Thursday, February 16, 2012

Defining killing down

From my hero Wesley J. Smith.

Wesley is the most dedicated defender of human life I know. He brings attention to a terrifying shift in bioethics. I see it happening as well in my own practice. There is a rapid shift from traditional understandings of the ethics of organ donation and of care for the disabled to the new paradigm: bring severely disabled people into the organ donor pool and end their lives with organ donation in mind.

Wesley Smith:

The killing-for-organs pushers 
By Wesley J. Smith
If you want to see where our culture may next go off the rails, read professional journals. There, in often eye-crossing and passive arcane prose of the medical intelligentsia, you will discover an astonishing level of antipathy to the sanctity of human life — to the point now that some advocate killing the profoundly disabled for their organs.
Case in point: “What Makes Killing Wrong?” an article published in the January 19, 2012 edition of the Journal of Medical Ethics. The authors argue that death and total disability are morally indistinguishable, and therefore harvesting organs from living disabled patients is not morally wrong. Bioethicists Walter Sinnott-Armstrong, of Duke University, and Franklin G. Miller, from the National Institutes of Health’s Department of Bioethics (which should really get the alarm bells ringing!) arrive at their shocking (for most of us) conclusion by claiming that murdering the hypothetical “Betty” isn’t wrong because it kills her, but rather, because it “makes her unable to do anything, including walking, talking, and even thinking and feeling.”
How do they get from deconstructing the definition of death to harvesting the disabled? First, they change the scenario so that Betty is not killed but severely brain damaged to the point that she is “totally disabled.” But their definition of that term encompasses hundreds of thousands of living Americans who are our mothers, fathers, children, aunts and siblings, uncles, friends and cousins — people with profound disabilities like that experienced by Terri Schiavo and my late Uncle Bruno as he lived through the late stages of his Alzheimer’s disease:
Betty has mental states, at least intermittently and temporarily, so she is not dead by any standard or plausible criterion. Still, she is universally disabled because she has no control over anything that goes on in her body or mind.
Since Betty “is no worse off being dead than totally disabled,” they opine, it is no worse “to kill Betty than to totally disable her.” Not only that, but according to the authors, “there is nothing bad about death or killing other than disability or disabling,” and since she is already so debilitated, then nothing wrong is done by harvesting her organs and thus ending her biological existence. And thus, in the space of not quite five pages, killing the innocent ceases to be wrong and the intrinsic dignity of human life is thrown out the window, transforming vulnerable human beings into objectified and exploitable human resources.
Alas, Sinnott-Armstrong and Miller are not on the fringe. And while they certainly don’t represent the unanimous view, they can hardly be called radical — at least by the standards of the medical/bioethical intelligentsia. Indeed, for more than a decade articles have been published in the world’s most notable medical and bioethics journals arguing in favor of killing profoundly disabled patients for their organs. Here is just a sampling:

● Bioethics: “If a patient opts for VAE [voluntary active euthanasia] in a society that permits it, and then chooses termination via RVO [removing vital organs], it seems clear that no more harm is done to others than if he were terminated by any other means.”
● Journal of Medical Ethics: “In the longer run, the medical profession and society … should be prepared to accept the reality and justifiability of life terminating acts in medicine in the context of stopping life sustaining treatment and performing vital organ transplantation.”
● Nature: “Few things are as sensitive as death. But concerns about the legal details of declaring death in someone who will never again be the person he or she was should be weighed against the value of giving a full and healthy life to someone who will die without a transplant.”
● New England Journal of Medicine: “Whether death occurs as the result of ventilator withdrawal or organ procurement, the ethically relevant precondition is valid consent by the patient or surrogate. With such consent, there is no harm or wrong done in retrieving vital organs before death, provided that anesthesia is administered.”
● The Lancet: “If the legal definition of death were to be changed to include comprehensive irreversible loss of higher brain function, it would be possible to take the life of a patient (or more accurately stop the heart since the patient would be defined as dead) by a lethal injection and then to remove the organs for transplantation …”
● Critical Care Medicine: “We propose that individuals who desire to donate their organs and who are either neurologically devastated or imminently dying should be able to donate their organs without first being declared dead.”

It is important to note here that transplant medicine remains an ethical enterprise and that doctors are not yet doing the deed. But if we want to keep it that way, it is important that these proposals not be allowed to germinate.
Here’s the good news. Sunlight is the great disinfectant. Most people will oppose killing for organs. Thus, the best way to prevent this dark agenda from ever becoming the legal public policy is to expose it in popular media every time it is proposed.

This is a surprisingly rapid shift taking place in bioethics. The trend is to narrow the gap between severe disability and death. It's most recent iteration began with the creation of a faux diagnosis-- Persistent Vegetative State-- and more recently with the creation of Minimally Conscious State, to be applied to those PVS folks who didn't get the memo that they weren't supposed to be aware.

The overall goal seems to be to certify severely disabled people unworthy of resources to keep them alive so that their lives can be intentionally ended, and to make them organ donors.

This is real, and it is coming. 


  1. Smith's passing remark about the "eye-crossing and passive arcane prose of the medical intelligentsia" put me in mind of a group of objectors to anti-Eugenics whom G.K Chesterton, in Eugenics and Other Evils, dubbed "Euphemists":

    Now before I set about arguing these things, there is a cloud of skirmishers, of harmless and confused modern sceptics, who ought to be cleared off or calmed down before we come to debate with the real doctors of the heresy. If I sum up my statement thus: “Eugenics, as discussed, evidently means the control of some men over the marriage and unmarriage of others; and probably means the control of the few over the marriage and unmarriage of the many,” I shall first of all receive the sort of answers that float like skim on the surface of teacups and talk. I may very roughly and rapidly divide these preliminary objectors into five sects; whom I will call the Euphemists, the Casuists, the Autocrats, the Precedenters, and the Endeavourers. When we have answered the immediate protestation of all these good, shouting, short-sighted people, we can begin to do justice to those intelligences that are really behind the idea.

    Most Eugenists are Euphemists. I mean merely that short words startle them, while long words soothe them. And they are utterly incapable of translating the one into the other, however obviously they mean the same thing. Say to them “The persuasive and even coercive powers of the citizen should enable him to make sure that the burden of longevity in the previous generation does not become disproportionate and intolerable, especially to the females”; say this to them and they will sway slightly to and fro like babies sent to sleep in cradles. Say to them “Murder your mother,” and they sit up quite suddenly. Yet the two sentences, in cold logic, are exactly the same. Say to them “It is not improbable that a period may arrive when the narrow if once useful distinction between the anthropoid
    homo and the other animals, which has been modified on so many moral points, may be modified also even in regard to the important question of the extension of human diet”; say this to them, and beauty born of murmuring sound will pass into their face. But say to them, in a simple, manly, hearty way “Let's eat a man!” and their surprise is quite surprising. Yet the sentences say just the same thing. Now, if anyone thinks these two instances extravagant, 1 will refer to two actual cases from the Eugenic discussions. When Sir Oliver Lodge spoke of the methods “of the stud-farm” many Eugenists exclaimed against the crudity of the suggestion. Yet long before that one of the ablest champions in the other interest had written “What nonsense this education is! Who could educate a racehorse or a greyhound?” Which most certainly either means nothing, or the human stud-farm. Or again, when I spoke of people “being married forcibly by the police,” another distinguished Eugenist almost achieved high spirits in his hearty assurance that no such thing had ever come into their heads. Yet a few days after I saw a Eugenist pronouncement, to the effect that the State ought to extend its powers in this area.

    Language is important, and potentially deceptive. We ought not allow ourselves to be lulled into lethargy by "eye-crossing and passive arcane prose" that serves merely as cover for evil, barbarism, and tyranny.

  2. Hey Egnor, are you ever gonna own up and respond to Steven Novella? You challenged him to the debate, he responded to your opening post and you were never heard back from. Now you're repeating claims here on your blog as if that exchange never took place. What happened?

    1. Yea. I run like a little girl when I see Novella.

      Which debate are you referring to?

    2. he one you invited him to here
      (, and his response is here
      ( Now I've looked quite a bit around on Evolution News and View and your own blog, but I came up empty. There is of course the chance that I've missed a reply. I was kinda interested in such an exchange because there haven't been many of such exchanges, most conservative Christians who had a stake in the Schiavo case were interested in legal matters and there's been quite a bit of silence after the autopsy came out.

      If you haven't replied to him, then yes you've chickened out, because I see you've done quite a bit of posting in the meantime on all sorts of other subjects.

    3. @Leonhard:

      I let it drop-- there were other points of contention to which I could devote my time.

      This is an interesting and important topic, and Novella and I are a good pair to discuss it.

      I'll try to put something together.

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  4. A debate about whether we should spend huge sums of money to keep people with largely lignified brains like Terri Schiavo alive while people with non-liquefied brains are dying for lack of transplants seems reasonable to me.

    What do Christians think happens to someone like Schiavo when they are allowed to die or die as part of an end of life plan that includes removal of life saving organs? Does she go to Heaven? Does God make her whole again? Might someone in a persistent vegetative state finally get to heaven and wish that her organs had been used to save the life of some sinner so the sinner has an opportunity repent and avoid infinite torture?


  5. @Anonymous/KW:

    What do Christians think happens to someone like Schiavo when they are allowed to die or die as part of an end of life plan that includes removal of life saving organs? Does she go to Heaven? Does God make her whole again?

    Yes, she (or he) goes to heaven. Yes, God makes her whole again.

    Of course Terri Schiavo was not involved in the decision-making process that ultimately ended her life. Assuming a victim made a knowing decision in advance to allow medical professionals to kill him or her ("kill" being the short word for the euphemism "active euthanasia"), there would be the open question: Was that decision tantamount to suicide? Christians might disagree about the rightness of such a choice.

    1. “Yes, she (or he) goes to heaven. Yes, God makes her whole again.”

      Terri Scheivo had a stoke (or something) that lead directly to a coma. If she was a hell bound unrepentant sinner at that moment would she still go to heaven? I mean, you’re not suggesting that persistent vegetative state is like a free pass are you? Or are you simply basing your answer on the religious reputation of her family?

      I’m just trying to figure out the Christian position here, because it seems to me that if you really believe she’s automatically in the fast lane to paradise and being whole again, I don’t see the religious objection for letting nature take its course.

      If on the other hand you thing she might become whole again only to suffer infinite torture, the argument to expend great effort to keep this woman alive gets much more compelling.


  6. @Anonymous/KW:

    Might someone in a persistent vegetative state finally get to heaven and wish that her organs had been used to save the life of some sinner so the sinner has an opportunity repent and avoid infinite torture?

    I don't know; your question is highly speculative. Perhaps it would be more profitable to consider a question for which we have sufficient historical precedent to give a confident answer: When a person who is strong (in this case, a care provider) is granted life-or-death discretion over a person who is helpless (in this case, the patient), will the strong be able to consistently resist the urge to benefit some third party (in this case, a potential transplant recipient) at the expense of the weak? The answer is often "No", even granting the most honorable motives to the strong. How many evils have been perpetrated against individual life under the flag of humanitarian impulse? Many evils -- regardless of whether the humanitarian impulse was sincere, or merely a cloak for fulfilling selfish ambition.

    There are good reasons why, in the Judeo-Christian tradition (and in other traditions as well), high hedges have been built around life, and the individual's right to life.

    1. “There are good reasons why, in the Judeo-Christian tradition (and in other traditions as well), high hedges have been built around life, and the individual's right to life.”

      Sure there are good reasons, but unfortunately for modern American conservative Christians those reasons dry up quickly if you’re not a fetus or literally have no brain. Death penalty, sure! Preemptive war, bring it on! Universal health insurance, not on my watch! Anthropomorphic climate change, not happening! It seems you’re motivated only by the raw numbers of lives, not the lengths of lives, or the quality of lives, just the number. Welcome to the high volume soul farm.