Psychiatric Darwinism SURVIVAL OF THE FITTEST, EXTINCTION OF THE UNFIT.(Brief Article)

Editor's note. Issues in Law & Medicine is a peer-reviewed professional journal published three times a year by the National Legal Center for the Medically Dependent and Disabled, Inc. and the Horatio R. Storer Foundation, Inc. Published since 1985, Issues is devoted to providing useful information on recent legal and medical developments to assist attorneys, health care professionals, educators, and administrators on legal, medical, and ethical issues arising from health care decisions.

The first article in the current edition of Issues in Law & Medicine, written by Madeleine Pelner Cosman, Ph.D., Esq., is entitled "Psychiatric Darwinism, Survival of the Fittest and Extinction of the Unfit." Her work is a critical analysis of the American Health Security Act of 1993 (AHSA).

AHSA was soundly defeated when first proposed by Hillary Clinton's health care reform team shortly after President Clinton took office. But parts of it were enacted into law in 1996, with the prospect of further piece-meal enactment in the future, especially with Senator Hillary Clinton now in office. AHSA includes matters of critical importance to American mental health practitioners, to vulnerable citizens with psychiatric disorders, to their families, and to their few champions in medicine and law.

Medical utilitarianism is the unstated philosophical root of AHSA and its legislative progeny, i.e., whatever cuts medical costs and saves money is good, regardless of the impact on our most vulnerable patients.

Dr. Cosman, professor emerita of City College of the City University of New York, explains AHSA's mental health entitlements and, more importantly, its limitations of in-patient, out-patient, and other patient care. She enumerates a dozen major imperfections and dangers of this mental health law, especially its medical utilitarianism emphasizing successful outcomes and quality of life.

Dr. Cosman argues that the emphasis on holding down medical costs, providing benefits only for treatments that have a high rate of successful outcomes and good quality of life, and managed competition threaten the essential liberties, medical choices, and lives of older persons, persons who are chronically ill or terminally ill, and most particularly those who are mentally impaired.

She concludes that if limited money, medicine, and time are invested only in patients when medical success is inevitable, then America's medicine by law will be medical Darwinism encouraging survival of the fittest by requiring extinction of ...