"Mercy" killing

Several countries, among them Belgium, the Netherlands, Canada, and now also some of the more "progressive" American states, have adopted "medically assisted suicide." But not, so far, Great Britain. "How Britain Escaped Assisted Suicide" explains some of the reasons, and they are good reasons:

In June 2025 Janet Daby, the Member of Parliament for Lewisham East, started having nightmares: terrible images of death and dying that disturbed her sleep and haunted her conscience. She didn’t need a psychotherapist to interpret them. That month she had joined 313 other MPs in voting through an assisted suicide bill. She was beginning to think she might have made the wrong choice, and the 291 MPs on the other side might have made the right one.

There was one conversation that added to Daby’s doubts: someone she knew who had HIV and AIDS, and who many years before, with a bleak prognosis, had wished for the swift exit of an assisted death; but who had since found the right drugs, and made a decent life for himself. The kind of person who might be swallowed up by a state suicide service before he or she had the chance to find help. That was the kind of person she had endangered with her vote. And now it was too late.

But the British constitution, like life, sometimes gives you a second chance. ....

A lot of people assumed that the Lords (who are appointed, not elected) would have to wave through a bill of such importance, given that elected representatives had approved it. The Lords themselves were less persuadable.

And as they examined the bill, over a long period in late 2025 and early 2026, they began to uncover the same kind of problems as Janet Daby. The Royal College of Psychiatrists pointed out, to a committee convened by the Lords, that if people were depressed, the state would help them kill themselves—without asking too many questions about what help they needed. Experts in coercion observed that if people were being psychologically terrorized by an abusive partner, the state would help them kill themselves. One organization after another pointed out that if people fell through the gaps in Britain’s rickety health and care system, the state would help them kill themselves. ....

What swung the result? Perhaps less one issue than a steady accumulation of doubts. Hospices and care homes might be closed or defunded—this was explicitly threatened by one of the main proponents of the bill. Disabled people would come under pressure. People would die because the health system had failed them. The high costs of care would provide a powerful incentive for death. .... (more)

Dan Hitchens, "How Britain Escaped Assisted Suicide," First Things, Sept. 11, 2026.

Never grow old

Please don't tell anyone you are "tired of life." The progress in countries like Belgium and the Netherlands has been from "voluntary" euthanasia to doctor prescribed euthanasia:

Belgium’s euthanasia laws should cover elderly people who are “tired of life” or who feel they are a burden on the public purse, a health insurance chief has urged. Luc Van Gorp, 57, the president of the CM health fund, a Christian mutual insurance provider, said that the number of Belgians over 80 would double to 1.2 million by 2050.

“Many elderly people are tired of life. Why would you necessarily want to prolong such a life? Those people don’t want that themselves, and when it comes to budgets: it only costs the government money,” he told the Nieuwsblad newspaper. “We must remove the stigma.”

"Expand Belgian euthanasia laws to prevent social care crisis, says insurance boss," The Times, April 9, 2024.

"It all starts from such a kindly place"

Sinclair Lewis's 1935 novel, It Can't Happen Here was about Fascism coming to America. He was supposing that the unimaginable might come true. Not so long ago the thought of state-sponsored suicide was unimaginable. Douglas Murray on Canada's MAiD ("Medical Assistance in Dying"):

.... Lovely, liberal Canada actually legalised ‘assisted death’ in 2016, but only for people with terminal illness. As long-term readers will know, this is a slope that I have worried about for some time, for there is a slipperiness to it. Sure enough, two years ago Canada expanded the law to encompass people who had non-terminal conditions. As of next year the criteria will expand again, this time to take in people whose sole underlying condition is mental illness.

You could see this coming. ....

You can expect Canada to find a lot of other ailments to cure in the years ahead. Just last year a Canadian armed forces veteran who has been suffering from post-traumatic stress disorder (PTSD) sought support from Veterans Affairs Canada. An employee of the agency asked him if he had considered taking advantage of the new euthanasia options available in Canada. The veteran in question said that this was suggested unprompted. ....

It is a Canadian twist on a Belgian horror I pointed out here last year. That was the case of Shanti De Corte, a young woman who, at the age of 17, had been caught up in the 2016 Brussels airport attack and had seen a number of her classmates die. Last year she opted to be ‘euthanised’. Alleged members of the cell who carried out the 2016 attack are still on trial in Belgium, but whether or not they are found guilty none of course can be given the death penalty. Because Europe, like lovely, liberal Canada, does not believe in the death penalty for criminals. Only for victims.

And so it does seem likely that at some point after March Canada will be able to go down a similar hell-path. As well as being able to kill the victims of crime and terror, they will be able to kill (or award ‘medically assisted suicide’) to people of any age who suffer from anorexia, depression, PTSD or a growing smorgasbord of other debilitating ailments. ....

Naturally I must stress, as does the Canadian government, that this ‘complex and deeply personal issue’ will ‘reflect Canadians’ needs’ and ‘protect those who may be vulnerable, and support autonomy and freedom of choice’. It all starts from such a kindly place. It’s all about bodily autonomy, you see, and freedom – including freedom of choice. That’s why the Canadian government is giving out information for all those who will become eligible for euthanasia in March. ....

Douglas Murray, "Canada’s assisted dying horror story," The Spectator (UK), July 22, 2023.

A slippery slope

From "The Week" by National Review's editors:

In 2016 legal suicide was introduced into Canada, and now that country has one of the most destructively persuasive euthanasia regimes in the world. Of all deaths in Canada, 3.3 percent are now caused by doctors who practice “medical assistance in dying.” The public appears all too enthusiastic. According to polls by Research Co., over a quarter of Canadians believe that their fellow citizens should have access to legal euthanasia because of poverty. Twenty-eight percent believe that an acceptable reason to request a medically assessed death is homelessness. The numbers rise to 43 percent for mental illness, 50 percent for disability, and 51 percent for inability to receive treatment. Progressive societies used to pride themselves on social services and welfare. Should it not trouble the relatively wealthy Canadian nation and its government that state services are now seen as so inadequate that a publicly accepted alternative is death itself?

"The Week," National Review, May 11, 2023.

"Good science"

From an important essay, "Why Did So Many Doctors Become Nazis?":

.... The Nazi euthanasia campaign was publicly justified with four main arguments. First, ridding Germany of the unfit was simply “good science.” Who better to determine what constituted good science than German physicians, who were already the best in the world? The experts knew what was best for the German body.

Second, euthanasia was deemed humane. Since it was supported and implemented by a profession with a long tradition of healing and caring, the argument was even more persuasive. Pediatric euthanasia was often supported by many parents of disabled children for this reason; yet, with mixed motivation, for many wanted to avoid the strong stigma of having a disabled child. This conflict of interest shows how medical culture can influence the ethics of both individuals and society at large. ....

By the end of the “T4” program to euthanize disabled adults and children, between 70,000 and 100,000 persons had lost their lives; stigma against the vulnerable in attitude and language had become codified in law. According to Proctor, these three programs—forced sterilization of the “unfit,” the Nuremberg Laws, and the euthanasia laws—were the primary means the Nazi physicians and scientists used to accomplish “racial hygiene,” and led directly to the technological and medical surge responsible for genocide at the death camps. ....

The physicians who actively aided the Holocaust believed that they were practicing “good science.” But scientific truth alone does not “grasp” the reality of life, and if we believe it so, we are further on the road to what the late Jean Bethke-Elshtain called “scientific fundamentalism.” Physicians and health care professionals must, therefore, remember the Holocaust, but remember, as Pope John Paul II said on his visit to Yad Vashem, to “remember with a purpose.” ....

...[S]ociety is created for the person, not the person for society, and hence the dignity and integrity of the person and her freedom cannot be sacrificed for the sake of society. No contingent factor—race, religion, economic status, disability, or actions of the past, present or future—can rob a person the dignity she is owed. ....

.... Targeted abortion for unborn children with genetic conditions such as trisomy 21 and cystic fibrosis have reduced populations by more than 90%, and are justified on utilitarian grounds. But if a person is the fundamental unit of value of our society, then no “other good” can eclipse her. Politically, legally, and medically, this would mean an expansive and firm definition of person, for it is a far smaller risk to give protection to an entity where personhood is possible, than to destroy the life a person who in the end deserved our protection. ....  (much more)

Why Did So Many Doctors Become Nazis?

Unworthy lives

Robert P. George:

"60,000 Reichsmark is what this person suffering
from a hereditary defect costs the People's
community during his lifetime.
Fellow citizen, that is your money too."

.... The Holocaust—the Shoah—did not begin with the mass killing of Jews or other ethnic or religious minorities, or even Hitler’s political opponents. It began with the killing of the handicapped and infirm. They were, according to Nazi ideology, “useless eaters,” “parasites,” lebensunwertes leben (“lives unworthy of life”). It is important to remember that this eugenic doctrine did not originate with the Nazis. It began with polite, urbane, well-educated, sophisticated people who saw “social hygiene” via, among other methods, euthanasia, as representing progress and modernity. They wanted to ditch the old Judaeo-Christian belief in the sanctity of all human life and replace it with what they regarded as a more advanced and rational philosophy.

This was the view articulated by, for example, noted legal scholar Karl Binding and psychiatrist Alfred Hoche in their treatise Permitting the Destruction of Life Unworthy of Life, published in 1920. Binding and Hoche were not Nazis, and when they were writing their book the Nazi party didn’t even exist. In a few years, however, Hitler and the Nazis would adopt their ideas about “social hygiene” (mixing in racialist ideology and nostalgia for a mythical golden age of Teutonic paganism) and carry out the euthanasia program with a remorseless, pitiless fervor. Thus, began what became the Shoah—the murder of six million Jews, two to three million Russians, two million ethnic Poles, and nearly countless other so-called “undesirables.”

Yes, let us truly say, from our hearts and with conviction: “Never again.”

On Holocaust Remembrance Day | Robert P. George | First Things, Life unworthy of life - Wikipedia

Dying isn't dead

As more and more states consider legalizing assisted suicide Wesley Smith explains why it's a really bad idea:

• Dying isn’t dead, it’s a stage of living, difficult yes, but so are other times of our lives.
• Sometimes people diagnosed with terminal illnesses don’t die as expected, and if we abandon them to suicide, we will never know who they are. ....
• Patients who are terminally ill and want to commit suicide are often relieved later that they changed their minds or didn’t succeed at self-destruction–just like other once suicidal people. Studies show this repeatedly and I have met such individuals.
• When society supports the terminally ill in committing suicide–by legalizing access to lethal means and by not engaging in prevention in the same way we do other categories of suicidal people–it sends an insidious and hurtful message that the lives of the dying are less important, and that their families and the rest of us are better if they do die sooner rather than later. I know, I hear from such wounded people on an ongoing basis.
• Facilitating the suicides of patients in hospice completely subverts that hospice philosophy as established by the great medical humanitarian, Dame Cicely Saunders.
• Once society generally accepts suicide as an answer for one aspect of human suffering–experiencing a terminal illness–it will sooner or later expand access to being qualified to be made dead, e.g., people with disabilities, the elderly, the mentally ill, as has happened in Netherlands and Belgium.

I get that people think they are being compassionate in supporting the legalization of assisted suicide. But they are not.

Unintentionally, they are abandoning the dying to their worst fears about being burdens, being less loved, and losing dignity.

More bluntly, they are telling the dying that their lives are not really worth living.

About the founder of the modern hospice movement, Dame Cicely Saunders:  

In 1958, shortly after she qualified, she wrote an article arguing for a new approach to the end of life. In it she said, "It appears that many patients feel deserted by their doctors at the end. Ideally the doctor should remain the centre of a team who work together to relieve where they cannot heal, to keep the patient’s own struggle within his compass and to bring hope and consolation to the end." ....

She was strongly against euthanasia, partly because she was a committed Christian, and also because she argued that effective pain control is always possible and that euthanasia is therefore not needed. ....

 Cruel to Abandon Dying to Suicide While Protecting Others | National Review

Lives not worth living

The UK Parliament is considering a proposal to legalize euthanasia. Consequently there is great interest in the experience of those places that have already done so, including our state of Oregon.

The number of mentally-ill patients killed by euthanasia in Holland has trebled in the space of a year, new figures have revealed.

In 2013, a total of 42 people with ‘severe psychiatric problems’ were killed by lethal injection compared to 14 in 2012 and 13 in 2011.

The latest official figures also revealed a 15 per cent surge in the number of euthanasia deaths from 4,188 cases in 2012 to 4,829 cases last year.

The incremental rise is consistent with a 13 per cent increase in 2012, an 18 per cent rise in 2011, 19 per cent in 2010 and 13 per cent in 2009.

The rise is also likely to confirm the fears of Dutch regulator Theo Boer who told the Daily Mail that he expected to see euthanasia cases smash the 6,000 barrier in 2014.

Overall, deaths by euthanasia, which officially account for three per cent of all deaths in the Netherlands, have increased by 151 per cent in just seven years. ....

Professor Boer, who has reviewed 4,000 cases of euthanasia in his role as a regulator, told Parliament in the summer: ‘Don’t go there.’

Once a firm advocate of euthanasia, he said that he now [believes] the Dutch were ‘terribly wrong’ to think they could control it. ....

He was also gravely concerned at the extension of killing to new classes of people, including the demented and the depressed. ‘Some slopes truly are slippery,’ he said.

Doctors in neighbouring Belgium, which this year legalised euthanasia for children, are now killing an average of five people every day by euthanasia, according to latest figures, with a 27 per cent surge in the number of euthanasia deaths in the last year alone.

In one of the most shocking cases, a Brussels man last week described how he arranged the double euthanasia of his octogenarian parents who wanted to die because they were afraid of loneliness.

It has also emerged that a Dutch woman in her 80s was killed by her doctors just because she did not want to live in a care home. ....

Dutch euthanasia patients trebles in a year as doctors say it is 'out of control' | Daily Mail Online

"We're better than that"

Sen. Edward Kennedy's widow, Vicki Kennedy, opposes assisted suicide in a letter to Massachusetts voters:

.... Question 2 turns his vision of health care for all on its head by asking us to endorse patient suicide — not patient care — as our public policy for dealing with pain and the financial burdens of care at the end of life. We’re better than that. We should expand palliative care, pain management, nursing care, and hospice, not trade the dignity and life of a human being for the bottom line.

Most of us wish for a good and happy death, with as little pain as possible, surrounded by loved ones, perhaps with a doctor and/or clergyman at our bedside. But under Question 2, what you get instead is a prescription for up to 100 capsules, dispensed by a pharmacist, taken without medical supervision, followed by death, perhaps alone. That seems harsh and extreme to me.

Question 2 is supposed to apply to those with a life expectancy of six months or less. But even doctors admit that’s unknowable. When my husband was first diagnosed with cancer, he was told that he had only two to four months to live....

Because that first dire prediction of life expectancy was wrong, I have 15 months of cherished memories — memories of family dinners and songfests with our children and grandchildren; memories of laughter and, yes, tears; memories of life that neither I nor my husband would have traded for anything in the world.

When the end finally did come — natural death with dignity — my husband was home, attended by his doctor, surrounded by family and our priest. .... (more)

And nurses, who attend people nearing death each day are considering a resolution opposing assisted suicide:

The American Nursing Association has a draft opinion out reiterating its opposition to euthanasia and assisted suicide. It is well worth the read. From the draft opinion:

The American Nurses Association (ANA) is strongly opposed to nurses’ participation in assisted suicide and active euthanasia.... Nurses have an obligation to provide humane, comprehensive, and compassionate care that respects the rights of patients but upholds the standards of the profession in the presence of chronic, debilitating illness and at end-of-life.

The ANA notes that the lives of the terminally ill have just as much value as the lives of other people.... (more)

Thank You, Vicki Kennedy!! She’s a Voice Against Assisted Suicide in Massachusetts - By Kathryn Jean Lopez - The Corner - National Review Online, Nurses Set to Oppose Assisted Suicide - By Wesley J. Smith - Human Exceptionalism - National Review Online

Someone who will care

The recent attention given to end of life issues has been related to the controversy about the President's health care reforms. My own concern long predates that argument. Back in the seventies when euthanasia was being debated in Britain (it could never happen here), I read arguments that convinced me, first, that healthy people are in no condition to know how they will feel about death when very ill or very old, and, second, that vulnerable people can easily be made to feel guilty about being alive. At about the same time, I became aware of hospice as a humane, non-coercive, and caring alternative to both euthanasia and pointless, prolonged medical treatment.

Today Jim Towey, founder of Aging with Dignity and creator of a model advance care planning document that has been widely accepted, describes how things can go very badly wrong — and this in the VA, an institution often touted by those who favor a government-run health system.

Last year, bureaucrats at the VA's National Center for Ethics in Health Care advocated a 52-page end-of-life planning document, "Your Life, Your Choices." ....

"Your Life, Your Choices" presents end-of-life choices in a way aimed at steering users toward predetermined conclusions, much like a political "push poll." For example, a worksheet on page 21 lists various scenarios and asks users to then decide whether their own life would be "not worth living."

The circumstances listed include ones common among the elderly and disabled: living in a nursing home, being in a wheelchair and not being able to "shake the blues." There is a section which provocatively asks, "Have you ever heard anyone say, 'If I'm a vegetable, pull the plug'?" There also are guilt-inducing scenarios such as "I can no longer contribute to my family's well being," "I am a severe financial burden on my family" and that the vet's situation "causes severe emotional burden for my family." ....

I was not surprised to learn that the VA panel of experts that sought to update "Your Life, Your Choices" between 2007-2008 did not include any representatives of faith groups or disability rights advocates. And as you might guess, only one organization was listed in the new version as a resource on advance directives: the Hemlock Society (now euphemistically known as "Compassion and Choices"). ....

After a decade of observing end-of-life discussions, I can attest to the great fear that many patients have, particularly those with few family members and financial resources. I lived and worked in an AIDS home in the mid-1980s and saw first-hand how the dying wanted more than health care—they wanted someone to care. .... (more)

Jim Towey: The Death Book for Veterans - WSJ.com

"First, do no harm"

Rick Esenberg, a blogging law professor at Marquette University, has begun a series about the proposed public option segment of health care reform. Here he explains "Why Obama is losing the health care debate":

We do know that when we look at things that the health care unambiguously delivers, i.e., timely care, good survival rates and medical innovations, the US system is unrivaled — and much of the innovation that leads to these things is then adopted by other countries which do not themselves produce them.

My conclusion - and I think it is a reasonable one — is that our current system does many things well for the overwhelming majority of people. So, to borrow from what has become an accepted part of the Hippocratic oath (although some say it was not there originally) — "first, do no harm." The reason that the President is losing the health care debate (indeed, may have already irrevocably lost it) is that his ambition largely dismisses that advice.

If there were nothing to lose, then the proposed centralization of "best practices, "pay for a (uniform concept of) performance," federally standardized coverages, and a public option that may undercut private alternatives and dampen incentives for innovation even as it results in greater equality wouldn't bother people.

But there is something to lose. The awful and immoral health care system that is portrayed by our friends on the left is not the health care system as experienced by somewhere between 75 and 90% of Americans. If you don't begin your thinking by acknowledging that, you aren't going to get anywhere.

And Obama hasn't. The problem is not that "special interests" (a much abused term) are unfairly frightening people. It's that people have reason to be frightened. Like Mrs. Clinton before him, Obama is making the perfect the enemy of the good.

This isn't to say that universal coverage isn't a laudable goal (we should seek it) or that there is no room for improvement. But folks are understandably reluctant to throw the baby out with the bath water. The President has consistently failed to take that concern seriously. He knows it is a problem. This is why he began by claiming that no one would be forced out of their current coverage before he had to acknowledge that he only meant that the government wouldn't mandate such an outcome, although it might very well occur. His speculation about "red pills" and "blue pills" and pain killers instead of treatment for those who are too old or too sick plays into what everyone knows are the weaknesses of public health plans. .... (more)

And this morning The Wall Street Journal explained further:

While claims about euthanasia and "death panels" are over the top, senior fears have exposed a fundamental truth about what Mr. Obama is proposing: Namely, once health care is nationalized, or mostly nationalized, rationing care is inevitable, and those who have lived the longest will find their care the most restricted.

Far from being a scare tactic, this is a logical conclusion based on experience and common-sense. Once health care is a "free good" that government pays for, demand will soar and government costs will soar too. When the public finally reaches its taxing limit, something will have to give on the care and spending side. In a word, care will be rationed by politics.

Mr. Obama's reply is that private insurance companies already ration, by deciding which treatments are covered and which aren't. However, there's an ocean of difference between coverage decisions made under millions of voluntary private contracts and rationing via government. An Atlantic Ocean, in fact. Virtually every European government with "universal" health care restricts access in one way or another to control costs, and it isn't pretty.

The British system is most restrictive, using a black-box actuarial formula known as "quality-adjusted life years," or QALYs, that determines who can receive what care. If a treatment isn't deemed to be cost-effective for specific populations, particularly the elderly, the National Health Service simply doesn't pay for it. Even France—which has a mix of public and private medicine—has fixed reimbursement rates since the 1970s and strictly controls the use of specialists and the introduction of new medical technologies such as CT scans and MRIs.

Yes, the U.S. "rations" by ability to pay (though in the end no one is denied actual care). This is true of every good or service in a free economy and a world of finite resources but infinite wants. Yet no one would say we "ration" houses or gasoline because those goods are allocated by prices. The problem is that governments ration through brute force—either explicitly restricting the use of medicine or lowering payments below market rates. Both methods lead to waiting lines, lower quality, or less innovation—and usually all three. ....

And seniors are particularly vulnerable:

Mr. Obama has also said many times that the growth of Medicare spending must be restrained, and his budget director Peter Orszag has made it nearly his life's cause. We agree, but then why does Mr. Obama want to add to our fiscal burdens a new Medicare-like program for everyone under 65 too? Medicare already rations care, refusing, for example, to pay for virtual colonsocopies and has payment policies or directives to curtail the use of certain cancer drugs, diagnostic tools, asthma medications and many others. Seniors routinely buy supplemental insurance (Medigap) to patch Medicare's holes—and Medicare is still growing by 11% this year.

The political and fiscal pressure to further ration Medicare would increase exponentially if government is paying for most everyone's care. The better way to slow the growth of Medicare is to give seniors more control over their own health care and the incentives to spend wisely, by offering competitive insurance plans. But this would mean less control for government, not more. .... (more)

Shark and Shepherd: Why Obama is losing the health care debate, ObamaCare Will Lead to Rationed Care for Elderly - WSJ.com

Too expensive to live?

Responding to an article at Salon, James Kushiner describes what bothers me the most about the proposals for nationalized health care.

...[M]edical costs are the topic of the hour in the context of health care "reform" debates. .... Some form of hospice seems preferable to me, in many cases, but what worries me most is that the conversation and decisions about all these matters will be made by politicians and bureaucrats who do not have a fundamental respect for the sanctity of human life in the first place. .... It's a small step from one imposed form of hospice to the duty to (voluntarily) die to the loss of the right to live (involuntary euthanasia). We are on very treacherous and slippery terrain here, and I'd prefer "bioethicists" of a truly Christian cast of mind, not eugenic bean counters or those who value only certain levels of quality of life or organ farmers looking for replacement parts for elite members of the exceptional ruling class. Who wants to be weighed in the calculus in the final days and be given a lethal injection? You may be required to check off an answer to that question someday on Federal HHS Form T70-666-70, Certificate of Termination Verification.

Update: Jim Geraghty at NRO explains why my anxiety is unwarranted:

In order to get myself back into the good graces of the White House Office of Disinformation, I'm going to take some time to clear up some of the misperceptions about the "end-of-life counseling" provisions in the various Democratic health-care bills.

"End of life counseling" isn't mandated under the Democrats' legislation. As the bill is currently written, at age 65, you're simply invited to participate in a discussion with a doctor about when the government will stop paying for your health care. The federal government has even generously decided to underwrite the costs of this meeting between you and the doctor about when the government will stop paying for your health care.

The decision of when you stop draining valuable and limited government resources and accept your demise is an intensely personal decision, between you, your doctor, and the yet-to-be-appointed members of the medical review board. And of course, it is absolutely unimaginable that this process could somehow lead to an incentive to limiting how much the government will spend on your health care as you become older and older. The federal government's newfound emphasis on eliminating "unnecessary and wasteful" expenditures in health care will find some other procedures to eliminate, like all those blue pills when the red pills are just as good and cost half as much.

Don't let these crowds of nervous seniors confuse you; they're probably confused themselves. Government programs never have unintended consequences, and federal programs never expand and grow beyond their original purpose and mandate. As you look at your federal government, you can rest assured that they have absolutely no problem spending hundreds of thousands of dollars on medical procedures to keep you alive, even if the actuarial tables suggest you'll be dead pretty soon anyway. ....

Touchstone Magazine - Mere Comments: Too Much Spent Dying?, Getting to the Bottom of 'End of Life Counseling' Proposals - Jim Geraghty - The Campaign Spot on National Review Online

How much are six months worth?

The Wall Street Journal describes how health care rationing works in the United Kingdom:

.... What NICE has become in practice is a rationing board. As health costs have exploded in Britain as in most developed countries, NICE has become the heavy that reduces spending by limiting the treatments that 61 million citizens are allowed to receive through the NHS. ....

.... [NICE] has by now established the principle that the only way to control health-care costs is for this panel of medical high priests to dictate limits on certain kinds of care to certain classes of patients.

The NICE board even has a mathematical formula for doing so, based on a "quality adjusted life year." While the guidelines are complex, NICE currently holds that, except in unusual cases, Britain cannot afford to spend more than about $22,000 to extend a life by six months. Why $22,000? It seems to be arbitrary, calculated mainly based on how much the government wants to spend on health care. That figure has remained fairly constant since NICE was established and doesn't adjust for either overall or medical inflation.

Proponents argue that such cost-benefit analysis has to figure into health-care decisions, and that any medical system rations care in some way. And it is true that U.S. private insurers also deny reimbursement for some kinds of care. The core issue is whether those decisions are going to be dictated by the brute force of politics (NICE) or by prices (a private insurance system).

The last six months of life are a particularly difficult moral issue because that is when most health-care spending occurs. But who would you rather have making decisions about whether a treatment is worth the price — the combination of you, your doctor and a private insurer, or a government board that cuts everyone off at $22,000? ....

Mr. Obama and Democrats claim they can expand subsidies for tens of millions of Americans, while saving money and improving the quality of care. It can't possibly be done. The inevitable result of their plan will be some version of a NICE board that will tell millions of Americans that they are too young, or too old, or too sick to be worth paying to care for. (more)

How much are six months worth? And who should decide?

Wesley J. Smith, responding to another advocate of limiting "end-of-life" care, and drawing the logical—disturbing—conclusion:

I am all for hospice care and refusing unwanted ICU—if that is what the patient wants. As long time readers know, I have been a hospice volunteer. My dad died of colon cancer receiving hospice as have other relatives and very close friends. But here’s the thing: Once we say that a life is not worth preserving based on costs, we have instituted explicit rationing and created a duty to die.

The doctor then talks about a “well thought out plan” for end of life care and the signing of advance directives. Again, I’m all for it, but recall that there are many forces wanting to give faceless bioethics committees the right to veto your desires—even if set in writing. ....

.... [T]hink of all the money to be saved if instead of hospice or an extended time of debilitation we could give the patient a lethal jab or a poison brew! Indeed, it’s already happening: Recall, in Oregon, Medicaid has refused life-extending treatment to cancer patients but explicitly offered to pay for assisted suicide. Not that assisted suicide will become the cornerstone of health care reform. But make no mistake: It is the monster lurking in the shadows that we ignore at all our peril.

So, here’s the gig as I see it developing: In the new health care order, “choice” will be sacrosanct if the choice is death—either naturally or by lethal means. But if the choice is to go on living—at a certain point “choice” will cease to be operative because you will have become unwanted ballast. Eventually, that could even mean nonvoluntary euthanasia as now occurs with regularity in the Netherlands.

Of NICE and Men - WSJ.com, Secondhand Smoke — A First Things Blog

Honor your father and mother

From Wesley J. Smith's blog, Secondhand Smoke, a series of posts describing how rationing actually works in a country that has nationalized health care.

In the UK, utilitarian bioethicists control who gets–and who is denied–treatment via the Orwellian named organization NICE (National Institute for Health and Clinical Excellence). NICE explicitly uses a quality of life judgment (QALY–quality adjusted life year) to determine which patients are worth treating. It has now denied coverage for anti-dementia medications to mild Alzheimer’s sufferers. From the abstract of the story in the British Medical Journal:

The hopes of people with mild Alzheimer’s disease have been dashed again by the agency that appraises treatments for use by the NHS in England and Wales, which has reaffirmed its original decision to deny them treatment with dementia drugs. The National Institute for Health and Clinical Excellence (NICE) has issued amended guidance but still asserts that the drugs would not be cost effective for the mild stages of the disease.

Interesting that NICE is also the acronym for the sinister scientific research foundation in C.S. Lewis's That Hideous Strength.

In another post, Smith describes "Futile Care Theory," the idea that care should be withheld when doctors decide it will do no good - something that a NICE-like agency would probably decide once the public cost of health care forces rationing.

A UK bioethicist named Daniel K. Sokol, who writes nary a word in opposition to Futile Care Theory, aka medical futility (meaning, I suspect, he is a futilitarian), has nonetheless written a valuable informative essay in the British Medical Journal (no link, 13 JUNE 2009 | Volume 338) called “The Slipperiness of Futility.” For example, he defines the different “kinds” of futility:

Although ethically aware clinicians need not be familiar with the vast literature on the concept of futility, they might wish to remember the following four points:

• Futility is goal specific.
• Physiological futility is when the proposed intervention cannot physiologically achieve the desired effect. It is the most objective type of futility judgment.
• Quantitative futility is when the proposed intervention is highly unlikely to achieve the desired effect.
• Qualitative futility is when the proposed intervention, if successful, will probably produce such a poor outcome that it is deemed best not to attempt it.

And he points out, physiological futility–which I think a physician should refuse–is the only objective “type.” Indeed, Futile Care Theory isn’t about truly futile interventions, but about withdrawing wanted treatment based on the medical team’s or bioethicists’ values:

As futility is so rhetorically powerful and semantically fuzzy, doctors may find it helpful to distinguish between physiological, quantitative, and qualitative futility. This classification reveals that a call of futility, far from being objective, can be coloured by the values of the person making the call. Like “best interests,” “futility” exudes a confident air of objectivity while concealing value judgments.

Frankly, I would prefer that such "value judgments" about my care be made by me, or by family members or friends, rather than by guidelines prepared by bureaucrats incentivised to reduce government costs.

Finally [for now], Smith reports an example of what I have no doubt would become common here in a health rationing regime:

Stories like this continue to mount in the UK, and are a warning to us of the growing utilitarian, quality of life/cost-benefit bent in health care. A stroke patient, it is charged, was almost neglected to death–if not worse–at a UK hospital. From the story:

John MacGillivray, 78, from Auchterarder, was admitted to Perth Royal Infirmary having suffered a stroke on May 22. Two days later, his family were told by hospital doctors he would die within hours. His daughter Patricia MacGillivray told Sky News:…”There were several issues we already had with the level of care he had received in the short while he had been in the hospital, so we started to become suspicious. That’s when we started asking about his medication. It was then we learned that the medication we had been told he was going to receive when he was first admitted, which was specifically for stroke, had been changed to medication for treating seizures which we’d never seen him have.

The MacGillivray family instructed doctors to immediately withdraw all medication and launched a round-the-clock bedside watch.Within two days, Ms MacGillivray says her father had made such a good recovery he was being recommended for stroke rehabilitation treatment and four weeks later he was back home walking around his garden in Auchterarder. Ms MacGillivray feels if her family had not intervened in the treatment her father was receiving at Perth Royal Infirmary then her father would not be alive today. “The effect of that medication was to sedate him.”

Not to prejudge the matter, but I think that is a pretty good bet. Indeed, if my private e-mail is any judge, the disdain for the moral worth within the health care community for elderly people with serious brain injuries or illnesses is growing here too. (That being said, I believe American health care remains fundamentally moral precisely because of the people working in the trenches at hospitals and in nursing homes.)

Note: the illustration of a medical ration book is also taken from Smith's site. Its appearance is based on the ration books used during the Second World War.

Update: 6/25 from Warner Todd Huston at RedState:

Obama said during the ABC Special on Wednesday night that a way to save healthcare costs is to abandon the sort of care that “evidence shows is not necessarily going to improve” the patient’s health. He went on to say that he had personal familiarity with such a situation when his grandmother broke her hip after she was diagnosed with terminal cancer.

Obama offered a question on the efficacy of further care for his grandmother saying, “and the question was, does she get hip replacement surgery, even though she was fragile enough they were not sure how long she would last?”

But who is it that will present the “evidence” that will “show” that further care is futile? Are we to believe that Obama expects individual doctors will make that decision in his bold new government controlled healthcare future? ....

Government does not work by negotiation. Government does not work from the bottom up. It works from the top down. This singular fact means that no doctor will be deciding if you are too old or infirm to get medical care. It will be a medically untrained bureaucrat that sets a national rule that everyone will have to obey. There won’t be any room for your grandma to have a different outcome than anyone else’s. ....

Secondhand Smoke — A First Things Blog, Did Obama Say We Should Kill the Old Folks to Save Money Last Night? - Warner_Todd_Huston’s blog - RedState

"Not every issue is of equal moral gravity"

The Catholic bishops of New York have issued guidance about how Catholics ought to decide how to vote. Their central point, that Catholics are called to look at voting as they should look at everything else - "through the lens of our faith" - is something every person of faith should acknowledge. Amanda Shaw at First Things quotes part of the statement:

We Catholics are called to look at politics as we are called to look at everything – through the lens of our faith. While we are free to join any political party that we choose or none at all, we must be cautious when we vote not to be guided solely by party loyalty nor by self interest. Rather, we should be guided in evaluating the important issues facing our state and nation by the Gospel of Jesus Christ and the teachings of His Church. .....

It is the rare candidate who will agree with the Church on every issue. But as the U.S. Bishops’ recent document “Forming Consciences for Faithful Citizenship” makes clear, not every issue is of equal moral gravity. The inalienable right to life of every innocent human person outweighs other concerns where Catholics may use prudential judgment, such as how best to meet the needs of the poor or to increase access to health care for all.

The right to life is the right through which all others flow. To the extent candidates reject this fundamental right by supporting an objective evil, such as legal abortion, euthanasia or embryonic stem cell research, Catholics should consider them less acceptable for public office.

First Things » Blog Archive » Faithful Citizens

"Euthanasia of the weak and the sensual"

Michael Coren in the National Post reviews an exhibit at the Canadian War Museum about "those scientific ideas that gave a grimy intellectual veneer to the Nazi genocide." Among them:

The most vociferous and outspoken of the socialist eugenicists was the novelist H. G. Wells, author of The Time Machine, The War of the Worlds and The Invisible Man. He argued in best-selling books such as Anticipations and A Modern Utopia that the world would collapse and from this collapse a new order should and would emerge.

"People throughout the world whose minds were adapted to the big-scale conditions of the new time. A naturally and informally organised educated class, an unprecedented sort of people." A strict social order would be formed. At the bottom of it were the base. These were "people who had given evidence of a strong anti-social disposition", including "the black, the brown, the swarthy, the yellow." Christians would also "have to go" as well as the handicapped. Wells devoted entire pamphlets to the need of "preventing the birth, preventing the procreation or preventing the existence" of the mentally and physically handicapped. "This thing, this euthanasia of the weak and the sensual is possible. I have little or no doubt that in the future it will be planned and achieved." ....

In the United States socialist writer Margaret Sanger, the founder of Planned Parenthood and the mother of the abortion movement, called for a radical eugenics approach as early as the first years of the 20th century. She wrote of the need for "a stern and rigid policy of sterilization and segregation to that grade of population whose progeny is already tainted or whose inheritance is such that objectionable traits may be transmitted to offspring. It is a vicious cycle; ignorance breeds poverty and poverty breeds ignorance. There is only one cure for both, and that is to stop breeding these things. Stop bringing to birth children whose inheritance cannot be one of health or intelligence. Stop bringing into the world children whose parents cannot provide for them. Herein lies the key of civilization." .... (more)

I recall that when my denomination was first considering taking a firm position against abortion, some of those most emotionally against adoption of the resolution were theologically liberal. I vividly remember one of them recounting his visit to a nursing home for the retarded and physically disabled with the implication that it would have been better if they had not been born. An elderly gentleman wrote me a letter informing me that my grandfather certainly would not have agreed with my anti-abortion views. He may have been right about that. Turn of the 20th century theological and political liberalism (Progressivism) seems to have been perfectly compatible with racism and eugenics. Witness, for instance, Justice Oliver Wendell Holmes of the Buck decision.

Socialists made eugenics fashionable

A duty to die

Laws permitting euthanasia have not passed in some of our most liberal states. One reason has been opposition to such legislation by those with disabilities. Albert Mohler explains:

Once a society adopts a right to die as a matter of policy, a duty to die cannot be far behind. This logic is already evident when it comes to babies born with Down syndrome. Among many doctors and ethicists, the question has shifted from the right of parents to abort a baby diagnosed with Down syndrome to a duty to abort.

These doctors and ethicists frame the question this way: What right do you have to bring such a child into this world when we already face huge social costs of health care and face scarce resources? This is the logic of the Culture of Death, but it is a logic now argued rather openly.

Disability rights activists understand that this same logic threatens persons with disabilities. When does the argument for a right to die morph into an argument for a duty to die? The question is not merely a matter of intellectual interest. It is a question of life or death.

The Los Angeles Times reports that a bill modeled on the Oregon legislation failed to make it out of a General Assembly committee in June. As the paper explained:

Many disability rights activists contend that the increasingly cost-conscious healthcare system, especially health maintenance organizations, inevitably would respond to legalized suicide by withholding expensive care from the disabled and terminally ill until they chose to end their lives.

Paul Longmore, a history professor at San Francisco State University, argued that assisted suicide would lead to inequities and would not be limited to those with a terminal illness. "Our concern is not just how this will affect us. Given the way the U.S. healthcare system is getting increasingly unjust and even savage, I don't think this system could be trusted to implement such a system equitably, or confine it to people who are immediately terminally ill." (more)

A Threat to the Disabled...and to Us All

"From the unthinkable, to the debatable, to the justifiable, on its way to the unexceptional"

On euthanasia and assisted suicide, by Wesley J. Smith in First Things.

Source: First Things: The Future of Assisted Suicide and Euthanasia

Dutch Euthanasia

Wesley J. Smith, at First Things, writes about euthanasia in the Netherlands, upon the fifth anniversary of its legalization. Euthanasia is always presented as a mercy to the person who will be killed - as "assisted suicide." But encouraging the old, the sick, and the vulnerable to believe that they and society would be better off if they were dead becomes pressure to die. Smith refers to a book titled Dancing with Mr. D by a Dr. Bert Keiser describing his work killing human beings:

.... For example, there’s Van de Berg, a Parkinson’s patient who asks for euthanasia. But before Keizer can kill him, Van de Berg receives a letter from his religious brother telling him that it would be a sin to commit suicide and would violate the way they were raised as children by their parents.

The man hesitates. Keizer is not amused. From page 94:

And now this letter, which to my surprise, he takes seriously. I don’t know what to do with such a wavering death wish. It’s getting on my nerves. Does he want to die or doesn’t he? I hope I don’t have to go over the whole business again. . . . Suddenly, I have an idea: “You know what we’ll do? We’ll ask Hendrik Terborgh, our vicar. Would you agree to that?” He cries and types “yes.” ...

Next day Hendrik tells me that it’s all right. He refers to his meeting with Van de Berg. “Well, he knows what has to be done. He knows what he wants now.” . . . It goes well. He has good veins.

Keizer does not tell us what the vicar told Van de Berg, but I think it is a good bet he didn’t engage in suicide prevention or validate the brother’s religious concerns. Also, note that Keizer is far more concerned about the bureaucratic matters than with the well being of his own patient. One can imagine how depressing it would feel to have such a doctor, how alone and abandoned it would seem.

Here’s another form of pressure: Not telling a patient about the ability to control pain, or even waiting for a final diagnosis before agreeing to kill a patient. Keizer is asked to euthanize Teus, a man whom he thinks—but does not know—has lung cancer. He discusses the case with his colleague on page 37, who asks if the patient is really suffering badly. “Is it for us to answer that question? All I know is that he wants to die more or less upright and that he doesn’t want to crawl to his grave the way a dog crawls howling to the sidewalk after he’s been hit by a car."

Patients with cancer do not have to die in this manner. Proper medical care would prevent it. But this is never mentioned to the patient. Nor, from what we read, does Keizer even know about the powers of morphine to control cancer pain. He doesn’t even discuss hospice with Teus or his family—which is outrageous negligence. Instead, as he describes on page 39, when Keizer gets ready to euthanize Teus, he will countenance no doubts: “I tell Jaarsma and De Goover [Keizer’s colleagues] that Teus is going to die that evening. Jaarsma seems sore but raises no objection. De Goover looks sharply at me, trying to work out how scared I am. If anyone so much as whispers ‘cortisone’ or ‘uncertain diagnosis,’ I’ll hit him.”

The most telling passage in the book may come when Keizer is asked by a colleague whether he should love his patients. “‘What about love,’ Herman wonders. ‘Shouldn’t you love your patients, if only a little?’ I don’t know right away what to say. I think it’s good for the profession if I heave a deep sigh now and declare my assent. And there are situations that upset you. But love? I doubt it.”

FIRST THINGS: On the Square » Blog Archive » Dutch Euthanasia

The slippery slope

Once the killing of the human embryo, the fetus, and the partially born baby is allowed - why not the infant? Life will be so much easier if we do away with everyone who is inconvenient. If we abort those who are unwanted, disabled, a burden to society - why not kill them off after they are born? What stands in the way of retroactive abortion? Perhaps the Nazis were just ahead of their time as they eliminated "life unworthy of life" and "useless eaters." The Daily Mail (London) reports on the growing moral irrelevance of official Anglicanism:

The Church of England has broken with tradition dogma by calling for doctors to be allowed to let sick newborn babies die.

Christians have long argued that life should preserved at all costs — but a bishop representing the national church has now sparked controversy by arguing that there are occasions when it is compassionate to leave a severely disabled child to die.

And the Bishop of Southwark, Tom Butler, who is the vice chair of the Church of England's Mission and Public Affairs Council, has also argued that the high financial cost of keeping desperately ill babies alive should be a factor in life or death decisions.

The shock new policy from the church has caused outrage among the disabled.

A spokeswoman for the UK Disabled People's Council, which represents tens of thousands of members in 140 different organisations, said: "How can the Church of England say that Christian compassion includes killing of disabled babies either through the withdrawing or withholding of treatment or by active euthanasia?

"It is not for doctors or indeed anyone else to determine whether a baby’s life is worthwhile simply on the grounds of impairment or health condition." [emphasis added]

Update [11/15] A clarification from NRO:

Wesley Smith e-mails:

[I]t did NOT endorse mercy killing. That was bad reporting. It endorse[d] the right to stop life-sustaining treatment. Where the AC [Anglican Church] is substantially different from the Catholic Church is that the CC keeps the focus exclusively on the patient and his or her intrinsic dignity and needs. The AC said that money could be a factor in the decision making.

This is wrong, in my view. But... [it did] not actually endorsed infanticide.

But the "professionals" still decide whether a life is "worth living."