Smith False History and Leaps of Faith.

It's hard to believe that Wesley J. Smith has been watching the assisted suicide movement for the past 17 years and still has to publicly ask the question, "Why Now?" Yet this is the shallow and disingenuous hook on which he hangs his new article at the Catholic magazine Legatus. After spending three paragraphs spinning the recent history of the aid in dying movement as a powerful force railroading the sanctity of life -- and seemlessly sliping in a new usurpation of social activism terminology, "sanctity/equality of human life"! -- he writes:

A question amidst all of this Sturm und Drang naturally arises: Why now? After all, 100 years ago when people did die in agony from such illnesses as a burst appendix, there was little talk of legalizing euthanasia. But now, when pain and other forms of suffering are readily alleviated and the hospice movement has created truly compassionate methods to care for the dying, suddenly we hear the battle cry “death with dignity” as “the ultimate civil liberty.”

With respect to Smith's long years on the euthanasia beat, this is a laughable misrepresentation of history -- and one that he certainly knows better of. While Smith's essay concoctions are typically junk-science based, they're at least sincere. But, as any reader of Ian Dowbiggin will tell you, the roots of the aid in dying (or euthanasia or assisted suicide) movement are far longer and deeper than Smith is letting on. Simply noting the rise of Christianity's condemnation of suicide and assisted suicide doesn't change the rates of each in pre-, modern, and post-modern society. Condemnation of practice is necessarily precluded by said practice....

He writes that there are two reasons why the aid in dying movement has scored some successes since 1994 (Death with Dignity is legal in two states, Oregon (1994), Washington (2008) and in Montana (New Year's Eve, 2009) the Supreme Court ruled that nothing in the state constitution prohibits doctor prescriptions of legal drugs for the terminally ill). Well, really he gives three:

First, the perceived overriding purpose of society has shifted to the benefit of assisted suicide advocacy, and second, our public policies are driven and defined by a media increasingly addicted to slinging emotional narratives rather than reporting about rational discourse and engaging in principled analysis. Add in a popular culture enamored with social outlaws, and the potential exists for a perfect euthanasia storm.

I've bolded the points. For someone lamenting the lack of "principled analysis" and "rational discourse," Smith seems to rely heavily on some "emotional narratives" himself! One can't combat poor logic with more of the same (The media promotes assisted suicide? Kevorkian (the assumed social outlaw, noted at the start of the article) is a boon to the assisted suicide movement?) Nor can one condemn "slinging emotional narratives" when advocating for Terri Schiavo's family and touting the "discovery" of Rom Houben, clear examples of Smith's own effort to sling "emotional narratives."

But let's play Smith's game of "Why Now?," but use facts like: the relatively recent advent of widely accessible palliative care and pain cessation; the lightening-quick advancement of technologies like defibrillators and respirators which have changed the definition of death (once the almost simultaneous cessation of lung, heart and brain function, now something that happens when machines are removed); the prevalence of CPR, 9/11 and other resuscitating procedures that, despite public understanding (thanks in part to medical shows) work about 15% of the time (to be released from the hospital) and often leave surviving patients with broken ribs and/or in persistent vegetative states; the rise of patient autonomy activism to give patients the ability to make their own decisions regarding health care, against the prevailing influence of a paternal medical system (women in the 70s were often given full mastectomies without being consulted); a medical and social culture that condemns dying patients as weak, unable to fight, and doctors as failures, as if death can be put off indefinitely; a "survivor" culture that celebrates those who recover from debilitating disease and, as with breast cancer, thus focuses fundraising and research on cures rather than preventions.

Yes, these developments have all occurred since the 1970s. Yes, they have jeopardized our economic stability by reducing health care to a privilege. Yes, they have been ignored by ideologically motivated individuals like Smith who would rather go on about emotional narratives, the fall of man, the horrors of media and Jack Kevorkian, a decline in human virtue, and the "culture of death." Yes, the powerful "pro-life" groups that have supported the rise of the Medical Right and the Legal Right have continued to cry persecution as they've worked to impose their idea of morality and ethics on the whole of society.

Smith's proof that he's right about the three causes of the movements recent escalation? Suffering! Virtue!

Social commentator Yuval Levin, a protégé of ethicist Leon Kass, described the new societal zeitgeist in his recent book Imagining the Future: Science and American Democracy. While not about assisted suicide per se, Levin hit the nail on the head when he described society as no longer being concerned primarily with helping citizens to lead “the virtuous life.” Rather, he wrote, “relief and preservation from disease and pain, from misery and necessity” have “become the defining ends of human action, and therefore of human societies.” In other words, preventing suffering and virtually all difficulty is now paramount.

Smith's extrapolation from that elegistic longing for (persistent) paternalistic, white, Christian-dominated, authoritarian times? "In such a cultural milieu, eliminating suffering easily mutates into eliminating the sufferer." How? He doesn't say. And he doesn't show examples beyond his own fact-less assertions. But he is toeing the same illogical line that we often hear from those who find glory in suffering (of the dying, of sexually active teens, of coerced women, of gays.) "If we could only save these sinners from themselves?!" he seems to say. Because ultimately, Smith and those who refuse to examine the effects of their "pro-life," discriminatory advocacy are really working to make all of society ascribe to their values, their rules, their false narratives and their beliefs. The fight over aid in dying (and abortion and gay rights, etc.) is really a fight for power; power for a select and moralistic few to tell all the citizens of our country what we should be doing.

As Tony Judt writes, there's another objective behind obscuring facts and thwarting serious, statistics-based discussion in the public square:

Today, we are encouraged to believe in the idea that politics reflects our opinions and helps us shape a shared public space. Politicians talk and we respond—with our votes. But the truth is quite other. Most people don’t feel as though they are part of any conversation of significance. They are told what to think and how to think it. They are made to feel inadequate as soon as issues of detail are engaged; and as for general objectives, they are encouraged to believe that these have long since been determined.

The perverse effects of this suppression of genuine debate are all around us. In the US today, town hall meetings and ‘tea parties’ parody and mimic the 18th century originals. Far from opening debate, they close it down. Demagogues tell the crowd what to think; when their phrases are echoed back to them, they boldly announce that they are merely relaying popular sentiment.

Ultimately, Smith tries to accomplish a number of things in his article, though his success is reliant on his readers' lack of curiosity about the real changes that have heightened discussion about futile care, aid in dying, living wills and advance directives, provider refusals, patient autonomy, organ donation and discrimination in health care. If he can paint them all as an offense to the "sanctity of life" he mis-frames and misleads the discussion from the facts. The agenda of his article is:

- make a case for "virtuous" suffering, as if "virtue" and "suffering" are clearly defined by all members of our racially, culturally, functionally diverse society

- conflate Kevorkian with the aid in dying movement when, while supporters of each may overlap, they are hardly a monolithic advocacy movement

- usurp rights, equality, and autonomy language (long the province of left-leaning advocacy) to his own "pro-life" purpose; this conflation of terms (particularly regarding abortion and feminism) has proved a successful "pro-life" juggernaut for true rights advocates

- stymy meaningful, substantive public discussion by narrowing, limiting, falsely framing the ways in which we discuss human autonomy, suffering, futile care, life, faith, and death; Smith has no interest in examining the facts surrounding superior end of life treatment and planning in states where Death with Dignity is legal; in looking at the ways medicine has until recently failed those who faced painful deaths; no facts on the cases of suicide or mercy killing that occur in the US because of extreme suffering; no discussion of futile care "tracks" that push suffering patients into one unhelpful treatment after another

- he pretends that history is static, that the idea of "traditional values" actually once represented the whole of society; an old tactic by those who wish to continue discrimination against gays, women, elders and those who do not live by dominant culture's rules

I often tackle Smith's vacuous, over-simplified articles; we can hardly ignore him when he has so much influence and plays such an important -- if self-aggrandized -- role in the "pro-life" movement. But I think singling out Smith is instructive for those of us who believe in human rights and liberty. He represents the larger thinking in anti-choice movements; he works for the Discovery Institute, a well funded promoter of bunk science like "Intelligent Design"; and he serves as a case study for how organized, influential, well-funded and well-promoted foes of individual rights are. He and others can cry persecution all they want; but I'm hopeful that the increasing prevalence the aid in dying (and other human rights) movement(s) will help the public discourse. We can't deny death forever.

Persecuted Doctors and Government Regulation of Health Care.

This cartoon image accompanies a post at Monty Pelerin's World of a 2000 article by a doctor about the "poor doctors" who are being unjustly subjected to government regulation. Of course the article is written by a doctor, a member of a profession which has for decades used its wealth, clout, authority, and professional associations to deny patients' rights and an overhaul of the medical industry. Doctor's gains of greater autonomy have been patients' loss, as is clear when the current state of care is assessed. Using doctors' authority to determine how the government should proceed in regulating delivery of medicine is like relying on the banking industry to look out for the public's financial needs. It doesn't work.

There's a lot of talk lately, spurred by the failed attempt by the Obama administration to reform the medical - and particularly the insurance - industry and regulate quality, affordable, accessible medicine for all, that doctors will be damaged by any regulation of "their" industry and practices. What has resulted from this tussle between patients' rights advocates, the medical industry, the church and the state is a failed bill that rewards the insurance industry with mandated payments for care. We're going the wrong way, progressive rightly claim. Yet another industry has been given a pass to discriminate, control, and financially thrive on the restrictions it exerts to the detriment of patients, particularly women, the poor, the elderly and the gay community.

What doctors claim is an entirely different thing. Despite the AMA's belated support for the plan - and why shouldn't they support a reform plan that essentially makes no reforms and brings more patients into their closed system - the association has historically worked to prevent any regulation of medicine delivery. As can be expected, their role is to advocate for doctors' rights, not patients'. Unfortunately, theirs is a position respected by the state and often the church.

A recent ad campaign by conservative doctors claims that health care reform will create a shortage of doctors, yet the AMA has long determined how doctors are trained - and how many. Any shortage of doctors will be in the general practitioner category because the association has protected and encouraged medical specialization. That's where the money is, where the prestige is. These new claims that reform or "socialization" in the form of government regulation will create a shortage is disingenuous from an industry that has worked to limit general practitioners. If you're a supplier, you want to keep your costs up by limiting access to your service. Since the advent of Medicare, the industry has kicked and screamed against further extending their reach in favor of specialization.

So these are the two prongs that the AMA has successfully worked in their fight against greater access for all citizens: prevent government regulation; and control the number of doctors available and in what discipline. It's a power play, pure and simple, which leaves patients' rights out of the equation.

Two weeks ago, I had the opportunity to communicate with the former chair of the AMA's Council on Ethical and Judicial Affairs. According to this doctor, patients had no rights because mandating such would infringe on doctor's rights. In other words, the doctor was the individual who should be left to decide what a patients receives. He actually likened a woman's need for a tubal ligation, unmet by providers in her area, to the challenges a consumer may have in finding collard greens for Thanksgiving or a new coat only sold at a department store the next city over.

This position, that care is not a right but a commodity, is abetted by religious cries for strict conscience clauses in health care reform. While I of course believe that individuals should be left to determine their own conscientious guidelines for their work, I do not think that such a decision should be allowed to institutions which receive government funding and are responsible to the entirety of society. You staff a doctor who won't inform, perform or refer a woman for abortions? You are discriminating against that woman's rights unless you provide a manner in which she can get the care she needs. Anything short of giving a woman a full range of options should never be allowed or funded by the government, to hell with institutional conscience, association ethics, government funding, church demands. If we are to develop a medical system that serves patients, we must do so without reserve or discrimination.

Our failed attempt to reform health care this year is yet another sad chapter in the demonstration of monopoly of medicine by the industry itself, left alone to regulate it's own responsibilities without the interference of government on behalf of the needs of patients.

Screaming that doctors will be forced out of medicine, that the AMA and doctors are being discriminated against, that government regulation of delivery of what should be considered a human right, is all unjustified claim of persecution. The "poor doctors" have been doing just fine for themselves. It's time to address the needs of the poor patients, as doctors' oath to the profession demands.

Church, State, and Marriage in New York.

Mitchell Bard, in a post at HuffingtonPost, takes down New York State's recent refusal to grant same-sex couples the right to marry. The decision is unconstitutional, he says:

Marriage has two essential elements to it. First, it is a union recognized by most of the world's major religions as being between a man and a woman. Second, and completely separate from the issue of religion, marriage is a contract between two individuals recognized by the 50 states. You will note that I identify the second element as completely separate from the first one because of a nifty little amendment to the U.S. Constitution (the first one, in fact) that reads, in relevant part:

"Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof"

Thanks to more than a century of U.S. Supreme Court decisions, we can safely conclude that, among other things, the First Amendment prevents the government (states are bound by the First Amendment via the Fourteenth Amendment, ratified after the Civil War) from enforcing religious decisions in carrying out its business. As such, it is not incumbent on the states to enforce religious laws on marriage, nor may the states force religious leaders to carry out certain policies that violate their faiths.

So there is religious marriage (based on the rules of a couple's faith) and state marriage (essentially a civil contract under which certain rights and responsibilities become enforceable under state law).

Now, there is no doubt that many American religious leaders feel that the marriage of two men or two women violates the rules of their faiths. While I can't support their bigoted views, I would be quick to defend their right not to marry two men or two women. That is a decision the state has no place getting involved in. And religions are not bound by any responsibility to treat their followers fairly or to extend them equal rights. If Catholics do not want to let women become priests, or if Orthodox Jews do not want to allow women onto the bimah (altar) during services, or if any other religion chooses to extend fewer rights under the rules of the faith to one group or another, that is the right of those religious institutions to do so. It's up to the members of the religious institutions to decide if they want to be part of a religion that discriminates in these manners.

But the government doesn't enjoy the same leeway as the religions. In fact, the Constitution, federal law and state law are filled with provisions that assure just the opposite, that every American should be treated equally under the law. So if a state decides to grant the right of two men or two women to marry, that is the state regulating state business (and I would argue it's both the legal and moral obligation of the state not to pick and choose to whom it extends these rights and responsibilities). The state isn't telling any priest, reverend, rabbi or imam to marry two men or two women, nor is it requiring the religions to accept the couples as being married under their faiths (in the same way that if a Jew and a Baptist are married by the state, the state doesn't require Orthodox rabbis or Baptist ministers to recognize the marriage in their faiths).

In other words, religious marriage is the domain of the religions, and state marriage is the domain of the states. And under the First Amendment, the states are not supposed to force religious rules on its people, nor are they to interfere in the beliefs of the religions. Seems simple enough.

Aid in Dying and the Manhattan Declaration.

I've culled the Manhattan Declaration for language on aid in dying - so you won't have to! Excerpts below.

(I'd like to note, by the way, that as I write, the Declaration has about 6,000 signatures.)

Because the "slippery slope" argument allows that legalization of "euthanasia" occurred because of the legalization of abortion and the rise of the "culture of death," often "sanctity of life" language includes both abortion and aid in dying.

And a snide aside: I find the "render unto Caesar" stuff really tacky. These organizations use the first amendment to provide social services to the public, all the while enjoying tax exemptions and suckling at the federal government's teet to the tune of 50% of their hospital budgets. (See my prior post for a quote about tax evasion "civil disobedience.")

A culture of death inevitably cheapens life in all its stages and conditions by promoting the belief that lives that are imperfect, immature or inconvenient are discardable. As predicted by many prescient persons, the cheapening of life that began with abortion has now metastasized. For example, human embryo-destructive research and its public funding are promoted in the name of science and in the cause of developing treatments and cures for diseases and injuries. The President and many in Congress favor the expansion of embryo- research to include the taxpayer funding of so-called “therapeutic cloning.” This would result in the industrial mass production of human embryos to be killed for the purpose of producing genetically customized stem cell lines and tissues. At the other end of life, an increasingly powerful movement to promote assisted suicide and “voluntary” euthanasia threatens the lives of vulnerable elderly and disabled persons. Eugenic notions such as the doctrine of lebensunwertes Leben (“life unworthy of life”) were first advanced in the 1920s by intellectuals in the elite salons of America and Europe. Long buried in ignominy after the horrors of the mid-20th century, they have returned from the grave. The only difference is that now the doctrines of the eugenicists are dressed up in the language of “liberty,” “autonomy,” and “choice.”

We will be united and untiring in our efforts to roll back the license to kill that began with the abandonment of the unborn to abortion. We will work, as we have always worked, to bring assistance, comfort, and care topregnant women in need and to those who have been victimized by abortion, even as we stand resolutely against the corrupt and degrading notion that it can somehow be in the best interests of women to submit to the deliberate killing of their unborn children. Our message is, and ever shall be, that the just, humane, and truly Christian answer to problem pregnancies is for all of us to love and care for mother and child alike.

A truly prophetic Christian witness will insistently call on those who have been entrusted with temporal power to fulfill the first responsibility of government: to protect the weak and vulnerable against violent attack, and to do so with no favoritism, partiality, or discrimination. The Bible enjoins us to defend those who cannot defend themselves, to speak for those who cannot themselves speak. And so we defend and speak for the unborn, the disabled, and the dependent. What the Bible and the light of reason make clear, we must make clear. We must be willing to defend, even at risk and cost to ourselves and our institutions, the lives of our brothers and sisters at every stage of development and in every condition.

Our concern is not confined to our own nation. Around the globe, we are witnessing cases of genocide and “ethnic cleansing,” the failure to assist those who are suffering as innocent victims of war, the neglect and abuse of children, the exploitation of vulnerable laborers, the sexual trafficking of girls and young women, the abandonment of the aged, racial oppression and discrimination, the persecution of believers of all faiths, and the failure to take steps necessary to halt the spread of preventable diseases like AIDS. We see these travesties as flowing from the same loss of the sense of the dignity of the human person and the sanctity of human life that drives the abortion industry and the movements for assisted suicide, euthanasia, and human cloning for biomedical research. And so ours is, as it must be, a truly consistent ethic of love and life for all humans in all circumstances.

And the most oft quoted paragraph:

Because we honor justice and the common good, we will not comply with any edict that purports to compel our institutions to participate in abortions, embryo-destructive research, assisted suicide and euthanasia, or any other anti-life act; nor will we bend to any rule purporting to force us to bless immoral sexual partnerships, treat them as marriages or the equivalent, or refrain from proclaiming the truth, as we know it, about morality and immorality and marriage and the family. We will fully and ungrudgingly render to Caesar what is Caesar’s. But under no circumstances will we render to Caesar what is God’s.