. the person's and family's wishes remain quite important, varying somewhat state-by-state. So the socialization accelerates the trend. But I'm expressly saying that it isn't what lies *behind* the trend. What lies behind the trend is a certain set of views in bioethics.

Those views in bioethics are not principally about "competition," either. They are principally about the concept of quality of life and what Wesley J. Smith calls "futile care theory" and "personhood theory." These concepts go back to the bioethics classroom. They are related to the devaluation of the human being based upon his current capabilities and the alleged value of his life in terms of his enjoyment of it, his independence, his "dignity," and so forth. It is a rather specific form of utilitarianism which a certain set of parameters and utilities already in place. If you lack value according to this system, you should be dead. It's that simple. The world will be a better place if you are dead. You will be (somehow) better off dead. Everything will be better if you are dead. This is also being systematically taught to medical personnel in their medical training. And the kind of one-way laws just passed in Australia force that set of values upon everyone.

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They are related to the devaluation of the human being based upon his current capabilities and the alleged value of his life in terms of his enjoyment of it, his independence, his "dignity," and so forth. It is a rather specific form of utilitarianism which a certain set of parameters and utilities already in place. If you lack value according to this system, you should be dead. It's that simple. The world will be a better place if you are dead.
end

I'm no bio-ethicist, but I'm aware of this. Do you know of the organization called "Not Dead Yet?" They are an organization based in Rochester, NY, and they deal very directly with these issues as they apply to people who are often thought unworthy of life.
http://www.notdeadyet.org/

Yes, an extremely interesting organization. One of the few places where people who are often in some sense "of the left" actually show some sense.

Quote:
Those views in bioethics are not principally about "competition," either. They are principally about the concept of quality of life and what Wesley J. Smith calls "futile care theory" and "personhood theory." These concepts go back to the bioethics classroom. They are related to the devaluation of the human being based upon his current capabilities and the alleged value of his life in terms of his enjoyment of it, his independence, his "dignity," and so forth. It is a rather specific form of utilitarianism which a certain set of parameters and utilities already in place. If you lack value according to this system, you should be dead.
end

Actually, I think, as these principles are and will be applied, they go back to H.L. Mencken, who tersely and wisely observed that when those interested in a venture tell you, "money is no object," rest assured, it's about the money.
Yes, "we all will be protected" the leftist promise goes. Where you hear the word "all," be sure to interpret as "those who we like" will be protected.

Well, as we've seen in multiple cases, they are actually willing to _spend_ money so as to get their way. (Think of the extra money being spent on the "shutdown" in order to make it hurt.) Consider even the case of Terri Schiavo. Guards were posted around in order to make sure that no one tried to give her ice chips or any small amounts of water. Her parents were willing to take her home and assume the expense of her care but were not allowed. The goal was not to save money. The goal was to make her dead.

I'm afraid that sometimes it has to be admitted that things are about power and ideology *even more* than they are about money. There will, of course, be individual cases where money is saved by making people dead, but whether that is true in each case or not is not what is ultimately most important to the people making the calls.

Lydia,

"Consider even the case of Terri Schiavo." I still get mad (and depressed) considering the case. It was one of those moments of clarity for me when I realized something was very wrong with the whole "culture of death" around me (I was moving right at the time, but Terri's death pushed me along).

What amazes me the most about cases like this is the fact that the medical profession is playing along:

"This is also being systematically taught to medical personnel in their medical training."

Whatever happened to the Hippocratic Oath? Even the Greeks knew you were supposed to keep patients from "harm and injustice"? Can you imagine training to be a doctor and wanting to heal the sick and then one day you are sitting in class listening to some crazed teacher telling you that some people aren't worthy of your continued care and you should instead help them die? Insane.

Most (all) medical schools discontinued the Hippocratic Oath years ago.

Funnily enough, I can imagine pretty well how the culture of death is worked into medical classes. For one thing, the term "futile" or "futility" is very useful. It sounds like an objective thing. A person might well say, "Oh, well, if what's being suggested is futile, then it's quite understandable that we wouldn't do it," not realizing how much baggage is coming along with that term. Then there is the analogy between all manner of invasive and even almost violent intervention (such as repeated intubation and rib-breaking CPR) and something extremely simple like a feeding tube.

I've seen on-line medical people argue this stuff. They're pretty steeped in it, and they usually sound eerily reasonable (or "reasonable"). Their attitude is, "I know all the nasty things we medical people are called upon to do to you fellow human beings to keep you alive, and *of course* we have to draw a line and say that enough is enough." To them, it's almost a backwards matter of conscience. The contempt for the patient's life itself (some phrase like "doing x to a patient just so he can live for years in a vegetative state") gets slipped in so fast that it's seamless.

It probably makes things easier (for bioethicists to wreck our doctors) that education in general at the college level has been surgically separated into unconnected areas of knowledge, with everyone required to become a specialist in one narrow area so that they rarely have a good view of an organic whole. In medicine, the end result seems to be a mechanistic approach to teaching: "this is what we do to keep a liver functioning, this is how we fix a heart, give them these chemicals when those levels on a blood test show up," etc. Treating the entire patient as a person can be lost in the shuffle. (Not that all doctors end up so mechanistic, but the training often has to be overcome to achieve that. It is true that alternative medical training quite frequently repudiates this approach, starting out with the assumption that the patient is a (whole, integral) person, and the medical practitioner's art is, fundamentally, the art of assisting the person to become healthy, not simply to "make" the body to be "fixed".) Anyway, given the specialization and narrowing of focus - not just an orthopedist, but an orthopedist hand surgeon - it is easier for bio- "ethics" to focus the doctor's attention on too small a scope of vision, too narrow a consideration of the "object" of his art.

Even aside from the empirical and historical reality that, at this point, bio-"ethics" professors are nearly all of the liberal anti-human anti-religious persuasion, and considering the theoretical possibility that one could have bioethics professors who are through and through good, I wonder whether we would really want there to be such a thing as "bioethics" as a distinct discipline. Should we instead prefer medical ethics to be taught organically with the teaching of anatomy, surgery, etc? There is certainly room for "ethics" as a discipline, and while I certainly want someone who teaches a course in ethics to be deeply studied specifically in ethical topics, I don't think a mastery of ethics can be had without a pretty fair exposure to general philosophy, to metaphysics, etc. (In addition, unlike expertise in chemistry or biology, I definitely want as qualifications to be an ethics professor that their personal life is free from any significant moral degradation.) Bio-ethics is another narrowing of scope, and still more is it the case, I think, that a person cannot be well grounded as an expert in bio-ethics who is not well grounded in ethics generally, which also means well grounded in philosophy. Consider economic-ethics, or even better: accounting-ethics. Do we think that there is a distinct discipline of ethics for accountants that is not pretty much just the application of general principles to what accountants are called to do? What about cement-ethics? ("Hey, it's not ethical to make cement shoes for a person against their consent unless you have a gun to your head...but in any case, cement shoes are not intrinsically evil, it's only the use to which they are put...")

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