The patriotic duty to die

Because we're seeing so many stories about bioethics, I've been trying to learn a bit more the field of thought. I recently read G.K. Chesterton's "Eugenics and Other Evils: An Argument Against the Scientifically Organized State." It's a collection of essays written in the 1920s at the height of the eugenics movement. One of the things I found so interesting about the book is that if it were read in the 1920s, one would think that Chesterton was fighting a lonely and losing battle. But a few more decades of eugenics -- punctuated by the Nazi embrace, of course -- and people began questioning and rejecting it.

Yet it seems as if eugenics is back big time. It's not just the sex-selective abortions or the 90 percent rate of abortions for children diagnosed with Down Syndrome, although those are great examples. In last week's New York Times, reporter and abortion rights supporter Emily Bazelon interviewed Supreme Court Justice Ruth Bader Ginsburg, who talked about abortion in the context of "populations that we don't want to have too many of." And in this upcoming Sunday's New York Times, Princeton professor Peter Singer was given more than a few words to talk about the inevitability of government rationing of health care under President Obama's reform plan. And, in no surprise to people who know anything about Singer's views, he's all for it:

Some will object that this discriminates against people with disabilities. If we return to the hypothetical assumption that a year with quadriplegia is valued at only half as much as a year without it, then a treatment that extends the lives of people without disabilities will be seen as providing twice the value of one that extends, for a similar period, the lives of quadriplegics. That clashes with the idea that all human lives are of equal value. The problem, however, does not lie with the concept of the quality-adjusted life-year, but with the judgment that, if faced with 10 years as a quadriplegic, one would prefer a shorter lifespan without a disability. Disability advocates might argue that such judgments, made by people without disabilities, merely reflect the ignorance and prejudice of people without disabilities when they think about people with disabilities. We should, they will very reasonably say, ask quadriplegics themselves to evaluate life with quadriplegia. If we do that, and we find that quadriplegics would not give up even one year of life as a quadriplegic in order to have their disability cured, then the QALY method does not justify giving preference to procedures that extend the lives of people without disabilities over procedures that extend the lives of people with disabilities.

This method of preserving our belief that everyone has an equal right to life is, however, a double-edged sword. If life with quadriplegia is as good as life without it, there is no health benefit to be gained by curing it. That implication, no doubt, would have been vigorously rejected by someone like Christopher Reeve, who, after being paralyzed in an accident, campaigned for more research into ways of overcoming spinal-cord injuries. Disability advocates, it seems, are forced to choose between insisting that extending their lives is just as important as extending the lives of people without disabilities, and seeking public support for research into a cure for their condition.

I excerpt the above not to highlight the sophistry so much as to give a taste of what the Times provides space for. I don't understand why someone who argues that parents should have the right to kill infant children -- indeed that it is ethical and right to do so -- is given such prestigious space. It's not like the Times solicits lengthy articles from David Duke, you know? Although with the run eugenics is making in the Times, maybe I'm speaking too soon. (Interesting side note -- Singer advocates using math that gives disabled people's lives three-fifths of the value of a non-disabled person.)

But having said that, I think it's about time that the mainstream media start discussing the government rationing of health care and what it will mean. I don't think many economists would agree with Singer that rationing can be done more efficiently by, um, the federal government than it's currently done by individuals. But it's obvious that if we go to a centralized system of health care, that will include a centralized system of health care rationing. So I commend the Times for bringing up the issue. I just wish they'd not give such a high profile to such a man.

Anyway, here's a bit more from the article:

When a Washington Post journalist asked Daniel Zemel, a Washington rabbi, what he thought about federal agencies putting a dollar value on human life, the rabbi cited a Jewish teaching explaining that if you put one human life on one side of a scale, and you put the rest of the world on the other side, the scale is balanced equally. Perhaps that is how those who resist health care rationing think. ...

Of course, it's one thing to accept that there's a limit to how much we should spend to save a human life, and another to set that limit. The dollar value that bureaucrats place on a generic human life is intended to reflect social values, as revealed in our behavior.

Yep. And in a society that values physical perfection over most anything else, some people should have every right to be scared. And the terminally ill? Just do your patriotic duty and die already! I always wonder how we define terminal illness. I mean, we're all terminal. So will we see even more genetic testing to determine which people with illnesses get treatments and which don't? Currently we make these medical decisions in a much less centralized fashion than could be done by the federal government. Some people probably wish we could make these decisions in an even more decentralized fashion. No matter what system we go to, there are harrowing ethical questions to be debated.

So hopefully we'll see more balanced treatments of these issues than the Times provides -- before Congress passes a huge bill it hasn't read at untold cost. Perhaps we can get input from other bioethicists, get some context, hear from advocates for the disabled, and correct some of the factual errors advanced by Singer.

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