OPINION:
The Covid-19 pandemic is making armchair bioethicists of all of us. In a world of limited medical resources — too few ICU beds for too many gravely ill patients — it’s only natural to wonder if we can safely rely on physicians to make the right triage decisions. It’s worrisome that Western medicine has been trending away from its noble (patient-centered) Hippocratic beginnings toward a utilitarian (society-centered) ethos.
Sadly, practices like elective abortion and assisted suicide promote this trend, as doctors grow comfortable with the moral acceptability of causing harm (to the fetus in abortion) or seeing some lives as “not worth living” (assisted suicide).
In the late 1990s, I did my medical training in a busy public hospital in Miami. It did not allow abortions, and this was long before suicide was considered a supportable end-of-life option. We had an especially busy trauma center; patients came in with gunshot wounds almost every night. On our long shifts, we not only learned technique but something equally important: How to treat each patient with the same zeal and consideration, even though many were the hardest of hardened criminals.
Not infrequently a drug-gang member slated for prison and his innocent victim would be fighting for their lives in adjoining rooms. And both trauma teams would be striving, with equal passion, to save them.
The lesson: Any judgment of a patient’s worth or value to society, or his or her quality of life, had to be withheld. Our job was to save lives, and all lives were, to us, sacred.
Sometimes every room was full, every medical team engaged, and the rescue units kept rolling in. Difficult choices had to be made about the allocation of resources and manpower. Standing on the foundation of person’s equal dignity, no matter that person’s race, ability, age, social position, value or danger to society, we learned to make decisions based solely on the patient’s clinical state. Those with the best chance of survival were given priority. The question was never “Is the patient worthy of treatment? The question was always “Is the treatment worthwhile?
Nothing in our training contradicted these noble ethical principles. On obstetric rotations, every pregnant woman presented the clinical challenge of bringing two separate and equal patients — mother and child — through safely. Elective abortions — procedures in which the mother’s desire to no longer be pregnant is given more weight than her son or daughter’s life — were not offered or performed.
When treating the terminally ill, the elderly and severely disabled, the only goal was to keep their pain and discomfort at bay and diminish their fear and loneliness through tender accompaniment. Offering them a poison pill to do away with themselves, as though their lives were a burden too heavy to help them carry, was inconceivable.
Fast forward 20 years. About one in five Americans now live in states where assisted suicide is legal, and the normalization and acceptance of the practice grows apace. Likewise, a poll of 1,000 physicians in 2019 showed that more than half now approve of the practice. This is a sea change in how doctors see their duty to patients.
No longer is it the doctor’s duty to preserve and enhance the lives of all the men and women in their care by using ordinary means and providing loving palliative care. No, now there exists a special subset of patients whose lives are deemed so miserable, so useless that their doctor should help end them. Two classes of patients requiring two different approaches from physicians.
A similar scenario plays out in abortion. Doctors who find elective abortion to be morally acceptable believe that there are two classes of fetuses — those wanted by their mothers and those whose existence is inconvenient or onerous to their mothers — and that it is ethical to support the dignity and rights of the first class while denying those of the second.
The growing normalization of these practices in health care predispose the medical mind to an all-too-human temptation: That of elevating the worth of one human life over another. This is dangerous in medical triage. Why? Because, by utilitarian standards (in a culture which idolizes youth and health) the elderly and disabled are less worthy of treatment, because they lack future productive value and chances of future happiness.
This health care trend toward a utilitarian ethos that tramples on the doctor-patient bond is not irreversible. In many ways, it is the result of vocal minorities within the profession pushing political agendas that a majority of the public and profession instinctively rejects. The courage, dedication and selflessness of our front-line health care workers in this pandemic have shown us just how noble our doctors and nurses are. We must trust that they are also too noble to yield to the temptation to play God with the lives of others.
• Grazie Pozo Christie, MD, is a policy adviser for The Catholic Association.
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