But that required difficult choices. I could have deleted all the older material and replaced it with newer stories and issues bearing on the same themes. Or I could have kept all the old material, adding in only a few updates. I chose a middle ground, removing significant sections of dated material but maintaining sufficient original text to show the continuity between what I foresaw then, what has happened since, and the reasons for my even greater alarm about where we seem to be heading now. I hope I have integrated the old and the new in a way that illuminates how we didn’t “just arrive” at our current peril but were brought intentionally to this place step by intentional step.
That noted, here are the most prominent changes readers will find in this new edition, beyond simple updating of case studies:
• Detailed material about the Terri Schiavo controversy;
• Updated text across several chapters on assisted suicide and euthanasia, including a discussion of the new horrors out of Belgium and reference to the late Brittany Maynard, who became a media-driven celebrity at the end of 2014 for committing assisted suicide;
• Continued and updated discussion of futile care theory;
• A more detailed focus on advance medical directives and a brief discussion of a new form of advance health care planning known as the POLST (physician’s order for life-sustaining treatment);
• Updating the question of health care rationing;
• A discussion of the impact the Affordable Care Act—also known as Obamacare—could have on bioethics;
• A greater discussion of the abortion question while omitting the issue of partial-birth abortion because a federal law was enacted that banned the procedure; and
• New discussion of the question of medical conscience protections and the threat of what I call “medical martyrdom” to health care professionals.
My primary purpose in writing this book has not changed since its original iteration: to alert readers to the subversive impact of bioethics and other ideological agendas on the fundamental moral principles that have long governed the practice of medicine specifically and our society’s values and mores generally. In so doing, I hope to help make these crucial debates about medical ethics and health care public policy accessible to those beyond the so-called expert caste that not only dominates these deliberations but also threatens to transform our health care system into a sclerotic technocracy. Thus, I invite those who will be directly affected by these matters—in other words, each and every reader—to enter into these debates with the understanding that the decisions we make in the next decade about issues such as euthanasia, medical rationing, end-of-life care, and organ transplant ethics—just to name a few—will determine both the future of Western medicine and—dare I say it—the continuing morality of our society.
The hour is late. The cause is urgent. The risks are real. As a greater writer than I once put it, ask not for whom the bell tolls, it tolls for thee.
WESLEY J. SMITH
Castro Valley, California
June 5, 2015
INTRODUCTION (TO ORIGINAL VERSION)
This book is the product of two years’ worth of intensive research and writing, but its genesis goes back much further than that. Since 1993, I have been an anti-euthanasia activist, during which time I have researched, written, appeared on national television and radio, lectured, and engaged in behind-the-scenes activism, fighting not only the euthanasia agenda but also the incursion of what I generally refer to as “related issues” into modern medical practice. My last book, Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder [the title was revised in a subsequent edition to Forced Exit: Euthanasia, Assisted Suicide and the New Duty to Die] dealt primarily with assisted suicide and euthanasia, as the title indicates. With this book, I explore related issues, many of which I believe are as dangerous and urgent as—if not more than—the ongoing public policy wrestling match over euthanasia.
Assisted suicide is just the tip of the iceberg of what has come to be known as the “medical culture of death.” Unbeknownst to most Americans, a small cadre of influential health care policymakers are working energetically and unceasingly to transform medical practice and the laws of health care away from the “do no harm” model established by the great Greek physician Hippocrates and toward a stark utilitarian model that would legitimize not only medical discrimination against the weakest and most vulnerable among us but also, in some cases, their active killing. To make matters worse, the first time many people become aware of what is happening to modern medicine is when they or loved ones experience a health care crisis and suddenly come face-to-face with the monster that they did not even know was lurking in their very midst.
Why are the ethics of our health care system so threatened? Some of it, no doubt, has to do with the times in which we live, in which objective truths are passé and the very concept of right and wrong itself is under assault. But make no mistake—more is at work than just societal drift or passive cultural evolution. The challenges to ethical medical practice and morality explored in this book are promulgated and promoted with great gusto by a cadre of so-called “experts,” a genre of moral philosophers, academics, lawyers, physicians, and other members of the medical intelligentsia known generically as “bioethicists.”
How does one become a bioethicist? It isn’t hard. A bioethicist is as a bioethicist does—no tests have to be passed, no qualifications met. Indeed, practitioners are not licensed, as are other professionals such as attorneys, physicians, real estate agents, or, for that matter, hairdressers. And while more than thirty universities offer degrees in bioethics, there are no standards of education or excellence that apply universally. A Catholic priest can be a bioethicist just as easily as an atheistic college professor. Health care professionals, such as nurses or community ombudsmen, can be appointed to hospital ethics committees, take a few training courses, and then self-identify as bioethicists. Indeed, by writing and lecturing extensively over the last eight years on bioethical issues, including assisted suicide and moves to permit doctors to unilaterally remove wanted medical treatment from dying and disabled people, I could say that I am a bioethicist, too—but I won’t.
Being designated a bioethicist in and of itself is of relatively little import. The title does not give one influence within the bioethics movement or the ability to sway society onto or away from the bioethics path. That is to say, there is a very big difference between being a bioethicist and the ideology of mainstream bioethics, the tenets of which will be described in the first chapter. It is the adherents to the ideology of bioethics—led by a relatively small “insider” group of elite practitioners—who are the bioethicists that hold a steadily increasing sway over the laws of public health, the application of medical ethics, and the protocols that govern hospital care. It is their agenda against which this book primarily warns.
As I began my research for this book, I had no idea the depth of the task that awaited me. Yes, I knew that matters were going badly akilter, but I really had little insight into how far bioethics has already helped push the practice of medicine away from the ideals and beliefs that most “regular” people count on to protect them when they or loved ones grow seriously ill or disabled. Indeed, the more I learned about the present being crafted by bioethicists and the future the mainstream movement seeks to create, the more I felt as if I had fallen through Alice’s looking glass into a Salvador Dalí painting. Our culture is fast devolving into a society in which killing is beneficence, suicide is “rational,” natural death is undignified, and caring properly and compassionately for people who are elderly, prematurely born, disabled, despairing, or dying is a “burden” that wastes emotional and financial resources. Perhaps most worrying: Bioethicists are constructing a system in which the rights of people in the medical system will be based on an explicit hierarchy of human life.
Culture of Death will tell the story of how these nihilistic attitudes are dismantling traditional medical ethics and endangering weak and vulnerable