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Some of our most formerly venerable medical journals are becoming increasingly radical. Critical Care Medicine, the journal for intensive care doctors, is a case in point. In the past, the Ethics Committee of the Society of Critical Care Medicine supported futile care theory, and quite notably, the Journal published an article arguing that “neurologically devastated” patients should be able to be killed for their organs assuming consent.

Now, Yale School of Medicine (of course) professor Constantine A. Manthous, MD, has published in CCM advocating for the permissibility of physician-assisted suicide. (No link, from the abstract):

Our collective repudiation of physician-assisted death, in all its forms, has complex origins that are not necessarily rational. If great care is taken to ensure that a request for physician-assisted death is persistent despite exhaustion of all available therapeutic modalities, then an argument can be made that our rejection constrains unnecessarily the liberty of a small number of patients.
Of course, “great care” is either not legally required under the assisted suicide laws—e.g, Oregon, Washington, and Switzerland—or not done, as in the Netherlands and Belgium. Montana? Why would “great care” be required when assisted suicide has been made a “fundamental right” under the state’s constitution via judicial fiat?

Manthous’s pretense is that there are no “rational” arguments being made against assisted suicide. From the article:

[T]here is room in this formulation for both nature and nurture to determine our moral selves. Our inherited neurologic circuitry is a template that is “finished” by institutional indoctrination which fires that circuitry repetitively throughout our development (e.g., “thou shalt not kill, thou shalt not kill,” ad infinitum). It both feels right and, when fully indoctrinated, is programmed into the fully moral individual. There is a very large literature suggesting that during “critical periods” of brain development, environmental triggers (language for example) act on the neural template to potentiate development of particular skills or behaviors. Although evidence remains circumstantial (e.g., in primate studies) developing morality may follow a similar paradigm. Accordingly, my thesis here is that our repudiation of PAS and euthanasia is a moral intuition, without rational foundations.

Ironically, hiding behind all that neuro-theory, Manthous is the one failing to grapple with the many rational arguments made against legalization. Indeed, books, after articles, after speeches , have been given for two decades by opponents of assisted suicide making the rational case for continued prohibition. Yet these arguments are not mentioned once in the article. There are no citations, for example, from the voluminous rational arguments made by Rita Marker. No citations from the psychiatrist, Dr. Herbert Hendin, who is probably the world’s foremost expert on euthanasia in the Netherlands.. No citations from Dr. Kathleen Foley, the country’s most notable palliative care doctor and an opponent of legalizing assisted suicide. No citations from yours truly, who has written one book solely dedicated to the rational arguments against assisted suicide—Forced Exit—and another—Culture of Death—that deals substantially with the rational reasons for opposing assisted suicide, and, not coincidentally, was named Best Health Book of the Year for 2001 by the Independent Publishers.

I guess the theory is that if you ignore rational arguments, they just don’t exist. It’s just a matter of “repulsion” or “aversion.”

But what happened to peer review? How does a professional medical journal of any quality allow an author to argue that there are no rational arguments against assisted suicide when there clearly are a boatload with which the author disingenuously refuses to grapple? More evidence that our institutions are losing both excellence and integrity.

It’s hard to do justice to an article in a single blog. Here’s another analysis of the article that gets into some areas I didn’t.

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