Sick Thoughts.(Review)

Culture of Death: The Assault on Medical Ethics in America, by Wesley J. Smith (Encounter, 285 pp., $23.95)

The stories Wesley J. Smith has to tell are appalling. If you have any doubt about the corruption of modern medicine, you need to read the anecdotes scattered through Culture of Death: The Assault on Medical Ethics in America. The sick man forced to call 911 from his hospital bed because the medical staff categorized him as beyond help. The elderly woman left to die in pain because the nursing home declared her life not worth the cost of her care. The unconscious teenager sentenced to death by untreated fever because his doctor decided his life was "effectively over."

The solution to the sickness that has infected American medical care, however, requires not only that we recoil at the symptoms, but that we grasp the underlying disease. And that proves, in certain ways, the harder task. For while we register our indignation at this or that horror story-thinking each an abuse of a system still basically Hippocratic, still primarily concerned with the saving of life-the engine of "bioethics" rolls silently on. Every day, another hospital board is captured, another treatment protocol is redefined, another medical student takes a course in physician-assisted suicide, another HMO is told that the money-saving measure of euthanasia is an ethically justifiable form of "care for the terminally ill."

It is to expose this disease that Wesley Smith has written Culture of Death. A lawyer by training, he has assembled what is, in essence, a brief against bioethics as it is presented in America's premier philosophy departments, think tanks, and scholarly journals. Nearly everyone has heard about Jack Kevorkian's serial-killing of people whose main problems were depression and bad pain control, just as nearly everyone has heard about Peter Singer's appointment to a chair at Princeton University as a reward for proclaiming that a baby is of less value than a pig. But the shocking thing that Smith reveals is just how casually approved is the theory that justifies Kevorkian and Singer in places like Georgetown University's Kennedy Institute of Ethics, the Hastings Center, and the New England Journal of Medicine-the institutions to which American medicine looks for ethical guidance.

It's not the cranks with mimeograph machines in their basements who want to kill you. The philosophers who assume that some lives are not worth living, the activists who believe that the infirm have a duty to die, the doctors who study the mechanics of killing their patients: They are now the threat, and they are establishment in America today. Of course, the irrepressible Peter Singer is in the lead. There's a chapter in his latest book, Writings on an Ethical Life, called "Euthanasia: Emerging from Hitler's Shadow," which may make you wonder how far we are from a Princeton professor writing "Anti-Semitism: Emerging from Hitler's Shadow." But Singer is, in fact, merely less circumspect than his colleagues. Wesley Smith reveals a world of well-rewarded establishment figures who "reject what until now has been the core value of Western civilization: that all human beings possess equal moral worth."

In the seven central chapters in Culture of Death, Smith lays out the assault on the traditional ethics that once assumed that the saving of individual lives was medicine's highest concern.

He shows how "patient autonomy" became the mantra that justified passive abandonment and even active killing of sick people. He rages against "the bioethics-driven medical policy called Futile Care Theory," by which, he argues, hospitals require doctors to give up on whole classes of their patients. He excoriates current models for rationing health care, arguing that they all assume individual lives are fungible and disposable. He points out how the public's acquiescence in organ donation from the dead has emboldened theorists to demand organ donation from the living. He demonstrates that the clamor for animal rights serves primarily not to elevate animal life but to depreciate human life. And he ends with a call for a "'human-rights' bioethics"-a medical ethics that reembraces the old, Hippocratic love of life and rejects the eugenic flirtation with death.