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Not So Subtle Coercion

The Guardian newspaper recently published an extensive and informative article on euthanasia and assisted suicide, Death on demand: has euthanasia gone too far?

I have written about how coercion is a subtle yet powerful thing–here and now in the United States. This vignette from the article demonstrates how all subtlety is lost after legalization and cultural acceptance.

For all the safeguards that have been put in place against the manipulation of applicants for euthanasia, in cases where patients do include relatives in their decision-making, it can never be entirely foreclosed, as I discovered in a GP’s surgery in Wallonia, the French-speaking part of Belgium.

The GP in question – we’ll call her Marie-Louise – is a self-confessed idealist who sees it as her mission to “care, care, care”. In 2017, one of her patients, a man in late middle-age, was diagnosed with dementia and signed a directive asking for euthanasia when his condition worsened. As his mind faltered, however, so did his resolve – which did not please his wife, who became an evangelist for her husband’s death. “He must have changed his mind 20 times,” Marie-Louise said. “I saw the pressure she was applying.”

In order to illustrate one of the woman’s outbursts, Marie-Louise rose from her desk, walked over to the filing cabinet and, adopting the persona of the infuriated wife, slammed down her fist, exclaiming, “If only he had the courage! Coward!”

Most medical ethicists would approve of Marie-Louise’s refusal to euthanise a patient who had been pressured. By the time she went away on holiday last summer, she believed she had won from her patient an undertaking not to press for euthanasia. But she had not reckoned with her own colleague in the practice, a doctor who takes a favourable line towards euthanasia, and when Marie-Louise returned from holidays she found out that this colleague had euthanised her patient.

When I visited Marie-Louise several months after the event, she remained bewildered by what had happened. As with Marc, guilt was a factor; if she hadn’t gone away, would her patient still be alive? Now she was making plans to leave the practice, but hadn’t yet made an announcement for fear of unsettling her other patients. “How can I stay here?” she said. “I am a doctor and yet I can’t guarantee the safety of my most vulnerable patients.”

We have come a long way philosophically since the introduction of hospice and through the Quinlan and Cruzan cases in refusing or stopping medical care that is burdensome. This has led not only to a deeper affirmation of the dignity of life and the reality of death but also the hope in eternal life.

We crossed the line when we began the push for advance directives in 1991. No longer do we decide what is burdensome in the present, but what we fear in the future. This leads to an inherent prejudice against the disabled by allowing people to declare states worse than death. This echoes the 1920 German eugenics essay The Announcement for the Destruction of Life Unworthy of Living that evolved into the Nazi T4 program.

Eugenicists made the mistake of declaring others unworthy of life by legalizing things like forced sterilization and abortion. Today euthanasia advocates have begun by playing on people’s fears and prejudices through advance directives, leading them to declare themselves unworthy of life should they become disabled. Once the barriers to PAS are removed, euthanasia will quickly follow. Those advance directives filled out to refuse care under certain conditions will then be used by physicians and courts to actively euthanize people.

The vignette above is the proof of it.

Jerome Lejeune and End-of-Life Care

In 1969, Jerome Lejeune became the 5th recipient of the William Allan Award of the American Society of Human Genetics, the highest honor a scientist can receive in the field of genetics.  He earned this honor for discovering Trisomy 21, the cause of Down Syndrome.

His discovery, rather than leading to a greater insight and acceptance of Down Syndrome, instead led to prenatal detection and subsequent abortion of those with Trisomy 21. This consequence greatly troubled Dr. Lejeune, a devout Catholic.  He had already become very active in pro-life causes by 1969.  Like any martyr urged to denounce Christ in order to spare his or her life, Lejeune was advised to just stick to scientific information in the speech he gave to the ASHG; instead he carefully decided to use it to reflect his deeply-held beliefs.

In his eight-page, hard-hitting lecture he wrote:

Nevertheless we human geneticists have to face everyday reality: disabled children and distressed parents exist…I believe our response must be guided by two sentiments only-humility and  compassion.  Hu­mility because we must recognize we have no ready-made answers, because geneticists have not broken the secret of the human condition, and because scientific arguments are of little help in ethical issues; compassion because even the most disinherited belongs to our kin, because these victims are poorer than the poorest, and because the sorrow of the parents cannot be consoled by science. But should we capitulate in the face of our own ignorance and propose to eliminate those we cannot help?

After his speech he wrote to his wife, “Today, I lost my Nobel Prize in Medicine.”

The medical and scientific communities severely punished Dr. Lejeune for his beliefs. The video demonstrates the hatred he and his family endured from the public for his views, some even calling for his death.  As grants were denied and colleagues shunned him, he no longer could work in genetics.  That was in the 1970’s.

Today, abortion as a result of prenatal screening is commonplace and abortion itself–for any reason and at any stage of development–has claimed the lives of millions.  Just as we are turning the tide in public opinion regarding the moral acceptability abortion, now at only 43%, we are seeing the rise in the acceptability of doctor-assisted suicide, now at 53% according to the a May 2016 Gallup poll.

The same medical establishment that martyred Dr. Lejeune professionally, one which has steadily grown in its acceptance not only of abortion but also of expensive technology to manipulate embryos, now wants to minimize our end-of-life care through physician-assisted suicide and physician orders for life-sustaining treatments (POLST). Society is aging, they claim, and it is too expensive to continue giving “futile” care.

POLST forms require patients to make decisions on the spot that go into effect immediately about treatment options for any future condition they may face (crystal ball not included.) They vary significantly from state to state and cover a wide array of treatments on only one page.  Accompanying instructions for clinicians filling out the form are extensive, and when actually put in practice these forms are commonly misinterpreted in a manner leading to even less care than the form specifies.

Had the medical establishment heeded Dr. Lejeune, we would not have aborted millions of lives; the percentage of the population considered elderly would be much lower and we would have many more people paying into Medicare than depending on it. Now that we have killed so many grandchildren we seek to hasten the deaths of grandparents.

Dr. Lejeune concluded his lecture with the following:

For millennia, medicine has striven to fight for life and health and against disease and death. Any reversal of the order of these terms of reference would entirely change medicine itself. It happens that nature does condemn. Our duty has always been not to inflict the sentence but to try to commute the pain. In any foreseeable genetical trial I do not know enough to judge, but I feel enough to advocate.

Replace genetic trial with decline in health and those words call out still more loudly today.