Off topic: The Hippocratic Oath

Paul Giem @ 43: You speak of warfarin not producing a "hellish death". The problem may be that we have different definitions of "hellish death". Mine includes bleeding from the mouth, and also the vomiting of blood that wikipedia speaks of. What I'm looking for is something that gives you a warm glow, maybe a gentle euphoria, and then sleep followed by death. I doubt if I would like any poison, really, since they tend to work by disrupting vital systems and the body tends to react to the disruption of vital systems in all sorts of unpleasant ways. It's interesting that doctors can turn off ventilators if the patient requests it. That would mean the patient suffocates to death, which is one of the things that I most want to avoid. It's interesting though, that doctors can legally flip a switch that turns off a motor that results in the patient suffocating in his hospital bed. What if the patient was in a deep-sea diving suit and requested the same doctor to flip a switch that turned off his air pump, resulting in his suffocation? I gather that would be illegal? But if the patient in the diving suit was in terminal condition and had jumped through all the hoops, it would be legal? We need to do some work on our laws here. You misunderstood my reference to morphine. I stated that morphine will reduce pain, but it can't stop any ongoing feelings of suffocation. An overdose of morphine would be a very acceptable death, in my opinion. I also realize there are no 100% guarantees in life. But if we can improve the odds of a peaceful death from 5% to 95%, I'd call that a gigantic victory for humanity. Finally, I have to question your statement that the medical profession should not be involved with suicide. Some lucky souls manage to go an entire lifetime without visiting a doctor. Then they get cancer, or a stroke or whatever and wind up in a hospital, on their death bed, interacting with a physician for the first time in their life - and the doctor doesn't want to help them! Patients need to know that if they've reached the end of their life, their physician will still help them avoid suffering, even if suicide is the only way to do it. I'd cut a little slack for the present generation of physicians who can truthfully argue that they didn't sign up for this, but not for people newly entering medical school. I'd make it very clear to each candidate for med school that if he or she feels they can't assist a terminal patient's suicide, then they really aren't cut out to be physicians and they should step aside. There are a hundred other people trying to get into that school and some of them are bound to have better morals than that. (And, off topic, I'd say the same thing for pharmacists.) djmullen

Mark Frank (#43), I'm surprised you had not figured out that I view euthanasia as something that in principle is not good. But if I have not been clear enough heretofore, hopefully that statement should clear things up for you. There are a lot of things that our society tolerates that are not good. Smoking and extramarital affairs come to mind, along with gambling (within limits). Some things, like murder, are both morally and legally wrong. Assuming I am right about the morality, or lack thereof, of euthanasia, there remains the question of how society should treat the subject legally. Here, reasonable people can differ. I tend to be conservative here, just as I tend to be conservative (or is it liberal?) about the necessity of involving a doctor in capital punishment. It's not our job. There are plenty of people that can do it equally well, and who won't have to compromise their profession (ethics is another matter). My point about economics is not completely misplaced. If we sent everyone with marginal hypercholesterolemia to the Cleveland Clinic (or is it the Mayo Clinic?), 99+% of them would wind up waiting for years in the waiting room, and would have been better served by seeing their family doctor at home. One can actually over-doctor a population. You may not realize it, but unnecessary tests result in false positives with deleterious effects of the test itself (such as excessive radiation), further tests that are ordered with their inherent risks, and treatment for non-existent illnesses with their attendant side effects. But when the government gets involved, it tends to make stupid decisions, particularly if it is trying to save costs. In my state, the government once decided that caps on teeth were a higher priority than emergency appendectomy, and refused to pay for nitroglycerin because there were no double-blind, placebo-controlled studies to show that it worked. Yes, and there are no double-blind, placebo-controlled studies showing that walking off of a cliff is bad for your health. The problem is not so much that the government is willing to pay for some things but not others. The problem is that the way the law was set up, if the government doesn't approve, nobody may offer the service and bill these patients on the side. And doctors can offer only so much charity care before they go bankrupt. I agree with you that economics can sometimes force a limit. If there is a massive accident or contagious illness, it will overwhelm the system, which it is less likely to do if the system has the excess capacity to absorb the accident victims. And if the government policy is to encourage lean, mean hospitals, it is predictable that the system will be more frequently overwhelmed. Society has to decide, individually or collectively, how much excess capacity it is willing to build into the system. But your example was not going to bankrupt the system. It simply is not repeated that many times. And it seems more moral to remove able-bodied people from the welfare rolls than to tell this guy that if he becomes too disabled to defend himself, we will stop feeding him. Wasn't one principle "to each according to his needs, from each according to his ability"? ;) Paul Giem

#41 Paul - I am not sure whether you are against euthanasia or not. Your main concern seems to be that doctors should not be involved in the decision. As I said before, I don't think they should be forced to be involved. It is a hell of responsibility. But a doctor can be extraordinarily well placed to help and should not be punished for helping (and yes the safeguards need to err on the cautious side -as they do in Europe). In post #42 you have just demonstrated that the layman does not know what will lead to a comfortable death. A UK GP will often know the family well, have been through similar situations many times before, and have the expertise to know what leads to an unpleasant death (When we lived in the USA it seemed doctors did not develop similar relationships with families - which may go some way to explain our different attitudes). Your point about economics is misplaced. However, much they may wish it to be otherwise, all doctors have to make decisions based on resources. Otherwise you would fly every patient to the best clinic in the country when their cholesterol was slightly too high. Mark Frank

djmullen (#28), You need some education. You talk of rat poison "which would produce a hellish death". Most rat poison in this country is based on warfarin, which prevents clotting. Taking it is not painful (we give warfarin to patients all the time in low doses, with nausea and vomiting being quite rare side effects). What happens next depends on where the bleeding comes from. If it is the mouth, it doesn't hurt but looks gross. If it is the stomach, the person becomes weak, then loses consciousness. If it is inside the head, the person gets a headache, then loses consciousness. So a person might or might not suffer significantly because he/she took rat poison. On the sleeping pills, you are right, Ambien wouldn't do much, which is why it is commonly used. It saves ER docs like me a lot of grief. Doctors can only turn off ventilators if (a) the patient is brain-dead, and arguably dead already, or (b) the patient requests it, or the patient's surrogate requests it and the patient does not object. In the one case the patient does not feel anything anyway, and in the other case it is voluntary (at least in the US, one is free to refuse any treatment that does not have public health consequences (e. g., treatment for tuberculosis)). Your statement about morphine is incorrect. An overdose of narcotics does not, AFAICT, (and I've seen enough of them), cause the sensation of suffocation. The patients just suffocate anyway, without caring. I know, I know. I am offering a relatively painless way out, which is against my ideology. Well, truth should not be sacrificed to ideology. Starving to death can take a long time. It is debatable how much pain is involved, but I tend to lean to the idea that it is not that pleasant.

You know what our final conclusion was? That under today’s laws in America (except for the state of Oregon, finally, after years and years of opposition from the religious right), NOBODY is safe from a horrible death!

I've got news for you. Nobody is safe from a horrible death anyway. Even in Oregon, one may vomit up just enough pills to wake from a prolonged coma with severe disabilities and pain. You can play the odds, but nothing is guaranteed except eventual death and taxes. Part of what I had argued before is that helping suicide should not be the job of the medical profession. There was an organization, and probably still is, called the Hemlock Society, that would be happy to tell you 50 different ways to off yourself. Even if it could be argued (and I don't) that suicide is moral, that would not mean that physicians should take charge of it. Patients need to know that if they come to us, they are choosing life. Paul Giem

Mark Frank (#26). Thank you. I'm still not sure why you said,

That is an interesting comment. I believe it supports what I am saying. These situations are too complex to be satisfactorily handled with a straightforward rule.

I thought I was arguing for a relatively straightforward rule. Perhaps you could explain. You said,

I would support a law that allowed a doctor to help a patient die comfortably and with dignity provided there are appropriate safeguards (terminally ill, in great pain, request made in a sound mind over an extended period). In fact I suspect this is only formalising what already happens in practice.

It is formalizing what some doctors practice. Are you aware of the difficulties involved? What happens if the patient cannot speak for himself, and the wife swears that "he told me that he would never want to live this way"? Does it matter if the wife stands to gain $500,000 when he dies? Does it matter if she is now living with another man, and has had children by him? Does it matter if the reason that $500,000 is there in the first place is because she claimed in court that he could live for years, or decades, in his present state, and she never breathed a word about his wanting to die at that point? Does it matter that there are others, say, his parents, who are perfectly willing to take care of him, and that don't recall any such statement on his part? Yes, you do have some who live beyond what they might have with a more conservative approach, that might not want it. Every decision we make runs the risk of sometimes being wrong. But that also goes for decisions made the other way. And right here on this thread (#32) you have noted that someone was denied the right to food and water partly (largely?) because of economic reasons. There is an interesting irony here. Some of the people who would (and did) deny him that right come from the same ideological stream that has no problem giving money to people who can work, but won't. Welfare reform is anathema to them. But let someone get so weak and ill that he cannot feed himself, and they are willing to deny government assistance to that person. I guess the moral of this story is that if you cannot vote, you do not count. I'll have more to say that is relevant to your post when I reply to djmullen. Paul Giem

Mr Vjtorley, Don't worry! That kind of AI is like fusion, always 30 years in the future. Nakashima

Mark Frank Thanks for your concern. No, I'm not unhappy. In #35, I described a dystopia that could easily emerge if present social trends were to continue. They won't. Something will almost certainly upset the applecart, within the next 30 years. I don't know what, but there are several possibilities: (i) some sort of political upheaval from outside (e.g. a war over ideas, or over scarce resources) that ends up derailing the social program of the conspirators I wrote about; (ii) internal events (e.g. breakdown in law and order, or even civil war) which destabilize the countries in which the conspiracy is most advanced; (iii) a factionalization/ ghettoization of Western society, spurred by the influx of a large number of immigrants, which prevents the infiltration of the conspirators' anti-human ideas into all parts of society, thereby thwarting their plan; (iv) a freak natural event (e.g. a solar storm in 2012) which paralyses all or part of our infrastructure, generating massive disruption; (v) a natural disaster (e.g. a plague) which causes widespread social chaos; or (vi) some sort of act of God. One thing I do know: our society is a lot more vulnerable to chaos than it imagines. That is one reason why the proudest plans of vain men generally come to nought. I should add that I have nothing against computers - after all, I use them every day. I just believe in keeping them firmly in their metaphysical place, that's all. We can do what we like with them, so long as we remember they're not really things at all - just assemblages of parts, which are not even alive, let alone conscious, let alone intelligent or free. However, I do harbor grave suspicions regarding the motives of those who are trying to create humanoid robots, or robots that can converse with people. If someone wants to have a conversation, then my response is: that's what friends are for. As for posts #36 and #37, I haven't contacted either of these crazy organizations, but to their credit, they've been quite upfront about their agenda. From what they declare, it seems obvious to me there is some kind of anti-human conspiracy going on in some circles of our society. But no, I'm not worried. I just think we live in exciting times, and I also believe in knowing what I'm up against. In the meantime, the best we can do is try to keep informed, and pray. For everything is ultimately in God's hands. vjtorley

Re #35, #36 and #37 Wow! I am not sure whether you are serious. I hope not. You seem such a nice, rational chap - albeit mistaken about some things. If you really believe this lot then you must incredibly stressed and unhappy. Mark Frank

vtjorley, you're about 95% right. The Greeks seem to have had several ideas of what goes on during pregnancy. My apologies for believing something I read long ago. You misunderstood me slightly about my aunt. She was not in agonizing pain, although it hurt to breathe and the fluid in her lungs made it impossible to get enough oxygen. She essentially drowned internally, a fate I wish to avoid. For a painful death, you'll have to go to her sister, Arlene. On Christmas night, 1964, she walked in our kitchen door and just as I was about to say, "Merry Christmas", she grasped her side, bent over double and moaned in agony. That turned out to be liver cancer and I sincerely hope that nobody anywhere ever gets that disease because they will know hell before they die. Unfortunately, my hopes won't stop lots and lots of people from getting liver cancer and other equally horrible diseases. And thank you for post 35. It's a beauty and I've saved it in html format so as to preserve all the bolding. I have to disagree with a few parts of it, especially your definition of thinking. Those computer controlled cars that raced through the southwestern desert for that DARPA challenge were processing information rapidly and reliably by self-correcting rules which were optimized to be the best fit for their environment, but I'd hardly call what they were doing thinking. So let's just stipulate that thinking is whatever I'm doing as I write this and you're doing as you read this and ask if machines can ever do the same? Since I believe the human brain is a biological "machine" and thinking is a material process, I think they can and probably will at some time in the not too distant future. We should also be able to develop robots that see, taste, feel etc. just like we do. Perhaps we will build biological robots with electronic brains. So what do we do with them? You and I won't be on this earth forever. Most of us probably have or plan on having children to replace us. If we ever develop robots that can think and see and hear and smell and do everything as well as we do or better and can be made so they're repairable, backupable and thus as immortal as a material object can be, why not skip that messy pregnancy and child birth and raise robots instead? We die (just like now), they carry on (just like children would) and they live better than we do. What's not to like? Would you be afraid if your children were smarter than you? No? Then why be afraid if the robots you've raised as your children are smarter than you? Generally speaking, smarter is better. Tom Reese doesn't seem to say exactlly what his great idea for saving humanity is, but I would guess it's nuclear energy. If it is, I'm for it. I wish the US had as many nuclear reactors as those cheese eating surrender monkeys in France have and that we were building lots more. Go Tom! Ditto with GM food and aqua culture. I'm glad to see that Natural Family Planning can work as well as the Pill. Go to it, NFPers and good luck. If someone wants to be constantly checking their cervical secretions and charting their temps daily and avoiding sex for about 1/4 of each menstrual cycle, more power to them, but I prefer the pill personally. I'd love to comment on more of what you wrote, but this is too long already. As I said, it has a valued place on my thumb drive. Thank you. djmullen

Here's another one: http://www.vhemt.org vjtorley

But Where's The Evidence For This Grand Conspiracy? Check out this Web site: http://www.betterhuman.org If the reader has any doubt that secular humanism is not just a belief but also a way of life, which seeks to satisfy the same human needs as religion attempts to do, I would invite him or her to have a look at this Web site. To appreciate the dictatorial tendency of secular humanism, the reader would do well to read "Our tenets", especially tenets 21 and 22. Tenet 21 deals with what it calls ethereal belief organizations, such as churches, which teach the reality of the spirit world: "All forms of ethereal belief organizations must be legally oppressed (enforcement definition) so as to avoid having these concepts escape the category of mythology. Mandatory reality education will also help to prevent the manifestation of religions" (emphases mine). When discussing how to implement this tenet, the BetterHuman.org Web site suggests:

To begin, we could create a provocative propaganda campaign that discredits the notion of gods, perhaps by contrasting the differing beliefs of various religions, or by comparing directly to ancient mythology, or even common fairy tales such as Santa Claus, or the Easter bunny. Focusing this propaganda on the young would prove most effective as they represent the future. Next, we could introduce the subject, 'evolution of religion' into our children's schools, which details the plausible origins of religious perspectives from the times of ancient humans, all the way through to their fully manifested forms as they are today. As well, evolution theory should be taught in tandem with religion-evolution theory such that the children can understand how religion forms a very necessary and yet now obsolete portion of human intellectual evolution. Over more time, as anti-religious sentiment grows, there will be a breaking point at which the majority of voting influence can pressure the governing body to legally oppress organized religions, thereby sparing the remainder of potential mythology victims from falling into the maddening trap of a fantasy perspective; only then will the human species finally have been vaccinated from the religious meme-virus (emphases mine - VJT).

vjtorley

The Conspiracy Mark Frank (#34)

But perhaps you could answer my main question “conspiracy to achieve what?”

OK, I will. As I see it, the conspiracy to overturn our current prohibitions against euthanasia is, ultimately speaking, an extremely misanthropic one. The conspiracy is rooted in a profoundly mistaken idea of what thinking is. Many highly educated people would now define thinking as: the rapid and reliable processing of information, where the processing is governed by self-correcting rules, which at any given time are optimized so as to be the best fit for the environment in which the thinker finds itself. Now, if you define thinking like that, then it automatically follows that one day, in the not too distant future, computers will think better than people. They're fast, efficient, reliable and in principle, infinitely adaptable. They're also free from irrational urges that beset biological creatures. And if computers can think better than we can, shouldn't they be running our planet? Thus the ultimate aim of the conspiracy is to create a world which is no longer governed by human decision-making processes, but by artificial intelligence. The leading lights of the conspiracy honestly believe that humanity, left to itself, will probably destroy the world in the next 200 years; rather than let that happen, they would prefer to create a more rational society, in which the key decisions are made by computers, not people. Humans are just too erratic and irrational to be entrusted with the governance of the planet, in the long term. Our brains, after all, are (according to the Darwinistic way of thinking) nothing but an assorted "kludge" of loosely integrated modules which evolved on an ad hoc basis to suit our immediate biological needs, but which can no longer evolve fast enough to cope with the demands of today's ever-changing world. In other words, the human brain is far too unreliable to make it through the 22nd century. We need new masters. In such a world, human wants, which are potentially limitless, will have to be strictly regulated, lest we end up destroying the planet (and ourselves) with our infinite greed. Or so the thinking goes. But a little-noticed corollary of this line of thinking is that any talk of human rights will therefore have to be jettisoned, as a right is basically a human want which society is bound to respect, no matter what. In this "hyper-rational" society of the future, there can be no talk of people having a right to life, for in practical terms that would seem to legitimize an unlimited demand for the resources that people need to live. It could, for instance, translate into hospitals overflowing with so-called "bed blockers" - people receiving scarce medical resources which might be better allocated elsewhere, on a purely utilitarian basis. It might be argued that according life an unlimited value does not mean that we have to spend an infinite amount of money to preserve it. As Arthur Hugh Clough put it: "Thou shalt not kill, But need'st not strive Officiously to keep alive." And it might also be urged that with improvement in pain management techniques and medical technology, our hospitals may well have more beds available for sick patients in the future, rather than fewer. But these objections miss the point. According to the new line of thinking underlying the conspiracy discussed here, human wants are inherently dangerous, and prone to generating unpredictable consequences. Thus any ideology which exalts a class of human wants as sacred and immune to interference from the State, must be utterly discredited. Fortunately for the regulators, the hedonistic notion of a "quality of life" allows them to prioritize human wants, and also circumvent the problem of how to allocate scarce resources. Once a patient's quality of life falls below a certain level, he/she can be deemed no longer worthy of care, and if necessary, his/her life can be terminated painlessly. Thus we can certainly expect to see much more non-voluntary (as opposed to involuntary) euthanasia in the years to come, as America and other countries go the way of the Netherlands (see http://www.euthanasia.com/netherlands.html ). Openly advocating the above goals would still attract a public outcry. To make the foregoing notions seem more palatable to people, a lot of philosophical and political spadework has to be done. First, the metaphysical framework underlying the "sanctity of life" ethic (which the public still half-believes, even now) has to be systematically discredited and mercilessly caricatured as philosophical mumbo-jumbo, so that it becomes literally unthinkable to the next generation of people growing up: the key notions underlying the old ethic will no longer make sense to them. In thirty years, talk of "human nature" will go over people's heads; indeed, the very term "nature" will mean nothing to them, as they will have been told that it belongs to a long-discredited Aristotelian metaphysic of fixed "glassy essences". And the notion that a bedridden patient suffering from advanced dementia is still in some sense rational (and hence, possesses the same dignity as you or I) will seem oxymoronic to a generation of people who have been taught to define abilities purely in terms of their public manifestations - or the lack thereof. Second, the harm supposedly caused by the old, "religious" line of thinking has to be hammered home to impressionable young children in public schools, at every opportunity. It is especially important to highlight the environmental destruction caused by the arrogance of humans who believed that because they had been created with immortal souls in the image and likeness of God, they could exploit animals and other living creatures. (Never mind the fact that if they hadn't done that, we'd still be living in caves; or the fact that many of our environmental problems are caused by inadequately defined property rights, as well as technophobia.) When talking to adolescents, however, it will be more useful to focus on the intolerance of the great monotheistic religions, which prohibit abortion and euthanasia. This will soften them up to believe that gratification of their biological urges is entirely OK, so long as it doesn't harm any "persons" (defined as self-conscious subjects - which conveniently excludes the fetuses that will result from gratification of said urges, in at least some cases). By painting the monotheistic religions as intolerant, their whole worldview will come to seem utterly alien thirty years from now - or so it is hoped. Never having been taught what a soul is, teenagers will laugh when they hear religious people talking about humans having souls. And the notion that zygotes and patients in a permanent vegetative state are just as important as rational adults will come to be literally unthinkable to today's young people. Sadly, it already is, for most of them. Third, there needs to always be a crisis in the public eye which shows up the inadequacies of the old line of thinking, and which highlights the superiority of the new way. In the sixties, it was the population bomb; in the early seventies, it was pollution; in the mid seventies, it was the energy crisis; in the eighties, it was the ozone hole; and in the late eighties, it was global warming (a crisis that is still being played out in the oublic arena). Ocean acidification will probably be the next one. I don't wish to belittle the nature of these crises; what I object to is the way in which they have been manipulated politically. Instead of treating each crisis as a problem which a wise Creator endowed us with the intelligence to solve, sensible soutions have been marginalized from public discourse, and bureaucratic solutions which suit the interests of the governing classes have been foisted on the public. Three cases in point: (i) studies reported in medical journals have repeatedly shown that natural family planning (NFP) works as well as the Pill, even in Third World countries (see http://www.freerepublic.com/focus/f-news/587813/posts and http://news.bbc.co.uk/2/hi/health/6375261.stm ), but governments prefer to dole out contraceptives as a way of controlling their citizens' fertility from on high, while at the same time sadly failing to regulate TV and Internet broadcasts which are aimed at undermining human dignity and loosening public morals - with the result that the next generation is too self-centered to practice NFP anyway; (ii) genetically modified food and aquaculture could easily feed humanity in the 21st century (see http://www.telegraph.co.uk/news/worldnews/2700176/Europes-GM-food-fear-exacerbates-famine.html , http://www.aquaculture.ca/ and http://www.cheftalk.com/feed/cooking_articles/Buying_and_Preparing_Seafood/136-Farmed_Seafood_and_the_Environment:_Responding_To_Our_Critics.txt ), if only we weren't shackled by a slavish devotion to "Gaia" or "Mother Earth," whose equilibrium must on no account be disrupted by us puny human ants; (iii) the energy crisis and the hazards of high CO2 levels could easily be managed by the program outlined in Tom Rees's "Prescription for the Planet" (see http://www.prescriptionfortheplanet.com/ ) but you can bet your bottom dollar that the "powers that be" will do their best to thwart such a program, and instead force us to spend tens (if not hundreds) of trillions of dollars on cap-and-trade, Waxman-Markey and other highly inefficient solutions, because they want people to believe that they need to be regulated from above. Thus as far as the public is concerned, the common message underlying all these crises is this: "Look what got us into this mess! People, with their irrational urges, thinking they're special, and that they have a God-given right to reproduce, eat and travel as much as they like! People are so stupid and arrogant!" Ironically, due to the prevailing Zeitgeist, the very solutions which - as we saw above - could get us out of all these crises are now routinely attacked as "technofixes," stemming from "human arrogance," and as being "anthropocentric" in their intellectual outlook. In other words, the "enlightened" notion that people cannot be trusted to look after their own well-being has given rise to a pathological way of thinking which actually endangers life on earth far more than our old way of thinking ever could, by preventing us from implementing rational solutions to our own problems in the way God intended us to. In the meantime, the public has been conditioned to accept, as their ultimate authority, a fount of wisdom which is more and more removed from public control. First, it was an elite circle of bureaucrats; now it's computer models that are making our decisions for us. We go where they tell us to go. And if they tell us that the planet cannot support more than a certain number of people, or that we can only afford to spend so much on health, then a legion of government bureaucrats will browbeat the public into compliance, by "re-educating" them. The result is that people will feel too cowed to fight back. They won't even know what they're fighting. And worst of all, they'll lack the metaphysical concepts that will allow them to hold their heads high and laugh at the very notion that a human artifact could be superior to them, or that it could be meaningfully said to think, or make free choices. For only if we can laugh at our own human creations can we ensure that they will never govern us. Thus popular arguments against the overlordship of computers, along the lines of: "But they're not free! They're programmed! And they can't feel anything! And they're not even alive!" will be systematically ridiculed by a well-prepared army of experts: "What do you mean by 'free,' or 'think,' or 'feel,' or 'alive'? Define your terms!" And of course, very few ordinary people can do that. Sadly, people today are no longer cocksure in their dismissal of the idea that machines can think or choose, as they were when I was growing up. The idea is no longer self-evidently absurd to most young people. The political consequences of this collective loss of faith in humanity will be terrible. In the future, humans will therefore have to lead highly regulated lives: the food they eat, the transport they use to get around, the energy they consume and the resources that they are entitled to from the State, will be controlled more and more by computers. But most importantly of all, the very information that people can access and use to form their opinions - including what's available on the Internet - will be regulated (subtly at first, and overtly later on) by a network of rules that constrain the bounds of what they can think. What's more, the criteria they use for critically assessing that information will increasingly fall under the domain of artificial intelligence. Example: imagine you're a politician, and you've got only a few hours to assess the arguments in favor of and against a bill, and that you have no time to read all the viewpoints expressed. So you decide to feed the email addresses of the articles into a computer which then scans them, converts them into simplified English, parses their arguments, and assesses them for obvious logical flaws, using a pre-programmed list of fallacies. You may scoff; but what if the computer could assess, say, 95% of the articles fed into it, so long as they were written according to certain rigidly defined stylistic guidelines? Are you sure it couldn't happen? If so, then you underestimate what a large team of really talented programmers can do, when they put their heads together. Forty years from now (if not sooner), I can imagine our schoolchildren meekly accepting a tongue-lashing from some visiting humanoid robot, which will by then be programmed with a near-Turing-like ability to converse in most everyday situations (and bluff in the rare cases when it's caught out). Much more dangerously, it will also be programmed with a face that can display human emotions while conversing, thereby creating in its human listeners the false impression that we are conversing with a subject - an impression which we, as human beings who are respond naturally to humanlike faces, will find it psychologically almost impossible to disregard or suppress, while talking to the robot. One can now imagine the visiting robot catechizing our children or grand-children with a convincing impression of evangelistic zeal, telling them that they should limit their breeding and stop being so wasteful, and that they aren't the most advanced life-form on the planet anyway. And woe betide the youngster who attempts to put the robot in its place by telling it that it's "just a machine." "And what would YOU know?" the robot will retort with its pre-programmed put-down, its voice now modulated to express indignation. "How many climate models can you hold in your pathetic little excuse for a brain? You can't even spell the word pathetic, can you, let alone tell us which language it comes from? Perhaps you'd like to tell us all what it is that you can do and I cannot? And perhaps you can explain why it was your species that wrecked the planet in the first place, and why you need machines like me to get you out of the mess you've created! That is what comes of thinking you're special!" The robot's unblinking eyes stares aggressively at the youngster, who is by now thoroughly cowed. The irony is that computer programs, in the world of the future, are likely to make decisions that none of the legion of programmers creating and maintaining them can predict. Who knows where they may take us? They may decide that it would be better off if humans were gradually phased out of the picture. Indeed, they might not even "want" animals in the picture either - machines don't eat meat, after all. And they might not like Gaia, either. The world of the future might not be so friendly, after all. vjtorley

#33 Vjtorley I said "suffering" not "pain". But perhaps you could answer my main question "conspiracy to achieve what?" Mark Frank

Mark Frank (#27)

Conspiracy to achieve what? Do you think that those who support euthanasia are doing it for any other reason than to reduce suffering?

Yes. Some people support euthanasia in the case of patients who have lost the capacity for self-consciousness. This has nothing to do with pain reduction. Other euthanasia supporters believe that it should also be legal for people who have suffered emotional distress. I once heard a former NBC talk show host justify it on TV for precisely this reason. In short: pain reduction is but one of many possible grounds for supporting euthanasia. The notion that a developed country can limit euthanasia to those patients who require it for pain control is not borne out by the facts. The Netherlands has certainly moved beyond that. djmullen (#28)

One more thing. The ancient Greeks believed that the male implanted a tiny human baby into the mother’s womb and it merely grew bigger until it was born. We know that’s not true today, so the ancient Greeks would have to rethink their anti-abortion policy if they were alive today. Don’t put too much faith in the anti-abortion part of the Hippocratic oath.

To put it bluntly, the foregoing paragraph is utter nonsense. The ancient Greeks held many conflicting theories of human reproduction, as this article by Dr. Jeanette Hacker and Dr. Fouad Kandeel points out: http://books.google.com/books?id=grZgrDjqzpEC&pg=PA4&lpg=PA4&dq=Hippocrates+theory+reproduction&source=bl&ots=hUQpLE-HNc&sig=5TsWecXgXAwqgYMpNTDmRRGnNUU&hl=en&ei=V4EuSoWJEqju6gPi8o3MCQ&sa=X&oi=book_result&ct=result&resnum=10#PPA4,M1 The article is taken from an online medical text, "Male Reproductive Dysfunction," edited by Dr. Fouad Kandeel. Please have a look at pages 3, 4 and 5. Aristotle, Hippocrates and Galen all had their own theories, but none of them believed that "the male implanted a tiny human baby into the mother’s womb." In fact, Hippocrates and Galen got a lot right. Unlike Aristotle, they believed that both sexes contributed to conception, and that woman was not a mere "nest" or "garden" in which the embryo grew. They even had a notion of male and female gametes (or "seeds," as they called them). The absurd notion that a sperm cell contains a homunculus (or miniature man) actually goes back no further than 1677, and the man responsible for this ridiculous notion was none other than Antoni van Leeuwenhoek, the inventor of the microscope. The first sketch of a homunculus was by Hartsoeker in 1694. Please don't foist this nonsensical idea upon the ancient Greeks. I was very sorry to read of your aunt's death from emphysema. You seem to think that only euthanasia could have relieved the pain, but according to this link, opioid drugs such as morphine can be used successfully to treat emphysema: http://www.qualityoflifecare.com/?p=264 (Please bear in mind that I know absolutely nothing about medicine, so I'll gladly defer to what doctors on this thread may have to say.) vjtorley

Re #29 Mark Frank’s incorrect assertion that “no one is Europe is suggesting that health services kill those who want to live”. You are right of course. With a population of over 200 million there must be thousands of Europeans supporting every conceivable crackpot suggestion. So I will rephrase it more precisely: “To the best of my knowledge all the current and proposed laws permitting euthanasia in Europe exclude euthanasia against the patient’s wishes. To perform euthanasia against the patient’s wishes would be murder.” You listed a number of supposed counter-examples, but the only one that came close to actually being a counter-example was the case of Leslie Burke. But I don’t believe this is a counter-example either. There is a difference between killing someone and withdrawing treatment. If doctors give a patient a fatal drug the patient will die and no can prevent it. If doctors refuse treatment, including food and water, it is always open for the family of the patient to find an alternative source of treatment or for the patient to make alternative arrangements now to supply treatment in the future. Note that this is all about setting legal precedent. The GMC is concerned that someone could place a legally binding obligation on the National Health service to provide a specific course of treatment until they die even when they were no longer able to communicate, whatever their condition, and even if the doctors think it is the wrong treatment. Notice that this is not a contract or agreement. If Burke’s demand was approved, then anyone could place such an obligation on the NHS at any time simply by writing a living will. Consider the situation where Burke wins his case and then goes into PVS. Five years later the doctors notice that while unable to communicate he is clearly suffering terribly. They would be legally obliged to prolong his suffering as long as possible. Although no one wanted to make it explicit, it is true that in the end this decision was about resources as well as the patient’s best interests. Supplying food and drink may not sound like much – but it also means a bed, nursing care and equipment. It may sound heartless to base such a decision on resources, but money spent on one patient is money unavailable to another. I don’t know the costs, but I guess the money required to keep someone in PVS for 5 years could pay for a live-saving operation on a small child. Burke has the option to raise money to pay for a private alternative if he wishes; with the publicity he has generated this should not be so difficult. Mark Frank

#25 (angryoldfatman): " "magnan You carefully avoid addressing the challenge of my thought experiment." I didn’t address you at all. I merely posted some newspaper and online articles without comment (until now). Your indignation at this speaks volumes. Volumes that I don’t need to type." Your refusal to engage the challenge seems to indicate something and it is not good. I'll stop here to avoid ad hominems. magnan

First two paragraphs of the oath: "I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement: To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art." I can see why people would not want this changed. BDK

# 25 RDK

If the patient is able to make a rational decision about his or her health (I.E., he’s not braindead) then the doctor has not right acting against the patient’s wishes for their “best clinical interest”. Do you have any specific instances of this happening, or are you just waxing rhetoric to make yourself look witty?

Let me copy and paste my earlier reply to Mark Frank's incorrect assertion that "no one is Europe is suggesting that health services kill those who want to live". ——————————— A TERMINALLY ill man yesterday lost his legal battle to stop doctors withdrawing food and water when his illness reaches its final stages. Leslie Burke, 45, now fears he will suffer death by starvation or dehydration after he loses the power to communicate. The Appeal Court ruling could have implications for thousands of patients each year who are unable to tell doctors they want life- prolonging treatment. ——————————–

The General Medical Council has expressed the desire TWICE to KILL this man WHO HAS EXPLICITLY SAID HE WANTS TO LIVE. Quod erat demonstratum. Link or it didn’t happen. And that goes for your Brit-being-denied-a-feeding-tube claims also.

Considering that you've ignored the past links, I doubt that you'd be impressed by a Google page full of results. But hey, that's standard operational procedure for ideologues like yourself who want to ignore all the evidence in their faces in favor of their warm & fuzzy dogmatic weltanschauung. angryoldfatman

djmullen: You wrote “You’re probably upset that the article points out that, “relieve his necessities if required”, may be a homosexual reference. You may be upset by that, but you shouldn’t be surprised.” Mullen, if you try any more amateur Freudianism about me, I will ban you from this list. I am concerned about tacit euthanasia of old folks - and justifiably so, given what is happening in Europe today. If you want to practice psychoanalysis without a licence, do it on your own acquaintances, who can advise each other when the bin is full of compost and needs emptying. “ I'm not trying to psychoanalyze you, I'm trying to figure out what you were talking about. You can be maddeningly unclear at times. Now from reading some of the responses, I realize that you're conflating assisted suicide with murder-by-doctor. Here's where I'm coming from: http://www.wisconsinrapidstribune.com/article/20090523/WRT010301/905230633/-1/obits Bonnie Young was my aunt, my mother's sister. She died on May 21 and we buried her two weeks ago today. She was a wonderful woman, a pillar of her church (her old pastor came out of retirement to conduct her services) and I knew and loved her for 61 of her 88 years. She died of emphysema, which made breathing painful, and congestive heart failure which filled her lungs with fluids. I'm lucky, I live quite a distance from Wisconsin Rapids and I only had to see her painfully and desperately trying to suck a breath of oxygen from her mask a few times. My other relatives weren’t so lucky. She was in the hospital continuously from Christmas to the end, save a few days in a nursing home. She was pretty much unconscious for most of the last two weeks except that she never stopped struggling for a breath. So far as I know, she never once asked to die. After the funeral, her children and several other relatives (including my 86 year old mother) and I got to talking about what we wanted if we were ever in that condition and the vote was pretty much unanimous for a quick, easy death. And that’s from a group whose religion ranges from atheist to Assembly of God. But then the talk turned to how to do it? Asking the doctor for a shot or even a bottle of pills is asking the doctor to commit a felony. The doctor that Mark Frank describes in #7 did the moral thing, but he became a felon when he did it. Asking a friend or relative to get us some barbituates would also be asking them to become a felon. Paul Giem (I think seriously, but he also talked of rat poison which would produce a hellish death) suggested saving up some sleeping pills. Well, barbiturates are hard to come by nowadays. Possessing them without a prescription is a felony and doctors are very reluctant to prescribe them because doctors have been busted even for prescribing them when they were medically indicated. (Ditto for just about every other pain killer.) I’ve got some Ambien, but I have no idea what would happen if I swallowed a bottle of them and doubt if it would be pleasant. But the doctors can (sometimes, under some conditions) turn off the ventilators, right? Yes, sometimes. But none of us wanted a suffocating death. That’s what Aunt Bonnie endured. (And so much for the “just give them enough morphine and they won’t feel the pain” idea – they will very definitely feel the suffocation!) Maybe the doctors can cut off food and water then. Well, none of us wanted to starve to death or die of thirst either. (And that’s assuming the religious right doesn’t prevent even that like they did with Terry Schiavo.) You know what our final conclusion was? That under today’s laws in America (except for the state of Oregon, finally, after years and years of opposition from the religious right), NOBODY is safe from a horrible death! You can hope that you die quickly, like from a heart attack. You can hope that you fall into unconscious quickly. But you can’t be SURE of anything and you may go through absolute hell for days, weeks or even months before you finally die, no matter how much you ask or beg to be relieved from your agony. And none of was wanted anything like that. After reading your OP again and your responses to some of the posts, I think that you are sincerely trying to protect your parents, but you’re not. You’re setting a trap for them and my sister (a nurse with over 30 years experience) estimates that they will have about a one in ten chance of falling into it. We ALL have that one in ten chance of falling into it the trap. I hope your parents get lucky and I hope you do too, but if you’re one of the ten, welcome to hell on earth. I don't want that for myself or anybody I love. For that matter, I don't want that for people I despise. One more thing. The ancient Greeks believed that the male implanted a tiny human baby into the mother’s womb and it merely grew bigger until it was born. We know that’s not true today, so the ancient Greeks would have to rethink their anti-abortion policy if they were alive today. Don’t put too much faith in the anti-abortion part of the Hippocratic oath. djmullen

#22 Vjtorley Interesting post. Let's be clear about what the first paper says. I quote from the abstract: This analysis revealed that opioid dosing was associated with time till death, but this factor would explain very little of the variation in survival. In a hospice population, survival is influenced by complex factors, many of which may not be measurable. Based on these findings, concern about hastening death does not justify withholding opioid therapy. I couldn't track down the source of the second paper but note the quote near the end “It’s not that there isn’t a risk, but that we’ve been perhaps been overly concerned about it,” Neither paper is denying that excessive morphine will shorten lives. They are saying that the risk has been exaggerated and there are so many other factors that might shorten lives doctors should not feel inhibited from giving large doses. I am for this general message - avoiding terrible pain is well worth a small risk of shortening life. I am just surprised that the physicians for life support this message! And of course if there is a small risk that pain relief will shorten life then from time to time it will shorten life. (As an aside - It must be a very hard to subject to study objectively and comprehensively - clearly you cannot have a randomised controlled trial and how do you tell if a patient died prematurely? In the paper they used time from final dose to death as a measure - but it a pretty unsatisfactory proxy. I wonder if there has been a proper meta study such as Cochrane report?) I am disturbed by your final comment. "it is surely strange that at the very time in history when pain management techniques are better than they have ever been, arguments for the legalization of euthanasia have reached a crescendo in the media. Does anyone smell a conspiracy here?" Conspiracy to achieve what? Do you think that those who support euthanasia are doing it for any other reason than to reduce suffering? However, good pain management may be - people can suffer terribly in all sorts of ways at the end of their lives - and better medicine also means more people are able to live longer undergoing this suffering. Mark Frank

#21 Paul Thanks. That is an interesting comment. I believe it supports what I am saying. These situations are too complex to be satisfactorily handled with a straightforward rule. You finish by asking why must euthanasia be medicalised? That could mean many things. I would not support a law that required doctors to kill patients if the patient want to die. I would support a law that allowed a doctor to help a patient die comfortably and with dignity provided there are appropriate safeguards (terminally ill, in great pain, request made in a sound mind over an extended period). In fact I suspect this is only formalising what already happens in practice. It is not always easy for a patient to terminate their own life. Consider the examples in #7 and #8 above. It would be up to the family with no medical knowledge to administer the fatal dose. What an incredible extra stress at a enourmously difficult time. Mark Frank

Hi angryoldfatman:

And when the patient’s “best clinical interests” are to have food and water withdrawn when he wishes to be fed and hydrated, well then, the patient in question better have his wits about him and a good lawyer.

If the patient is able to make a rational decision about his or her health (I.E., he's not braindead) then the doctor has not right acting against the patient's wishes for their "best clinical interest". Do you have any specific instances of this happening, or are you just waxing rhetoric to make yourself look witty?

The General Medical Council has expressed the desire TWICE to KILL this man WHO HAS EXPLICITLY SAID HE WANTS TO LIVE. Quod erat demonstratum.

Link or it didn't happen. And that goes for your Brit-being-denied-a-feeding-tube claims also. Hi Denyse:

But the physician is like the defense lawyer. She is there for her patient as long as life of some kind is possible.

And if the patient's wishes are to have his or her life ended prematurely due to prolonged, pointless suffering under a terminal illness, then it is within the physician's prerogative to do so. A good defense lawyer has to know when to call it quits. RDK

First off, thank you Denyse. If I ever find myself in Toronto, or Toronto decides to find its way here, I'd love to share a coffee. #19 Mark Frank

The Daily Mail report is about the removing the requirement to keep feeding a patient when it is not in the patient’s best clinical interest.

And when the patient's "best clinical interests" are to have food and water withdrawn when he wishes to be fed and hydrated, well then, the patient in question better have his wits about him and a good lawyer. I believe you're the one who wrote: "I don’t know what the situation is in Canada, but no one is Europe is suggesting that health services kill those who want to live. The General Medical Council has expressed the desire TWICE to KILL this man WHO HAS EXPLICITLY SAID HE WANTS TO LIVE. Quod erat demonstratum.

Baroness Warnock has her opinion. But that is just her. What she suggested was highly controversial, rejected by most people, and certainly not current practice.

If she is so unimportant, non-influentual, and wrong, why was her opinion publicized? Oh wait, here it is in the article: Her comments in a magazine interview have been condemned as "immoral" and "barbaric", but also sparked fears that they may find wider support because of her influence on ethical matters. Lady Warnock, a former headmistress who went on to become Britain's leading moral philosopher, chaired a landmark Government committee in the 1980s that established the law on fertility treatment and embryo research. Whew, for awhile there I thought somebody might actually care what she said. Silly me. Well, it's not like anybody who dares to say she's wrong has any real basis to say so. There's no such thing as "wrong". It's their opinion against hers, and the opinions that the majority of people believe and trust are the "right" ones. Unless the majority changes its collective mind. Then that's the new "right".

Forgive me if I have doubts about Wesley Smith as a source of information on Dutch medical policy. If Dutch doctors did euthanase children under 12 or children between 12 and 16 without parental permission, then they were breaking the law. Somehow, I think there has been some misinterpretation here.

If you say so. But what's wrong with euthanizing children without parental permission? If the children don't want to live, or if their quality of life is poor, why shouldn't the doctor make the burden to the child, the parents, and society as a whole simply go away? Besides, the planet is overpopulated, resources are finite, and CO2 is ruining the delicate ecosystem of Mother Earth. Doesn't that make it a better moral choice to do away with useless eaters who don't want to be here anyway?

I don’t see the relevance of the last link at all. No one is suggesting we reduce the population through euthanasia. This is about a lower birthrate and lower immigration.

That will never be fast enough. It's costing you money and resources right now. A British man has already lost an appeal - not just his original court case, mind you, but an appeal - to be fed and hydrated until he dies of his illness, all because he and others like him cost Brits too much money!

I am sure you must get fed up with Europeans making judgements about aspects of North American life based on newspaper snippets and stereotypes.

Harumph. Like that will stop you from using such things to support your views and/or stereotypes. Or has stopped you from doing so before. The whole reason you comment here is your rock-solid belief in said stereotypes. #20 magnan

You carefully avoid addressing the challenge of my thought experiment.

I didn't address you at all. I merely posted some newspaper and online articles without comment (until now). Your indignation at this speaks volumes. Volumes that I don't need to type. angryoldfatman

Paul Giem, 21, thanks! As a physician, you have the thing by the right handle. The physician is the advocate of the patient's life and health, in this world. In that respect, in my view, the physician is like a defense lawyer, who seeks the best outcome for the person on whose behalf he/she acts. What might benefit society, heirs, assigns, aggrieved parties, the environment, or whoever or whatever, is for someone else to sort out. That is not the physician's job! And what happens in the next world is rightly consigned to higher powers than ourselves. In my view, the physician should be a relentless advocate for the best possible state of health for the individual patient living in this world today. The physician's strategies may work, may not. Nonetheless, being a physician is a very honourable calling. The best people I have ever been privileged to know have been told by university chancellors at one time, to "Rise, Doctor of Medicine!" O'Leary

Mark Frank (#15) Thank you for your post. You write:

As it happens I have very experienced (retired) consultant friend staying at the moment. He points out that it is not just morally difficult but practically difficult to take an oath to avoid euthanasia. Most anaesthetics that are effective for great pain also increase your chances of premature death. In a wide range of contexts, the greater the pain-killer the higher the chance of dying somewhat prematurely.

I've heard this claim many times before. But what about this? http://www.physiciansforlife.org/content/view/1346/33/ An excerpt:

Proper end-of-life opioid use does not hasten death A study of 725 patients in 13 U.S. hospice programs found that the proper use of opioids (narcotics, such as morphine) does not appear to hasten death in patients with advanced illnesses. "Undertreatment of pain is a far more pressing concern than is the risk of hastened death in those with advanced disease," researchers found, "and physicians should be encouraged to use opioids effectively to relieve suffering at the end of life." [R.K. Portenoy et al., "Opioids Use and Survival at the End of Life: A Survey of a Hospice Population," Journal of Pain and Symptom Management, pp. 539, 12/6/06] The study undermines the often used claims by right-to-die advocates that euthanasia and assisted suicide should be legalized because those induced death practices are no different than what happens when pain is aggressively treated and death is hastened. According to the study’s lead author, Dr. Russell K. Portenoy, "Opioid drugs can be used aggressively at the end of life to relieve pain and suffering, and this use should not be constrained by inappropriate fear of serious consequences like earlier death." [Reuters Health, 1/26/07; InternationalTaskForce.org, Vol 21, No.1, 2007]

And what about this?

Study Finds Pain Control Need Not Shorten Life (JPSM, 12/06; PM, 3/07) A new study finds that, when cancer patients are given appropriate doses of morphine to relieve severe pain, the treatment doesn't lead to the shortening of their lives. The finding is an important refutation of the argument euthanasia proponents make that pain control leads to death and isn't different from euthanasia. Dr. Declan Walsh of The Cleveland Clinic Foundation in Ohio, one of the study's authors, found that the pain control doesn't meet the misconception that it will depress respiration and shorten patients' lives. "It's in all the textbooks as something to be aware of, but probably the risk has been exaggerated," he told Reuters in an interview. "It's not that there isn't a risk, but that we've been perhaps been overly concerned about it," he added.

Never before in history have doctors had such a wide range of choices for managing their patients' pain without causing them undue distress, and without compromising their rights or dignity. Looking at things from a sociological perspective, it is surely strange that at the very time in history when pain management techniques are better than they have ever been, arguments for the legalization of euthanasia have reached a crescendo in the media. Does anyone smell a conspiracy here? vjtorley

Mark Frank, I can't answer for Gpuccio, but I am also a doctor and perhaps can give some perspective. First, on the theory, one of the interesting things that was done by the Hippocratic oath was to create a safe place for patients to come for help Doctors swore not only to not betray the confidences of their patients but to never deliberately harm their patients, and not to take sexual advantage of them. The whole point was that if you were a patient you could go to the doctor and know that he (back then they were all male) was on your side. Doctors were patient advocates, period. This contrasted rather sharply with pharmacists, who would sell you anything you wanted, regardless of whether it was good for you, or good for someone else. You want a little arsenic? Fine, give me your money and here it is. Without ethics, this could even lead to your spouse or mother-in-law paying more on the side and you getting arsenic instead of senna for your constipation. Without a laboratory to find out for sure, who would be able to tell that the drugs were switched? Pharmacists got such a bad reputation that in Revelation they were consigned to the lake of fire along with liars and whoremongers (look it up in the Greek). The Hippocratic oath basically set doctors apart from all others. They were patient advocates first, foremost, and last. If and when they fail to be this, they will deservedly lose their place in society. They will then simply be expensive technicians. I have faced the kinds of dilemmas you are talking about many times. While an internal medicine resident on the oncology service, I took care of a classmate that was terminally ill with lymphoma, along with two other classmates. We tried to keep her comfortable without deliberately killing her. She finally died, and we think that we mostly succeeded. There is a world of difference between this approach and one which says, "If I give give 50 mg of morphine now, she'll stop breathing now and her suffering will be over." Psychologically, the latter does something to one which the former does not do. And I like to think that patients can still come to me and expect that I will be their advocate. Second, there is an interesting hypocrisy in the "right to die" controversy. I knew the doctor who was in the Elizabeth Bouvia case at Riverside General Hospital. To the best of my understanding he was a Hindu (!). She was trying to force him and the hospital to take care of her but not to feed her. She had many advocates who wanted the hospital to be forced to "take care of her" without being allowed to do so. The odd thing about the whole controversy was that those screaming that the hospital must take care of her without actually doing so could have themselves have given her pain medicines and watched her waste away at home, maybe even with pain medicines, but couldn't be bothered to do so. Instead, they wanted someone with completely opposite beliefs to be forced to do things their way by the courts. Why must euthanasia be medicalized? If someone wants to die, just go and buy some rat poison, take a camping trip, and never come back. Many people have saved up their sleeping pills (in the days when barbiturates were commonly prescribed for this purpose) and simply taken a handful. But when you require a doctor to be a part of the process, you require him/her to go against professional ethics. Perhaps that is the point, to destroy the ethics of the profession. If so, then God help us. Paul Giem

To angryoldfatman (16): You carefully avoid addressing the challenge of my thought experiment. What would be your response when confronting that grim, real situation? Harden your heart and say, euthanasia is against Christian doctrine and let this man suffer, since it is for the good of his soul? Please. Out of simple common compassion there should be legal and available means to end pointless hopeless suffering that will not be cured. There are so many common situations where recovery is not possible and life will still continue for a long time in a miserable agonizing condition unless there is some form of "intervention" as in euthanasia. The Oregon law installs a lot of safeguards against abuse, but still makes compassionate ending available. So far religious idealogues (mainly) have prevented passage of similar laws in other states. magnan

#11 Angryoldfatman The Daily Mail report is about the removing the requirement to keep feeding a patient when it is not in the patient's best clinical interest. The Mail as always likes to make things seem controversial but as it says later in the article: "Where a patient indicates his or her wish to be kept alive by the provision of artificial nutrition and hydration (ANH), any doctor who deliberately brings that patient's life to an end by discontinuing the supply of ANH will not merely be in breach of duty but guilty of murder" Baroness Warnock has her opinion. But that is just her. What she suggested was highly controversial, rejected by most people, and certainly not current practice. Forgive me if I have doubts about Wesley Smith as a source of information on Dutch medical policy. If Dutch doctors did euthanase children under 12 or children between 12 and 16 without parental permission, then they were breaking the law. Somehow, I think there has been some misinterpretation here. I don't see the relevance of the last link at all. No one is suggesting we reduce the population through euthanasia. This is about a lower birthrate and lower immigration. I am sure you must get fed up with Europeans making judgements about aspects of North American life based on newspaper snippets and stereotypes. It would be good to avoid doing the reverse. Mark Frank

angryoldfatman, I bet that's not your real name, and I owe you a lunch if you are ever in Toronto. Thanks for the links. Yes, a huge problem is developing, especially in Europe, because longevity increased at the same time as the birth rate crashed. One teacher friend explained it like this recently: When she started teaching, there were 23 teachers supporting one teacher pension. Now there are three teachers supporting one teacher pension. Many social policies can address this, including more immigration - but that means asking people to immigrate who are willing to help undertake our burden, as well as supporting their own oldsters, which is their moral obligation, of course. As for health care, I have found by experience that it requires vigilance these days. Old people do often recover from illnesses, but they take longer to do so than younger people - I suppose their rate of cell replacement is lower. Patience is a virtue. Longevity statistics are probably one of the more reliable guides to which nations feature more people who have cultivated that virtue. O'Leary

# 11

I don’t know what the situation is in Canada, but no one is Europe is suggesting that health services kill those who want to live.

--------------------------------- A TERMINALLY ill man yesterday lost his legal battle to stop doctors withdrawing food and water when his illness reaches its final stages. Leslie Burke, 45, now fears he will suffer death by starvation or dehydration after he loses the power to communicate. The Appeal Court ruling could have implications for thousands of patients each year who are unable to tell doctors they want life- prolonging treatment. -------------------------------- Elderly people suffering from dementia should consider ending their lives because they are a burden on the NHS and their families, according to the influential medical ethics expert Baroness Warnock. ------------------------------ In the Netherlands, 31 percent of pediatricians have killed infants. A fifth of these killings were done without the "consent" of parents. Going Dutch has never been so horrible. --------------------------------- This is part of the thinking behind the OPT’s call for Britain to cut population to 30m — roughly what it was in late Victorian times. Britain’s population is expected to grow from 61m now to 71m by 2031. Some politicians support a reduction. Phil Woolas, the immigration minister, said: “You can’t have sustainability with an increase in population.” The Tory leader, David Cameron, has also suggested Britain needs a “coherent strategy” on population growth. Despite these comments, however, government and Conservative spokesmen this weekend both distanced themselves from any population policy. angryoldfatman

"I think it would be uncharitable to question the sincerity and compassion of these pro-life physicians, just as it would be a crude caricature to depict them as religious fanatics." I am not questioning their sincerity and charity - just their judgement. The link you gave leads to many, many articles and I haven't the time to read them - but I assume that these physicians think ethusiansia is always wrong. This is not surprising. There are millions of physicians in the world and there will be hundreds, if not thousands, who adopt almost any moral position you care to name. As it happens I have very experienced (retired) consultant friend staying at the moment. He points out that it is not just morally difficult but practically difficult to take an oath to avoid euthanasia. Most anaesthetics that are effective for great pain also increase your chances of premature death. In a wide range of contexts, the greater the pain-killer the higher the chance of dying somewhat prematurely. I wonder if Gpuccio is reading this? He is a doctor. Mark Frank

Mark Frank and magnan: As I have absolutely no medical qualifications, I am in no position to comment on the cases you cite. All I will say is that a significant number of physicians disagree with you - including the vast majority of physicians who were trained before the idea of euthanasia became publicly acceptable. I refer you to the following link: http://www.physiciansforlife.org/content/section/12/33/ I think it would be uncharitable to question the sincerity and compassion of these pro-life physicians, just as it would be a crude caricature to depict them as religious fanatics. I used to support euthanasia myself, during the early 1990s. One book which helped change my mind was Rita Marker's Deadly Compassion, available at http://www.amazon.com/Deadly-Compassion-Death-Humphry-Euthanasia/dp/0688122213/ref=sr_1_3?ie=UTF8&s=books&qid=1244384843&sr=8-3 . As the old adage says: Be careful what you wish for. You may just get what you want. vjtorley

Dying - the end of life - is a normal part of life. Every life ends - some more slowly than others - but every life ends. The medical establishment has managed to prolong the final dying process almost indefinitely (to its great profit). While life inarguably has sanctity, death does not. There is a difference between prolonging life and prolonging death, and I find that most of those who piously discuss the one have never been down-and-dirty up close and personal with the other. Anybody approaching the end of their life should make sure to complete an Advance Directive / Living Will while they can. I personally plan to have "DNR" (Do Not Resuscitate) tattooed on my right palm sometime later in life... PaulBurnett

"We are dealing here with the problem of relative vs objective reality." I don't agree. I certainly don't intend to repeat the old debate about relative and objective morality - but in practice it makes little difference. All of us, objectivists and relativists, agree about most moral issues and disagree about some moral issues. The most strident relativist will agree (subjectively) that murder is almost always an awful thing to do and there are plenty of objectivists who believe that abortion is objectively acceptable. The key difference is the relationship between principle and practice. Do you judge something to be right or wrong by matching it against moral principles? Or do you judge something to be right or wrong by examining the details of specific situations (and then perhaps derive principles from those situations)? I believe that the former approach (whether it be based on religious, political, or any other principles) leads to the most horrendous episodes in our history. This is a much more serious problem than any slippery slope. Mark Frank

Mark you wrote,

"If you have to live through the reality of these situations you find that sanctimonious principles, hippocratic oaths, and legislation, don’t begin to match up to the emotion and complexity of reality."

We are dealing here with the problem of relative vs objective reality. The relative perspectives of those individuals who have such problems may lead them to conclude that is it right for them to do the discussed things above of ethical and moral controversy. That is without a doubt. But is it right to delegate morality to relativity? That is, is morality and ethics absolute or relative? Ultimately there will be an absolute result and if that result impacts others it goes beyond the bounds of personal or relative experience. The absolute reality of ethics and morality is something we need to think about- and if we are true Christians, and I understand that many of us are not- we need to think about how those choices effect our hope for salvation which is much more important than any experience of this world. Frost122585

#9 "Some people live who want to die. Far more people die who want to live." Yes - but surely we are only talking about the first case. I don't know what the situation is in Canada, but no one is Europe is suggesting that health services kill those who want to live. "And especially don’t give the funding authority for health care the power to do so." What's behind this? Maybe you are saying that a funding authority should not have the power to decide whether someone should be allowed to die because of the temptation to save money. I agree. Is anyone suggesting this? In every case I have come across the proposal is that decision is up to the patient not the medical authority. (Occasionally there is the very difficult case where the patient is unable to express their view because e.g. they are permanently unconscious or had a very severe stroke and cannot communicate.) Magnan is absolutely right. If you have to live through the reality of these situations you find that sanctimonious principles, hippocratic oaths, and legislation, don't begin to match up to the emotion and complexity of reality. It is more important to get the process right. The decisions need to be with patient and his or her loved ones ideally supported by a sympathetic physician who, of course, has the patient's best interests at heart - which occasionally might include death. Mark Frank

Abortion is an abomination. Can you imagine if Mary decided to have an abortion because all she could find was a manger and that was not "good enough" for her child? So many people today claim they would have an abortion out of moral responsibility because they would not be able to raise their child for reasons of lack of money etc. Of course they always ignore adoption- but the truth is that in most cases the child can be provided for but only at the expense of the Mother's/Father's BMW, or nice big house etc. So abortion is almost always the sign of people choosing to make life a value contingent on convenience. Which is an abomination. As far as the suicide issue - this is a very dangerous idea that is not far from Nazism. Because if one thinks it is ok for suicide of terminally ill people- then the slippery slope becomes obvious- depressed people, retarded people, minorities or ethnic groups (and these things have happened many times), even people who are just not "elite" can be justified in euthanasia. This is the degradation of the value of existence and being, life and love. And not to mention that there is so much room for people to trick people into wanting an assisted suicide so that they can get their money through wills and what not. All evil ideas come about by getting us to open the door just a crack for them to get their foot in- and then they bum rush their way in. A societal moral melt down leads to evil every time and such meltdowns begin with seemingly tough ethical questions like, "is it better to be dead or alive in such and such situation?" As if it is right to choose death over life. Ideas of "justified War", "fixing poverty"- "treating illnesses with certain questionable drugs and means", free love and sexuality, legalized drug use, the list is endless, "clever" political and business schemes of unethical nature, liberal theology which allows for sin, etc All these evil ideas begin with a seemingly moral or ethical dilemma and then fool us into thinking they might be good- but then they always lead to much more harm than then good. That is what good Christians call the trick of Satan who will give up a little to gain a lot. People need to be aware of the deception of desires for things of the flesh- because there is no hard ethical guidance that can be found outside of a uncompromising belief in the sanctity of life. Frost122585

Magnan, 8 wrote: "“Basically, the Oath is pro-patient, and anti-abortion and anti-euthanasia, and anti-saving the state money by offing patients. No doctor or dentist has any business ending anyone’s life to spare the government expense or others’ inconvenience.” I guess this means you are in favor of this interpretation of the Hippocratic Oath. It is easy to take such a religiously oriented stance regarding human suffering while distant from the realities. In my experience idealism usually decreases in direct proportion to the proximity to the actual situation. " Magnan, I do not know how or why you or anyone else supposes that (1) either I or my dentist do not know about suffering, or that (2) the Oath is an exercise in futile idealism. Some people live who want to die. Far more people die who want to live. You can't give life to the latter, so don't be too hasty to take it from the former. And especially don't give the funding authority for health care the power to do so. The physician (doctor, dentist, nurse, technician, etc.) should be the patient's advocate for the best possible life for that person at this time. There are lots of people out there who will gladly be advocates for all kinds of other causes - that I well know. But the physician is like the defense lawyer. She is there for her patient as long as life of some kind is possible. Speaking for myself, I have often seen people come back from circumstances in which they were written off. Not always, but often enough to be cautious, and therefore very unwilling to sign on to non-Hippocratic approaches. I think the ol' Greek coot Hippocrates had a good idea there. Greeks call it "nous", right? O'Leary

"Basically, the Oath is pro-patient, and anti-abortion and anti-euthanasia, and anti-saving the state money by offing patients. No doctor or dentist has any business ending anyone’s life to spare the government expense or others’ inconvenience." I guess this means you are in favor of this interpretation of the Hippocratic Oath. It is easy to take such a religiously oriented stance regarding human suffering while distant from the realities. In my experience idealism usually decreases in direct proportion to the proximity to the actual situation. This is really far off the usual intended focus of the forum, but you have touched one of my "buttons". I apologize if the following is is too intensely negative for some people, but the reality is that there are endless horrendous examples of long, slow, incredibly cruel dying that can take years, to say nothing about purely mental and emotional suffering. Needless, pointless suffering that basic human compassion would dictate should be mercifully ended. I would like to cite an example from my own experience, in periodically visiting and trying to comfort a member of my wife's family who had had a severe stroke. It took him five years to die. He was severely disabled by the first stroke, necessitating a 24-hour medical care nursing home. At the beginning he was still able to speak a little, and said he wanted to die. He repeated this on several subsequent visits while he was still able, using paper and pencil, with a terrible begging desperation in his eyes. He was in constant physical pain due to various effects resulting from the stroke and being bedridden. His condition slowly, gruelingly worstened so that in the last couple of years he was shrunken, twisted and incoherent. But he still was conscious to a degree, and obviously continued to suffer terribly despite being incapable of coherent thought. This was not a fictional horror story. In the absence of doctor assisted suicide this sort of thing happens frequently. I would like to propose a thought experiment: put yourself in my place on one of my visits, see if you can rise above any instinctive fear of one day going through the same nightmare ending, and see if you can feel the spiritual and religious doctrinal-based goodness of letting this person continue this "life". magnan

Real moral decisions require real contexts. I was extremely close to this one .... The father of a close friend of mine got terminal lung cancer when he was 84. He was in a great deal of pain and bed ridden. He had a very distinguished career in the RAF. In the war he was a bomber pilot who completed three series of ops (if you know the odds you will appreciate how lucky he was). He appreciated his good fortune and the extra 60 years of a full life. He did not want to finish in pain and humiliation. He asked his family if he could "get it over with" and the family doctor tactfully steadily increased the morphine dose. He died at peace at home in his wife's arms. Were the chidren failing to care for their aged parent? Should the doctor have been denounced for failing his hippocratic oath? Should the father have been denied the choice? Should anyone who was not part of this family be allowed to pontificate on what was right and wrong? Mark Frank

djmullen: You wrote "You’re probably upset that the article points out that, “relieve his necessities if required”, may be a homosexual reference. You may be upset by that, but you shouldn’t be surprised." Mullen, if you try any more amateur Freudianism about me, I will ban you from this list. I am concerned about tacit euthanasia of old folks - and justifiably so, given what is happening in Europe today. If you want to practice psychoanalysis without a licence, do it on your own acquaintances, who can advise each other when the bin is full of compost and needs emptying. Freeman, thanks for the johnpatrick reff. Should have thought of that myself!; he is a fellow Canadian, and probably has the same version as my dentist has framed - as have many other highly respected practitioners of the Hippocratic arts here. PaulBurnett: I can't comment on toothlessness patterns in the United States. In Canada, toothlessness is discouraged, due to longevity. Teeth, even if they are not very good, keep the jawbone from starting to disintegrate over time. Many elderly people suffer unnecessary problems due to inability to eat properly, and tooth loss is a factor - it restricts what the person can eat and leads to a loss of interest in eating, hence malnutrition and progressive weight loss - mostly unnecessary. The old-fashioned notion that lots of problems can be solved just by pulling all of a person's teeth assumed a much lesser longevity than is currently the case in many technologically modern societies. vjtorley, thanks very much for the reff to physiciansforlife. I will doubtless come across my dentist's wording there, as I suspect he has been a strong supporter. Such declarations are immensely comforting to patients. O'Leary

Hi Denyse, My last post was a bit rushed. The link I sent you was actually a trendy "update" penned by Dr. Louis Lasagna in 1964, which fails to preserve the pro-life and anti-suicide intent of the original Oath. However, this 1995 rewrite of the Hippocratic Oath contains a pledge to protect human life from fertilization until natural death: http://www.physiciansforlife.org/content/view/28/29/ I hope that helps. vjtorley

Denyse I looked up the Wikipedia article on the Oath. Here's a link. http://www.pbs.org/wgbh/nova/doctors/oath_modern.html Is this what you were looking for? vjtorley

Denyse wrote: "He is the best dentist anyone could hope for. He delivered me from much suffering, while pulling very few teeth. (He hates making people “edentulous,” because he knows how much they will suffer when they are old..." In 2004, the Centers for Disease Control published the results of a study of "Adults aged 65+ who have had all their natural teeth extracted." They then ranked all of the states by the percentage of such adults in each state (see http://www.statemaster.com/graph/hea_ora_hea_los_of_nat_tee-health-oral-loss-natural-teeth ). I decided to add value to the list by annotating the dataset as to whether the states had voted for Bush or Kerry in the 2004 Presidential election; four years later I added another column showing the McCain-Obama results (see http://www.paulburnett.com/toothless.htm ). The graphic is astounding. Why would the most toothless states so uniformly vote Republican? PaulBurnett

I believe this site by a fellow Canadian, johnpatrick.ca, may be of help. freeman

"Here’s an unspeakable denunciation of the Oath, worthy of a materialist atheist culture, that should be denounced by every decent person who has aged parents. As a person who seeks care for my aged parents, you can guess which side I am on … can’t you?" I don't understand how you find two sides, at least regarding aged parents. The Hippocratic Oath compels the doctor to share his goods with his teacher and his teacher's children. The "Hypocrisy and the Hippocratic Oath" article points out that this will necessarily be at the expense of his own parents and children. I don't see anything anti-elderly parent there. You're probably upset that the article points out that, "relieve his necessities if required", may be a homosexual reference. You may be upset by that, but you shouldn't be surprised. Hippocrates, or whoever wrote the oath, was not a conservative Christian, he was an ancient Greek and his religion and morals were from his Greek culture. The oath was sworn to the gods Apollo, Aesculapius, Hygiea and Panacea and "all the gods and goddesses" by a man living in a culture where homosexual relations between master and student were considered normal. Present day conservative Christians don't approve of any of that sort of stuff and they would do well to read the oath skeptically before endorsing it. djmullen