Der Spiegel is one of the best news magazines around. In the current issue, it carries an interview with an emergency room physician who thinks he should be able to refuse to save the life of patients whose quality of life he finds too low, and kill others, based on the same criteria. From the interview with Berlin ER physician, Michael de Kidder:
De Ridder: We need a concept for the treatment of hopeless cases. We can delay the time of death almost indefinitely with dialysis, artificial respiration and feeding tubes. But at what point does this no longer serve the welfare of the patient? As an intensive-care doctor, there have been times when I’ve treated patients and said to myself afterwards: That wasn’t a good decision. I too have experienced the long-term consequences of medical aid that doesn’t make sense.
Even assuming his perspective is right–and I don’t–many of these situations involve circumstances in which the outcome is uncertain. That something didn’t work out well, doesn’t mean it was wrong to try. But De Ridder would rather lose someone who could be saved in difficult circumstances than save many who will live in a severely disabled condition:
SPIEGEL: What criteria should a doctor use to decide which lives are worth preserving?
De Ridder: It isn’t about morals. It’s about empiricism. You could say, for example: If a treatment was not successful the first 100 times, it should not be used for the 101st time. With the example of resuscitation: No brain can survive without oxygen for more than eight to 10 minutes. If I know that this time limit has been exceeded — the patient has enlarged pupils and is almost clinically dead — then my efforts are pointless. Unless of course, I think it’s a good thing to produce patients in a vegetative state, at a 99-percent success rate. But doctors are fighting such concepts with all their might. They say: But you never know! There are 100 extraordinary circumstances that may mean that it is possible to help one out of 100 patients to continue to live a meaningful life, they say.
SPIEGEL: So should that person, that one out of 100, simply be abandoned?
De Ridder: Let me answer that with a question: Should I be allowed to put 99 people into a terrible situation, just because what I do benefits one person? How ethical is behavior where 99 decisions cause suffering: Are these (decisions) not as important? The guiding principle for any physician is not to harm the patient…
The italicized statement should turn on everyone’s flashing red lights! These are value judgments, not medical determinations, that the physician has no right to impose.
Having decided he can abandon patients whose quality of life he disdains, De Ridder then assumes the right to kill patients who want to die, including people with disabilities:
SPIEGEL: Would you help [kill the patient]?
De Ridder: Yes, if their decision were permanent and it was reached without external pressure, and if there is no evidence of psychiatric illness. You have to know the patient very well for this. [Me: This is just pabulum. In Oregon, for example, many patients have received assisted suicide from doctors they had just met for the purpose of being made dead--e.g., rank Kevorkianism.] Over the past year and a half, I have come to know a young woman, a brilliant scientist, who, since an accident two years ago, has been paralyzed from the head down and is completely without feeling. She wanted the artificial respiration shut off but she was refused, as that is clearly illegal. She was literally reproached for being the only patient in the ward who didn’t want to live.
SPIEGEL: How is the young woman doing now?
De Ridder: She is breathing on her own again. But she says that she can’t touch anyone anymore, she can’t do her work anymore, she can’t even lift a pebble. She doesn’t want to live like this. Mind you, it’s a life that wouldn’t even exist without advanced medical procedures and it’s also one that she can no longer end on her own. In that situation, I can’t exactly order that the woman should be turned so-and-so-many times a day, that she should be fed and that she should lie there for another 40 years, just because we have the technological know-how and we want to satisfy our ethical standards.
SPIEGEL: So what do you intend to do?
De Ridder: If she stands by her decision, then I will help her. And I will face the consequential controversy.
I am reminded of an important statement made by another German physician Christoph Wilhelm Hufeland back in the 19th Century, whom I have quoted before:
It is not up to [the doctor] whether . . . life is happy or unhappy, worthwhile or not, and should he incorporate these perspectives into his trade . . . the doctor could well become the most dangerous person in the state.
Hufeland’s worry was prescient, as history proves. Alas, physicians like De Ridder want to move us away from human exceptionalism in health care, and replace it with a discriminatory quality of life ethic that can only victimize the medically vulnerable and defenseless. This view cannot be allowed to prevail or none of us is ultimately safe.
April 5th, 2010 | 7:13 pm
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April 5th, 2010 | 8:51 pm
This doctor is presupposing the validity of a version of utilitarianism, which has hardly been shown superior to other ethical theories, such as deontology, for example. And, why do we have this bias that people with disabilities, however profound, cannot live meaningful lives. And where would this doctor draw the line? Would he help kill say, a person paralized from the waist down, who wants to kill himself as long as he is in his ”right mind”, i.e., free of psychiatric illness?
April 5th, 2010 | 9:42 pm
It isn’t a good thing to produce 99 patients in a PVS, but it’s not a bad thing either. Nobody is harmed by being brought from the brink of death into a PVS. And if you save 1 life, it’s worth it.
And given his answers about euthanasia, he should be able to just euthanise all the PVS patients who result from his unsuccessful attempts at resuscitation.
April 6th, 2010 | 8:25 am
I find it interesting that people who are so concerned about the cost of health care reform don’t think twice about the cost of maintaining a PVS patient. The argument that the PVS patient’s life is “meaningful” simply begs the question: meaningful to whom? To the person who’s living without being in a PVS? I suppose these same folks want to require hospitals and doctors to ignore patients’ DNR directives.
Wesley J. Smith Reply:
April 6th, 2010 at 9:57 am
History Writer: Whatever the answer to that question, the doctor’s opinion is irrelevant.
April 6th, 2010 | 11:18 am
“SPIEGEL: What criteria should a doctor use to decide which lives are worth preserving?
De Ridder: It isn’t about morals….”
Interesting exchange. And revealing, I think.
>>I find it interesting that people who are so concerned about the cost of health care reform don’t think twice about the cost of maintaining a PVS patient.>>
Funny – I’ve often had the same thought about those who reject the death penalty. The fact is that we are a wealthy society, so questions arise that wouldn’t – if we were a society without resources. And again – somewhat unrelated, but maybe relevant – somewhere I read that in a time when divorce was not as common as it is today, marriages that were likely to have problems due to money were not the impoverished, and not the uber-wealthy, but the middle class. The impoverished spent every penny on necessities, the uber-wealthy spent whatever they wanted, but the middle class had discretionary cash, and tension and division arose due to disagreements on how that excess should be spent.
April 6th, 2010 | 4:45 pm
It isn’t a good thing to produce 99 patients in a PVS, but it’s not a bad thing either. Nobody is harmed by being brought from the brink of death into a PVS. And if you save 1 life, it’s worth it.
I don’t mean to be crass, but how much are you willing to spend to save that one life? We could devote every last cent to medical care for people on the brink of death on the theory that if we save just one, it’s worth it. But, that theory is wrong, the fact is all people die and it’s just transhumanist denialism to complain that we aren’t spending enough money on preventing death. Those 100 people all received exceptional care and if they could have been saved, they would have been saved. It’s disrespectful to doctors and nurses to imply that they aren’t trying hard enough.
April 6th, 2010 | 6:32 pm
Wesley: Why do you say the doctor’s opinion is irrelevant? If he creates a PVS patient out of someone who’s brain has been oxygen-starved for 15 or 20 minutes, instead of simply letting him/her die, he can (and ought to) be sued for malpractice.
And what about the patient who leaves a DNR directive? Do you know of anyone whose opinion on the matter is better than that patient’s (excepting your own, of course)?
Wesley J. Smith Reply:
April 6th, 2010 at 7:44 pm
I grow weary with your obtuse comments, History Writer, which I am beginning to think is intentional, which makes me irritated. If there is a DNR, there is–obviously–no CPR. But that is the patient’s/family’s choice, not the doctor’s, or at least should be.
April 6th, 2010 | 6:58 pm
suek:
Re: cost of maintaining PVS patients and cost of non-imposition of death penalty, you wrote: “I’ve often had the same thought about those who reject the death penalty.”
Your thoughts are understandable, and one might readily think execution is cheaper than incarceration — except that research by penologists tends to show that death penalty trials and related appeals are far more costly than keeping someone incarcerated for life without possibility of parole. For more information on both sides of the question please see: http://deathpenalty.procon.org/view.answers.php?questionID=001000
April 6th, 2010 | 7:01 pm
Sorry folks:
In my post above, “…someone who’s brain has been oxygen-starved …” should read “…someone WHOSE brain…”
Mea magna culpa.
HW
April 7th, 2010 | 11:44 am
>>…research by penologists tends to show that death penalty trials and related appeals are far more costly than keeping someone incarcerated for life without possibility of parole.>>
I’m aware of this. “related appeals” is the relevant term…. Without the extended legal maneuvers, the death penalty wouldn’t be nearly as costly, and those appeals are largely funded by those who object to the death penalty itself, not the guilt or innocence itself. In other words, it’s yet another application of the Cloward-Pivens principle.
April 7th, 2010 | 7:54 pm
“SPIEGEL: So should that person, that one out of 100, simply be abandoned?
De Ridder: Let me answer that with a question: Should I be allowed to put 99 people into a terrible situation, just because what I do benefits one person? How ethical is behavior where 99 decisions cause suffering: Are these (decisions) not as important?”
I agree to Bret Lythgoe’s comment. De Ridder is a kind of doctor who practiced utilitarianism and consequentialism. What is good to many will be good to all and the end justifies the means is the concept that this doctor carries with him.
“The guiding principle for any physician is not to harm the patient…”
Well if this is the guiding principle, is killing a person no matter how “unmeaningful ” his life is not a form of harming him?
Lastly as I read this interview I was reminded of a story in the Bible regarding one lost sheep out of 100. The shepherd knowing that he had lost only one finds a way to find it even leaving the 99. This gives me an impression that even one life is very worthwhile that we humans have no right to take it away.
April 8th, 2010 | 2:44 pm
I had a severely handicapped son. He didn’t walk or talk and he had a feeding tube. He was born that way. He was not in a permanent vegetative state. He lived 30 years and his life had meaning. He touched many, many people. He had a beautiful smile. He was my son and I loved him. God has a purpose for every life. Every life is precious to Him. And it should be to us. Who’s to say that the life of a severely handicapped person is not as worthwhile as yours or mine?
April 8th, 2010 | 5:04 pm
Yeah, and who IS saying that? No one. The issue being discussed is how doctors should decide whether to give a patient a treatment or not, and it doesn’t come down to saying whether some lives are more valuable than others, or even if some living conditions are more acceptable, it just comes down to how much money can we spend and how best to spend it. Spending lots of it on people very likely to not be helped much at all is not a good way to spend it, when there are so many people who would benefit so much more. We have to make medicine sustainable and make sure it stays available to people, rather than let the resources get used by the elite for radical transhumanist life-extension.
April 10th, 2010 | 10:36 am
Gee, Wesley, you grow weary and irritated with my obtuse comments — and I grow weary of your self-serving, sanctimonious blather about human exceptionalism and thinly-disguised political pandering. I guess we’re even up. So?
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