Followup on Warnock – Art Caplan Strongly Disagrees With “Duty to Die”

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Art Caplan, Director of the University of Pennsylvania Center for Bioethics, dropped me a line to give me his reaction to Warnock’s comments about people with dementia. He gave these to a reporter at ABC but says they weren’t used in whatever coverage they ended up giving to Warnock:

No one has a duty to die. The notion that society should ‘expect’ someone to end their lives because they fear being a burden upon others is simply ethically repugnant. It is one thing for a person to decide that they do not want to accept medical care –and this decision may include considerations of their quality of life or even the economic consequences of their decision for those they love. There are patients today who refuse expensive cancer drugs knowing they will only get minimal benefit at a huge cost that will bankrupt their families. But individual decision-making should never ever be coerced or pressured by societal considerations–third parties or legislators–weighing in that it is best for them to die! Society must do
all that it can to provide the mean to efficacious medical care to all who want it. The Warnock view risks taking the frail and vulnerable and making them expendable–a position that no humane society can or should take.

In his note, he also said he was “shocked and saddened” by Warnock’s statements.

Unlike Caplan, I wasn’t shocked by Warnock’s statements. Other than that, I am pretty much in agreement with the sentiments expressed in the paragraph above. It would have been nice if ABC had used his remarks. –Stephen Drake

Bioethics Blog Defends Warnock’s Call for Killing of People with Dementia

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Last week, Baroness Warnock, a well-known “ethicist” who has advised the British Government on health care policy for ages, shocked advocates for the elderly in the UK when she suggested that people with dementia should be assisted in killing themselves or even outright killed. She suggested that the lives of these people are a “waste” and eat up valuable resources.

Her statements have drawn condemnation from just about every corner, including advocates for people with dementia and their families. Even the pro-euthanasia societies in the UK haven’t jumped to her defense. (OTOH, they haven’t condemned the remarks, either, so maybe they’re taking a “wait and see” in terms of public reaction before they take a public stand.)

Alex Schadenberg and Wesley Smith both have entries on Warnock’s comments you can read.

I guess I shouldn’t be all that shocked, but virtually alone, out of all the voices out there commenting on Warnock, Summer Johnson, PhD has done what even pro-euthanasia forces in the U.K. have been too timid to do – defend (and coming close to endorse) Warnock’s statements and her reasoning:

Some Brits are shocked at Baroness Mary Warnock’s latest quote regarding the significant burden placed on Alzheimer’s caregivers and her call for euthanasia for the demented.

The St. Louis Examiner reported that she said, “Elderly people with dementia are ‘wasting’ the lives of those who have to care for them.”

Not only are they wasting lives, says Warnock, but they are also wasting resources. Not exactly warm fuzzies from the Baroness. Yet, in a socialized health care system every dollar spent on one person is a dollar not spent on another. Thus, years spent in a demented state means that tens to hundreds of thousands of dollars spent on a demented patient are not spent on essential preventive and life-saving services for children, young adults, and the middle-aged who have a chance of leading longer, healthy, fulfilling lives.

Thought about that way Warnock’s argument doesn’t seem so harsh. Is Baroness Warnock’s position cold-hearted? No. It’s practical. (Emphasis added.)

The Bioethics Blog is owned and operated by the editors of the American Journal of Bioethics, which is heavily loaded with bioethicists who work at or have ties to the Alden March Bioethics Institute (AMBI) in Albany, NY.

I want to personally thank Summer Johnson for firing a warning shot over the bow in terms of what kind of health care policy advocacy we can expect from the folks at AMBI. As a current resident of New York State, NY health care policy is a lot more personal for me than it used to be.

BTW, for those who might think that there’s something familiar about the sound of Albany and bioethics, NDY and CDR organized a visit to a conference organized by the group a couple years ago. Guess we could always visit them again sometime. –Stephen Drake

Addendum and Correction: Someone emailed me to let me know that neither Glenn McGee (former director of AMBI) nor Summer Johnson works at AMBI any more. McGee has officially transformed his Bioethics Education Network into a for-profit enterprise. I am guessing that is where Summer Johnson is working as well. To the extent that McGee’s enterprise is successful, there is good cause for concern for many of us who worry about the impact of certain bioethicists on policy makers – there is, after all, no way that policy makers have of distinguishing “good” ones from “bad” ones.

Painfully True Humor from The Onion

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Universal health coverage, like so many things those of us living below the median income line could use, is probably off the table now that we’ve got to figure out how to prevent total economic meltdown — in which we all get to pay for the bad behavior of rich people who operated in an environment bereft of any accountability for their actions. (The only good aspect of this whole thing right now seems to be the impending death of an irrational infatuation with deregulation that has dominated public policy for decades.)

What better time than to go to The Onion to remind us all what we’ll continue to live and die with thanks to having to bail out big investment houses on Wall Street:

DENVER—After years of battling crippling premiums and agonizing deductibles, local resident Michael Haige finally succumbed this week to the health insurance policy that had ravaged his adult life.

Haige, who had suffered from limited medical coverage for nearly a decade, passed away early Monday morning. According to sources, the 46-year-old was laid to rest at Fairplains cemetery, surrounded by friends, family members, and more than $300,000 of mounting debt.

“I miss Michael every single day, but at least he can finally rest now,” said Sheila Haige, who watched as insurance rates ate away at her husband over time. “What Michael went through, the humiliating forms, the invasive background checks, the complete loss of dignity and hope—I wouldn’t wish that kind of torture on anyone.”

The article continues…

According to an independent study released last month by the Mayo Clinic, health insurance is the nation’s No. 2 cause of death, claiming the lives of some 400,000 Americans each year. A silent killer, health insurance often strikes without warning, its harmful and profit-based policies avoiding detection until it is far too late. Although the cruel bureaucratic disorder does not discriminate, statistics have shown that senior citizens, young dependents, and those woefully underemployed are most at risk.

“I can’t tell you the number of patients I’ve had to deliver the bad news to over the years,” said Haige’s longtime family physician, Dr. Howard Silverman. “It’s never easy to look someone in the eye and tell them it’s going to have to be out-of-pocket. For most of these poor people, prayer is the only hope.”

If you enjoy reading humor that hits at some painful truths, read the whole thing here.

India: Kerala Commission Recommends Euthanasia Legalization

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Well, this had to happen sooner or later. A legal commission is the state of Kerala has recommended a pretty sweeping legalization of euthanasia:

Kerala Law Reforms Commission has presented a proposal, which recommends that euthanasia or mercy killing should be made legal in the state. The proposal also suggests deletion of Section 309 of the Indian Penal Code which holds attempt to suicide as an offence. The panel was headed by retired Supreme Court judge V.R. Krishna Iyer.

Euthanasia is defined in the proposal as “deprivation of life by oneself, or by any other person at the insistence of the person whose life is lost, or by medical practitioner doing any act or omission resulting in termination of life.”

The proposal says that if the victim of suffering and his closest relatives, after taking responsible medical opinion about the irrecoverability of pain-free normality, creates the right to euthanasia. Solace compassion, justice and humanism make euthanasia a legally permissible farewell to life in its misery and desperation.

Sounds nice, doesn’t it?

Trouble is, it ignores the reality of the rash of highly-publicized pleas for “mercy killings” put forth by families and individuals in India over the past few years. This is a fairly representative example:

KOLKATA: An ailing 40-year-old woman and her husband have written to the District Magistrate of North 24-Parganas seeking permission to undergo euthanasia, official sources said.

Swapna Das, suffering from a kidney disorder, and her husband Biswanath, a soccer coach at a local club, got married five years ago. The couple stated that they have decided to end their lives because they can not meet the cost of treating Das’ illness.

“We need Rs 6,000 for a dialysis and another Rs 3.5 lakh for a replacement,” Das said. Biswanath said they were currently dependent on neighbours’ help for her survival.

This couple is typical of the “mercy killing” pleas that have emerged in India. Central to virtually every story is the despair over the inability to get treatment, support or in some cases even adequate food and shelter.

But the Kerala Law Reforms Commission neatly ignored the economic and social factors that have been central to the plight of those who have sued for permission to kill themselves, a relative or be killed by a third party.

In almost every publicized case, the plea for euthanasia was lost, but the publicity forced the government to free up some resources for the suffering family or individual.

Maybe the members of the Kerala Law Reforms Commission are tired of that kind of embarrassment. If the recommendations of the commission are followed, families in dire straits won’t have to file suit. There will be no public clamor or attention called to how little support there is for families with ill or disabled family members. No demand on the government to do more for these families.

Instead, they just get to die quietly. And the government can call it “compassion.” –Stephen Drake

Confusing editorial from the Oregonian

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Over the weekend, the editorial board at the Oregonian published an editorial claiming that the fears of critics of Oregon’s assisted suicide law appear to be unfounded. Nevertheless, the editors of the Oregonian don’t endorse the Washington attempt to legalize assisted suicide.

Confused?

So, apparently, is the editorial board at the Oregonian:

Ten years’ experience with Oregon’s one-of-a-kind Death With Dignity Act has shown that our deepest concerns were unfounded. Safeguards built into the law appear to be working.

Terminally ill people from other states have not flocked to Oregon to commit suicide, and Oregonians themselves are not using the law in large numbers. It has not targeted the disabled as feared, nor has it steamrollered vulnerable people into taking their lives.

But…

On the negative side, Oregon’s physician-assisted suicide program has not been sufficiently transparent. Essentially, a coterie of insiders run the program, with a handful of doctors and others deciding what the public may know. We’re aware of no substantiated abuses, but we’d feel more confident with more sunlight on the program. (Emphasis added.)

Given the statement about the lack of transparency and the closed shop “running the program,” shouldn’t they say that they really can’t say tell if the fears of abuses were unfounded? At the very least, promoters have fallen far short of their original promise to bring what they claimed was a widespread secretive practice into the light.

For what it’s worth, here’s the reason they give for opposing the Washington state initiative:

Our fundamental objection is the same it has always been — that’s it’s wrong to use physicians and pharmacists to hasten patients’ deaths.

That’s fine as far as it goes. But given the harsh critique of how the program is run, they could have done a far better job of informing the public discussion of this policy issue. That critique is literally begging for longer analysis of the failure of Oregon to provide the transparency, openness and accountability that was originally promised.

I always thought that one of the things the press was supposed to do was hound overnment and bureaucracies when openness and accountability fall short.

Apparently, that one sentence is as far as the Oregonian is willing to go. –Stephen Drake