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Nine-year-old Mikey came to see me today. His parents wanted a second opinion about the tumor that is growing out of control a hair's breadth from that part of his brain that tells his lungs to breathe, his heart to beat. Mikey sat in a wheelchair during our visit, his eyes closed against the light, ears plugged to mute the ambient noise. This helps his headache.

"What do you want, Mikey?" his mother asked, softly.

"I want to live," Mikey said.

Mikey is not afraid of death itself. He knows Jesus, and the two of them have discussed this matter thoroughly. His oncologist gave him only four more days to live, but Mikey and Jesus don't agree. That was weeks ago. Like most dying children, Mikey will make a fool out of any doctor who pretends to be a prophet.

The team at the hospital who treated Mikey had their own nurses to follow terminally ill children through to the end at home. But managed care has changed all that. The family's insurance offers hospice services, but only through a provider of the company's choice. The first day the "hospice" nurse came to Mikey's home, she criticized the oncologist's prescriptions.

"We need to get him off Decadron," she said to his mother, about the steroid used to reduce the swelling in his brain.

"But it helps with his headaches," his mother pointed out.

"We'll use morphine for that," the nurse informed.

"But Decadron has helped the headaches before, and it doesn't depress his breathing," his mother responded (correctly).

"Decadron will only prolong things," said the nurse of the child who does not yet intend to die.

Even before the Supreme Court has spoken its piece on physician-assisted suicide (PAS), the merchants of managed death are recasting the name hospice into their own cost-effective, choice-limited toboggan ride down the slippery slope. While the country's focus has been riveted on highly vocal sufferers who want to cut their own lives short, few are listening to dying people who do not want to shorten their lives, even by a day.

A "right" that is simply wrong
Joseph Cardinal Bernardin is one voice that may be heard. "There can be no such thing as a 'right' to assisted suicide," he wrote during the last week of his life. The most straightforward and pastoral of the 62 amicus curiae briefs filed with the Court came from a saint who had already finished his race before the honorable justices began hearing arguments on January 8 to permit states to allow physician-assisted suicide.

"Creating a new 'right' to assisted suicide will endanger society and send a false signal that a less than 'perfect' life is not worth living," wrote Bernardin. pas "introduces a deep ambiguity into the very definition of medical care, if care comes to involve killing."

On the opening day of arguments in the Supreme Court, several wise justices verbalized their misgivings about such a right. Justice Ruth Bader Ginsburg expressed her concerns about giving such a dangerous power to the medical profession. The Clinton administration weighed in as opposed to PAS as well, but polls continue to demonstrate that the majority of the American public supports its legalization.

Today we struggle with issues of life and death in a culture that denies the existence of a common ethic. For many years, the first principle of the medical ethic was that of beneficence—generosity of the healer toward one's fellow beings. But relying on physician beneficence was not an adequate safeguard for Jews in Nazi Germany. In the wake of the Holocaust and disclosure of the role that physicians played in the carnage, society turned to the law to bridge that ethical gap. Thus, the Geneva Convention and the Nuremberg Code, with their emphasis on the rights of individuals and autonomy, supplanted the Hippocratic tradition. Today the debate over physician beneficence and patient autonomy is carried out in the courts.

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March 3 1997, Vol. 41, No. 3