Thursday, November 19, 2009

Peter Singer, Catholic Directives, and the "Slippery Slope"

I was lucky enough to catch a showing last night of the movie "Examined Life" by Astra Taylor at the Brooklyn Society of Ethical Culture, hosted by (my sometimes other home). It's a beautifully shot series of interviews with a number of philosophers including Cornell West, Martha Nussbaum, Kwame Anthony Appiah, Judith Butler and Peter Singer. They are outside, not in their academic halls or behind desks, talking about ethics, life's meaning, revolution, justice, and cultural relativism, roving around cities in cabs, digging through trash, rowing boats on a lake, or perusing shops on 5th Avenue. While the movie is demanding, the take away is worthwhile.

And in one of life's overlaps, Peter Singer, one of the featured philosophers in the movie, has an article up at the DailyStar today titled, "Voluntary Consent is Neglected in the Euthanasia Debate."

Singer writes that while the Catholic Church and opponents of aid in dying often cite the "slippery slope," the argument that allowing patient-elected aid in dying will result in state or doctor directed assisted suicide, this argument has been disproven in countries and US states where aid in dying is legal. The greater danger, explains Singer, is in what the Catholic Church has decided is theologically acceptable:

In 1957, a group of doctors asked Pope Pius XII whether it is permissible to use narcotics to suppress pain and consciousness “if one foresees that the use of narcotics will shorten life.” The pope said that it was. In its Declaration on Euthanasia, issued in 1980, the Vatican reaffirmed that view.

The Vatican’s position is an application of what is known as “the doctrine of double effect.” An action that has two effects, one good and the other bad, may be permissible if the good effect is the one that is intended and the bad effect is merely an unwanted consequence of achieving the good effect. Significantly, neither the pope’s remarks, nor the Declaration on Euthanasia, place any emphasis on the importance of obtaining the voluntary and informed consent of patients, where possible, before shortening their lives.

According to the doctrine of double effect, two doctors may, to all outward appearances, do exactly the same thing: that is, they may give patients in identical conditions an identical dose of morphine, knowing that this dose will shorten the patient’s life. Yet one doctor, who intends to relieve the patient’s pain, acts in accordance with good medical practice, whereas the other, who intends to shorten the patient’s life, commits murder.

(Incidentally, the Catholic Church supports the use of the "double effect" for pregnant women whose life is in danger: an ectopic pregnancy can be ended by surgery because the objective is to save the woman's life; less invasive medicinal treatment is not allowed because the objective is to kill the fetus.)

Singer uses the example of doctors at Memorial Medical Center in New Orleans who ended the lives of immovable patients during Katrina rather than let them suffer alone and unattended in the hospital after nurses and other patients were evacuated. Of one doctor and what occurred at Memorial, Singer writes:

Cook had little time for such subtleties. Only “a very naive doctor” would think giving a person a lot of morphine was not “prematurely sending them to their grave,” he told Fink, and then bluntly added: “We kill ‘em.” In Cook’s opinion, the line between something ethical and something illegal is “so fine as to be imperceivable.”

At Memorial Medical Center, physicians and nurses found themselves under great pressure. Exhausted after 72 hours with little sleep, and struggling to care for their patients, they were not in the best position to make difficult ethical decisions. The doctrine of double effect, properly understood, does not justify what the doctors did; but, by inuring them to the practice of shortening patients’ lives without obtaining consent, it seems to have paved the way for intentional killing.

And concludes:

Roman Catholic thinkers have been among the most vocal in invoking the “slippery slope” argument against the legalization of voluntary euthanasia and physician-assisted dying. They would do well to examine the consequences of their own doctrines.

By poking a finger at the Catholic Church's directives, Singer means to turn the "slippery slope" argument around on them, insinuating that patients' consent is already undermined by Catholic doctrine. He pits the Church and medical profession against one another (at a time when the Catholic Church is working double duty to "protect" doctors with conscience clauses so long as they do the Church's bidding).

Yet Singer fails to address what ethical decisions the doctors at Memorial should have made: should they have allowed the immobile patients to die in suffering? Should they have risked their own lives and the lives of their staff by remaining with patients?

The Catholic Church has never been a strong defender of patients' rights in any way. They are too invested in their own fight for jurisdiction over suffering, working to impose their own doctrines over end of life situations for both patients and doctors.

The medical profession too has not strongly come out on the side of patient's rights; they have their own claims to suffering that are enforced by the contemporary nature of their profession: aggressive treatment, avoidance of developments and investment in hospice and palliative care, reticence to talk about death, what the doctor views as failure.

The Death with Dignity, aid in dying movement - a movement that has asserted around the world a patient's right to choose how they die - works to prepare patients for those questions and establishes that the patient is the one who controls their death decisions with advanced directives, medical proxies, and access to information. This is done in conjunction with doctors and family members in a way that prepares all parties to accept and enact a patient's decisions.
What occurred at Memorial hospital had nothing to do with patients' rights, as Singer points out. It was a crisis situation that forced doctors to determine the best way to keep patients from needless suffering. It's a practice, mercy killing, as old as time.

The Catholic Church's directives on the "double effect" had little bearing on the doctor's decisions: with or without Catholic approval, the "double effect" is used in hospice and retirement facilities and hospitals across the country every day to prevent suffering and to protect doctors from prosecution. It shocks us because we don't like to talk about it; because we don't often have to face how we die in such a graphic manner as the Memorial event portrays.

If Singer's purpose is to show the complicity the Catholic Church has in the erosion of patient's rights - in essence, that they have created their own slippery slope - I fear he has chosen the wrong example; yet the point is incredibly valid. (Note the USCCB's recent decision to reclassify removal of patients from artificial nutrition and hydration as impermissible, despite the patient's advance directives.)

If the purpose of the article is to assert patient's rights, again, the sad situation in New Orleans would not have been helped if all the patient's choices had been written on their charts. And lastly, if he intends to vilify doctors like Cook who had few if any options of how to keep abandoned patients comfortable, his argument is unconvincing.

In "Examined Life," Slavoj Zizek addresses what he calls, "the temptation of meaning." Once we assert ideas of "meaning" on life, we tend to stop questioning that meaning, we cling to old traditions, beliefs or practices that may no longer apply. I wonder if Singer's ethics have settled on a meaning of patients' rights that advancement in medicine and the stagnation of Catholic doctrine have too long dictated and obfuscated. Perhaps it's time to find a new meaning.

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