Bioethics, aging, and the future of medicine by James I. Ausman, MD, PhD

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Saturday, March 14, 2015
SNI Newsletter

Dr. James I. AusmanIn its ongoing effort to examine controversial subjects, Surgical Neurology International (SNI) explores a recent paper on limiting life to the age of 75 by Dr. Ezekiel Emanuel. Dr. Miguel Faria, an Associate Editor in Chief of SNI, in his Editorial, "Bioethics and why I hope to live beyond age 75 attaining wisdom!: A rebuttal to Dr. Ezekiel Emanuel's 75 age limit," provides a response to "the government planners, supported by the ever-accommodating bioethicists, who posit that with increasing longevity and augmentation of the population of American elderly, more drastic actions will be required to prevent the bankruptcy of the public financing of medical care. They believe, therefore, that outright government-imposed euthanasia, not only for the terminally ill but also for the inconvenient infirm and the superfluous elderly, will become necessary."

This subject is a very important one for physicians and neurosurgeons to understand, as it has major implications for the practice of medicine. Recently, Dr. Ezekiel Emanuel, whose paper was quoted by Faria, proposed this idea. Emanuel stated that people should not be allowed to live beyond the age of 75, as they are no longer productive for society, and consume resources needed by those younger. Emanuel is one of the architects of ObamaCare.

When one adopts a viewpoint that there is a limitation of resources, the danger is that a self-selected few become empowered to dictate the life and death of an individual. These authoritarians will then control the lives of many with this power. These types of decisions, which we have witnessed throughout history, come from centrally controlled political systems. The reasons for this belief in finite resources are explained by desire for power over the masses. Also central planners desire for power prevents them from recognizing any solutions that will take their power. In addition, there are large increases in the costs of supporting a growing bureaucracy to administer a centrally controlled system.
Furthermore the central planners purposefully develop programs, which make the people increasingly dependent on the government and the central planners. Central planning fails because it does not have the efficiencies of free market approaches as all witnessed in the fall of the Soviet Union. It does not respect the freedom of each individual, a concept that is in direct conflict with the establishment of central control. Religion, which provides powerful personal guiding principles for the individual is also debased intentionally to remove it as a challenge to the concepts of the leadership by central control. The unchecked power of the planners, and their disregard of laws lead to corruption, waste, and the unequal treatment of people. In a constant crisis environment that is created politically, the masses surrender more power to the central planners looking to solve these crises. History has documented those reasons for the fall of the Roman and other empires.
Other evidence to support the contrary point of view was stated by University of Chicago economist, Gary Becker, who wrote that the greatest achievement of the 20th century was the doubling of life expectancy. The futurist, R. Naam, listed the worldwide advances in the last 150 years, including: 1) the rising life expectancy, 2) massive reduction in poverty, 3) increasing education of the masses, 4) the rapid access to information (cell phone usage has grown from 0 to 4 billion in 20 years), 5) the doubling of democracies since 1970, 6) the discovery of huge resources of energy, 7) the increased productivity of food from smaller amounts of land, 8) the exploration of space, 9) the potential to harness the sun’s energy, and to desalinate the ocean water for the increasing world population, and 10) the recent finding of the potential of life on another planet similar to earth.[1] These are all spectacular achievements.

In his article in The Futurist, Naam states that with these changes, people are demanding more control over their lives and more individual freedom.[1] These examples are not the story of limited resources and human potential. They signal the creativity, imagination, and determination of individuals of all ages, who, when liberated, will make great achievements for humankind in solving its challenges. The papers cited in this newsletter, particularly, provide a view of the huge potential available through the creativity of neurosurgeons and other scientists.

So, Drs. Emanuel and Faria present two opposing views of the future and how society can cope with this challenge. One projects the idea of the acceptance of limited resources that must be centrally controlled in all ways. The other idea supports the unlimited opportunities to solve the challenges faced by our civilizations under a system of individual liberty and competition. That is the fundamental conflict that has been going on for centuries as civilization has evolved. Because of the nature of individuals to want freedom, no centrally controlled system has survived, as recorded by Durant and Durant.[2]

Corruption is the threat to all theoretical systems of governance, including democracy. Which system will provide the best healthcare for the people? That is your decision. SNI is presenting the controversy that will affect your life and the practice of medicine.


1. Naam R. How innovation could save the planet. The Futurist 2013 March/April;47(2). 

2. Durant W. The Lessons of History. New York: Simon and Schuster; 1968, p. 52-80.

Written by Dr. Jim Ausman

James I. Ausman, MD, PhD, is Professor of Neurosurgery at the University of Southern California in Los angeles (UCLA); Editor-in-Chief of Surgical Neurology International (SNI); President, Future Healthcare Strategies; Chairman of the Board, The Waymaster Corporation Productions' and Creator, Executive Producer, THE LEADING GEN® TV Series.

This article may be cited as: Ausman, JI. Bioethics, aging, and the future of medicine. March 14, 2015. Available from:

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Vital force in history!

Hi Dr. Ausman,

I am digesting the papers by Dr.Ezekiel Emmanuel about dying at 75 and the response by Dr.Miguel Faria — one indication of the cultural winds sweeping our time and with the potential to change radically how our culture lives (and dies). Unfortunately I don’t think enough people are aware of these currents...

I also wanted to quote two of my favorite passages from Will & Ariel Durant's book, The Lessons of History (1968) - they may have some relevance to the discussion of Drs. Faria and Emmanuel, as well as to your comment [derived from the Durants that "the fundamental conflict that has been going on for centuries as civilization has evolved. Because of the nature of individuals to want freedom, no centrally controlled system has survived"].

“Intellect is therefore a vital force in history, but it can also be a dissolvent and destructive power. Out of every hundred new ideas ninety-nine or more will probably be inferior to the traditional responses which they propose
to replace. No one man, however brilliant or well-informed, can come in one lifetime to such fullness of understanding as to safely judge and dismiss the customs or institutions of his society, for these are the wisdom of generations after centuries of experiment in the laboratory of history.” p.35.

"There is no significant example in history, before our time, of a society successfully maintaining a moral life without the aid of religion.” p.51.

Thanks again and best personal regards,
George I. Chovanes, MD, FACS, FAANS
Dr. Chovanes is a neurosurgeon in Pennsylvania and the author of the medical thriller, The Sharp Edge of the Soul (2001)

The social utility concept is central to collectivism

This is an excellent summery article by Dr. Ausman. He touches on many important concepts that are central to one's understanding of liberty. It has been observed by many thinkers that while one would not attempt to redesign their own watch by tinkering with its intricate, well balanced and interlocking mechanisms, many elitists think it is rational to make drastic assaults on traditional wisdom; social organizations that have withstood the test of time, religious beliefs and the rule of law based on natural law, all without consequences. Human society is infinitely more complex than a watch. Russell Kirk in his monumental tome The Conservative Mind observes that to do so leads to an utter destruction of civilization down a eventual road to hell. In attempting to restructure all of health care they have come upon the realization that to do so with a growing population will quickly lead to bankruptcy. Thus, they conclude, the only solution is a condition of continuous rationing of care, mainly by encouraging people to die at an earlier age. The age of 75 is arbitrary, soon it will change to 68, then 65 and so on. This rationing process soon entails all manner of tinkering--denying certain operations, limiting testing and legalizing euthanasia. The deeper the treasury sinks into debt and impending bankruptcy the more vigorous and inhumane the rationing. Every physician and citizen should read this article.


Imaginary hobgoblins!

Excellent commentary! You are correct about your world assessment. It reminds me of the real journalist, H.L. Mencken, who wrote: “The whole aim of practical politics is to keep the populace alarmed (and hence clamorous to be led to safety) by an endless series of hobgoblins, most of them imaginary.” Orchestrated chaos (by constant change) is used for social engineering, wealth redistribution (but not their own) and the preservation of power!

Here is another quote, another favorite of mine on this subject "[The elites] are the invisible powers behind the thrones of Earth, and men are but marionettes, dancing while the invisible ones pull the strings. We see the dancer, but the master mind that does the work remains concealed by the cloak of silence."This one is by Manly P. Hall, from "What the Ancient Wisdom Expects of Its Disciples" in the Philosophic Research Society.

Religious morality, the family, and most traditional institutions that have survived the test of time are all bulwarks for freedom and against the State's usurpation of power. They should be defended because they are a net benefit to society, despite the iconoclasts. And that is also why liberals attack them — and specially the Catholic religion, which is on the rise in Latin America and within Hispanics in the U.S. If the Democrats lose the Mexican-American vote, the larges Hispanic bloc, the Democratic Party (and its redistributive, multi-culturalist pseudo-diversity philosophy — will be in trouble. Mexico is privatizing PEMEX! And the richest man in the world is a self-made entrepreneur billionaire Carlos Slim, who began with Corona beer, and is greatly admired in Latin America because of his success!