Managed death care

Dead_babyPundits belittled Francis Schaeffer and C. Everett Koop in the 1980s, when their book and film series Whatever Happened to the Human Race? predicted that euthanasia and infanticide were the logical companions of unrestricted abortion.

When Ronald Reagan nominated Koop as surgeon general, Elisa Isaacson wrote in The New Republic, “Dozens of newspapers and national organizations oppose Koop on the basis of his doctrinaire anti-abortion stance, his backward views on women’s and gays’ rights, and particularly his inexperience in the field of public health.” (This was before Koop won over all but his most vociferous critics with his stances on AIDS, condoms and smoking.)

Now the Netherlands seems hell-bent on proving that Schaeffer and Koop were connecting the ethical dots, albeit a few decades before euthanasia and infanticide were mentioned regularly in the same sentence as “dignity,” “compassion” or “mental retardation.”

Toby Sterling of the Associated Press delivers the grim news in his terse opening:

AMSTERDAM, Netherlands — A hospital in the Netherlands — the first nation to permit euthanasia — recently proposed guidelines for mercy killings of terminally ill newborns, and then made a startling revelation: It has already begun carrying out such procedures, which include administering a lethal dose of sedatives.

The practice is beginning with the hardest cases of suffering infants:

The Groningen Protocol, as the hospital’s guidelines have come to be known, would create a legal framework for permitting doctors to actively end the life of newborns deemed to be in similar pain from incurable disease or extreme deformities.

The guideline says euthanasia is acceptable when the child’s medical team and independent doctors agree the pain cannot be eased and there is no prospect for improvement, and when parents think it’s best.

Examples include extremely premature births, where children suffer brain damage from bleeding and convulsions; and diseases where a child could only survive on life support for the rest of its life, such as severe cases of spina bifida and epidermosis bullosa, a rare blistering illness.

But there are the standard voices arguing that if a culture is going to kill babies, at least the killing should be supervised by the state:

“As things are, people are doing this secretly and that’s wrong,” said Eduard Verhagen, head of Groningen’s children’s clinic. “In the Netherlands we want to expose everything, to let everything be subjected to vetting.”

To see where such vetting may take a culture, consult P.D. James’ dystopian novel, The Children of Men: in a world rendered sterile by an unexplained catastrophe, old people begin killing themselves in despair. The state begins supervising those suicides so everything will be orderly, clinical and tidy — and before you can say “I’d like to join the Hemlock Society,” euthanasia becomes mandatory.

Sterling gives the prolife movement’s concerns a few mentions, including this remark from Wesley J. Smith: “The slippery slope in the Netherlands has descended already into a vertical cliff.”

But he closes with another “Let’s end the hypocrisy” argument:

“Measures that might marginally extend a child’s life by minutes or hours or days or weeks are stopped. This happens routinely, namely, every day,” said Lance Stell, professor of medical ethics at Davidson College in Davidson, N.C., and staff ethicist at Carolinas Medical Center in Charlotte, N.C. “Everybody knows that it happens, but there’s a lot of hypocrisy. Instead, people talk about things they’re not going to do.”

More than half of all deaths occur under medical supervision, so it’s really about management and method of death, Stell said.

Well, that’s a relief.

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  • Darrell Grizzle

    I saw this AP article in the newspaper and was chilled to the bone. As a theological and political liberal, I oppose euthanasia for the same reason I oppose the death penalty and “pre-emptive” warfare: the sanctity of each and every human life made in the image of God.

  • AH

    It seems to be a snowballing category error. Once some horrific practice joins the list of “what doctors (or the State) sometimes do,” they then want to regularize it, at least to the extent of being safe from disapproval for doing it. Then it joins the list of “approved procedures under certain circumstances.” Next “approved procedures where professional discretion dictates,” then, “whatever is easiest.”

    There is a logical or practical principle that seems to have neither a name nor a place any more, that it’s best to have flat prohibitionary rules, discretionarily enforced, an open secret that sometimes they must be violated. Rather than the sequence I outlined above.

    Perhaps it’s related to hypocracy being the tribute that vice plays to virtue. When vice “joins the list,” virtue is never “what is easiest.”


  • Molly

    I heard this story on NPR yesterday morning and I thought about what my parents went through in the late 50s when their first born child came into the world with severe brain damage due to an acute loss of blood when Mom was in her first trimester of pregnancy with him.

    My mother is convinced that the miscarriage should have been allowed to happen; however, she went to a Catholic obstetrician who gave her DES to keep the pregnancy from spontaneously aborting and Mom carried him to term. He lived for nine days and my parents went through the nightmare of burying an infant.

    Technology has replaced God.

    The OB played God by refusing to allow the pregnancy to end. If my older brother had been born in another era, the pediatricians would have refused to let him die and done everything possible to keep him alive-including bankrupting my parents’ emotional and financial health.

    If a child is going to die, let it die. I do not advocate euthanasia; I advocate letting God be God and finding a way to remain faithful to God’s presence even in the face of great pain. Here is where the church is the advocate for “dignity” and “compassion”.

  • Susan Peterson

    I agree with Molly that there are situations in which it is best, and moral, and in accord with the church’s teachings, to let someone, whether child or adult, die without further burdensome intervention. I am more familiar with this principle as it applies to the aged. For instance a person with terminal COPD (chronic obstructive pulmonary disease, emphysema) who is told that his blood gasses (amounts of oxygen and carbon dioxide dissolved in the blood) are so bad that if he doesn’t go on a ventilator he will soon die, has a right to refuse the ventilator. I have seen people make both decisions, to go on a vent or not. Surprisingly, in either case, people seem to come to a decision almost instantly. Maybe they have known for a while it would come to that point and have thought it all through before the moment came. I also think that a person has a right to refuse a feeding tube, and that in some cases it is right for a family to make that decision for someone. For an elderly person who has lost the ability to eat normally through one of the degenerative processes often associated with aging, or through a stroke or series of strokes, the calculus involved is somewhat different than with a young person such as Schiavo. Every problem associated with immobility occurs more quickly and progresses faster in the elderly. They develop contractures very quickly. (limbs frozen in a bent position.)

    Skin breakdown and pressure ulcers also occur very quickly without meticulous care; sometimes an expensive special bed is required. Sometimes they develop anyway despite all efforts at prevention. Tube feeding almost always leads to loose stools, and few facilities have the staff to clean the person as soon as this happens; more likely when the family isn’t there to alert staff, they will be checked every two hours. (if they are in a good facility.)So they will frequently remain soiled for an hour or more. This promotes skin breakdown on buttocks and perineal area. Urine on these areas of skin breakdown can be very painful. An indwelling catheter is a possible solution to that, but this almost always leads to urinary tract infections, eventually if not sooner. There is also a high incidence of reflux of tube feedings and what is refluxed often then winds up in the lungs, causing pneumonia. Between urinary tract infections and pneumonia, these elderly long term tube feeders frequently wind up in acute care hospitals for antibiotic treatment. Antibiotics cause yeast infections and this makes perineal skin problems worse. Often while in the hospital these patients pick up one of the nasty chronic infections which live in the hospital: MRSA (methicillin resistent staphlococcus aureus) VRE (vancomycin resistant enterococcus) and most immediately unpleasant for all concerned C-DIFF,or clostridium difficile, which causes a mucousy foul smelling diarrhea,which depletes nutrients and fluids, exacerbates skin integrity problems, requires further antibiotics and a longer hospital stay to get rid of it, sometimes comes back when one thinks it is gone, is very infectious, and is a spore forming organism and therefore very difficult to kill on environmental surfaces.

    This whole scenario is very typical for an elderly adult who is being tube fed and is either demented, or unable to communicate due to a stroke.

    Nurses who work with children in hospitals which take care of many extremely ill children could probably give a similar realistic picture of what some terminally ill multiply disabled children go through.

    There is a difference between children and old people of course. Old people are supposed to die at some point, and at some point their illnesses and chronic medical conditions constitute their natural dying process rather than a failure or an imperfection in the natural order. Children who are terminally ill can’t be said to be following the natural course of their lives in the same way. A more vigorous intervention makes sense. But there may come a time when continued intervention just prolongs everyone’s pain and has no hope of real success. No parent should be made to feel that he is killing his child when he makes the decision to end such interventions.

    It would be hard to make a law which specified all the parameters to be taken into account in making such a decision. I think maybe the person is right who said that it is better to state a prohibition and then let exceptions be handled privately, than to keep making a lower level of severity the norm and then making exceptions from that which in turn become the norm.

    Susan F. Peterson RN

  • SamChevre

    As Susan points out, these aren’t always easy questions. I studied under Dr Stell (in another area of Philosophy), and what he says above certainly sounds like him. But he has a point–it was a very typical question for him to raise. “What is the ethical difference between deliberate action and deliberate inaction?” Is there a difference between letting someone die (by, say, not giving antibiotics for pneumonia) and causing them to die (by, say, administering an OD of morphine)? I never found that to be an easy question; I still don’t.

  • Michael

    As best I understand it, the Netherland’s new policy is to provide a quick, painless death for an infant that would otherwise be doomed to a slow, agonizing one. As I prefer a quick, painless death for myself (when that time finally comes), I would not deny the same to an innocent baby. The conservative views on this issue are the ones I find chilling.

  • Molly

    Susan, as a pastor I saw many many many elderly folks suffering from oncoming death in many of the ways you described. I remember one woman with a feeding tube whose incision “pushed” the tube back out and led to even more indignity and pain for her and her family. I provided a “strong shoulder” for a woman who decided to take her father off oxygen because it was prolonging his death. That was a hard one because I knew and loved this man. I can’t count the number of comatose people into whose ears I whispered: “It’s okay. We’ll be alright. You can go.”

    First hand witness of the struggles of life and death is a humbling, awesome experience and I really have very little patience with people who pontificate from a safe distance without ever having witnessed the suffering and release of death. I don’t know that quick and painless is any more humane; birth is neither quick nor painless. Why should death be any less a mortal struggle that reminds us that we are not God?