Jacob Appel: Bad Medical Historian, Questionable Ethicist or Just a “Spin Doctor?”

As a left-handed tribute to “bioethicist and medical historian” Jacob M. Appel, I have titled this blog entry as a question, leading uninformed readers to think maybe I will seriously analyze an issue with two or more sides.  In fact, as readers of this blog know, I have a definite viewpoint and people come to this blog reading the content with that in mind.

However, when readers of the Huffington Post come across an entry by “bioethicist and medical historian” Jacob M. Appel, titled in the form of a question, they might be inclined to think they are going to get expert, honest and unbiased analysis.  Since most readers of the Huffington Post aren’t any more inclined to critical thinking than attendees at a Tea Party event, most readers might miss that while Appel may be an “expert,” they don’t get any analysis, let alone unbiased and honest analysis.

The source of this mini-rant is an essay posted by Appel on Huffington Post:

Should Children Have A Right to Die?

First off, the essay is about killing children rather than “letting them die.”

Second, the essay is about why we should allow children to be killed, rather than an analysis of the pros and cons.  The title is subterfuge.

The title, to be honest, should read something like “Parents should be able to ask doctors to kill their seriously ill and disabled children.”

But the misleading nature of the title only skims the surface of the distortions, omissions and manipulations in the essay by Appel.  They begin with the first sentence:

Advocates for aid-in-dying have largely focused their efforts on the rights of mentally-competent adults to end their lives when and how they wish.

Almost a year ago, this blog featured a post devoted to revealing the history of pro-euthanasia leaders promoting legalized killing of ill and disabled kids in the US and Canada. Maybe “historian” Appel didn’t know about that.

The impetus for Appel’s essay was the publication of a new study published in Archives of Pediatrics & Adolescent Medicine.  From the AP story on the study:

The study was published Monday in the March edition of Archives of Pediatrics & Adolescent Medicine. It was based on interviews with parents of 141 children who had died of cancer and were treated at three hospitals, in Boston and Minnesota.

Among parents studied, 1 in 8, or 13 percent, said they had considered asking about ending their child’s life, and 9 percent said they had that discussion with caregivers. Parents of five children said they explicitly requested euthanasia for their dying children, and parents of three said it was carried out, with morphine.

The lead author of the study is quoted as doubting the interpretation of parents who believe the lives of their children were ended, saying they were probably given sufficient morphine to quell symptoms and that timing of death (imminent anyway) was “coincidental.”

None of those nuances are explored by Appel.  He reasons that since a small percentage of the parents wanted the lives of their kids ended, it should have been legal for doctors to do it. 

What else does Appel do in the course of his essay?

• Fails to mention that the Netherlands – after lobbying from some medical professionals – has accepted infant euthanasia as a practice.  The first known “beneficiaries” were infants with (nonterminal) spina bifida and hydrocephalus.Where’s a “medical historian” when you need one?
• Sets up a “straw man” argument citing fears of “nefarious parents,” ignoring the historical reality of the willingness of some doctors in the US to manipulate parents to accepting “nontreatment” leading to death as the best thing to do with infants with spina bifida and hydrocephalus.  It’s an important episode in US medical history – to disability advocates and activists, anyway.  To bioethicists and “medical historians,” – not so much.
• Engages in his own rhetorical “slippery slope” as he glides through the essay discussing the euthanasia of “terminally ill” kids with cancer, then moves on without effort to include “chronically ill.”  All of it falls under “end of life.”
• Finally, and probably most egregiously, Appel really should have told his readers that he took a public position on this matter in an article published last year.  And to be totally honest, his position is that the potential suffering of a child or infant should be the determining factor in deciding to kill them – not the consent of parents.

I already knew that intellectual honesty and rigor weren’t required to gain prominence in bioethics circles.  Apparently these traits aren’t held in esteem in the field of medical history, either.  –Stephen Drake