Dr Philip Nitschke, Australia’s leading advocate for euthanasia and assisted suicide, was recently suspended (but not deregistered) after his involvement in the suicide of a man suspected of murdering two of his wives. This has not stopped Dr Nitschke from campaigning. In today’s issue of The Guardian, he makes a passionate case for allowing prisoners to choose euthanasia rather than linger in prison with a life sentence.
“Imprisonment for life, with no hope of parole, is torture. I thought then and now that a modern civilised Australia should not be involved in torture, no matter the crimes of the prisoner.”
Dr Nitschke has been very impressed by the progressive policies of Belgium, where a judge recently allowed a prisoner to choose euthanasia. “Under the Belgian model, physical or psychological suffering that is incurable or constant can be the grounds for voluntary euthanasia. What is there not to agree with?” he writes.
His facts, for starters.
The case of the Belgian rapist and murderer, Frank Van Den Bleeken, illustrates much of what is wrong with Nitschke’s argument. Strictly speaking, despite his horrific crime, Van Den Bleeken was not a prisoner but a patient. He was being held “at the Governor’s pleasure”, as Australian law quaintly puts it, because he was mentally ill and a danger to society. Belgium’s dysfunctional mental health system was unable to treat him, so Van Den Bleeken applied to be transferred to a Dutch prison with advanced treatment for sex offenders. When the Belgian government refused, Van Den Bleeken requested euthanasia.
In short, Van Den Bleeken’s suffering could have been cured, but it was either too expensive or too much bother for the Belgian government. As with most cases of euthanasia or assisted suicide, the real problem is that society has tossed its most vulnerable citizens onto a scrap heap. And, as Dr Nitschke has kindly demonstrated, the best way to defend this option is to twist the facts out of shape.
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Are bioethicists more ethical than the rest of us? I’m not aware of data about bioethicists as such. However, some research has been published about moral philosophers, of which bioethics is a sub-discipline. One study found that ethics texts were more likely to be missing from academic libraries than non-ethics books in philosophy.
A couple of other studies found that ethicists behaved no more courteously than non-ethicists and that they were just as likely to avoid paying registration fees as non-ethicists at conferences of the American Philosophical Association. And last year, the world was shattered by the scandalous news that moral philosophers were no more likely to respond to student emails than other kinds of philosophers.
It is a bit disappointing to learn that bioethicists probably land in the middle of the Bell curve in terms of everyday ethical behaviour. But do they still have special ethical obligations? An interesting article in the latest issue of the Cambridge Quarterly of Healthcare Ethics argues that they do. Bioethicists are supposed to be whistleblowers.
D. Robert MacDougall, of New York City College of Technology, argues that they have “a heightened obligation to whistleblow”. Not because bioethicists are obliged by virtue of their professional training to be saints – they aren’t. But because “the condition of that employment is the widely held supposition that bioethicists do not ultimately defer to an employer’s determination about acceptable risks, but rather that they exercise independent judgment on these matters”.
In other words, society expects that bioethicists will make up their minds without fear or favour.
Does this actually happen? Dr MacDougall references a 1996 article in the Journal of Clinical Ethics, “Where are the heroes of bioethics?” The author’s opening sentence was “Here is my problem: I don’t know of a single case of a bioethicist who has acted as a hero in that role.” Have things changed since then? Are there any nominations for bioethical heroes, people who have risked life, limb or employment to fulfil their responsibilities?
My Latin is not what it once was and it was never much. All I can remember is classic phrases like Caesar ad sum jam forti, Brutus et erat; Semper ubi, sub ubi; and Illegitimi non carborundum. So lately I have been making amends for schoolboy sloth by reading a few of the classics. I have just finished (and highly recommend) The Annals of Imperial Rome, by Tacitus, which chronicles the years of Tiberius*, Claudius, Caligula and Nero. Tacitus would have made a good op-ed writer on the New York Times, with his sardonic analysis of palace politics.
Whoa! Excuse me: just where is all this going? Will we get bioethics or just bloviation?
Well, sort of. Let me press on.
It was a bit dismaying to read how determined the Emperors were to pass on their power and prerogatives to their children -- but how little they did to produce them. Augustus had no sons and adopted Tiberius, his step-son by his third wife. Tiberius was succeeded by an adopted grand-nephew, Caligula, and the odious Caligula by his uncle, Claudius. Claudius’ only son died in his teens and so he was succeeded by the perverse and capricious Nero, the adopted son of his fourth wife. As the Romans would have said, contortum est, it’s complicated.
Is it drawing too long a bow if I see a parallel in the couplings of our own era?
Below we report on services provided by EggBanxx, a new company in Manhattan which freezes eggs for socially infertile single women. Reading between the lines, you can feel the pain of its over-achieving clients, who are mostly in their early or mid-30s and desperate to bring at least one child into the world before their biological clock stops ticking. Behind them may be two or three relationships; ahead is loneliness. The statistics say that most of them will fail.
Like the emperors of Rome, the yuppies of Manhattan have nearly all the autonomy they like. Autonomy is the cement of most contemporary bioethical frameworks. But just as it brought little joy to the emperors, it fails us as well. There must be something more to ethics.
2014 marks 2,000 years since the death of Augustus. You would think that two millennia of technological, educational and social progress would have raised the level of our romantic relationships as well as our standard of living. It seems not.
* Sorry, I wrote Domitian originally, instead of Tiberius.
BioEdge passed a milestone this week – our 10,000th subscriber. We are delighted that so many people receive the newsletter and pass it on to their friends. Word of mouth is the best advertising!
However, we feel that our potential readership is really many times this figure, so please encourage friends and colleagues to sign up. It’s free! If you are teaching bioethics at a university, why not suggest that your students subscribe? It will give them lots of stimulating ideas to ponder.
After more than 2,000 deaths, most of them civilians, I ought to write something about the war in Gaza. But it is excruciatingly difficult for no matter what you say, it will be denounced by one side or the other as biased and idiotic.
The Lancet recently published an incendiary letter attacking Israel which provoked furious replies from Israeli doctors. One allegation was that The Lancet had lowered its high editorial standards by publishing politically biased material.
I’m not sure whether this holds water. The Lancet – and most of the other leading journals, like Science, Nature, JAMA, the New England Journal of Medicine – often take sides on issues like abortion, euthanasia, healthcare and so on. They don’t ignore them and hope that they will disappear. Why not a war?
Well, for one thing, wars are even more ethically snarled than abortion. It may be beyond the wit of the editors. Painting one side as the villain is simply wrong; both sides have made bad choices.
Nonetheless I think that it is important for medical journals at least to point out that war is always a deeply ethical issue, not just a utilitarian calculus. If doctors are supposed to be custodians of humane values, their journals ought to be ethical gadflies.
That’s why I think that The Lancet is right to take a stand on this tragic war and the that the other journals have been remiss, perhaps even cowardly, in ignoring it. What do you think?
An obituary of Mark Twain once appeared before his demise. When asked about this by the press, his characteristically wry response was “the report of my death has been greatly exaggerated”.
I wonder what he would make of 200 exaggerated reports. Just as a bit of comic relief, let us focus on the latest hospital scandal in Australia. The Austin Hospital in Melbourne sent out 200 reports to general practitioners informing them that their patients had died. The real story was that they had been successfully discharged from the hospital.
Explanation? The hospital blamed clerical error and a wrong mouse click. According to its spokeswoman:
"Austin Health automatically notifies GPs when their patients are discharged from hospital. Notifications sent in the early hours of Wednesday, 30th July, incorrectly advised GPs that their patients, who had been discharged the previous day from the Austin Hospital, had died.”
The hospital has apologised unreservedly for the night of the living dead, but the issue is still alive in Parliament. The opposition leader used it to hammer the government: it is "symptomatic of a health system that is in crisis, a health system where emergency departments are full".
It’s lucky that the paperwork was sent to GPs rather than to families. I can imagine that some people might have turned up their toes immediately upon opening a letter like that. Why do we need expensively-produced TV comedy when all we need to do is look at the evening news?
It’s amazing how mistaken I can be about how the public will react to bioethical issues. Take the recent sad case of Baby Gammy which has featured in newspapers around the world. He is a Down syndrome infant boy, one of twins carried by a surrogate mother in Bangkok for an Australian couple, David and Wendy Farnell. She refused to abort Gammy and the couple allegedly refused to take him. So now he lives in limbo with his surrogate mother.
The media was horrified, especially after it emerged that Mr Farnell, 56, had spent three years in jail for molesting two girls aged 7 and 10. Baby Gammy looked so cute and his Thai birth mother so loving. How could anyone be so heartless to propose aborting a twin? How could anyone be so heartless as to abandon their own baby? How could a paedophile be allowed to commission a surrogate mother?
To be honest, I didn’t think that the story was a big deal. I thought that everyone knew that 90% of Down syndrome babies in Australia and most Western countries are aborted. I thought that everyone knew that “foetal reduction” (ie, aborting excess children in a multiple pregnancy) is common. I thought that everyone knew that surrogacy in developing countries exploits young women. I thought that everyone knew that many, if not most, clients of these surrogates were creating unconventional families – either for gays or single women.
How wrong I was! Apparently the media used to believe – and probably still does – that surrogacy is just an odd way to give children to doting mums and dads. They were completely ignorant of the many reasons why surrogacy is bad public policy which should be banned.
Flash! Bangkok police raided an apartment this week and discovered nine babies between one month and two years, all born to surrogate mothers from the same Japanese businessman father. The births were not registered. He is a very loving dad, his lawyer told The Japan Times. Maybe. Maybe not. It sounds to me like a child sex trafficking scheme. It happened recently in Australia. Notch up manufacturing babies to be abused as another good reason to ban surrogacy.
Every once in a while, I enjoy revisiting misanthropic classics. I picked up Gulliver’s Travels the other day and thumbed through his adventures in Luggnagg. This destination is less famous than Lilliput, but has one memorable feature, the immortal struldbrugs. When he first hears about them, Gulliver rhapsodizes about the wisdom, wealth, power and “sublunary happiness” which they must enjoy.
However, the inhabitants of Luggnagg set him straight. The struldbrugs have immortality, but not perpetual youth. When Gulliver examines them, he realises his error: “They were the most mortifying sight I ever beheld; and the women more horrible than the men. Besides the usual deformities in extreme old age, they acquired an additional ghastliness, in proportion to their number of years, which is not to be described.”
What I had forgotten was the attitude of the citizens of Luggnagg. At the age of 80, the struldbrugs are forced to become non-persons, maintained at the expense of the state with a scanty pension.
“… they are looked on as dead in law; their heirs immediately succeed to their estates; only a small pittance is reserved for their support; and the poor ones are maintained at the public charge. After that period, they are held incapable of any employment of trust or profit; they cannot purchase lands, or take leases; neither are they allowed to be witnesses in any cause, either civil or criminal.”
Are there any lessons for the 21st Century in Jonathan Swift’s satire? Perhaps. Because of declining birth rates around the world, the proportion of octogenarians, nonagenarians and even centenarians is growing rapidly. Modern medicine may keep them from degenerating into struldbrugs, but they will inevitably become more dependent and lose their political and social influence.
The scariest thing would be if we were to become as misanthropic as Swift and to treat our elderly with contempt and bare tolerance, rather than respect their contributions and their inalienable dignity. The struldbrugs “are despised and hated by all sorts of people,” he writes. In a latter-day Luggnagg, euthanasia and assisted suicide begin to sound rather sensible. Perhaps we need a Struldbrug Pride movement to protect our elders from abuse.
Tales of atrocities emerging from the regions captured by the Islamic State, or ISIS, or the Caliphate, are already legion. There have been beheadings, crucifixions, mass executions, expulsion of Shia and Christian families unless they convert, burned churches.
You could believe almost anything about these guys. But something sounded a bit fishy about claims of female genital mutilation in Thursday’s Guardian. A UN official told reporters: "We have current reports of imposition of a directive that all female girl children and women up to the age of 49 must be circumcised.”
Even more sinister was a report in BasNews, a Kurdish website: “The Spokesman of Mosul Police Ahmed Obaydi told BasNews: ‘Baghdadi’s decision to have all women circumcised is, as he claims, to prevent immorality and promote Islamic attitudes among Muslims. The decision was made by Baghdadi as a ‘gift’ for people in Mosul.’”
Something tells me that this will be proven false. The Islamic State has denied it (via Twitter) and the Guardian was unable to verify the claims. Bad as the Caliphate is, this is probably an urban myth created by the embattled Syrian government to scare off donors to the caliphate.
This is remarkably like the ghoulish stories of harvesting organs from prisoners of war which have accompanied conflicts in Kosovo, Iraq, Syria and Palestine. For instance, an article on an opposition website called The Syrian Observer has reported trafficking by government officials:
“… a thief crashed into a house in a luxurious Damascus suburb [in 2008] and discovered a warehouse full of frozen organs, ready to be sent around the world. The thief turned himself over to the authorities and reported the place. After monitoring the house for hours, police managed to arrest the criminals, thus explaining a series of mysterious attacks going back years. As the story unfolded, the names of high-ranking members of the Syrian regime began to pop up and the story suddenly disappeared from the local news.”
There could be some truth in a story like this, as organ trafficking does happen in these countries. But it is just as likely to be a fabrication aimed at smearing the Assad regime.
Perhaps there is a paper for an ambitious young academic in these dark tales – bioethics in information warfare. We all feel a deep horror when confronted with the violation of bodily integrity – rape, first of all, but also FGM or being a quarry for organs. It is a fear that can be exploited for political ends.