Sick Thoughts.

Culture of Death: The Assault on Medical Ethics in America, by Wesley J. Smith (Encounter, 285 pp., $23.95)

The stories Wesley J. Smith has to tell are appalling. If you have any doubt about the corruption of modern medicine, you need to read the anecdotes scattered through Culture of Death: The Assault on Medical Ethics in America. The sick man forced to call 911 from his hospital bed because the medical staff categorized him as beyond help. The elderly woman left to die in pain because the nursing home declared her life not worth the cost of her care. The unconscious teenager sentenced to death by untreated fever because his doctor decided his life was "effectively over."

The solution to the sickness that has infected American medical care, however, requires not only that we recoil at the symptoms, but that we grasp the underlying disease. And that proves, in certain ways, the harder task. For while we register our indignation at this or that horror story-thinking each an abuse of a system still basically Hippocratic, still primarily concerned with the saving of life-the engine of "bioethics" rolls silently on. Every day, another hospital board is captured, another treatment protocol is redefined, another medical student takes a course in physician-assisted suicide, another HMO is told that the money-saving measure of euthanasia is an ethically justifiable form of "care for the terminally ill."

It is to expose this disease that Wesley Smith has written Culture of Death. A lawyer by training, he has assembled what is, in essence, a brief against bioethics as it is presented in America's premier philosophy departments, think tanks, and scholarly journals. Nearly everyone has heard about Jack Kevorkian's serial-killing of people whose main problems were depression and bad pain control, just as nearly everyone has heard about Peter Singer's appointment to a chair at Princeton University as a reward for proclaiming that a baby is of less value than a pig. But the shocking thing that Smith reveals is just how casually approved is the theory that justifies Kevorkian and Singer in places like Georgetown University's Kennedy Institute of Ethics, the Hastings Center, and the New England Journal of Medicine-the institutions to which American medicine looks for ethical guidance.

It's not the cranks with mimeograph machines in their basements who want to kill you. The philosophers who assume that some lives are not worth living, the activists who believe that the infirm have a duty to die, the doctors who study the mechanics of killing their patients: They are now the threat, and they are establishment in America today. Of course, the irrepressible Peter Singer is in the lead. There's a chapter in his latest book, Writings on an Ethical Life, called "Euthanasia: Emerging from Hitler's Shadow," which may make you wonder how far we are from a Princeton professor writing "Anti-Semitism: Emerging from Hitler's Shadow." But Singer is, in fact, merely less circumspect than his colleagues. Wesley Smith reveals a world of well-rewarded establishment figures who "reject what until now has been the core value of Western civilization: that all human beings possess equal moral worth."

In the seven central chapters in Culture of Death, Smith lays out the assault on the traditional ethics that once assumed that the saving of individual lives was medicine's highest concern.

He shows how "patient autonomy" became the mantra that justified passive abandonment and even active killing of sick people. He rages against "the bioethics-driven medical policy called Futile Care Theory," by which, he argues, hospitals require doctors to give up on whole classes of their patients. He excoriates current models for rationing health care, arguing that they all assume individual lives are fungible and disposable. He points out how the public's acquiescence in organ donation from the dead has emboldened theorists to demand organ donation from the living. He demonstrates that the clamor for animal rights serves primarily not to elevate animal life but to depreciate human life. And he ends with a call for a "'human-rights' bioethics"-a medical ethics that reembraces the old, Hippocratic love of life and rejects the eugenic flirtation with death.

In his relentless attack in Culture of Death, Smith scatters some of his shot. He is not entirely fair, for example, in his complete rejection of Daniel Callahan, co-founder of the Hastings Center and probably the most respected bioethicist alive, just because the man once proposed medical rationing. (Although it has to be admitted that Callahan, in his decades spent trying to dance at everyone's ball-to be a liberal among liberals and a conservative among conservatives-has not always been entirely fair to himself.)

So, too, Smith may be right that we should reject utilitarianism in its totality, but it is not clear he understands that Peter Singer, for example, represents the triumph of one school of utilitarianism over a potentially less-dangerous school-or that much bioethical theory isn't utilitarian at all, but derives instead from the lethal mixture of home-grown American philosophical pragmatism and radical European liberationism that has infected so much of our nation's culture.

Indeed, it is exactly this point that produces the one real problem in Culture of Death. Smith relies finally on a sensibility rather than a philosophy: What contemporary bioethics creates are practices that feel like murder, and therefore its philosophical underpinnings must be wrong.

It's unreasonable, of course, to complain that Smith lacks a sufficient philosophical anthropology to complete his indictment of bioethicists. But you can see one ill effect in Smith's nearly complete ignoring of abortion, which he avoids in a way one would not have thought possible in a book entitled Culture of Death.

And you can see a worse effect when the question arises of what we should do about it all. At times Smith argues that bioethicists are the "new high priests," imposing their vile eugenics on a helpless populace. But at other times, he suggests that bioethicists are only mirroring, in philosophical ethics, an anti-life corruption that has been growing in the whole society since the 1960s. If the problem lies in the culture, why bother with the bioethicists, who are simply its mouthpiece? And if the problem lies in a philosophical elite, what good does it do to attack them with nonphilosophical arguments?

The answer, Smith would probably say, lies in the nature of democratic action. Smith is an old Naderite; before he took up the battle against the new medical ethics with his excellent 1997 book Forced Exit, he cowrote four books with Ralph Nader, and he dedicates Culture of Death to Nader. Most of the time, Smith's Naderism shows up only as a fading echo of the style of argument he used to make. Culture of Death has, for example, a slight preference for populist economics: We should be especially frightened by euthanasia because it allows large corporate HMOs to put the poor at risk. And there's a slight aiming of the book at liberals-as though the best way to fight the evils of bioethics is to convince us that the pro-life cause properly belongs to caring liberals rather than heartless conservatives.

As a matter of logic, Smith is clearly wrong not to connect euthanasia and abortion. But as a matter of persuasion, he may be right. There is not the least purchase on liberals right now for an antiabortion argument; liberalism in America has boiled down, in fact, to little except support for abortion. But euthanasia and physician-assisted suicide may not be quite so politically defining. Contemporary liberals will actually sit still long enough to hear an argument about how, for example, the poor are put at risk by murderous bioethical theories gladly embraced by big insurance companies and HMOs.

And how does that make a difference? Wesley Smith's old-fashioned Naderism shows up most of all in his belief that democratic action can be successful because elites are forced to hide in plain sight. In their publications and notes and conferences, they say things to one another that they don't want us to listen to. And when a populace that still believes in caring, life-affirming doctors finds out what is actually dominating medicine, it will rise up in righteous anger and change things.

In this case, he may be correct. Certainly Smith has no equal in bringing an indictment against what is transforming medical care. He is exactly right to focus our attention on the bioethicists who provide the theories that allow or, when adopted by a hospital or HMO as a treatment protocol, actually compel doctors to murder.

You probably missed the places where they did this. Who wants to read technical journals in bioethics? Who imagines that they have actual influence in the immediate world in which we live? Well, Wesley Smith has read them, and he demonstrates that, hidden in plain sight, each little article in the Kennedy Institute of Ethics Journal or the Hastings Center Report adds another blade to the harrow that wants to put you out of your suffering the next time you fall ill. Read Culture of Death. Your life may depend on it.