Dissecting the age of ‘do harm’ medicine

A leading voice in American bioethics peers into the future in his new book

M_heart-665185_1280Wesley J. Smith is one of America’s leading commentators on bioethical issues, especially assisted suicide and euthanasia. His columns are published in the National Review and he is the author of 14 books. MercatorNet interviewed him about his latest, Culture of Death: The Age of “Do Harm” Medicine.

MercatorNet: This is a thoroughly revised edition of a book you published 16 years ago. In your view, is there less respect for life in American medical culture now? Are there any bright spots?

Wesley J. Smith: There is less respect for human equality and the sanctity of life in healthcare generally, I fear, and not only in the U.S. Indeed, I changed the subtitle of the book to “The Age of ‘Do Harm’ Medicine” because it now grapples with developments outside the United States as well as in my own country. We are all connected, so that what happens in Canada impacts Australia, what happens in the USA can have a pull on South Africa.

I have observed in the 15 years since the first edition of Culture of Death, that throughout the developed world and the West we see a terrible and increasing disrespect for the intrinsic value of the most weak and vulnerable among us. Euthanasia has spread like a stain and grown increasingly toxic. For example, in Belgium medicalized killing is now coupled with organ harvesting—including of the mentally ill. Health care rationing, which is blatant and invidious medical discrimination, is a growing threat. Advocacy continues to discard the dead donor rule in organ transplant medicine, even proposals for the live-harvesting of patients with profound cognitive disabilities.

If there is a “bright spot,” it is to be found among the medical professionals—doctors, nurses, pharmacists, physicians assistants, etc.—who continue to resist these utilitarian bioethical agendas and work in the trenches of clinical medicine with an ongoing commitment to the wellbeing and equal value of all patients.

MercatorNet: A serious problem in dealing with issues like stem cell research, surrogacy, futile care and so on is that people (including politicians) just don’t seem to be interested – at least until it touches them. How can we get voters and policy-makers to think about these issues more deeply?

Smith: It’s a difficult problem. The popular media is increasingly tabloid in its approach to reporting. It is the rare story that informs the general population about the threatening and radical ideas emanating from the academy, in the professional journals, and from among the leaders of the bioethical/medical establishments.

One of the purposes of the book is to help readers be forewarned of the potential threat they or their loved ones could face in a clinical setting—note, I don’t say will, but could—to enable them to mount a defense should an attempt be made to push a vulnerable patient out of the lifeboat.

Ironically, the media can be very helpful in such circumstances, because while the journalistic sector does a terrible job generally of reporting about bioethical issues—and are very boosting of assisted suicide—they often cast klieg lights on individual cases of medical oppression against particular patients, which can personalize the issue in such a way as to gain the attention and sympathy of the general public.

The great disinfectant of “light” can be very powerful at such times. Indeed, I am convinced this is why organ transplant medicine remains a generally moral and ethical enterprise. It is also the greatest defense against medical futility. Because the people generally reject such bad ideas and that acts as a popular bulwark against utilitarian incursions. …


MercatorNet: You describe bioethics as a kind of religion. What is the creed of this new faith?

Smith: It is more an orthodoxy, I think. Unless a “bioethicist” has a modifier in front of her name, such as “conservative” or “Catholic,” most are very liberal politically, activist culture warriors, and utilitarian in their approach, either explicitly or in outcomes. The movement seems increasingly disdainful of religious belief as well. I think the most remarkable aspect of all of this is that the values of mainstream bioethics do not comport with the views of most people. And yet we are supposed to follow their “expert” lead in establishing crucial public policies and medical ethics. I think not.

MercatorNet: Let’s peer into the future. What are the battles you are preparing for, the big issues?

Smith: Assisted suicide and euthanasia are going to continue to be bioethical hot potatoes. Medical futility. Protecting medical conscience rights for health care professionals who wish to adhere to Hippocratic values is going to be huge internationally. I mean, if we are not careful, in 20 years one may not be able to find a doctor who would not be willing to kill you under some circumstances, which I find a very frightening prospect.

I think health care rationing will also become an increasing hot button issue in the US, particularly if Hillary Clinton is elected and the Affordable HealthCare Act’s centralized control over American medicine becomes more centralized. And dealing with the ethical implications of CRISPR is going to be a daunting prospect. …

MercatorNet: I was pretty touched by your own experience with suicide, disability and care for the elderly. How have these experiences shaped your views?

Smith: I got into this mess after a friend committed suicide under the influence of Hemlock Society literature. She killed herself on her 76th birthday, and I saw first-hand how the insidious Hemlock message convinced her that suicide was empowering.

I am currently taking care of my 98-year-old mother in my home, with serious Alzheimer’s. I have seen at very close quarters how devastating that disease is—it’s not just memory loss—and how easy it would be to manipulate her into a hastened exit. Coercion happens behind closed doors, which no “guidelines” can protect against.

I have been impressed with the importance of treating the dying as equals and “us” by my training as a hospice volunteer. The courage and fortitude of families I have observed caring for their dying loved ones regardless of the emotional cost touched me at a very fundamental place. The disability rights community has revealed, I think the power and dignity of resisting the dismissive and discriminatory attitudes too commonly seen in the medical context, which perceives the lives of people with disabilities are less worthy of total care than those of other people.

I especially appreciate their insistence that nobody should have to “earn” their moral value by possessing “characteristics” that those with the power to decide determine provide greater importance. …

Wesley J. Smith is a lawyer and author who lives in San Francisco. He is the author of 14 books. The most recent is Culture of Death: The Age of “Do Harm” Medicine,

Editor’s note. This is excerpted from a post that appeared at Mercatornet.