November 2003 (vol. 20, #1)
1601 N Tucson Blvd #9, Tucson AZ 85716
c 2001 Physicians for Civil Defense
Many atrocities, beginning with euthanasia and ending in attempted genocide, were of course carried out under the banner of National Socialism.
The question is whether our self-righteousness in deploring these evils immunizes us against repeating the same actions when they are not conveniently labeled with a swastika.
The most dreaded method of execution at Auschwitz was not the gas chamber, which was mercifully quick. It was the starvation bunker that was used to terrorize prisoners, as by punishing ten when one escaped. There, deprived of both food and water, prisoners died in agony in about two weeks.
The method of starvation/dehydration was first applied, not against convicts who had somehow offended the regime, but against helpless babies with birth defects and other ``useless eaters.'' The rationale was that of the lebensunwertes Leben, or a life unworthy to be lived.
Some say that it could never happen here: ``Regarding the Holocaust experience,...any moderately dispassionate examination of that terrible time in history reveals that the analogy is of very limited applicability. The Nazis did not slide down any slippery slope; they started in a cesspool at the bottom, with their genocidal ideology in place,'' writes Steve Heilig, M.P.H., of the Bay Area Network of Ethics Committees and Robert Brody, M.D., of San Francisco General Hospital (West J Med 1998;169:323).
The very debate about the ``infamous slippery slope'' will deter abuse, as ``the Nazi experience has changed our individual and collective memories and our moral imagination forever,'' opines medical student Eric Zachary Nielsen, winner of the 2001 Alpha Omega Alpha Helen H. Glaser Student Essay competition. ``Science...permeated the Holocaust,'' but ``the new generation of physicians has learned that technology must be responsibly used.'' Nielsen reassures us that we are even ``moving up the slope'' (Pharos 2001;autumn:4-11).
Most Americans are not aware that deliberate dehydration deaths are already commonplace in the U.S., as a cadre of ``bioethicists'' has gained the upper hand in legislatures, courts, and academia. A complex calculus of ``quality of life'' points and cost:benefit analysis has displaced the concept of the sanctity of human life, as chronicled by Wesley J. Smith in his books Forced Exit and The Culture of Death.
Nazi crimes against humanity were not solely a product of National Socialist ideology. Euthanasia had been aggressively promoted as ethical public policy by the German medical and legal intelligentsia since the late nineteenth century. Germany actually lagged behind the U.S., where eugenics laws had been in force in some states for years. Courses in eugenics were taught in more than 350 American colleges in the 1920s. Philanthropic foundations such as Rockefeller and Carnegie funded eugenics research and policy initiatives.
The horrors of the German death camps cast a pall over the eugenics movement. The Euthanasia Society of America changed its name several times, to the Society for the Right to Die, Choice in Dying, and now Partnership for Caring, but still honors its legacy of 1937, which called for involuntary euthanasia, as of ``born defectives.''
The rhetoric has changed from racial hatred to compassion or scholarly dispassion, but the philosophic foundation and some of the acts have not.
The Physician Assisted Suicide (PAS) movement is one obvious manifestation. Although PAS is now legal only in Oregon, and the next step-voluntary euthanasia-only in the Netherlands, it has broad support. Up to 60% of U.S. physicians, and 65% of medical students, believe that PAS should be legal in some circumstances. Nationwide, 36% of physicians and 60% of medical students say they would be willing to write a lethal prescription (JAMA 1999;282:2080-2081).
The illegality of PAS and official disapproval by organized medicine should not be cause for complacency. ``A good death can be achieved-without assisted suicide'' states a press release by Finding Common Ground, a joint initiative of the Center of Bioethics at the University of Pennsylvania Medical Center and the American College of Physicians.
PAS is fifth on a list of ``last-resort palliative interventions'': (1) standard pain management; (2) forgoing life-sustaining interventions (which now are understood to include a feeding tube); (3) voluntarily stopping eating and drinking (``requires time and discipline''); (4) terminal sedation, without increasing the dose once sedation is achieved (death is certain because the ``standard practice'' is to withhold fluids); (5) PAS (illegal but unlikely to be prosecuted); (6) voluntary active euthanasia (likely to be prosecuted, and there is ``no consensus on acceptability'') (Ann Intern Med 2000;132:488-493).
Death from thirst is unlikely to be chosen by a conscious, competent patient. At first, it was reserved for ``permanently unconscious'' patients, or those in an apparently conscious but presumably nonsentient (``persistent vegetative'') state, who had previously expressed a wish not to be kept alive in such a state.
AMA policy now approves the use of this method for patients who are neither terminally ill nor unconscious, ``in accordance with a proper substituted judgment or best interests analysis'' (see AAPS News 12/03, www.aapsonline.org). At least one patient, Marjorie Nighbert, has been dehydrated to death by court order despite asking nursing staff for food and water, on the theory that she was not competent to make a medical choice (Smith WJ, Culture of Death).
Under a grant from the Robert Wood Johnson Foundation, the AMA has created the Education for Physicians on End-of-Life Care (EPEC) curriculum, with the ambitious objective of ``retro-training'' all 750,000 American physicians in the new bioethic within three years (Pain Net News 10/99).
It is impossible to go to a hospital facility, even for a minor outpatient procedure, without being asked about a Living Will or Advanced Directive-in which withdrawal of nutrition and hydration is probably an ``option.''
Diane Coleman, President of Not Dead Yet, fears that the body count of disabled but not terminally ill patients involuntarily dehydrated and starved to death in hospice could exceed the 200,000 killed in the Nazi euthanasia programs.
Euthanasia, ``the situation in which the doctor kills a person who is suffering unbearably and hopelessly at the latter's explicit request, usually by administering a lethal injection,'' is legal in the Netherlands. Although the Royal Dutch Medical Association (KNMG) did not endorse legalization, it set up standards to bring it under the control of physicians. These include completion of a 51-item questionnaire.
According to a government survey of physicians, about half the cases of euthanasia go unreported, to avoid paperwork and to spare grieving families an interrogation by law enforcement.
The Dutch, however, are not sliding down a slippery slope, in the view of Marcia Angell, former editor of the New England Journal of Medicine, among others (JAMA 1999;281:566-567).
If some 1,000 patients per year are involuntarily put to death, it is called ``termination of patients without explicit request.'' A much larger number of patients are deliberately overdosed with pain medicines with the intention of ending life; only 20% with consent. About a quarter of Dutch physicians admit to having ended patients' lives without their consent, in violation of the guidelines (JAMA 1997;278:817-818).
Oregon physicians are not even asked to provide the Oregon Health Division (OHD) with significant medical information on patients for whom they prescribe lethal medications. A diagnosis of a terminal illness and a prognosis of death within six months are required, but no basis for the determination need be stated-and no autopsies have been done. No psychiatric evaluation-the accepted standard for other suicidal patients-is required (Hastings Center Report, May-June 1999). Intolerable suffering need not be experienced; for many who took the fatal potion, fear that they might become dependent was the primary motive (Smith WJ, Wall St J 2/28/99).
The OHD admits that it is unable to detect underreporting or to determine whether PAS is occurring outside the framework of the Death with Dignity Act (N Engl J Med 1999;340: 577-583). It made no effort to interview the physicians who refused to write lethal prescriptions (40% of patients had to consult two or more doctors), family members, or treating physicians not participating in the PAS (Smith WJ, op. cit.)
The Oregon Health and Sciences University ``remains neutral on the moral issue of PAS,'' but faculty members advocate ``meeting patients' wishes for death'' in other ways, such as discontinuing or refusing ``artificial hydration and nutrition'' (JAMA 2002;288:91-98).
Even Bindung and Hoche, authors of the ``crucial work'' Permitting the Destruction of Life Not Worthy of Life, called for ``protective guidelines,'' including the need to apply to an oversight board, investigation by at least two physicians, a finding that the patients were ``beyond help,'' and submission of a final report on the act of killing (Smith WJ, Forced Exit). Their book was published in 1920; progress down the slippery slope took more than the mere six years that have elapsed since the Oregon Death with Dignity Act.
The method of dehydration/starvation, favored for use on disabled human beings, is illegal to use for animals: Failure to provide food and water constitutes cruelty. In Arizona, where animal abuse recently became a felony, a man arrested in Arizona for the starvation death of a horse faces a maximum penalty of a year in prison and a $150,000 fine (Smith WJ, Culture of Death).
The Montreal Protocol that banned CFCs did not cause the loss of the space shuttle Columbia, states Russell Seitz.
Some have attributed the Columbia disaster to a change in chemical used to expand the foam insulation that keeps its cryogenic fuel tank cold. Russell Seitz writes: “This was one of the many technical issues examined by the accident investigation board in its exhaustive survey of the case. However, while the blowing agent used to inflate the foam's cells changed, the material itself did not.
“The shuttle was plagued by foam tearing off during launches before and after the change from a CFC to an HCFC expansion agent, and the repeated failures of the ill designed thick foam bipod ramp have been traced to gross thermal, cryogenic, and aerodynamic stresses on and in that particular structure rather than the very small shift in mechanical properties that arose from the CFC changeover. To argue that the blowing agent caused the crash is akin to blaming the loss of the Titanic on a shift in the brand of linseed oil in its paint job.”
At the World Trade Organization conference in Cancun, the eco-purists got a dose of street theater. Niger Innis, spokesman for the Congress of Racial Equality (CORE), conferred first prize in the Green Power - Black Death awards on Greenpeace, ``for leading million-dollar campaigns against energy, pesticides, biotechnology, trade and economic development that could save or improve millions of lives.''
``I'd like to thank the mosquitoes for bringing malaria to less developed countries,'' bubbled the coed who accepted the award. ``But most of all I'd like to thank the millions of children who died to make this award possible.''
``We always hear how bad colonialism was,'' stated Leon Louw, president of the Free Market Institute of South Africa. ``But colonialism rarely did more than enslave people and take a country's natural resources. Eco-imperialism is far worse. It actually kills people'' (Driessen P, TWTW 10/20/03, see www.sepp.org).
China, which is exempt from the Kyoto Protocol, is now the world's second largest emitter of greenhouse gases, after the U.S. Coal use in China has been climbing faster than anywhere else in the world. Coal-fired electrical power generation in China is growing nearly four times as fast as Western experts predicted, and by 2020 is projected to be three times as great as in 2000. Three Gorges dams and five new nuclear generating stations will also be providing power by 2007.
The Chinese standard of living is rising dramatically. ``Only the old people do not have air conditioning now,'' a Zhanjiang woman told The New York Times (NYT 10/22/03).
By 2030, the U.S. is expected to be emitting about 7.5 billion metric tons of carbon dioxide per year, compared to about 16.5 billion for the industrialized world, about 6.5 billion for China, and 18 billion for the developing world (Intl Energy Agency). According to Senator John McCain (R-AZ), referring to a ``U.N. study,'' every ton costs each American $160 per year. (WSJ 10/30/03). [34.5 x 109 x $160 = $5.52 trillion]