Bioethics — Part 2: Is it compassion, personal autonomy, or ulterior utilitarian motives at heart?

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Monday, August 24, 2015

Following the publication of the first part of this article dealing with bioethics and infanticide,[1] I received correspondence from a former colleague, Dr. Richard L. Elliot, Director of Medical Ethics at Mercer University, contending there is little difference among medical and biomedical ethicists; that my characterization of bioethicists as utilitarian moralists (useful agents of the State) may not be accurate; and that autonomy (and personal choice) is given “high priority” by bioethicists.[2] I beg to differ on all counts.

I have served as a chief medical editor in four medical publications, the Journal of the Medical Association of Georgia (1993-1995), the Medical Sentinel (1996-2003), Surgical Neurology (2004-2010), and Surgical Neurology International (SNI; 2010-present). In all four of these journals there were considerable discussions about ethics and the nuances of tenets between traditional medical ethicists who follow Hippocratic teachings and biomedical ethicists who Moral Dilemma Aheadfollow utilitarian precepts, and articles to that effect were published in them, as well as in the Journal of the American Medical Association (JAMA); at least four articles and/or letters on the subject were published in the last two years in SNI revolving around this subject.

As far as disagreeing with my characterization of bioethicists and their alleged prioritizing for autonomy, below are telling remarks, not by death-obsessed crackpots but by leading lights of the bioethics movement:

1. Dr. Daniel Callahan, Professor of Bioethics and former Director, now President Emeritus, of the Hastings Center: “Denial of nutrition, may, in the long run, become the only effective way to make certain that a large number of biologically tenacious patients actually die.”[3]

2. Dr. Peter Singer, Professor of Bioethics at Princeton University: “Fetuses like newborns lack the essential characteristics of personhood — 'rationality, autonomy, and self-consciousness’ and therefore ‘killing a newborn baby is never equivalent to killing a person, that is, a being who wants to go on living.”[4,5]

3. Dr. John Hardwig, Professor of Ethics at the University of Tennessee has repeatedly affirmed that elderly patients, who have lived a full life as well as those citizens whose lives have become not worth living because of chronic disease, have a "duty to die" for the good of society and the proper utilization of societal health resources. Moreover, he has gone farther than most pointedly admitting denial of individual autonomy by asserting there is a “responsibility to end one's life in the absence of any terminal illness…a duty to die when one would prefer to live…even those who want to live can face a duty to die.[6]

4. Dr. Ezekiel Emanuel, Director of the Clinical Bioethics Department at the U.S National Institute of Health and one of the architects of Obamacare has proposed that we should all die by age 75 because "we are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic." Dr. Emanuel claims he is not advocating euthanasia at age 75 "in order to save resources, ration health care, or address public-policy issues," but that is exactly what he is inferring and in fact later he makes utilitarian proposals to redistribute health resources from the old and infirm to the younger generation.[7]

In reference to my previous article in which I referred to the bioethicists call for newborn infanticide, I received inquiries as to why not adopt, instead of killing these babies. Here is how the bioethicists responded:

“On this perspective, the interests of the actual people involved matter, and among these interests, we also need to consider the interests of the mother who might suffer psychological distress from giving her child up for adoption. Birthmothers are often reported to experience serious psychological problems due to the inability to elaborate their loss and to cope with their grief… those who grieve a death must accept the irreversibility of the loss, but natural mothers often dream that their child will return to them. This makes it difficult to accept the reality of the loss because they can never be quite sure whether or not it is irreversible.”[8]

Thus according to the bioethicists, ostensibly adoption would be too traumatic, more so than the killing of the newborn infant. At this juncture, we must pause and ponder whether we have here a pathologic inversion of priorities due to some sort of convoluted compassion, or plain, deliberate and deceitful casuistry!

It is no wonder, then that with all this obsession to push society towards "a duty to die" mindset and euthanasia for the most vulnerable in our society — not necessarily respecting individual autonomy, as it is claimed by some as “the right to die,” but really for utilitarian reasons, the conservation and redistribution of resources — moral philosopher Wesley Smith has pointedly called the bioethics movement a “culture of death.”[9]

References

1. Faria MA. Bioethics — Should they encourage the killing of unwanted newborn infants? HaciendaPublishing.com, July 12, 2015. Available from:  http://haciendapub.com/articles/bioethics-%E2%80%94-should-they-encourage-killing-unwanted-newborn-infants

2. Elliot, Richard L. Bioethics and Infanticide. Hacienda Publishing.com, July 22, 2015. Available from: http://haciendapub.com/articles/bioethics-%E2%80%94-should-they-encourage-killing-unwanted-newborn-infants#comment-1360

3. Callahan, Daniel. "On Feeding the Dying," Hastings Center Report 1983;13(5):22. Much more can be found in Daniel Callahan’s book, Setting Limits — Medical Goals in an Aging Society. New York: Simon and Schuster, 1988. A recent article encapsulates the views of Dr. Callahan which have not changed since the publication of his book. Available from: http://khn.org/daniel-callahan-limits-on-health-care/

4. Singer, Peter. FAQ. III: The Sanctity of Human Life. Princeton University, March 2009. Available from: http://www.utilitarian.net/singer/by/200509--.htm

5. Singer, Peter. "An Interview” in Writings on an Ethical Life. 2001, p. 319–329. 

6. Hardwig, John. Is there a duty to die? Hastings Center Report 1997;27(2):34-42. In this comprehensive article, Hardwig goes to great lengths to defend his rationalization for “the duty to die” and enumerates all of the criteria for death, "even for those individuals who would prefer to live.”  Available from: http://web.utk.edu/~jhardwig/dutydie.htm

7. Emanuel, EJ. Why I Hope to Die at 75: An argument that society and families — and you — will be better off if nature takes its course swiftly and promptly. The Atlantic, September 17, 2014.  Available from: http://www.theatlantic.com/magazine/archive/2014/10/why-i-hope-to-die-at-75/379329/ 

8. Giubilini A, Minerva F. After birth abortion: why should the baby live?  J Med Ethics (2012). doi:10.1136/medethics-2011-100411. Available from: http://jme.bmj.com/content/early/2012/03/01/medethics-2011-100411.full

9. Smith, WJ. Culture of Death — The Assault on Medical Ethics in America. San Francisco, CA: Encounter Books, 2000. Book Review available from: http://www.haciendapub.com/medicalsentinel/bioethics-movement-emerging-culture-death

Additional Reading

10. Faria MA. Bioethics — The Life and Death Issue. HaciendaPublishing.com, October 24, 2012.

11. Faria MA. Euthanasia, Medical Science, and the Road to Genocide. Medical Sentinel 1998;3(3):79-83.

12. Faria MA. Slouching Towards a Duty to Die. Medical Sentinel 1999;4(6):208-210.

13. Faria MA. The road being paved to neuroethics: A path leading to bioethics or to neuroscience medical ethics? Surg Neurol Int 2014;5:146.

14. Faria MA. Bioethics and why I hope to live beyond age 75 attaining wisdom!: A rebuttal to Dr. Ezekiel Emanuel's 75 age limit. Surg Neurol Int 2015;6:35.

Written by Dr. Miguel Faria

Miguel A. Faria, Jr., M.D., is an Associate Editor-in-Chief and a World Affairs Editor of Surgical Neurology International; Clinical Professor of Surgery (Neurosurgery, ret.) and Adjunct Professor of Medical History (ret.) Mercer University School of Medicine. He served under President George W. Bush as member of the Injury Research Grant Review Committee of the Centers for Disease Control and Prevention (CDC; 2002-05); His website is http://www.haciendapub.com or http://www.drmiguelfaria.com

An edited version of this article (due to space constraints unreferenced) appeared in the Macon Telegraph, August 30, 2015 under the title: "Opinion — Bioethicists versus medical ethicists." The full version here is fully annotated and the reader is invited to avail themselves of these references to find out the reality of the bioethics movement.

This article may be cited as: Faria MA. Bioethics — Part 2: Is it compassion, personal autonomy, or ulterior utilitarian motives at heart? HaciendaPublishing.com, August 24, 2015. Available from: http://www.haciendapub.com/articles/bioethics-%E2%80%94-part-2-it-compassion-personal-autonomy-or-ulterior-utilitarian-motives-heart

Copyright ©2015 Miguel A. Faria, Jr., M.D.

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Comments on this post

"Hypocritical" bioethicist in chief!

As for the defense of Dr. Daniel Callahan — despite the passing of decades, he remains a staunch proponent of the "duty to die," for the elderly but apparently not for himself and the elite. Here is an interesting article in the Kaiser Health News by Beth Baker, author of the book, Old Age in a New Age — The Promise of Transformative Nursing Homes:

"For decades, ethicist Daniel Callahan has argued that expensive medical care be parceled out carefully essentially rationed for elderly patients. Now, at 79, his quest to stem late-in-life spending is coming face to face with his own mortality.

"Twenty-two years ago, the co-founder and president emeritus of the Hastings Center, a nonpartisan bioethics research institute in New York, wrote the highly controversial book, Setting Limits — Medical Goals in an Aging Society. It made the case for limitations on care based on age a topic that recently provoked intense, if sometimes hyperbolic arguments during the health care debate — and against the provision of extraordinary, expensive medical procedures for people who have already lived a full life. But recently Callahan himself underwent $80,000 worth of treatment for a heart condition.

"That drew a rebuke from blogger James Pinkerton, a fellow at the New America Foundation. He called Callahan a hypocrite for having the expensive heart procedure. Callahan laughs off the criticism, but notes that his experience is indicative of the difficulty in trying to contain medical costs…"

Read more: http://khn.org/daniel-callahan-limits-on-health-care/

Deceptive Professionalism

How deceptive and ironic that Dr. Elliot launches an ad hominem attack on me using the word “ignorant” and makes false allegations about dishonest citations! His mind and judgment have been clouded by his irrepressible progressive ideology that he has bottled up calling himself deceptively a “Republican” and a “Conservative,” while spending untold amount of time battling true conservatives in the online pages of the Telegraph. His name-calling and allegations are not only erroneous and mendacious, but also not worthy of the eminent person who should be holding the title “Director of Professionalism and Medical Ethics” at Mercer University.

It’s ludicrous as well because I’m way more published than he is not only in politics and history, but also in medical journals in the fields where in Elliot’s own mind, he considers himself an authority, e.g., medical socioeconomics, professionalism, medical ethics, and bioethics, not to mention neuroscience and neuropsychiatry! Anyone can investigate this by doing a scholar search under Faria MA (most but not all refer to me) vs. Elliot RL in PubMed, Google scholar search, and/or Mercer University Library services. My own CV is available here.

Drs. Elliot vs. Faria!

August 26, 2015, Comments in the Macon Telegraph and replies

Mr. Fred Dixon: Dr. Faria explains his views on that particular issue in reasonably plain language For your edification: http://haciendapub.com/articles/bioethics-%E2%80%94-part-2-it-compassion...

Dr. Elliot: Mr. Dixon, I wish those comments, which I have seen previously, were indeed edifying. Unfortunately, Dr. Faria mischaracterizes an entire field by the comments of a few. As I have noted elsewhere, bioethics is a framework, within which individuals may come to differing conclusions based on personal assumptions and biases. But these idiosyncratic, personal opinions can no more be held to represent an entire field than can those of a wayward neurosurgeon be held against the field of neurosurgery.

Mr. Dixon, The "sources" are not what they seem to be. Daniel Callahan was referring to removing tubes from patients with irreversible conditions such as persistent vegetative state. When he wrote this in 1983, pre- Nancy Cruzan, removing feeding tubes was an uncertain practice, and maintaining such support led to grisly situations such as Karen Quinlan or, later, Terry Schiavo. Emanuel really is opposed to physician-assisted suicide and euthanasia (did you read the article?), despite Faria's insinuations. Faria has manipulated citations, and you. But my main point is that, even had he presented things more honestly, is it fair to condemn an entire field because of a few aberrant opinions? Is it fair to criticize all news sources, organizations, and professions in general because of a few fringe elements? Should all neurosurgeons be condemned because Faria has overstepped himself? And, as a conservative myself, I would defend our right to free speech, but would also expect more from another physician. This is disappointing.

Richard L. Elliott, M.D., Ph.D.
Professor and Director, Professionalism and Medical Ethics
Mercer University School of Medicine
Adjunct professor, Mercer University School of Law

August 27, 2015 —Notice of addendum: Dr. Elliot's and all others' Narratives are exactly as originally expressed in the Telegraph online; no words have been changed, except to correct typos (usually Elliot's) and Dr. Elliot's titles were added from personal correspondence to me for the edification of the readers.

Fred Dixon: Richard Elliott, And so I have asserted myself between two doctors, but I would note that Dr. Faria sourced his article quite thoroughly, and if we are talking absolutes, perhaps it is only the vast majority. Just as all professors are not liberals, I suspect the the conservatives are the quietist in the lounge.

Everyone has opinions. Some sourced-some not!

Dr. Miguel Faria: I challenge Dr. Elliot to provide statements by any of the leading authorities in bioethics supporting the right to and the sanctity of life, repudiating abortions and assisted suicide, quoting Hippocrates forbidding the use of abortifacients or denouncing euthanasia, in his supposed alleged support of diversity of opinions! I would like to see those remarks made and properly referenced by leading ethicists with sources as I did!

As to the possibly insinuating remarks (or intellectually poor choice of comparison) about “wayward neurosurgeon,” I believe “wayward psychiatrist” may be a better choice. I no longer see any reference to his specialty (psychiatry) for Dr. Elliot in his academic titles at Mercer. As to his last remarks — "...manipulate citations... Should all neurosurgeons be condemned because Faria has overstepped himself? And, as a conservative myself, I would defend our right to free speech..." — it is the epitome of duplicity, casuistry, and overt mendacity. Anyone can check those references for themselves. There is no need to manipulate citations. It is all there for all to see; just click on the links! Does he think Americans are that dumb? "Conservative" — my foot, as any poster in the Macon Telegraph is well aware. He is a disingenuous closet liberal (progressive type!), who unable to keep his trap door down, runs his mouth (or fingers) on Viewpoints supporting ObamaCare, supporting increasing taxes for social programs, supporting doctors asking patients about guns, etc.! As to his personal insinuations:

I retired early from a very successful neurosurgical practice at the top of my profession, having just served as Chief of Staff at Coliseum Park Hospital and having been asked (but declined) to be in the Board of Trustees of that magnificent Coliseum Medical Centers.

As to my well-publicized travails based on principle and because of my support for the Second Amendment and my condemnation of the AMA for its one-sided gun control agenda, I’m very proud of what I accomplished, despite the pain it might have caused me,[1] but would not trade it for any monetary, salary or honorific sell out, as many others do! In fact it led with others to Congressional testimony that led to the defunding of gun [control] research by the CDC.[2]

[1]I have written a tell all book on the subject: Medical Warrior — Fighting Corporate Socialized Medicine (1997) that no one to this day has challenged in its accuracy and portrayal in what went on!

[2] Faria MA. Gun Research 2013 — an interview with Dr. Miguel A. Faria by Craig Schneider of Atlanta Journal Constitution. January 20, 2013. Available from: http://haciendapub.com/articles/gun-research-2013-%E2%80%94-interview-dr...

Dr. Richard L. Elliot

The following comments were posted in the Macon Telegraph under the article Dismantling Christianity and Western civilization — and replacing them with what?

Enjoy them and my responses in this and previous post:

Dr. Richard Elliot: I fear Dr. Faria reveals his ignorance of bioethics once again. Bioethics is not part of secular humanism any more than are science and philosophy. Bioethics is a broad field that attempts to provide a means of addressing a number of important ethical issues in biology and medicine (e.g., how are human embryos to be considered and used), but does not necessarily embrace a particular point of view on any particular issue. For example, some bioethicists are pro-life, some are pro-choice. Some are theologians, priests or pastors, others are indeed secular. To make such a sweeping indictment of bioethics by labelling it part of secular humanism undermines Dr. Faria's credibility.

Richard L. Elliott, M.D., Ph.D.
Professor and Director, Professionalism and Medical Ethics
Mercer University School of Medicine
Adjunct professor, Mercer University School of Law

Dr. Miguel A. Faria: Obviously despite the fact we have debated the issue and he ends up with the short end of the stick, Dr. Elliot has not bothered to read my article above debunking his comment preemptively. So I fear he is looking at the ignorant self in the mirror. Although not all bioethicists may be secular humanists, the bioethics movement is centered in secular humanism and utilitarianism, as referenced in my article. It is his own credibility (or incredulity!) that is put into question, as I referenced every one of my points, and the telling statements came directly from the horses' mouths!

Faria MA. Bioethics — Part 2: Is it compassion, personal autonomy, or ulterior utilitarian motives at heart? HaciendaPublishing.com, August 24, 2015. Available from: http://www.haciendapub.com/articles/bioethics-%E2%80%94-part-2-it-compas...

August 27, 2015 —Notice of addendum: The Narrative is exactly as originally expressed in the Telegraph online; no words have been changed, except to correct typos (usually Elliot's) and Dr. Elliot's titles were added from personal correspondence to me for the edification of the readers.

And here are more supporting references on the sweeping indictment of bioethics and its link to secular humanism. Articles by Russell L. Blaylock M.D., another premier neurosurgeon, basic neuroscience researcher, and President of Advanced Nutritional Concepts and Theoretical Neurosciences:

1. Blaylock RL. National Health Insurance (Part II): Any Social Utility in the Elderly? HaciendaPublishing.com, September 26, 2009. Available from: http://www.haciendapub.com/articles/national-health-insurance-part-ii-an...

2. Blaylock RL. Collectivism, secular humanism, scientific positivism (scientism) and centralized state power—Part 1: A most dangerous admixture. Hacienda Publishing.com, August 14, 2015. Available from: http://haciendapub.com/articles/collectivism-secular-humanism-scientific...

3. Blaylock RL. Collectivism, secular humanism, scientific positivism (scientism) and centralized state power—Part 2: Centralization of power. Hacienda Publishing.com, August 14, 2015. Available from: http://www.haciendapub.com/articles/collectivism-secular-humanism-scient...



Diary of Dreams performs at the 2016 M’era Luna festival in Hildesheim, Germany. M’era Luna, “one of the biggest dark music events in Germany,” is held each year on the second weekend in August. Close to 25,000 people attend the festival annually to hear gothic, metal and industrial music performed on two large festival-style stages.