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“Duty to Die”

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The “Duty to Die” Advances

by The Center for Bioethics and Culture on OCTOBER 19, 2011
By Wesley J. Smith, J.D., Special Consultant to the CBC

Is there such a thing as a “duty to die?” Some notable voices
in bioethics say, yes. They believe that as a matter of
distributive justice, when people reach a certain advanced
age, severe disability, or very poor health, they owe it to
society, their families—and even themselves—to allow life to
(or make it) end.

Thus, in 1997, University of Tennessee bioethics professor,
John Hardwig, wrote in the prestigious Hastings Center Report,
“A duty to die is more likely when continuing to live will impose
significant burdens—emotional burdens, extensive caregiving,
destruction of life plans, and yes, financial hardship—on your
family and loved ones. This is the fundamental insight underlying
a duty to die.”

One of the United Kingdom’s leading bioethicists, Baroness Warnock,
has also supported the duty to die. As reported by the UK’s
Independent newspaper in 2008:

She is quite happy with the notion of the ‘duty to die’ . . .
A couple of months ago, in an interview with the Church of Scotland’s
magazine Life and Work, she said: “If you’re demented, you’re wasting
people’s lives—your family’s lives—and you’re wasting the resources
of the National Health Service.”

To date, no country has actually enacted such a legal requirement on
its citizens. But that should not make us sanguine. To the contrary,
a through-the-back-door duty to die has already been launched through
policies that permit doctors to refuse so-called “futile” treatments.

Futile Care Theory, aka “medical futility,” has been on the bioethics
movement’s agenda for more than ten years. Here’s how it works: If
a patient or their family want life-sustaining treatment—generally
in the ICU setting—but doctors and/or bioethicists think it is
“inappropriate” based on quality of life or cost/benefit judgments,
the treatment may be unilaterally withheld or withdrawn. Let’s be
clear: “Futile care” treatments aren’t refused because they don’t
work. To the contrary, they are denied because they keep the patient alive.

Futile Care principles have now escaped the ICU with the growing
trend to deny life-extending cancer treatment to terminally ill
patients, often outside the hospital setting. For example, a committee
of doctors in Lancet Oncology recommended rationing cancer
therapies that won’t save—but could extend—terminal cancer patients’
lives. From the Daily Mail story:

Such uncompassionate denials have already been imposed on unwilling
patients in the USA. For example, Medicaid is legally rationed in Oregon.
In 2008, two cancer patients were refused coverage for prescribed
chemotherapy that would extend their lives for months. Showing t
the current trend, the state instead offered to pay for their assisted
suicides. (One of the patients received the treatment free from the
pharmaceutical company. The decision about the other was reversed after
a public outcry.)
The duty to die tide is flowing, and it won’t stop with the terminally
ill. When I was researching my book Culture of Death, I interviewed
an advocate of medical futility and noted that refusing ICU treatment
wouldn’t save a lot of money. I asked what futilitarians (as I call them)
would try to cut next? He responded, “marginally beneficial care.”
His example? Refusing mammograms to women above the age of 80.

Make no mistake, when medically efficacious treatment is denigrated as
“futile” or “marginally beneficial,” it isn’t really the care that is
being so described, it is the patients.

CBC special consultant Wesley J. Smith is a Senior Fellow in Human
Exceptionalism at the Discovery Institute and a lawyer for the
Patients Rights Council. 25/01/17

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