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Have you ever watched an old movie, where the hero or heroine, in an effort to convince the "townfolks" of something, would get up on  an old crate ("soapbox") where he/she could be seen and heard by all, and speak their piece? Well, this is our "soapbox".  Please feel free to submit an essay on a nutrition or health related topic that you feel strongly about, and we might just post it in here for all to see.  Discussions about these topics can take place in our Discussion forum.  

To get us started, we have a topic a little off the subject of nutrition-- which is our usual goal-- this topic is about health and life itself, as well as our attitude about life.  Caution:  This is a very intense topic.  

Bioethics: Changes in Moral Correctness

Judith Curren, a 42 year old woman with chronic fatigue syndrome and Fibromyalgia, a nonlethal muscular disorder, died after an injection of potassium chloride; the same chemical given to condemned inmates executed in some states. She was one of 48 people whose suicides were assisted by Dr. Jack Kevorkian.

Three weeks before her death, her husband, who actively assisted in making arrangements with Dr. Kevorkian, had been arrested on a domestic assault charge. Twice he had been arrested for abusing his wife. Curren was addicted to painkillers and had complained of depression as well as spousal abuse.

Like Curren, many of those Kevorkian has assisted in suicide were not terminally ill. Some had doubts about dying and at least one showed on autopsy no evidence of  physical disease. Reading through the list of Dr. Kevorkian's "patients" is a sobering experience. Their ages ranged upward from 27 years old and their disease states ranged from none to very severe. In some cases it is understandable why they chose this course of action and in other cases it is difficult to comprehend. In all cases, however, one is faced with the complex bioethical issue of euthanasia, an issue debated by physicians and professors in hospitals and universities everywhere.

The general public appears to have taken all this in as if it were just another entertaining television show. Why are the majority of citizens ignoring this issue, or brushing it aside as just one more interesting tidbit among thousands covered by the media on a regular basis? Is media coverage so sparse that its importance has not yet been realized?

Bioethics, or the ethics of medical research and care, is normally thought to be a topic reserved for either scholars in committees discussing the philosophy and social impact of the life sciences; or Physicians faced with life and death issues in a hospital setting. However, since we are all impacted by these life-altering questions, shouldn’t we involve ourselves more in events that could change our lives forever? How do you feel about assisted suicide? Did you watch the 60 Minutes television show that aired the death of Thomas Youk, by a lethal injection given by Dr. Kevorkian? Should physicians be allowed to routinely dish out death on demand to their patients? If so, would this be limited to terminal patients only, and who decides if the person is terminal?

If the day comes when euthanasia or assisted suicide is deemed legal, the potential for abuse must be addressed. Among those Dr. Kevorkian assisted to their deaths are a few whose emotional state or degree of depression may have prevented them from making a rational decision regarding their suicide. Depression can be tremendously debilitating, but can also be treated. Eventually those who work their way through a depression can return to a happy, fulfilling life. How many would die needlessly, in a world where assisted suicide was legal?

Many doctors in the United States argue that they should have a veto over a patient’s request to be allowed to live if the doctor, in disagreement with the patient or the family, thinks the patient’s quality of life is so poor that her/his life is not worth living. Never mind that the physician’s determination of "quality" of life is completely subjective. These doctors consider treatment inappropriate not only when it will not save a life, but also when it would save a life--if that life’s quality is deemed poor. Houston hospitals are actually implementing formal procedures for the involuntary denial of life–saving medical treatment. Hospitals all over have already enacted similar policies regarding what is termed futile treatment.

A well-known and respected physician in Southern California, who chairs a small local hospital’s bioethics committee, diligently studies all topics he feels come under its umbrella.  I have attended these meetings, and the committee is never able to cover all the issues on his agenda, with many  postponed for a month of two before there is time enough to address them. One of his major projects has been the draft of a new hospital policy on futile care. The importance of this, according to the doctor, is to " avoid using limited hospital resources and funds in a vain attempt to save someone’s life." This particular policy addresses the problem of allowing the physician to discontinue, or refuse treatment on a patient that he or she feels is in no condition to adequately benefit from the treatment.

Although this may sound straightforward, it rarely is. There are many cases when the family and even the patient feel that treatment is needed and appropriate, only to have a physician say that the quality of life after the treatment would not be sufficient to justify the expense. Although the hospital the above mentioned physician practices in is a small rural one with an average census of only around 50 patients, similar futile care policies, as well as physicians with beliefs much the same as Dr. Kevorkian’s are becoming surprisingly common throughout the nation and in some parts of the world.

In Great Britain, for example, the British medical Association (BMA) has issued guidelines that include the withholding and withdrawal of tube feeding and hydration without court approval. The BMA believes that doctors should not have to be routinely required to seek court permission. These guidelines are not only aimed at patients who would only live for a few weeks if treatment were given, but who might possibly live for years if treatment were given. It covers all ages and if the guidelines were widely used, the patients would most likely die a lot earlier. In addition to withholding feeding and hydration, these guidelines would also hold treatments such as: Cardiopulmonary resusitation (CPR), artificial ventilation, specialized treatments like chemotherapy or dialysis, antibiotics, and other types of artificial nutrition and hydration. This type of futile care policy holds that doctors, not family members, or designated health care decision makers, have the ultimate say as to whether a person does or does not receive treatment.

In one case, a British mother of a disabled 12 year old boy sued doctors, claiming they had no right to refuse to give life-saving treatment to her son. The High Court ruled against the mother.

The Netherlands has a system that allows physicians to either end a patient’s life, or act as a consultant to the physician who will induce death. (update: as of Nov. 2000, euthanasia or mercy killing is now legal in Holland) The consultant, required by law, is a type of watchdog who determines if the physician is acting according to practice requirements, and if the patient’s death request is voluntary, well considered and persistent. The consultant is also responsible for looking into the degree of the patient’s suffering and if alternative treatment exists. He is expected to have a background as a physician that has assisted with many deaths. Unfortunately, studies done on how the system works have shown much abuse. The physician generally pairs up with a consultant who does most if not all of his cases. Close to 99 percent of the cases are approved by the consultant. This partnership, in any other circumstance would be widely considered unethical.

In still another part of the world, there is an Australian professor, and president of the International Association of Bioethics, named Peter Singer. He has recently won a prestigious appointment to Princeton University as a tenured professor of Bioethics at the University center for Human Values. This happened, in spite of how infamous Peter Singer is in Australia. He advocates the killing of what he terms "non-persons". Included under this term are "defective" babies, the senile, the comatose, and those physically disabled. Singer believes in a quality of life ethic. In Practical Ethics, he is quoted as having said, "Killing a disabled infant, is not morally equivalent to killing a person. Very often it is not wrong at all." Peter Singer believes that even ‘healthy’ babies lives may not be worth protecting since babies are not "rational and self-aware". He has even gone so far as to say that parents should have the first 28 days of their infant’s life to decide whether to keep or kill the "non-person" newborn. Obviously, protests against Singer’s philosophy are worldwide.

Another infamous Australian is Dr. Philip Nitschke, known as Australia’s "Dr. Death". Nitschke travels around with a mobile clinic and gives euthanasia advisory clinics. Responsible for four euthanasia deaths, Nitschke developed a computer program that would kill patients by delivering lethal drugs through an intravenous line. His future goals include developing a suicide pill with common ingredients that cannot be traced by police.

Has human life becomes less "sacred" or less valuable? When does it stop? When society gets used to killing humans under some circumstances, will it go on to find more reasons to kill? Or do you believe that these changes are good, and that we need to have more options for life’s end?

Recently, a prison inmate made national headlines when he requested to donate a kidney to his seriously ill daughter, badly in need of a transplant. This question seemed to have actually been given some serious consideration. In the end, however, the prison officials denied his request, as he had already donated one kidney to his daughter, and this second donation would seriously jeopardize his own life.

According to widely circulating reports, the Chinese government takes this one step further, by executing criminals and political-prisoners so that it coincides with the need for organs to transplant. How the execution is carried out depends on the specific organ needed. They are said to be sold for $30,000. Although the U.S. condemns this practice, in China transplants are scheduled well in advance even with the absence of organ donor programs.

I remember growing up watching television shows about physicians risking their futures for the sake of their patients. Is our own future destined to be filled, instead, with physicians who take it upon themselves to decide who should live and who should die? The initial decisions concerning euthanasia are now being made. They are moving along in a step by step progression toward the ultimate end when someday one of your grandchildren may decide it’s time for them to die, or perhaps, time for you to die. In the United States there is a group called the Physicians for Mercy, who have actually published guidelines for assisted suicide. There may not be an easy, clear-cut answer to the question of legalizing euthanasia. An unfortunate reality is that when you take that step, another follows. There is usually someone not too unlike Peter Singer just around the corner to argue for even more leniency and more freedom to kill. Don’t let this important issue be decided behind closed doors. Let your feelings be known. In several states there is pending legislation either to legalize some degree of euthanasia or to declare it illegal. Oregon has passed the most permissive assisted-suicide law so far. Will your state be next? Dr. Kevorkian has been the most widely publicized proponent of making assisted suicide legal, and even though he is now behind bars, his protégés carry on his work. This is an issue that will not soon waste away into oblivion, and should concern us all.

"Man makes a death which Nature never made".

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