"Brave new bioethics".

Only a few years ago, patients and their families were battling in the courts against physicians bent on subjecting terminally ill patients to unwanted treatments that served only to prolong the dying process. "The issue has now been turned on its head," affirms Dr. Charles Weijer, a professor of medicine at Dalhousie University. "In Canada today, physicians sometimes refuse to provide, or threaten to withdraw, life-sustaining treatment against the wishes of patients and their families.

In an outstanding new book, Culture of Death: The Assault on Medical Ethics in America, Wesley J. Smith, a lawyer and associate of Ralph Nader, cites several examples of such abuses in the United States and Canada. The account of the sorry death of a Montreal man, Herman Krausz, is an all-too- common one.

In 1998, Krausz was in Montreal's Jewish General Hospital, dying from a respiratory infection that was complicated by a burst vein in his lung. Krausz's son, George, told Smith: "Dad wanted to stay alive long enough to see his estranged brother." So what happened? Smith relates: "Doctors at the Jewish General Hospital did not allow Herman, age 76, that last wish. Over 15 hours, they slowly turned off his respirator against the family's expressed wishes and, George contends, against his father's stated desires."

At a coroner's inquest into the death, Dr. Patricia Macmillan testified that she did not believe that Herman's physician needed the consent of either the patient or his family to withdraw treatment. And in a story last May on the outcome of the inquest, Canadian Bioethics Report, a publication of the Canadian Medical Association, stated that the coroner's report "did not make a determination as to whether a dying patient's consent is necessary before doctors can remove life support when the medical opinion is that the prolonging of life would be medically futile."

Fifty years ago, the entire Western world anathematized the Nazi notion of "life unworthy of life." Today, many physicians in Europe and North America have no compunction about deliberately killing a patient without so much as consulting him or his family, on grounds that it would be futile to prolong the patient's life.

In making these God-like decisions, most physicians do not act alone. They follow guidelines set down by a hospital bioethics committee. But for patients, that's no consolation. Smith reports that many members of these bioethics committees are ill-trained. Others have the most sophisticated academic credentials, yet uphold a utilitarian bioethics that denigrates human life.

Peter Singer, the Ira W. DeCamp Professor of Bioethics at Princeton University, is a prime example of such academic barbarism. Despite acknowledging that "ethical ideals, like individual rights, the sanctity of life, justice, purity, are incompatible with utilitarianism," he remains a champion of utilitarianism and a leading exponent of animal rights, assisted suicide, euthanasia and infanticide.

Smith points out that, for utilitarians, there is neither objective right nor objective wrong. "Lacking a firm commitment to the sanctity of human life," he writes, "utilitarians may justify profoundly dangerous and immoral schemes and not even blush." Thus in Applied Ethics, a book of readings edited by Singer, a British bioethicist, John Harris, has suggested, "Whenever doctors have two or more dying patients who could be saved by transplants, and no suitable organs have come to hand through 'natural deaths,' they (should be allowed to) ask a central computer to supply a suitable donor ... at random and he will be killed so that the lives of two or more others may be saved."

Smith explains: "To the radical utilitarian Harris, saving two or more lives at the expense of one murder would bring greater overall happiness than the suffering caused by the killing of one man or woman. And since under utilitarianism, no individual possesses human rights per se, why not go ahead and perform the human sacrifice?"

Such is the "Brave New Bioethics" dissected by Smith in Culture of Death. It's a profoundly important book that eminently fulfils Smith's stated aim: "to alert my readers to the intentional undermining by bioethicists of the fundamental moral principles that have long governed our society, and to invite them into the crucial, ongoing debates about their health care debates that will, quite literally, determine the future of Western medicine."