Christopher’s temperature subsided. Soon thereafter he was moved to a rehabilitation center for therapy and began a slow recovery. Not long after, he moved home with his parents, where he spent his time relearning to walk with assistance and worked at a local youth center where he fed animals and counseled at-risk teenagers. Oh yes, Christopher felt very glad to be alive, as were his parents and the many troubled people he helped everyday.3
As I have spent more than twenty years traveling the country (and internationally) speaking about assisted suicide and other issues involving the ethics of modern medicine, as people react to my appearances on talk radio, television programs, and to my newspaper and magazine columns, with multiplying frequency I hear similar medical horror stories. People are afraid. They are deeply worried about what is happening to medicine: the potential impact of the Affordable Care Act (ACA, also known as Obamacare), doctors pressured by HMOs to reduce levels of care, hospital nursing staffs cut to the bone, the sickest and most disabled abandoned to inadequate care, elderly people dying in filthy nursing homes or in agony because their doctors fail to prescribe proper pain control.4 There have even been reported instances of desperate patients in hospitals calling 911 because they were unable to access needed medical attention.5
These anecdotes are symptoms of a disintegrating value system in health care that disdains the sickest and most disabled among us as having lives that are not worth living; that views expensive medical treatments for such people as a waste of valuable resources; indeed, that accepts their demise—or increasingly, even their killing—as a legitimate answer to the difficulties caused by their serious illnesses and disabilities. In short, the ethics of health care are devolving into a stark utilitarianism that is quickly transforming the “do no harm” tradition of medicine that has for millennia been the cornerstone—and hope—of medicine.
At the same time, medical economics are exerting a gravitational pull into the moral abyss. For example, when Arizona’s Medicaid program—the state/federal health insurance for the poor—ran into significant money problems, it canceled organ transplant surgeries for 98 percent of those eligible for the procedure.6 As this book will explain—sometimes in painful detail—with medical technology growing ever more sophisticated and expensive, while the viability of the old sanctity/equality of life ethic comes under increased cultural pressure, these kinds of controversies are going to become increasingly common and the divisions they sow among us more deep and viscerally felt.
THE NEW HIGH PRIESTS
We have not entered this era of potential medical authoritarianism by chance. We were steered into it by an elite group of moral philosophers, academics, doctors, lawyers, and members of the medical intelligentsia—known generically as bioethicists—who have dedicated themselves over the last four decades to bending public and professional discourse about medical ethics and the broader issues of health care public policy to their desires. They are the cultural aggressors, as the mainstream view in the field is openly hostile to the traditional moral values and ethical traditions of our society.
Medical ethics focuses on the behavior of doctors in their professional lives vis-à-vis their patients. Bioethics focuses on the relationship between medicine, health, and society. This last element allows bioethics to pursue policies that go far beyond the well-being of the individual and to presume a moral expertise of breathtaking ambition and hubris. Many view themselves, quite literally, as the forgers of “the framework for moral judgment and decision making”7 who will create “the moral principles” that determine how “we are to live and act,” a “wisdom” they perceive as “specially appropriate to the medical sciences and medical arts.”8 Indeed, some claim that “bioethics goes beyond the codes of ethics of the various professional practices concerned. It implies new thinking on changes in society, or even global equilibria”9 (my emphasis). Not bad for a school of thought that has only existed for about forty years.
Bioethicists typically see their work as integrating “medical ethics and universal morality” beyond “a few general principles” toward the determination of “the meaning of the good life.”10 It is “both a discipline and a public discourse, about the uses of science and technology” and the “values about human life . . . with a view toward the formation of public policy and a teachable curriculum.”11 Put more simply, bioethics seeks to create the morality of medicine, define the meaning of health and wellness, and determine when life loses its value (or has less value than other lives) toward the end of forging the public policies and influencing the individual choices that will establish a new medical and moral order. More than a set of tenuous speculations, bioethics in recent years has ossified into an orthodoxy and perhaps even an ideology.
Many bioethicists rejected this claim after the publication of this book’s first edition. They act in good faith, these objectors contended. The “quality of life” ethic will create a better world. Besides, they argued, bioethics is not monolithic.12 After all, practitioners have widely divergent opinions about these issues and controversies—ranging from assisted suicide to cloning to the definition of “health”—with which bioethics discourse grapples. Moreover, many adherents claim, bioethics doesn’t have an end goal. It is more akin to a conversation among professional colleagues, a process that merely seeks consensus about the most pressing moral and medical issues of our time.
If that were ever true, I contend that it is true no longer. Bioethics, at least of the kind without a modifier (conservative bioethics, Christian bioethics, etc.) may not be a monolith—a claim I never made. Disagreements certainly exist within the field. But they are more akin—with some exceptions—to the arguing of people who agree on fundamentals but disagree on details—sort of like Catholics bickering with Lutherans.
Most bioethicists recoil at their depiction as “true believers” subject to orthodox precepts and the emotional zeal generated by intensely felt ideology. Their self-view is that of the ultimate rational analyzer of moral problems who, were pipe smoking still fashionable, would sit back, pipe firmly in mouth, acting as dispassionate “mediators” between the extremes of medical technology and the perceived need for limits.13
But that is self-deception. Once bioethics moved away from ivory tower rumination to actively influence public policy and medical protocols, by definition the field became goal oriented. Indeed, University of Southern California professor of law and medicine Alexander M. Capron noted that from its inception, “bioethical analysis has been linked to action.”14 If dialogue is linked to action, at the very least that implies an intended direction, if not a desired destination. Even bioethics historian Albert R. Jonsen, a bioethicist himself, calls bioethics a “social movement.”15 Has there been any social movement that was not predicated, at least to some degree, in ideology? Moreover, bioethics pioneer Daniel Callahan, cofounder of the bioethics think tank the Hastings Center, has admitted that “the final factor of great importance” in bioethics gaining societal respect was the “emergence ideologically of a form of bioethics that dovetailed nicely with the reigning political liberalism of the educated classes in America.”16 Thus, mainstream bioethics is explicitly ideological, reflecting the values and beliefs of the cultural elite.
I asked the venerable author, medical ethicist, and physician Leon R. Kass, MD, whether he shares my opinion. Kass told me, “With due allowances for exceptions, I think there is a lot to be said for that view. There are disagreements about this policy or that, but as to how you do bioethics, what counts as a relevant piece of evidence, what kinds of arguments are appropriate to make, there is a fair amount of homogeneity. If you don’t hone to that view, you are considered an outsider.”17
The noted sociologist Renée C. Fox, a close observer of bioethics from its inception, told me in a similar vein, “I would call it an inadvertent orthodoxy. You could even call it ideology, depending on how you define the term.” Fox added, “I do think bioethics has gotten institutionalized. It is being taught in every medical school in this country. The training people receive and the content of the curriculum of the short courses as well as the masters’ and doctoral programs,