- The Washington Times - Friday, April 13, 2001

The Hippocratic oath may be on its deathbed, succumbing to a fatal disease called bioethics, according to Wesley J. Smith.

Bioethics is a relatively new field of philosophy concerned with social issues in medical care. Its leading theorists have increasingly come to emphasize "quality of life instead of sanctity of life," meaning that some patients are viewed as "discardable," says Mr. Smith, a lawyer and anti-euthanasia activist.

Because of this new philosophy, he says, doctors and other health care providers often refuse lifesaving treatment to those patients, including the elderly and disabled, whose quality of life is judged to be not worth preserving. In some cases, the California Nurses Association reports, desperate patients in hospitals have resorted to calling 911 because they could not receive needed medical care.

A former associate of consumer advocate Ralph Nader, Mr. Smith began exploring the field of bioethics after writing a 1997 book, "Forced Exit," about the assisted-suicide movement.

Mr. Smith says he was shocked to discover that views he regarded as extreme such as those of Princeton bioethics professor Peter Singer, who has claimed that some human lives are less valuable than the lives of chimpanzees are widely accepted among bioethicists.

"Peter Singer, I thought, was on the fringes of bioethics. It turns out he's in the mainstream," says Mr. Smith, whose new book, "The Culture of Death: The Assault of Medical Ethics in America," explores the real-life consequences of bioethics theories.

"One of those [theories] is called futile care theory or medical futility, in which doctors are … giving themselves the right to say no to wanted, life-extending medical treatment based on the doctor's judgment of the patient's quality of life," he says.

Such a theory "does away with the Hippocratic oath which few doctors take anymore and leads us to a place where the weakest and most vulnerable among us, in essence, become discardable," Mr. Smith says.

Bioethicists, he says, view the deaths of such patients "as answers to [the patients'] own problems, as answers to the problems of their families as caregivers, as answers to issues of better distribution of medical resources, which has put our medical system in a transition where the right to die quickly becomes the duty to die."

In his book, Mr. Smith chronicles how these theories are turned into actual medical practice. For example:

• John Campbell's teen-age son, Christopher, had been in a coma for three weeks because of brain damage suffered in an auto accident. When Christopher developed a 107-degree temperature, a doctor refused to order treatment, saying the boy's life was "effectively over" and there was no point in treating the fever, according to Christopher's father. The doctor, fearing legal consequences, finally relented in face of Mr. Campbell's angry insistence. Christopher survived and has slowly begun recovering from his injury.

• In 1997, a top Cleveland neurologist was accused of being part of a "conspiracy" to "commit homicide so as to obtain organs" for transplant operations. The doctor had proposed new treatment protocols that allowed organs to be surgically removed after heartbeat and respiration stopped, but before patients were declared "brain dead." Although the case led to a report on CBS' "60 Minutes," similar policies had long been in effect and are still in effect at other hospitals.

• Between 1977 and 1982, 69 babies born with a severe birth defect called spina bifida were used in an experiment in which 36 received aggressive treatment and 33 were to get only "supportive care." All of the treated children lived; nearly all the rest died, most in less than two months. But four of those who were recommended for "supportive care" survived only because their parents refused to accept the doctors' recommendations and sought treatment for their babies.

Mr. Smith says such "horror stories," as he calls them, are reminiscent of Nazi Germany, where the diseased and disabled were deemed "unworthy of life."

Despite his own long history of liberal activism with Mr. Nader "He taught me how to be a citizen advocate … I think of myself like Paul Revere," Mr. Smith says he acknowledges that conservatives seem to be much more concerned about problems in bioethics.

"The liberal groups, which I perceive as being about protecting vulnerable and defenseless people, seem to have difficulty looking this issue square in the eye," he says. "Many right-to-life groups have come to appreciate the bioethics issues. I think there is an anti-intellectual streak among some liberals that says if right-to-life people think one thing, they are duty-bound to think another."

That's one reason Mr. Smith avoids the abortion issue.

"I don't want to lose half my audience," he says. "I have nothing to say about abortion. I don't want to allow that issue to interfere with what I'm doing on bioethics, because the minute that issue begins, rational discussion ends. People on both sides get equally angry with me for not taking a stand on abortion."

Mr. Smith says the bioethics debate provides "an opportunity for those on both sides of the abortion debate to come together in an alliance to stand up for the sanctity and the equality of all human life," he says.

"Indeed, some of the most effective opponents of the bioethics movement are disability rights activists, who tend to be liberal, secular and pro-choice," Mr. Smith says. "Yet, disability rights activists work shoulder-to-shoulder with pro-life activists who tend to be conservative, religious and pro-life, [because they] have found common ground on these issues and have stood together on the equality of human life."

Despite worrisome trends in bioethics, Mr. Smith says, he sees hopeful signs including the 1999 murder conviction of assisted-suicide advocate Jack Kevorkian. "You haven't seen any forward advancement of [legalized] assisted suicide since 1994," Mr. Smith says, and an effort to legalize assisted suicide was defeated in Maine last year.

"We need to create a human rights bioethics that approaches all of the intricate and complex issues we face, whether it be cloning or end-of-life care, from a position of universal human equality," Mr. Smith says. "There is no 'them,' there is only 'us.' We do that, and we can prevent 'Brave New World.' But the time is short and the generation that is to do that is ours. Complacency is not an option."


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