“Why is he refusing to prescribe antibiotics?” I asked.
“He says that she’s ninety-two and an infection will kill her sooner or later. So it might as well be this infection.”
As disturbing as this call was, as outrageous the doctor’s behavior, I wasn’t particularly surprised. I have been receiving such desperate communications with increasing frequency for the past two decades. Not every day, not every week, but with sufficient regularity—increasing in volume since this book was originally published—to become very alarmed about the state and ethics of American medicine, and its impact on culture.
Among the more disturbing calls I received came from John Campbell, whose teenage son, Christopher, had been unconscious for three weeks because of brain damage sustained in an auto accident. The boy had just been released from the hospital intensive care unit when he developed a 105-degree fever in the hospital’s “step-down unit.” Campbell asked the nurses to cool his fever. They replied that they needed a doctor’s orders. Campbell asked them to obtain it, but Christopher’s physician was out of town and the on-call doctor said no. “It was an evening of hell,” Campbell says. “My son’s life meant less than hospital protocol. When the doctor refused to order treatment, the nurses said that there was nothing they could do.”
Campbell desperately tried to reach the doctor on call personally, but he refused to take Campbell’s phone calls or return his increasingly urgent messages. Meanwhile, Christopher’s condition worsened steadily, rising over a period of some twenty hours, to 107.6 degrees. Finally, the nurses, caught between a desperate father’s pleas and a doctor’s steadfast refusal to treat, put Campbell on the phone directly with the doctor.
Campbell demanded that his son’s fever be treated immediately. The doctor refused. When Campbell grew more insistent, the doctor actually laughed. The boy was unconscious. His life was effectively over. What was the point?
“By this time,” Campbell recalls with much emotion, “my son’s eyes were black, as if he had been in a fight. He was utterly still. He was burning up. The back of his neck was so hot you couldn’t keep your hand on it. I said to the doctor, ‘This is not a joke! This is my son. His life is at stake. His temperature is over 107 and you are going to do something about it.’” The doctor, hearing the angry determination in Campbell’s voice and perhaps fearing legal consequences if Christopher died untreated, finally acquiesced.
Christopher’s temperature subsided. Soon thereafter he was moved to a rehabilitation center for therapy and began a slow recovery. Not long after, he moved home with his parents, where he spent his time relearning to walk with assistance and worked at a local youth center where he fed animals and counseled at-risk teenagers. Oh yes, Christopher felt very glad to be alive, as were his parents and the many troubled people he helped everyday.3
As I have spent more than twenty years traveling the country (and internationally) speaking about assisted suicide and other issues involving the ethics of modern medicine, as people react to my appearances on talk radio, television programs, and to my newspaper and magazine columns, with multiplying frequency I hear similar medical horror stories. People are afraid. They are deeply worried about what is happening to medicine: the potential impact of the Affordable Care Act (ACA, also known as Obamacare), doctors pressured by HMOs to reduce levels of care, hospital nursing staffs cut to the bone, the sickest and most disabled abandoned to inadequate care, elderly people dying in filthy nursing homes or in agony because their doctors fail to prescribe proper pain control.4 There have even been reported instances of desperate patients in hospitals calling 911 because they were unable to access needed medical attention.5
These anecdotes are symptoms of a disintegrating value system in health care that disdains the sickest and most disabled among us as having lives that are not worth living; that views expensive medical treatments for such people as a waste of valuable resources; indeed, that accepts their demise—or increasingly, even their killing—as a legitimate answer to the difficulties caused by their serious illnesses and disabilities. In short, the ethics of health care are devolving into a stark utilitarianism that is quickly transforming the “do no harm” tradition of medicine that has for millennia been the cornerstone—and hope—of medicine.
At the same time, medical economics are exerting a gravitational pull into the moral abyss. For example, when Arizona’s Medicaid program—the state/federal health insurance for the poor—ran into significant money problems, it canceled organ transplant surgeries for 98 percent of those eligible for the procedure.6 As this book will explain—sometimes in painful detail—with medical technology growing ever more sophisticated and expensive, while the viability of the old sanctity/equality of life ethic comes under increased cultural pressure, these kinds of controversies are going to become increasingly common and the divisions they sow among us more deep and viscerally felt.
THE NEW HIGH PRIESTS
We have not entered this era of potential medical authoritarianism by chance. We were steered into it by an elite group of moral philosophers, academics, doctors, lawyers, and members of the medical intelligentsia—known generically as bioethicists—who have dedicated themselves over the last four decades to bending public and professional discourse about medical ethics and the broader issues of health care public policy to their desires. They are the cultural aggressors, as the mainstream view in the field is openly hostile to the traditional moral values and ethical traditions of our society.
Medical ethics focuses on the behavior of doctors in their professional lives vis-à-vis their patients. Bioethics focuses on the relationship between medicine, health, and society. This last element allows bioethics to pursue policies that go far beyond the well-being of the individual and to presume a moral expertise of breathtaking ambition and hubris. Many view themselves, quite literally, as the forgers of “the framework for moral judgment and decision making”7 who will create “the moral principles” that determine how “we are to live and act,” a “wisdom” they perceive as “specially appropriate to the medical sciences and medical arts.”8 Indeed, some claim that “bioethics goes beyond the codes of ethics of the various professional practices concerned. It implies new thinking on changes in society, or even global equilibria”9 (my emphasis). Not bad for a school of thought that has only existed for about forty years.
Bioethicists typically see their work as integrating “medical ethics and universal morality” beyond “a few general principles” toward the determination of “the meaning of the good life.”10 It is “both a discipline and a public discourse, about the uses of science and technology” and the “values about human life . . . with a view toward the formation of public policy and a teachable curriculum.”11 Put more simply, bioethics seeks to create the morality of medicine, define the meaning of health and wellness, and determine when life loses its value (or has less value than other lives) toward the end of forging the public policies and influencing the individual choices that will establish a new medical and moral order. More than a set of tenuous speculations, bioethics in recent years has ossified into an orthodoxy and perhaps even an ideology.
Many bioethicists rejected this claim after the publication of this book’s first edition. They act in good faith, these objectors contended. The “quality of life” ethic will create a better world. Besides, they argued, bioethics is not monolithic.12 After all, practitioners have widely divergent opinions about these issues and controversies—ranging from assisted suicide to cloning to the definition of “health”—with which bioethics discourse grapples. Moreover, many adherents claim, bioethics doesn’t have an end goal. It is more akin to a conversation among professional colleagues, a process that merely seeks consensus about the most pressing moral and medical issues of our time.
If that were ever true, I contend that it
