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I have a piece in the current Center for Bioethics newsletter about the so-called “duty to die.” I discuss two examples of notable bioethicists advocating a duty to die, with quotes.  I then note that enacting such a legal duty remains theoretical, but note that may be less meaningful than it might seem. From my article:

To date, no country has actually enacted such a legal requirement on its citizens. But that should not make us sanguine. To the contrary, a through-the-back-door duty to die has already been launched through policies that permit doctors to refuse so-called “futile” treatments.

I discuss the Baby Joseph case, which we have dealt with often here at SHS, and then note that medical futility principles have leaped past the doors of the ICU into clinical practice—such as refusing to cover life-extending chemotherapy for patients dying of cancer,  both proposed and actually imposed.  I also illustrate how the predictable nexus between assisted suicide and cost cutting has been explicitly made in Oregon with the Barbara Wagner case, and has been promoted in Vermont to help pay for a single payer health care plan.

I conclude:

The duty to die tide is flowing, and it won’t stop with the terminally ill. When I was researching my book Culture of Death, I interviewed an advocate of medical futility and noted that refusing ICU treatment wouldn’t save a lot of money. I asked what futilitarians (as I call them) would try to cut next? He responded, “marginally beneficial care.” His example? Refusing mammograms to women above the age of 80.

Make no mistake, when medically efficacious treatment is denigrated as “futile” or “marginally beneficial,” it isn’t really the care that is being so described, it is the patients.

I don’t think the rising tide is deniable.  The only question is whether one wishes it to continue flowing or wants to build dikes protecting Hippocratic values against the flood until it runs its theoretical course, and finally ebbs.

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