Is There a Duty to Die? (Biomedical Ethics Reviews)

Book Review

Is There a Duty to Die?
(Biomedical Ethics Reviews)

James M. Humber and Robert F. Almeder (eds.)

(Humana Press, Totowa, NJ, 2000, 240 pp., $49.50, ISBN: 0-89603-783-5.)

The inherent vice of capitalism is the unequal sharing of blessings; the inherent virtue of socialism is the equal sharing of miseries.

Sir Winston Churchill

From Webster's Dictionary:

Benevolence --- the disposition to do good; ...love of mankind, accompanied with a desire to promote men's happiness, an act of kindness, ...charity given.

Altruism --- regard for and devotion to, the interests of others as an ethical principle.(1)

The idea of a "duty to die" created a political firestorm when mentioned by former Colorado governor Richard Lamm while addressing the Colorado Health Lawyers' Association in 1984.(2) The "duty" supposedly is owed by the individual to "society." As envisioned by Prof. John Hardwig, in his 1997 Hastings Center Report,(3) the family plays a central role, and the main criterion to be used is whether one will be a burden on loved ones. Hardwig also believes that, "in determining whether I owe it to others to die, my interests and preferences are no more important than theirs."(4)

Is There A Duty to Die? is the seventeenth annual volume of Biomedical Ethics Reviews. It is an "in-depth" discussion of the topic and contains papers from twelve authors, who insist that decisions about one's life may be made on a democratic basis by others; that the owner of her life must trade it for a lesser value to benefit someone else; that it is moral or ethical to kill some individuals to benefit others; that killing a family member is an example of "love, devotion, and true family values"; and that we can use intuition instead of reason to deal with our problems. The following ideas, as proposed by four of the authors, are typical of those found throughout the book:

* Margaret Battin ("Global Life Expectancies and the Duty to Die") wants to make "the life prospects of all humans more nearly equal." She would use a "duty to die" in the wealthy nations to transfer wealth to the poor nations, and she would remedy the "social and economic circumstances that contribute to early death: reducing malnutrition, endemic disease, poverty, and civil warfare in Africa; controlling the sex trade in southeast Asia; combating alcoholism, environmental toxins, and exposure to freezing cold in Russia, (and) reducing our own consumption in a significant way...."(5)

* Judith Lee Kissell ("Grandma, the GNP, and the Duty to Die") states that the "duty to die" is "...on a par with other well-recognized duties such as preventing harm, or helping one's neighbor in trouble." She asks whether the elderly should be helped to commit suicide or "as some seem to favor, should they simply be directly killed?" Even young children should be used: "...children can be led to realize early the wisdom of terminating lifesaving or life-preserving treatment of disabled siblings. Such self-sacrifice from a young member of their own household would provide an invaluable lifelong example of love, devotion, and true family values. Even very young children can understand that medical costs can quickly absorb money that could otherwise be put aside for college education or a family vacation, for example."(6) Finally, the wealthy do not owe this "duty" "...someone with sufficient money to buy any desired health care...seems absolved of the 'duty to die...' "(7)

* Rosemarie Tong ("Duty to Die?") views dying early as a choice, a gift for others, chosen because we love each other. She cites Lawrence Kolberg's six-stage process of moral development, the highest level of which is a Kantian perspective where one no longer is governed by self-interest, but by "universal principles, such as those of justice, reciprocity, and respect for the dignity of human beings as intrinsically valuable persons."(8)

* J. Angelo Corlett ("Analyzing the Moral Duty to Die") states that physicians' incomes are not justified to be as high as they are, but should be set "objectively at only that mark that is morally justified, all things considered." He bases his opinion on a "plausible principle of justice as distributive equality...."(9)

In addition to the above, subtle deceptions abound. "Society" is used as a specific entity, but "society" has no rights --- it does not exist apart from the individuals which comprise it. The implication by one author, that one who uses health insurance takes away benefits from her fellow subscribers is, because of the very nature of insurance, false. One author, Marilyn Bennett, misrepresents the conclusions of Merrill Matthews' study of the economic impact of early death.(10,11) She implies his study showed that dying early would save the health care system money, whereas his conclusion was the opposite.(12)

Many nonsensical concepts and terms are part of the "biomedical ethics" fantasy, which bewilder the reader, such as: maximizing average social utility; mutual health-related obligations between rich and poor nations; wedge arguments; the rule utilitarian argument; and the three criteria that indicate a moral duty to die --- the agency condition criterion, the ability condition criterion, and the moral liability condition criterion.

Kind intentions and the disposition to do good may indeed lead to good deeds. On the other hand, a devotion to the welfare of others may result in zeal and illogical thinking, and, when combined with the elitist concept that one knows what is best for others, may lead to disastrous consequences. The book's authors insist that, under certain (economic) circumstances, the poor (but not the wealthy) have an obligation to others to die early. But this requires either suicide or murder, which most would agree are themselves immoral.

To understand why these absurd ideas have been proposed, one must examine the philosophy* on which they are based. Is There A Duty to Die? is based on the same evil philosophy as is Pellegrino and Thomasma's For The Patient's Good (see Medical Sentinel 1999;4(5):82-83) and, unfortunately, most other ethics textbooks used in our medical schools today. This subjective Kantian philosophy, whose politics of collectivism (socialism) is based on its ethics of altruism, makes the use of logic and reason impossible. Its irrational ideas simply must be accepted on faith. It disassociates morality (ethics) from value. The authors cannot identify value, cannot assign relative values, and cannot determine who should benefit from them. Not only is this philosophy espoused in articles in our major medical journals, (including JAMA, NEJM, and Lancet), but nearly every major medical organization in the country --- knowingly or unknowingly --- has taken steps to further the socialization of American medicine. Our citizens are inundated by its ideas daily, courtesy of our national news media, so that now it permeates our entire society. If we do not reject this philosophy, with its tragic implications, it is only a short step to the eugenics and euthanasia of Hitler's Germany or the social cleansing of Stalin's Russia, using altruism and compassion to facilitate its acceptance by the American public.(14)

The philosophy's ethics, altruism, insists that one's most important reason for existence is to serve others. (Under socialism and communism, one's highest moral duty is to serve the state.) It holds that the good of others is the end of moral action and that a moral agent should increase the pleasures and eliminate the pains of others. But critics question why, if no one has a moral obligation to provide for his own happiness, should anyone else have this obligation? Also, what if the good proposed by the doer is not the same as that desired by the beneficiary?(15) History repeatedly shows us that altruism goes beyond benevolence, kindness, or good will, and instead makes these impossible. In practice, the givers are never blessed, but ultimately must give up everything --- even, as this book so shockingly demonstrates, life itself.(16) In fact, because of state-sponsored altruism, during this past century alone, over one hundred million citizens have lost their lives at the hands of their governments.(17)

Is There A Duty To Die? provides astonishing documentation of the depraved state of "biomedical" ethics. It should serve as a clarion call to all physicians (and all citizens) to reject the politics of socialism and the ethics of altruism, on which the book is based. Instead, we should insist on the restoration of our individual rights under the Constitution, and should pursue an objective ethics based not on emotion or intuition but on reason, which identifies life as its highest value, promotes happiness and productivity, and minimizes suffering and death. For over two thousand years, we physicians have recognized this life-enhancing ethics in the Oath of Hippocrates.

Footnote

* The five branches of philosophy are metaphysics, epistemology, ethics, politics, and esthetics.(13)

References

1. Webster's New International Dictionary of the English Language, 2nd Ed., Unabridged. G.C. Meriam Co., Springfield, MA, 1959.
2. The New York Times, March 29, 1984, Section A.
3. Hardwig J. Is there a duty to die? Hastings Center Report 1997;27(2):34-42.
4. Humber JM, Almeder RF. Is There A Duty to Die? Totowa, NJ, Humana Press, 2000, p. 137.
5. Ibid., p. 11.
6. Ibid., pp. 200-201.
7. Ibid., p. 197.
8. Ibid., p. 145.
9. Ibid., p. 120.
10. Ibid., p. 50.
11. Matthews M. Would physician-assisted suicide save the health care system money? Cited in Battin, Rhodes, and Silvers, Physician Assisted Suicide. Routledge, New York, 1998, pp. 312-322.
12. Personal communication with the author, March 3, 2000.
13. The New Encyclopaedia Britannica, 15th Ed., Propaedia. Chicago, IL, Encyclopaedia Britannica, Inc., 1986, pp. 517-518.
14. Peikoff L. The Ominous Parallels. Briarcliff Manor, NY, Stein and Day, 1982.
15. The New Encyclopaedia Britannica, 15th Ed., Chicago, IL. Encyclopaedia Britannica, Inc., 1986, pp. 302-303.
16. Binswanger H. (ed.) The Ayn Rand Lexicon. New York, NY, Penguin Books, 1988, pp. 4-8.
17. Rummel RJ. Death by Government. New Brunswick, NJ. Transaction Publishers, 1997.

Reviewed by Jerome C. Arnett, Jr., MD
Elkins, WV

Dr. Arnett is a pulmonologist in Elkins, West Virginia and a member of the Editorial Board of the Medical Sentinel.