I am away at a medical conference, and so have reposted an older essay, which you will hopefully enjoy. Back soon.

 
This week’s news brought the remarkable story of Wesley Autrey, a 50 year-old Vietnam veteran who jumped in front of a subway train to save a man who had fallen onto the tracks while having a seizure.

18-year-old Cameron Hollowpeter suffered a seizure while Autrey, accompanied by his two daughters, was waiting on the platform for the subway. Hollowpeter fell to the tracks after losing his balance, as an incoming train approached the platform. Autrey jumped down to save him — as his daughters looked on — initially attempting to pull him out, but realizing with split-second judgment that there was insufficient time to extract the still-seizing man from the tracks. He threw himself over Hollowpeter, wrapping him in his body to protect his flailing arms, in the shallow ditch between the electrified rails. The train screeched to a halt after passing overhead with but inches to spare, miraculously leaving both men without serious injury.

True acts of heroism are of course newsworthy, and at once both extraordinary and sobering (would you or I have done what Wes Autrey did?) — and draw a sharp and unflattering contrast with what often passes for heroism in our modern culture.

We hear of heroes daily in the papers and on TV: the fireman who rescues a child from a burning building; the policeman shot in the line of duty; the soldier who throws himself on a grenade to save the lives of his buddies. Such acts are heroism indeed, comprised of its core virtue: the willingness to sacrifice one’s life or well-being for another. We say this although we expect such things of these men and women, for this is their chosen calling and career, one which by its nature places them in harm’s way for the benefit of others.

Cheap heroism seeps deeply into our culture like some toxic effluent, poisoning even simple principled acts with a pretension of greatness.

Yet there is increasingly a class of acts now painted as “heroism” which deserves no such depiction. Such cheap heroes — the civic equivalent of Dietrich Bonhoeffer’s cheap grace Christians — seem to grow in number daily. They make no sacrifices, take no risks, suffer no losses when their “heroic” deeds are done. In a society increasing bereft of moral standards and the simplest traits of noble character and integrity, we paint a heroic stamp of approval on increasingly pathetic gestures, gilding our self-serving deeds with a thin gloss of glory.

These hollow heroes come quickly to mind. Talented athletes, paid millions to toss balls through nets or batter baseballs into distant bleachers with steroid-enhanced expertise are idolized as paladins, as children pine to reproduce their acts of glory and emulate their rich, undisciplined, and often decadent lifestyles. Hollywood celebrities are hailed as heroes for attending media-saturated charity events, where a trivial pittance of their vast fortunes are donated to self-serving causes such as AIDS research, hedging bets against their own hedonism. Heroes in TV dramas and film are violent, vengeful, and have the sexual morality of Caligula. Our modern heroes seem far more hollow and self-serving than honorable.

Cheap heroism seeps deeply into our culture like some toxic effluent, poisoning even simple principled acts with a pretension of greatness. Children are given “Hero” stickers for finishing homework or showing up at school; I receive a hero tee-shirt for lying on a couch, getting a pinprick, and donating a pint of blood. We are heroes for donating a few bucks to a charity, for helping out at our children’s school, for volunteering at a hospital or soup kitchen. Every patient undergoing chemotherapy for cancer is now a hero — especially if they have a disease such as breast cancer or Kaposi’s sarcoma which reach disproportionate degrees of prominence by occurring in politically vocal victim groups such as feminists and gays.

The ever-contracting world of a narcissistic culture seeks half-pint heroes to ennoble their selfish, empty deeds and sustain their overwrought egos.

What we have done, in short, is hyperbolize deeds which should be commonplace and hardly noteworthy for people of character and integrity on an everyday basis. We have glorified those actions which are trivial and turned them into great triumphs — thereby making ourselves much smaller by their enlargement. The ever-contracting world of a narcissistic culture seeks half-pint heroes to ennoble their selfish, empty deeds and sustain their overwrought egos.

When genuine acts of heroism occur, such as Mr. Autrey’s extraordinary rescue, the narcissistic culture erupts into spasms of euphoric ecstasy, as if some alien from another planet had landed: they have no grasp whatsoever of what would motivate any man to do such a thing, and have no frame of reference to discover one. Watch closely as Mr Autrey makes his rounds on Regis and Oprah, or beams from the cover of People magazine promoting their vapid interview within. You will see slack-jawed awe at his actions, but eyes reflecting the empty souls which long ago abandoned the place from which such deeds arise — if indeed they ever knew it.

True acts of heroism arise from a willingness to sacrifice self for others, inculcated either by training, such as that given to soldiers, or arising from the strength of spiritual conviction that such deeds have redemptive value, or spring from the gratitude and power of transformational grace. When you have nothing to live for, there is nothing worth dying for. The saint and the soldier understand this; the secular skeptic enthrones tiny kings on tinplate thrones, paying homage to images of themselves while pretending such worship makes life worthwhile.

Wesley Autrey has taught us all a great lesson, of the power of self-sacrifice and the value of character and integrity. How sad it is that so very few will truly grasp its import.

In contemporary political discourse, we often discuss the Rule of Law, especially in our postmodern culture where bad behavior is often justified (and excused) by situation, upbringing, or historical injustice. But no one ever talks about the Law of Rules.

Today in the office I reviewed one of Medicare’s bulletins, clarifying (at least in intent, if not in practice) their regulations in some arcane area of reimbursement for surgical procedures. Few outside of the health care field have any idea of the complexity of regulations governing medicine. When last I checked several years ago, Medicare had about 150,000 pages of regulations in the Federal Register, approximately 3 times of the volume of the IRS tax code. American medicine is more highly regulated than Soviet state industry ever was, and getting more so by the day.

Without launching into a diatribe on the evils of government-funded and regulated medicine (perhaps another time), it strikes me that the explosive growth of rules, laws, and regulations in society as a whole is a reflection of an underlying shift in our culture, values, and individual moral integrity.

There are two ways to implement good behavior in individuals and society: from within or from without. Human beings are morally flawed (a surprisingly controversial statement in our current, “values neutral” culture), and therefore in order to maintain a peaceful, stable, functioning society, laws – and the means to enforce them – are required. Laws exist not for the good in man, but rather for the evil, as a restraint. If man were morally perfect, no laws would be needed. Yet law cannot create morality, but serves only to protect the good from the evil. The more moral goodness there is in a society–restraint from harming one’s neighbor, acts of service, honesty, integrity — the fewer laws are needed and the better those laws already in place function. As individuals (and consequently the society they constitute) change from being other-oriented and self-restrained to self-centered and self-seeking, the more law-breaking occurs, the greater the enforcement required, and the more laws are required to manage and restrict human behavior. Hence the Law of Rules: Rules beget more rules.

We humans are intelligent, resourceful beings who are ever looking for new ways to achieve the goals and desires important to us. If our intent is to deceive, steal, or harm, there is almost always a way around existing law to accomplish our aims. The result of this is twofold: harsher enforcement of existing laws and more laws to cover the loopholes discovered by us innovative creatures, as society seeks to protect itself. Hence the result of a deterioration in individual moral restraint is both more laws and harsher penalties. The logical end result of such a progression is something resembling totalitarianism: there are laws about everything, and brutal punishment for their violation.

We often hear totalitarian regimes such as China or the former Soviet Union boast of their low crime rates and the safety of their streets. And Islamic countries and cultures often proclaim their inherently higher moral status over us libertines in the West, cutting off the hands of robbers and the like. But while it is possible in large measure to restrict behavior through law and retribution, such measures do not make a society or its individuals moral as a consequence. In fact, the effect is quite the opposite. Laws intended to restrict evil behavior often have the unintended consequence of negatively impacting those intent on good. So, for example, the law designed to discourage fraud in Medicare by the few (a worthy goal) results in less time for patient care, restriction of access to care by the needy, and the exodus of good health care providers to other professions to escape their crushing burden — all bad outcomes affecting far more people than the few who would game the system. One need only look at the extreme effects of Islamic teaching on some (not all) of its adherents, with the wanton murdering of women, children, unbelievers–and even other Muslims–to conclude that constrictive law-abiding society does not promote moral goodness as a consequence.

What’s the answer? Other than a fundamental reversal in individual moral virtue–an inside-out change–I fear there are few good alternatives. But I am not gloom-and-doom about the prospects for such change–I have seen and know of too many who have undergone such a change to be pessimistic, and am convinced of the existence of a God capable of implementing such change.

The burgeoning new sciences of psychology, genetics, and medicine provided a glimmer of hope in this darkness. An intense fascination developed with strengthening and improving the nation through Volksgesundheit–public health. Many physicians and scientists promoted “racial hygiene” – better known today as eugenics. The Germans were hardly alone in this interest – 26 states in the U.S. had forced sterilization laws for criminals and the mentally ill during this period; Ohio debated legalized euthanasia in the 20′s; and even Oliver Wendall Holmes, in Buck v. Bell, famously upheld forced sterilization with the quote: “Three generations of imbeciles are enough!” But Germany’s dire circumstances and its robust scientific and university resources proved a most fertile ground for this philosophy.

These novel ideas percolated rapidly through the social and educational systems steeped in Hegelian deterministic philosophy and social Darwinism. Long lines formed to view exhibits on heredity and genetics, and scientific research, conferences, and publication on topics of race and eugenics were legion. The emphasis was often on the great burden which the chronically ill and mentally and physically deformed placed on a struggling society striving to achieve its historical destiny. In a high school biology textbook – pictured above – a muscular German youth bears two such societal misfits on a barbell, with the exhortation, “You Are Sharing the Load!–a hereditarily-ill person costs 50,000 Reichsmarks by the time they reach 60.” Math textbooks tested students on how many new housing units could be built with the money saved by elimination of long-term care needs. Parents often chose euthanasia for their disabled offspring, rather than face the societal scorn and ostracization of raising a mentally or physically impaired child. This widespread public endorsement and pseudo-scientific support for eugenics set the stage for its wholesale adoption — with horrific consequences — when the Nazi party took power.

The Nazis co-opted medicine fully in their pursuit of racial hygiene, even coercing physicians in occupied countries to provide health and racial information on their patients to occupation authorities, and to participate in forced euthanasia. In a remarkably heroic professional stance, the physicians of the Netherlands steadfastly refused to provide this information, forfeiting their medical licenses as a result, and no small number of physicians were deported to concentration camps for their principled stand. As a testimony to their courage and integrity, not a single episode of involuntary euthanasia was performed by Dutch physicians during the Nazi occupation.

Would that it were still so.

The Netherlands is today the only country in the world in which euthanasia and assisted suicide are legally performed, having fully legalized the practice three years ago after several decades of widespread illegal–but universally unpunished–practice. The Dutch have come into the public consciousness periodically over the past 15 years, initially with the consideration of assisted suicide laws in Oregon, Washington, Michigan and elsewhere in the early 90′s, and again with their formal legalization of physician-assisted suicide and euthanasia in 2001. Once again they are on the ethical radar, with the disclosure last week of the Groningen Protocol for involuntary euthanasia of infants and children.

The Groningen Protocol is not a government regulation or legislation, but rather a set of hospital guidelines for involuntary euthanasia of children up to age 12:

The Groningen Protocol, as the hospital’s guidelines have come to be known, would create a legal framework for permitting doctors to actively end the life of newborns deemed to be in similar pain from incurable disease or extreme deformities.

The guideline says euthanasia is acceptable when the child’s medical team and independent doctors agree the pain cannot be eased and there is no prospect for improvement, and when parents think it’s best.

Examples include extremely premature births, where children suffer brain damage from bleeding and convulsions; and diseases where a child could only survive on life support for the rest of its life, such as severe cases of spina bifida and epidermosis bullosa, a rare blistering illness.

The hospital revealed last month it carried out four such mercy killings in 2003, and reported all cases to government prosecutors. There have been no legal proceedings against the hospital or the doctors.

While some are shocked and outraged at this policy of medical termination of sick or deformed children (the story has been widely ignored by the mainstream media, and has gotten only limited attention on the Internet), it is merely a logical extension of a philosophy of medicine widely practiced and condoned in the Netherlands for many years, much as it was in Germany between world wars. It is a philosophy where the Useful is the Good, whose victims are the children whom Reason scorned.

Euthanasia is the quick fix to man’s ageless struggle with suffering and disease. The Hippocratic Oath — taken in widely varying forms by most physicians at graduation — was originally administered to a minority of physicians in ancient Greece, who swore to prescribe neither euthanasia nor abortion — both common recommendations by healers of the age. The rapid and widespread acceptance of euthanasia in pre-Nazi Germany occurred because it was eminently reasonable and rational. Beaten down by war, economic hardship, and limited resources, logic dictated that those who could not contribute to the betterment of society cease being a drain on its lifeblood. Long before its application to ethnic groups and enemies of the State, it was administered to those who made us most uncomfortable: the mentally ill, the deformed, the retarded, the social misfit. While invariably promoted as a merciful means of terminating suffering, the suffering relieved is far more that of the enabling society than of its victims. “Death with dignity” is the gleaming white shroud on the rotting corpse of societal fear, self-interest and ruthless self-preservation.

It is sobering and puzzling to ponder how the profession of medicine – whose core article of faith is healing and comfort of the sick – could be so effortlessly transformed into a calculating instrument of judgment and death. It is chilling to read the cold scientific language of Nazi medical experiments or Dutch studies on optimal techniques to minimize complications in euthanasia. Yet this devolution of medicine, with some contemplation, is not hard to discern. It is the natural gravity of man detached from higher principles, operating out of the best his reason alone has to offer, with its inevitable disastrous consequences. Contributing to this march toward depravity:

• The power of detachment and intellectualization: Physicians by training and disposition are intellectualizers. Non-medical people observing surgery are invariably squeamish, personalizing the experience and often repulsed by the apparent trauma to the patient. Physicians overcome this natural response by detaching themselves from the personal, and transforming the experience into a study in technique, stepwise logical processes, and fascination with disease and anatomy. Indeed, it takes some effort to overcome this training to develop empathy and compassion. It is therefore a relatively small step with such training to turn even killing into another process to be mastered.

• The dilution of personal responsibility: In Germany, the euthanasia of children was performed with an injection of Luminal, a barbiturate also used for seizures and sedation of the agitated. As a result, it was difficult to determine who was personally responsible for the deed: was it the nurse, who gave too much? The doctor, who ordered too large a dose? Was the patient overly sensitive to the drug? Was the child merely sedated, or in a terminal coma? Of course, all the participants knew what was going on, but responsibility was diluted, giving rationalization and justification full reign. The societal endorsement and widespread practice of euthanasia provided additional cover. When all are culpable, no one is culpable.

• Compartmentalization: an individual involved in the de-Baathification of Iraq said the following:

There is a duality in Baathists. You can find a Baathist who is a killer, but at home he’s completely normal. It’s like they split their day into two twelve-hour blocks. When people say about someone I know to be a Baathist criminal, ‘No, he’s a good neighbor!’, I believe him.

Humans have the remarkable ability to utterly separate disparate parts of their lives, to accommodate cognitive dissonance. Indeed, there is probably no other way to maintain sanity in the face of enormous personal evil.

• The banality of evil: Great evil springs in countless small steps from lesser evil. Jesus Christ was doubtless not the first innocent man Pilate condemned to death; soft porn came before child porn, snuff films, and rape videos; in the childhood of the serial killer lies cruelty to animals. Small evils harden the heart, making greater evil easier, more routine, less chilling. We marvel at the hideousness of the final act, but the descent to depravity is a gentle slope downwards.

• The false optimism of expediency: Solve the problem today, deny any future consequences. We are nearsighted creatures in the extreme, seeing only the benefits of our current actions while dismissing the potential for unknown, disastrous ramifications. When Baby Knauer, an infant with blindness, mental retardation and physical deformities, became the first child euthanized in Germany, who could foresee the horrors of Auschwitz and Dachau? We are blind to the horrendous consequences of our wrong decisions, but see infinite visions of hope for their benefits. As a child I watched television shows touting peaceful nuclear energy as the solution to all the world’s problems, little imagining the fears of the Cuban missile crisis, Chernobyl and Three Mile Island, the minutes before midnight of the Cold War, and the current ogre of nuclear terrorism.

Reason of itself is morally neutral; it can kill children or discover cures for their suffering and disease. Reason tempered by humility, faith, and guidance by higher moral principles has enormous potential for good – and without such restraints, enormous potential for evil.

The desire to end human suffering is morally good. Despite popular misconception, the Judeo-Christian tradition does not view suffering as something good, but rather something evil which exists, but which may be transformed and redeemed by God and grace, to ultimately produce a greater good. This is a difficult sell to a materialistic, secular world, which does not accept the transformational power of God or the existence of spiritual consequences, or principles higher than human reason.

Yet the benefits of suffering, subtle though they may be, can be discerned in many instances even by the unskilled eye. What are the chances that Dutch doctors will find a cure for the late stage cancer or early childhood disease, when they now so quickly and “compassionately” dispense of their sufferers with a lethal injection? Who will teach us patience, compassion, unselfish love, endurance, tenderness, and tolerance, if not those who provide us with the opportunity through their suffering, or mental or physical disability? These are character traits not easily learned, though enormously beneficial to society as well as individuals. How will we learn them if we liquidate our teachers?

Higher moral principles position roadblocks to our behavior, warning us that grave danger lies beyond. When in our hubris and unenlightened reason we crash through them, we do so at great peril, for we do not know what evil lies beyond. The Netherlands will not be another Nazi Germany, as frightening as the parallels may be. It will be different, but it will be evil in some unpredictable way, impossible to foresee when rationalism took the first step across that boundary to kill a patient in mercy.