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What’s Wrong with the World is dedicated to the defense of what remains of Christendom, the civilization made by the men of the Cross of Christ. Athwart two hostile Powers we stand: the Jihad and Liberalism...read more

Safeguards? We don't need no stinkin' safeguards

So as not to be misunderstood, let me say at the outset that suicide is always wrong, gravely evil, that "assisted suicide" is murder, and that it would not make everything okay if euthanasia and assisted suicide were confined to "those who really want it and are competent and rational," "those who are terminally ill," "those who have met stringent criteria" or any of the other bromides we hear. The "safeguards" don't make it all right, period. If someone sat before me and told me, in the calmest terms, that he wanted to kill himself because he was going to die of cancer in six months, that he had weighed all the options, and that he was willing and able to go through any necessary mental evaluation or other evaluation to show that he was under no constraint or coercion, to jump through a variety of bureaucratic hoops, in order to obtain a "peaceful and dignified death" for himself, it would still be absolutely wrong to cooperate, and such a person should still be prevented from murdering himself.

Nonetheless, the fact of the matter is that assisted suicide is never, ever confined to such cases. Wesley J. Smith has reported countless times where the news media have distorted actual practice, stating that some law allows "only the terminally ill" to commit suicide when this is not true, stating that "strict safeguards" will be in place, when in fact they will not be, and so forth.

We need to remember this, partly for rhetorical and political reasons and partly to keep our own minds clear about what it means in a society to turn healers into killers and to make death an end in itself.

This has already been made abundantly clear in Europe, particularly in Holland and Belgium, where babies are killed, children can "request" suicide, and the elderly are euthanized without request. In Oregon--vaunted as an example of moderation in assisted suicide laws--doctors are required by the law to falsify medical accounts, patients can easily go doctor shopping to find one (including a doctor who does not know their case well) willing to help make them dead, and state health care plans not-so-subtly have encouraged suicide by covering death but not treatment.

So any alleged safeguards are a lot of baloney, and the reason for this is that, once death is counted as treatment, it devours a culture's sense that there should be a preference for life over death, which in turn makes safeguards seem discriminatory and pointless.

A recent example of this dynamic in Holland connects it with the issue of medical conscience.

Milou de Moor, a patient with lupus, wanted to be made dead. Under Holland's protocols, her local GP was supposed to approve of her being euthanized. That's one of those "safeguards," presumably to bring into the decision-making process a doctor who knew the patient in a holistic fashion. (Another article says that the approval of the doctor was not strictly required, but the fact that the other doctors refused to carry out the euthanasia without the GP's approval gives the strong impression that they, at least, did not consider themselves "covered" without it.)

Milou was going to be killed by a neurologist at the University Hospital in Ghent (Belgium) who had been treating her for some time for her lupus. But the local GP refused to sign off. Her reasons for hesitation are given nowhere in any of the articles I have found. They merely state that she had wavered on the matter, sometimes seeming to approve but ultimately unwilling to concur. One is left to conjecture that the GP thought Milou was too young to die, that the doctor felt squeamish about signing off on death for someone who was not actively dying, that she thought Milou could be treated or helped for her suicidal ideation. Who knows?

The upshot was that Milou, at only 19, hung herself from a tree in an orchard, and her family has gone on a professional vendetta against the GP who prevented her from being made dead in a doctor's office instead. Because being bumped off by someone in a white coat using a lethal injection is dignified, but hanging from an apple tree is icky, or something.

The parents have made a complaint against the GP, and a disciplinary board will decide whether to launch a case against the doctor.

The success of such a complaint would mean, in practice, that GPs would be expected to rubber-stamp suicide demands. The notion of independent judgement and checks and balances would be the merest illusion. Doctors would have to fear, justifiably, that even hesitating to approve a euthanasia could get them in trouble. Death now, death fast, death at all costs. Death is the good decision, death is the better decision. Hurry up and make people dead or they might do it themselves messily, and that's the only thing we really feel horrified about.

So much for safeguards. In such a climate, suppose that a doctor suspected coercion? Suppose that the doctor did not think that the patient understood the nature of the request, or was not of sound mind? It is entirely plausible that a doctor could nonetheless face exhausting and career-destroying investigation and/or discipline for exercising medical judgement in such a case. The prima facie case, it appears, must be pro-death.

Oh, by the way: No, I don't think doctors in Holland just have to "do their job [of making patients dead] or quit."

Comments (13)

"I call heaven and earth to record this day against you, that I have set before you life and death, blessing and cursing: therefore choose life, that both thou and thy seed may live:"

A society that chooses death chooses death, and must worship it wholeheartedly.

Are there any implications for the hypothetical doctor who did not rubber stamp the euthania of a patient facing criminal charges related to negligence or malpractice?

In the case of this specific doctor, I believe the sanctions would be professional and perhaps civil (civil suit, perhaps?) rather than criminal. But my impression is that they could be pretty serious professional sanctions.

(Meanwhile, in our own country, we're hearing crickets about any investigation or even professional sanctions against a "doctor" who deliberately blinded a patient, as related in my earlier post!)

Curiously, the one thing both conservatives and liberals seem to agree upon with terminal patients is that handing out pain killers like candy to terminal patients who are in severe pain is not on the table. For liberals it's a knock off of euthanasia that is morally licit and for conservatives, we obviously can't have a patient with 4 months to live becoming a drug addict...

Oh, rubbish, Mike T. Any conservative pro-lifer who is interested in this issue is talking about adequate pain control. It's one of our talking points. For that matter, doctors already sometimes give so much morphine that it amounts to a form of euthanasia in itself, but good hospice care (which conservatives push when talking about this issue) involves knowing how to give meds so that one isn't essentially bumping the person off with an od of morphine but one is controlling the pain. In fact, something that people like Smith (who is a "conservative" on this particular issue though not overall) often talks about is the fact that adequate hospice care and pain treatment suffer in countries where suicide becomes legal.

I have never met a single conservative who says that we should be rationing pain meds for a person with four months to live because he "might become an addict."

Let me also add that Milou de Moor was neither a "terminal patient" nor in constant and severe pain. The article makes that clear. She was afraid of the recurrence of emotional and psychological symptoms and afraid of losing her mental faculties.

Most people in Oregon who commit suicide under the suicide law in Oregon do _not_ do so because of severe and intractable pain, but rather because of things like fear of losing control of their deaths, fear of becoming a burden, fear of losing their faculties, etc. This has turned out to be generally true. Assisted suicide is not about pain, usually, but rather about control. It is also about a kind of hatred for one's hypothetical future self who might be incapacitated.

I have never met a single conservative who says that we should be rationing pain meds for a person with four months to live because he "might become an addict."

You mean other than conservatives who, for example, oppose the use of marijuana by patients who have terminal cancer? I think the real question is what they think they are saying when they talk about "treating pain." In some cases, a doctor may have to flirt with an OD in order to properly treat the pain.

I also notice that conservatives seem to be pretty cavalier about the DEA's treatment of doctors who actually do long term pain treatment outside of terminal cases. There is a near total lack of interest in the DEA prosecuting good doctors and scaring many away from treating people who have serious medical issues that require levels of drugs beyond what the DEA, in its extremely finite wisdom, thinks is medically necessary.

The only conservative I know who generally disagrees and despises the DEA with a passion, is a relative of mine who was a federal agent who had to actually deal with the DEA.

I am not a doctor, but my understanding is that long term users of opiates for medicinal purposes can require substantially higher doses than normal patients. Levels that would send a typical patient into the ER with an overdose. So the issue is not entirely cut and dry, and is something that the government should tread lightly on (hah!)

Levels that would send a typical patient into the ER with an overdose.

Yes, hospice workers know all about this and talk about this. It's not news. Of course, a person who is dying is not ipso facto a long-term user, so OD definitely still has to be worried about.

This thread isn't going to turn into a discussion of medical marijuana. (I notice too that you ignored my point about why people really commit physician-assisted suicide and continue to harp on the canard about intractable pain.) As far as I'm concerned, Wesley Smith's answer to that is spot-on: No, don't create a lawless situation like we have now with the joke of "medical marijuana" use but _do_ make the active ingredient a controlled substance that can be dispensed in non-smoking ways, with a normal prescription, when medically indicated, just like morphine or anything else. That regulates the whole thing, takes away the claim that legitimate needs are not being met, and avoids the silliness we have now with fake doctors, fake prescriptions, fake "medical" use, and a free-for-all of potheads.

But remember: Milou de Moor's problem was not the DEA and was not drug laws in her own country.

You show a tendency to try to bring everything around to your preoccupations.

No, don't create a lawless situation like we have now with the joke of "medical marijuana" use but _do_ make the active ingredient a controlled substance that can be dispensed in non-smoking ways, with a normal prescription, when medically indicated, just like morphine or anything else.

The problem still remains that law enforcement is not qualified to make medical decisions. This is the main problem with the DEA. It has its own views of what is medically appropriate, and the medical community's input is usually not even a factor. So you can say he has a spot-on answer all you want, but you are just saying that he has a way of making THC part of a treatment regimen in a system in which unqualified people are overseeing treatment by more qualified individuals. At the end of the day, it's not the treatment options that are the serious issue, but rather that law enforcement should generally have no say whatsoever in how doctors treat their patients with controlled substances unless it is malicious or criminally negligent (with the reasonable person standard being that of a doctor, not the general public).

You show a tendency to try to bring everything around to your preoccupations.

You show a tendency to claim moderation on subjects like the use of narcotics here and pretend that it isn't part of a larger issue. There are places like Florida where doctors often won't treat chronic pain patients precisely because that is safer than having the DEA and local vice cops treating them like a common drug dealer.

Most people in Oregon who commit suicide under the suicide law in Oregon do _not_ do so because of severe and intractable pain, but rather because of things like fear of losing control of their deaths, fear of becoming a burden, fear of losing their faculties, etc. This has turned out to be generally true. Assisted suicide is not about pain, usually, but rather about control. It is also about a kind of hatred for one's hypothetical future self who might be incapacitated.

This is the best practical argument against "safeguards" as a moderation on euthanasia. Even most moderates understand the slippery slope and can see how over time doctors would be pressured into applying euthanasia casually. Any law which allows doctors to face a consequence for not performing an act of euthanasia has the potential to be used against them in cases where no rational person could ever support euthanasia.

It's much like how we don't give patients control over most of their treatment choices precisely because inverting the power structure would put the doctor into an untenable position of power over them, but retaining ultimate responsibility for the decision they make under coercion.

Actually, my post isn't generally about the use of narcotics at all. (A point you seem to fail to notice.)

But as it happens, I disagree that law enforcement can never and should never be deciding what counts as an overdose and that a doctor should be able to say just anything because "he's the expert." That's an open invitation to lethal injection with a bare-faced lie--massive overdose of morphine, bump off the patient, and then say, "Oh, I'm the expert, and I thought it wasn't an overdose. Oops." And nothing happens. Heck, for that matter, that could even be done in all sorts of blatant situations--e.g., for insurance money, where the beneficiary is going to share the swag with the doctor. But, hey, the non-expert law enforcement guy, and a jury, are _completely_ unqualified to make the "medical decision" of what counts as an overdose, so the doctor can do whatever he wants.

The fact of the matter is that *that happens* (doctor murder by o.d.) in end-of-life care all the time. Even granting what you say about the problems with treating chronic pain, what we actually have too often in nursing homes, etc., is a _failure_ to prosecute euthanasia even where it is illegal, because the over-use of morphine (in particular) is left to the "experts." A principle that the doctor can never be wrong and/or lying about that sort of thing, codified in law, just makes those cases literally _impossible_ to prosecute, even with medically qualified witnesses and a willing prosecutor.

One of the reasons "A Canticle for Leibowitz" is so great is that in the brilliant final novella, when Miller tackles euthanasia, he doesn't play around with any of this "there are other options" crap.

No, Miller looks at the absolute worst case scenario: A mother whose infant child is suffering from incurable radiation burns. And he says, "It's evil anyway. If you kill your child, you will be committing a murder." It's much, much more powerful than if he'd kept some easy out.

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