It’s also saying that brain-damaged and demented people just cost too much: what’s happened to medical ethics?
Under the arresting headline “When did it become acceptable for the British Medical Journal to advocate the murder of patients?”, Deacon Nick of Protect the Pope brings to our attention an outrageous BMJ editorial (headlined “Sanctity of life law has gone too far”) by one Raanan Gillon, a retired professor of philosophy, which argues, in brief, that some dementia patients should be starved and dehydrated to death, among other reasons to save money, since their care “skews the delivery of severely resource-limited healthcare services” to patients who can really benefit from them.
As the BMJ doesn’t give free online access to its articles, I rely here on the account given by Dr Peter Saunders on the official blog of that admirable outfit the Christian Medical Fellowship (CMF). In his editorial, Professor Gillon reviews the case of M, a woman in a minimally conscious state, who was the subject of a court of protection ruling last year. The judge decided that M’s feeding tube should not be removed as she did not have a valid and applicable advance directive in place. Instead he gave priority to preserving her life. Gillon objected to this judgment on two grounds. First, that the judge “did not accord ‘significant weight’ to the patient’s previously expressed values, wishes, and views”. But these were not in fact clear and in the absence of a clear statement of the patient’s wishes, precedence was given in the judgment to the preservation of life over uncertain autonomy. The judge gave undue weight, in other words, to “the sanctity of life”.
Essentially, Gillon’s real point is that he doesn’t like the current law and considers that the lives of some people are not worth living and should therefore be brought to an end. He thinks that giving nutrition and hydration to people with severe brain damage or dementia is not beneficial and that they should have their basic care withdrawn and be allowed to die.
One important reason is that he thinks that not only is it not in the interests of the patient to continue living a life “not worth living”, it just costs too much: “The logical implications of this judgment threaten to skew the delivery of severely resource limited healthcare services towards providing non-beneficial or minimally beneficial life prolonging treatments including artificial nutrition and hydration to thousands of severely demented patients whose families and friends believe they would not have wanted such treatment. The opportunity cost will probably be reduced provision of indisputably beneficial treatments to people who do want them.” Now this statement is very interesting indeed, since M is not actually demented, just seriously brain damaged. In addition she has some degree of residual brain function.
It is noteworthy, says Dr Saunders, “that Gillon is very selective in his reporting of these facts and conveniently does not mention that M had some awareness of herself and her environment, some understanding of language, occasionally spoke, appeared to be able to appreciate some things that were said to her and responded to music. Although she regularly experienced pain, this was not constant or extreme, and her condition was stable. And unlike dementia patients, who are terminally ill, she had a non-progressive condition.”
Now, that notion that the patient M should have been “allowed to die” because her “life is not worth living” reminded me strongly of a talk given by the historian Michael Burleigh years ago at a weekend conference I attended, run as it happens by the CMF. His ideas were subsequently elaborated in his book Death and Deliverance: “Euthanasia” in Germany c. 1900–1945 (1995). Two diabolical Nazi phrases stuck in my mind from his talk: “the sacred right to death” and a “life unworthy of life”. Now, the Nazi euthanasia programme was of course an intrinsic part (not simply a precursor) of the so-called final solution, which came to its climax during the war in the death camps. It was all part of the programme of Nazi eugenics: “life unworthy of life” was the life of the brain-damaged and mentally handicapped”: it was also that of the Jews and other “inferior” races.
I am well aware that Professor Gillon isn’t going anything like that far. But what he is saying is part of the same family of ideas: it’s potentially on the way. For, once a society abandons or weakens the idea of the sanctity of life, as he expressly wants ours to, it has no ultimate safeguard against this and other hellish deformations. That’s why in modern Germany — in sharp contrast to Holland — there is such an absolutely rigid taboo against euthanasia, against “mercy killing”: for the Germans can never forget that that was another Nazi phrase dreamed up to give their euthanasia programme a sentimental veneer of supposed compassion: and it should never be forgotten, by us, too, that the Nazis in their propaganda films didn’t sell their euthanasia programme to the German public by emphasising specifically Nazi ideas about racial strength and purity: they appealed directly to the feelings of sympathy of decent Germans for those who were suffering from lives “not worth living”.
The Nazi euthanasia programme was heavily influenced by the ideas of one Alfred Hoche, who coined the phrase “life unworthy of life”, and who believed that the killing of patients who, he insisted, had value neither for society, nor for themselves, should be allowed. He focused particularly on what he called the “mentally dead”, by which he meant those who have no clear imagination, no feelings, wishes or determination. These, he said, have no subjective claim to life: their feelings are just simple elemental ones such as those found in the lower animals.
Hoche also argued for the killing of the mentally disabled and handicapped for financial reasons. Calculating the “financial and moral burden” on an individual’s environment, hospital and on the state, Hoche claimed that those who were “mentally dead” at the same time weighed heavily on “our national burden”.
The dissimilarities between this and the BMJ editorial shouldn’t of course be ignored; Professor Gillon isn’t a proto-Nazi. But neither should the clear parallels be ignored. “The logical implications of this judgment,” says Professor Gillon, “threaten to skew the delivery of severely resource-limited healthcare services towards providing … minimally beneficial life prolonging treatments… The… cost will probably be reduced provision of indisputably beneficial treatments to people who do want them.” In other words, the “financial and moral burden” of these patients, whose “life is unworthy of life”, weighs heavily on “our national burden”. It’s precisely the same argument, and it depends on exactly the same assessment of the value of impaired human life.
The implications of Professor Gillon’s arguments – and of the support for them of the BMJ – for any assessment of the current moral condition of our society and of the current ethical awareness of the medical profession itself are deeply disturbing. Raanan Gillon is an emeritus professor of medical ethics: how many doctors-to-be, over the years, have sat at his feet, have had their own medical ethics influenced, even wholly formed, by his?
It simply doesn’t bear thinking about.