Culture of Death: the assault on medical ethics in America. (Book Review).

Wesley J. Smith, Culture of Death: the assault on medical ethics in America, San Francisco: Encounter Press, pp. 285, $36.95 Cdn.

Wesley Smith has written ten books previously, and is an excellent writer. In this book he concentrates on the question of euthanasia, on which he has written before. He shows that many people today accept almost without question medical principles which just a few decades ago they would never have approved of. If a frog is placed in cold water and the water is gradually heated, the frog doesn't notice it and is happily boiled to death. So gradual encroachments on killing the unwanted have brought us to what is happening in medicine today.

This program of encroachment has been orchestrated by bioethicists, among most of whom there is little religious faith. They are mostly philosophers, doctors, lawyers, and judges. After the legalization and widespread practice of the culture of death at the beginning of life, there is now the gradual legalization and practice of the culture of death at life's end.

The book is replete with accounts of old and very ill people (and even young and severely handicapped people) who are put to death, simply abandoned to death, or even counselled into wanting to end their life or have it ended for them.

The basic premise allowing all this is the conviction that some lives are more important than others. When someone is viewed as not having sufficient quality of life, a decision is made that this person must make way for others. One factor in this decision is how much trouble the person is to others, how great sacrifices others must make to keep the person alive. But the chief factor, and an increasingly more demanding one, is how much money will be required to keep the person alive. Many treatments are quite costly. If a person is dependent on public health assistance, the state is concerned about the amount to be spent on those judged to have a "life unworthy of life." If a person is dependent on health insurance, the insurance company is equally concerned, and thus sets conditions on treatments.

The physician Hippocrates (460-377 B.C.) formulated an oath which all physicians used to take at their graduation. It taught, among other things, that the primary duty of the physician was to his patient. Today that is gone. The bioethicists seem to have taught doctors that they have an equal duty to the state. And modern legal cases are giving doctors the right to make life-and-death decisions about their patients in view of what the state or the insurance companies want. No matter how much the family may want its loved one to live, other voices are gradually gaining the right to make the decision.

Another controversial area is that of organ donation. The general public would be horrified to be told that patients have organs removed before they are dead. That would probably end the organ donation program. But many physicians change the ordinary criteria of death, and give it a new name, brain death. (See Dr. John Shea's article in our Jan/Feb 2002 issue, pp. 17-20). Smith thinks that there is a legitimate use of this term, but warns that it is quite possible to interpret it in such a way that organs are removed before the patient is dead.

Smith also is concerned about the teaching of some philosophers that some animals are superior to some human beings, and are therefore more worthy of protection and care. Most people are alarmed by such teaching, but its proponents are given prestigious chairs in universities.

The author makes a number of recommendations:

* That the difficult decisions about treatment be made not by doctors but by a neutral mediating group.

* Patients should not be denied food or liquids (even if intravenously administered) simply so that they will die.

* Certain expressions should not be used because they are false and demeaning, expressions such as "vegetative state" or "vegetable" or "dying with dignity."

* Give the disabled community a big part in policy matters dealing with the disabled.

* Affirm the dignity of being a human being.

* Promote the hospice movement, which treats all people close to death with food, warmth, freedom from pain, and love.