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Here’s an article by Len Doyal, Professor Emeritus of Bioethics at the University of London, who argues that doctors should have the right to kill us when they judge that our lives are no longer worth living.
In fairness to Professor Doyal, I should point out that he recommends some safeguards. He argues that doctors should have the right to kill patients without their consent only when the patient is incapable of communicating his wishes, when the time remaining to live is short, and when the patient’s suffering is (in the opinion of the doctor) “intolerable.”
No doubt about it, people can suffer terribly when they are the ends of their lives. But it’s not clear to what extent the medical profession is the solution, and to what extent it is the source of the problem. In the book AIDS: The Ultimate Challenge by Elisabeth Kubler-Ross, a young man tells the sad story of his 77-year-old grandmother whose body was riddled with cancer and who suffered several broken ribs as a result of misguided attempts to revive her after her heart had stopped. Probably most people can tell a similar horror story about a loved one suffering at the hands of a medical establishment which has completely lost sight of the patient. Is it a good idea to expand the power of the medical profession, to solve a problem which, to a large extent, is the result of their own hubris?
In a recent post, I argued against physician-assisted suicide on the grounds that it’s already too easy for doctors to get away with murder, and I don’t want them to get in the habit of killing us. I have come to realize there is another, even more compelling argument: the medical profession has a really lousy track record of stopping at the point of diminishing returns, or even at the point of negative returns.
According to this book by Ivan Illich, in 1934 researchers conducted a fascinating experiment. They surveyed 1,000 children from the New York City public schools, and they found that 61% of these children already had their tonsils removed. They took the remaining children to a group of physicians, who recommended that 45% of them have their tonsils removed. The children remaining after this round of elimination were taken to a second group of physicians, who recommended that 46% of them have their tonsils removed. They took the children left over from that group and took them to a third group of physicians, who recommended that a like percentage of them have their tonsils removed. By this time, the researchers were down to 62 kids, and the experiment was terminated because they ran out of doctors.
Here’s the punchline: these doctors were working at FREE clinics, so they didn’t even have any vested interest in recommending the children for surgery!
It is worth quoting Illich at some length here: “More than 90% of all tonsillectomies performed in the United States are technically unnecessary, yet 20 to 30 percent of all children still undergo the operation [this was written in 1976]. One in a thousand dies directly as a consequence of the operation, and 16 in a thousand suffer from serious complications. All lose valuable immunity mechanisms. All are subjected to emotional aggression: they are incarcerated in a hospital, separated from their parents, and introduced to the unjustified and more often than not pompous cruelty of the medical establishment. The child learns to be exposed to technicians who, in his presence, use a foreign language in which they make judgments about his body; he learns that his body may be invaded by strangers for reasons they alone know; and he is made to feel proud to live in a country where social security pays for such a medical initiation into the realty of life.” (p. 112)
No doubt there was a tiny minority of children who benefited from tonsillectomy (i.e., those who were having trouble breathing from enlarged tonsils). But the vast majority did not.
Of course, tonsillectomy has since gone out of fashion. But overmedicalization is alive and well. Millions of Americans have been infantilized into believing that they can’t function without their psychotropic medications, even though a meta-analysis of 35 clinical trials showed that antidepressants help only the most severely depressed patients. For the great majority of patients, antidepressants are no better than a placebo.
I could have told them that. There may be a tiny minority of patients who truly do have something out of whack with their brain chemistry, but for that majority of them it’s just a matter of developing the internal and external resources to cope with adversity, of making their way in a world that was not designed for them. Just like the rest of us.
Here's another example. According to these books by Shannon Brownlee and Nortin M. Hadler, M.D., the vast majority of cardiac catheterizations and bypass surgeries are totally unnecessary. Only the 3% or so of patients with left main disease are helped to live longer by these procedures. The vast majority of patients would do better with noninvasive treatments. Every year, thousands of people die and tens of thousands of people are left with varying degrees of dementia from operations which, according to these authors, are almost always unnecessary.
Need more examples? Consider the most expensive treatment in all of medicine, the heart transplant. Here’s a study published in BMJ which followed all patients listed for a heart transplant in Germany in 1997. The study found NO DIFFERENCE IN SURVIVAL RATES between those who actually received a heart transplant and those who did not. Only the sickest 12% of patients lived longer with a heart transplant than with more conservative treatment.
Do you see a pattern here? They always start off with a treatment which has the potential to benefit a tiny number of patients, and then they foist it on as many patients as they possibly can. Today the medical profession is the third-biggest killer in the United States, and the fourth-biggest, cerebrovascular accidents, isn’t even close.
If we give our doctors the right to kill us, under the narrow circumstances outlined by Professor Doyal, why does anybody think it’s going to stop there?
Still think physician-assisted suicide is a good idea? I implore you to think again.
And a thousand times again after that.
Photo via Wikimedia Commons