Euthanasia Investigation in New Orleans:
Medical Personel Charged

syringeFor those who may have read my earlier posts (here, here, and here) about the possibility of euthanasia at a hospital in New Orleans in the aftermath of Hurricae Katrina, you may be interested in the following report on the conclusion of an investigation by the Louisiana Attorney General, just reported by CNN:

NEW ORLEANS, Louisiana (CNN) — In the desperate days after hurricane Katrina struck, a doctor and two nurses at a flooded New Orleans hospital allegedly killed four patients by giving them a lethal drug cocktail, Louisiana’s top law enforcement official said Tuesday.

“We’re talking about people that pretended that maybe they were God,” Attorney General Charles C. Foti Jr. said, announcing second-degree murder charges against Dr. Anna Pou, Lori L. Budo and Cheri Landry.

“This is not euthanasia. It’s homicide,” Foti said.

The charges stem from the post-Katrina deaths of some patients at New Orleans Memorial Medical Center.

An affidavit said tests determined that a lethal amount of morphine was administered on September 1 to four patients ages 62, 66, 89 and 90. Hurricane Katrina swamped the city on August 29.

According to the court document, the morphine was paired with midazolam hydrochloride, known by its brand name Versed. Both drugs are central nervous system depressants. Taken together, Foti said, they become “a lethal cocktail that guarantees that you die.”

The doctor and nurses were taken into custody late Monday, following a 10-month investigation that continues. Each was charged with four counts of being a principal to second-degree murder and released on $100,000 bond.

The original reports showed up in a British tabloid not known for its reliability, and this sourcing, as well as some of the details therein, led to widespread scepticism about their reliability. However, interviews with physicians and health care workers at Memorial Hospital raised troubling questions as well, and a formal investigation was launched. The investigation was delayed by the reluctance of the involved hospital personal to testify, as well as the difficulty of obtaining autopsy evidence on the badly decomposed bodies after the fact.

What struck me the most, at the time I first posted it, was the vehemence of some commenters about how ridiculous this report was. One suspects there will be no humble pie eaten by those who sarcastically castigated me for posting on such obviously fictitious urban legends.

But sometimes the truth can be more frightening than fiction.

UPDATE: Here’s some earlier media links filling in some detals of the investigation as it unfolded (I’ll keep this updated as more becomes available):

Euthanasia Investigation in New Orleans

hospital bed

In the aftermath of hurricane Katrina, there were some scattered reports–in an admittedly questionable media source (a British tabloid)–of euthanasia of patients trapped in a New Orleans hospital. I discussed the initial media report here, and did a follow up post here which expanded on the questionable nature of the sources and some of the comments in response. In brief, there was widespread skepticism from some commenters on the veracity of this report, which was, in their opinion, pure urban legend–and I was castigated for lending credence to such an outrageous myth.

Apparently they never got the word to the Louisiana Attorney General.

CNN is now reporting that a very active investigation is currently underway of Memorial Hospital–where 45 patients were found dead–by the Attorney General’s office. This investigation to date has uncovered additional testimony that euthanasia was actively discussed and may well have been performed:

The Louisiana attorney general’s office is investigating allegations that mercy killings occurred and has requested that autopsies be performed on all 45 bodies taken from the hospital after the storm.Orleans Parish coroner Frank Minyard said investigators have told him they think euthanasia may have been committed.

“They thought someone was going around injecting people with some sort of lethal medication,” Minyard said.

A nurse manager, Fran Butler, is quoted as saying:

“My nurses wanted to know what was the plan? Did they say to put people out of their misery? Yes. … They wanted to know how to get them out of their misery,” she said.

Butler also told CNN that a doctor approached her at one point and discussed the subject of putting patients to sleep, and “made the comment to me on how she was totally against it and wouldn’t do it.”

Dr. Bryant King, a physician who was present at the hospital, was also interviewed by the AG’s office, and recounts his story:

But King said he is convinced the discussion of euthanasia was more than talk. He said another doctor came to him at 9 a.m. Thursday and recounted a conversation with a hospital administrator and a third doctor who suggested patients be put out of their misery.

King said that the second physician — who opposed mercy killing — told him that “this other [third] doctor said she’d be willing to do it.”

About three hours later, King said, the second-floor triage area where he was working was cleared of everyone except patients, a second hospital administrator and two doctors, including the physician who had first raised the question of mercy killing…

One of the physicians then produced a handful of syringes, King said.

“I don’t know what’s in the syringes. … The only thing I heard the physician say was, ‘I’m going to give you something to make you feel better,’ ” King said….

King said he decided he would have no part of what he believed was about to happen.

Time will tell how this investigation turns out–and it may ultimately be very difficult to prove what happened at Memorial Hospital, given the poor condition of the bodies and the difficulty in distinguishing therapeutic pain management and sedation versus the same drugs used in doses sufficient to kill. One suspects that those involved in such actions–if they occurred–will be loath to admit it–and likely would have been careful to avoid witnesses, if at all possible.

And I’m sure those who so vehemently argued the absurdity of this story will belly up to the bar and confess they may have overreacted just a bit–but I’m not holding my breath waiting.

Update 10-27-2005: CNN is reporting that dozens of subpoenas have been issued to find out what happened at Memorial:

The subpoenas were served on employees of all levels at Memorial Medical Center, which is owned by Tenet Healthcare, because “cooperation, lately, has not been as good as I had hoped,” Foti said.

The subpoenas require that people appear before investigators for questioning.

“Some people were not coming forward. We learned Tenet sent out a letter that had a chilling effect,” Foti said. “We had no choice but to issue these subpoenas.”

“They [Tenet] seem to be in a position of protecting themselves, while we are just trying to get to the facts of what happened at the hospital,” the attorney general said.

Stay tuned–this may begin to get very interesting…

Euthanasia in New Orleans?

skullMy last post, riffing off a report that physicians may have euthanized some patients in a New Orleans hospital during Katrina caught a fair amount of heat for promoting a news story which was, in the eyes of some, an urban legend. One of my more–umm, hyperbolic admirers– has some choice words about my decision to lend credence to this obviously fraudulent story, drawing the conclusion that I am a moron seriously in need of growing a brain, and a threat to my patients’ health and well-being. Well, you can’t please all the people all the time–and no suggestions on just how to grow a brain were proffered, so I guess I am on my own there. But criticism–never pleasant–can be both cathartic and corrective, as indeed it was in this case. And so I thought a few words of reflection on that post might be in order.

First, when I first ran across this report in The Mail, a British tabloid, I was alarmed that it might have occurred, and frankly found the story at first generally plausible (perhaps a bias on my part to believe it existed), but nevertheless found it suspect in some regards. British tabloids are not known for accuracy in their sensationalism–lagging behind even the NY Times in this regard. It appeared to be single-sourced, and only one named witness was given. The witness was separately mentioned in another, unrelated story quoted on the BBC, as a British citizen living in a town near New Orleans, and plausibly involved in relief efforts there, lending some credence to the story. Other aspects of the story seemed very odd–the pharmacy lockdown, the use of high-dose morphine to kill (potassium chloride or barbituates are much more efficient), and the oddness of having a non-medical emergency worker notify the families. Based on these reservations and the single source, I twice expressed some reservations about the story’s veracity. This was clearly not enough skepticism for some, but I trust my readers’s intellects and instincts, and doubt any would be misled to believe the story was absolutely verified. For those who may have come to this conclusion, let’s be clear:

I do not know if this story is true–in fact, there is substantial reason to doubt that it is, and that doubt is growing.

Over the past day or so I have been following the story on the web. It has been repeated almost verbatum in several British, Australian and Canadian papers–often without attributing The Mail as its source. But nothing in the States, nothing from the affected families or local population. To date, Snopes has nothing, pro or con, on the topic. Orac–whose skeptical birddogging of alternative medicine and thoroughness in debunking all things mythical, has an excellent summary of the information to date, and comes down (not surprisingly) on the side of urban legend. Even the crowd over at Democratic Underground are bouncing this one around with some skepticism (odd for this conspiracy-loving crowd–although if it did happen, it was Bush’s fault), which is summarized here.

So why run an iffy story like this as a basis for a commentary on physician-assisted suicide? Well, several reasons: I was at first, less skeptical about the story than I am now–and probably less skeptical than I should have been. Secondly, it was an easy framework in which to comment and discuss many of the issues surrounding euthanasia. How could an urban legend be the legitimate basis for such discussion? The answer, I believe, is simple–and is the reason this story has sustained a life of its own on the web, even if legend: quirks and odd details notwithstanding, the scenario is entirely plausible.

First of all, voluntary and involuntary physician-assisted suicide is already a reality in this country–although it is rare, and much of it is underground. An anonymous survey of over 3100 physicians published in 1998 in the New England Journal of Medicine cited the surprisingly high incidence of physicians who had considered–or performed–assisted suicide: 11% said they would be willing to administer a lethal medication to a patient who asked, even if illegal; 7% would be willing to administer a lethal injection themselves; and nearly 5% stated they had already administered such a lethal injection. Significantly higher percentages said they would consider such a recourse if it were legal. It should be noted that this was not a cross-section of all physicians, but the survey was directed at those involved in terminal care. A smaller survey in JAMA, also in 1998, revealed that nearly 16% of oncologists had participated in active euthanasia–and over 15% of these cases were involuntary (i.e., without patient request). Oregon’s Death with Dignity Act was passed in 1994, and as of 2004, 208 patients have died from a prescription for a lethal dose of barbituates given them legally by their physicians (Oregon physicians are not allowed to directly administer lethal oral or injectable medications). The incidence of unreported physician-assisted suicide (PAS) is impossible to gauge–in part because of the grayness of deaths due to high-dose opiates in terminal cancer pain, which may be either incidental or intentional. But there is fairly widespread support among physicians for some sort of PAS–with as many as a third supporting the idea, at least at the theoretical level.

Furthermore, anyone who has any experience discussing euthanasia with proponents or listening to such debates will have heard every single argument put forth by the anonymous physician in the New Orleans story. We hear about “death with dignity”, “compassion” “they are going to die any, so why not be merciful?” And who would doubt, should such a scenario occur, that the media would be apologists, to prevent exposure if possible to those who committed such acts lest they be “scapegoats”? This story–true or fabrication–embodied the bulk of the rationalizations and arguments of those who support assisted suicide or active euthanasia, and therefore served–even if fictitious (and I surely hope it is)–as a hypothetical framework for addressing these points.

I will in the future be more cautious about such stories–even when they prove a teachable moment, and I apologize if any of my readers were led to place more credence in this story than it appears to merit at this time.

And one more comment–about comments: I continue to marvel at how absolutely clueless and disrespectful some commenters can be. Believe it or not, it is possible to disagree–even passionately–with another individual with insulting them personally or questioning their integrity. The anonymity of the web allows–even encourages–such abrasive discourse, seemingly without consequence. And I generally try to tolerate such excesses in comments, up to a point. But though you are anonymous, your character shines through when you resort to personal attacks and character assassination. The chances that your point or position–whatever it may be–will be heard and considered, by either me or a reader, drop like a rock. And a life lived stewing in a cesspool of anger and hatred–popping your head up only long enough to throw an anonymous turd at someone you do not know, but detest anyway–will be its own reward. I may listen, I will pray for you–but have little interest in giving you a soapbox for your arrogance and condescension. Folks like you have nothing positive to add to life–and the rest of us tune you out immediately. So keep it civil, folks–the Delete Comment button is just too easy to hit.

A Dark Mercy

There have been growing numbers of stories about the heroism of rescuers and medical personnel, such as this one, who risked their lives and personal safety and comfort to rescue, comfort and evacuate often critically-ill patients in New Orleans. But not all the medical care was directed at saving and healing the sick, as this troubling report indicates (HT: Orbusmax):

Doctors working in hurricane-ravaged New Orleans killed critically ill patients rather than leaving them to die in agony as they evacuated hospitals…

With gangs of rapists and looters rampaging through wards in the flooded city, senior doctors took the harrowing decision to give massive overdoses of morphine to those they believed could not make it out alive.

In an extraordinary interview with The Mail on Sunday, one New Orleans doctor told how she ‘prayed for God to have mercy on her soul’ after she ignored every tenet of medical ethics and ended the lives of patients she had earlier fought to save.

Her heart-rending account has been corroborated by a hospital orderly and by local government officials. One emergency official, William ‘Forest’ McQueen, said: “Those who had no chance of making it were given a lot of morphine and lain down in a dark place to die.”

Euthanasia is illegal in Louisiana, and The Mail on Sunday is protecting the identities of the medical staff concerned to prevent them being made scapegoats for the events of last week.

Their families believe their confessions are an indictment of the appalling failure of American authorities to help those in desperate need after Hurricane Katrina flooded the city, claiming thousands of lives and making 500,000 homeless.

‘These people were going to die anyway’

The doctor said: “I didn’t know if I was doing the right thing. But I did not have time. I had to make snap decisions, under the most appalling circumstances, and I did what I thought was right.

“I injected morphine into those patients who were dying and in agony. If the first dose was not enough, I gave a double dose. And at night I prayed to God to have mercy on my soul.”

The doctor, who finally fled her hospital late last week in fear of being murdered by the armed looters, said: “This was not murder, this was compassion. They would have been dead within hours, if not days. We did not put people down. What we did was give comfort to the end.

“I had cancer patients who were in agony. In some cases the drugs may have speeded up the death process.

“We divided patients into three categories: those who were traumatised but medically fit enough to survive, those who needed urgent care, and the dying.

“People would find it impossible to understand the situation. I had to make life-or-death decisions in a split second.

“It came down to giving people the basic human right to die with dignity.

“There were patients with Do Not Resuscitate signs. Under normal circumstances, some could have lasted several days. But when the power went out, we had nothing.

“Some of the very sick became distressed. We tried to make them as comfortable as possible.

“The pharmacy was under lockdown because gangs of armed looters were roaming around looking for their fix. You have to understand these people were going to die anyway.”

Mr McQueen, a utility manager for the town of Abita Springs, half an hour north of New Orleans, told relatives that patients had been ‘put down’, saying: “They injected them, but nurses stayed with them until they died.”

I find this story deeply troubling at any number of levels. I have written before on my concerns about the practice of active euthanasia (here and here), which arise not merely because of my Christian convictions about its morality, but perhaps equally so because of the great potential danger I see in breeching the moral and social levies which protect us from hubris and the creeping progressive tolerance of evil inherent when crossing them. The weariness of great tragedy saps the spirit, making it all to easy to rationalize the repulsive, to move on to the next horrid scene without reflecting on the last. But sometimes we must stop and focus amid the deadening blur of death and suffering. This story demands such a pause.

I am assuming, first of all, that this story is true–although I have seen no independent confirmation elsewhere. The name of the hospital where this occurred is not given, but it makes one wonder if it is the same facility where 45 dead patients were found abandoned. If it proves true, one must wonder whether there will be less outrage over patients euthanized than abandoned to die–somehow I suspect there might be. After all, they were terminated mercifully, rather than just abandoned–which would be oh, so terribly, terribly heartless.

But of course, if they were euthanized they were abandoned–abandoned by their providers and sworn protectors, those whom they trusted to comfort, heal, and protect them. Granted, the circumstances were horrendous: deprived of power, light, medications, and security, threatened by a mob of barbarians bent on drugs, theft, and destruction–one can hardly begin to imagine the terror, the helplessness, the frustration shared by doctors, patients, and nurses alike. It is easy to judge those who were there, sitting as I am dry, safe and secure, far from this hell on earth. It would be foolish to say that–were I there–my behavior would have been different, more noble, more self-sacrificing, more righteous. I would hope so–but I have been known to underestimate my frailties and potential for moral lapses far too often to be smug or self-righteous: I simply do not know how I would have handled this situation, were I there.

But still I must ask: you killed them? Actively, deliberately, methodically? What has occurred here, it seems, steps over a line clearly blurred by the panic, fear, and hopelessness of a terrible storm and its even more horrible aftermath–the opportunism of human evil in the face of Nature’s wrath–into the realm of a darkness far deeper than wind and water and chaos could wreak. Have you not countered evil with evil? “And if Satan cast out Satan, he is divided against himself; how shall then his kingdom stand?”

Could not the morphine you used to end their lives be instead used to ease their pain, their fear, as you stood by their bedside doing what little you could to comfort them? It takes far more morphine to kill than to comfort. Could you not stand and defend them against the looters, the rapists, the thugs–though ill-equipped you might well lose your safety, your well-being, even your life. There is a word for those who act thusly, defending the weak against the strong at the cost of their lives: heroes. Did you not, by actively terminating their lives, avoid the shameful option of abandoning suffering and dying patients to save yourselves? They were condemned to die by their disease, by the untimely fate of a hospital in harm’s way, by social chaos and raging mobs. You are alive today because you expedited their inevitable death. But your life, so secured, is not enobled by this act: you may indeed find forgiveness, but the act remains: a dark mercy, an act of weakness, heinous forever.

The interview in The Mail is redolent with the special pleading and specious arguments so common among those who have compromised principles for expediency, and by those who justify any and all such moral relativism. The paper protects the anonymity of those who so acted “to prevent them being made scapegoats for the events of last week.” Scapegoats? Whose sins are you carrying into the desert, if not your own? What was the proximate cause of their death, if not your syringe?

The doctor informs us: “This was not murder, this was compassion. They would have been dead within hours, if not days. We did not put people down. What we did was give comfort to the end.” Aahh, compassion–I’ll have a double dose, please. Com-passion: “to suffer with”–this is its root, its meaning. To suffer with a patient, to experience their pain while strengthening their spirit–that is compassion. To stand in the breach, between the looter and the lost, to suffer that they may be spared–that is compassion. To stay with a dying patient, when the lights are out and you have no treatment to offer–that is compassion. To stop their breathing with an overdose so that you can escape without abandoning them to die alone may be rational, understandable, defensible, even arguably reasonable–but it is not compassion. Words have meanings: I know what murder means, what compassion involves, what comfort entails–and they are not the same.

The doctor informs us: “It came down to giving people the basic human right to die with dignity.” Death with dignity–is that indeed our right? Who ordains such a right? Who enforces it? What about the bloated bodies floating face down in sewage-laced water, drifting down streets in the company of dead rats and fire ants–is that dignity? Who stole their right to die with dignity? Would you have injected them also to save such an indignity? And how is it we now define “dignity” as the right to die when and where we want–or when our doctor thinks it’s best? Is not dignity instead dying with inner grace, strengthened by those around you, comfortable that your life has been lived with meaning and purpose–though your body be racked by pain–in the presence of others who care? Many died just this way in Katrina–under circumstances just as horrid and terrifying and degrading as the good doctor experienced. They died with dignity–brutally, but with nobility, grace, and courage, saving and protecting family members, pets, friends, strangers.

The doctor informs us: “You have to understand these people were going to die anyway.” Yes, I do understand–and that is true of every living breathing human on this planet. But your patients died early–in your time, not theirs, under your hand, not that of a looter, nor the ravage of a disease, nor the savagery of storm. Your hand, doctor. Who granted you this right, this power?

But someone in this story sees through the hollow rhetoric, the noble talk, the faux compassion: “Mr McQueen … told relatives that patients had been ‘put down’, saying: ‘They injected them, but nurses stayed with them until they died.'” America, meet your new compassion, your new dignity: the nurse will stay by your side after your doctor puts you down.

Now, perhaps this story is a tabloid fabrication. Perhaps–so often the case–the truth of the situation was mangled beyond recognition by truncated quotes, Dowdian ellipses, or the pure fabrication that passes for journalism in our oh-so-enlightened 21st century. And I was not there–would my behavior have been that much different? I don’t know. Tragedy rips the scab–covered by layers of makeup and cheap jewelry–from the deep wounds of the humans spirit. It may reveal bleeding, and pain, and health, and healing–or the putrid aroma of rotting flesh and festering maggots. A white coat does not bestow deity, but bespeaks instead service and sacrifice–and the dark horrors of a dying hospital do not change this simple truth.

Dancing With Death

Boat at sunsetThe war rages on. It is a battle with ancient roots, deeply embedded in religion, culture, and the tensions between rich and poor. It is a war of contrasts: high technology and primitive cultural weapons; knowledge versus ignorance; speed and urgency against the methodical slowness of an enemy who knows time is on his side.

It is a war in which enormous strides have been made, with countless victories large and small.

The enemy is death. The avenger is medicine. And the war is going very poorly indeed.

In many ways, the gains of modern medicine against death and disease are truly impressive: longer life expectancies; progress and cures against heart disease, cancer, and diabetes; surgical and procedural marvels hard to imagine even 15 or 20 years ago. Yet, it is these very advances which seem to lie at the heart of a growing problem. We are so engaged in the battle, so empowered by our growing capabilities, that we have lost sight of the bigger picture. While pushing back the adversary of death, we are ever so steadily being destroyed by the very battle itself.

Several recent experiences have driven this dichotomy home for me. Last week, I was asked to evaluate a man who had been hospitalized for a over a week. A nursing home resident in his late 80’s, his overall health was fair to poor at best, and he suffered from severe dementia. He was unable to communicate in any way, and could recognize no one — not even his wife of many years, who remained in possession of her full facilities. He was admitted to the hospital with a severe urinary tract infection with a highly resistant bacteria, and septic shock. When he arrived at the ER, the full extent of his dementia was not apparent to the physicians there, and his wife insisted that all measures be engaged to save him. Aggressive medical care was therefore initiated — intensive care unit, one-on-one nursing care, hemodynamic monitoring, drugs to support blood pressure, intravenous nutrition, and costly antibiotics. After nearly two weeks of such intensive therapy, the patient largely recovered from his life-threatening infection — returning to his baseline of profound dementia. Yet the underlying risk factors which led to it — his age, a chronic bladder catheter and bacteria-harboring stones, diabetes, — remained in place, lying in wait for another, inevitable opportunity, in a matter of weeks or months. The cost of his hospitalization was easily in 6 figures.

In another situation, an elderly women presented to the hospital with signs of a serious, life-threatening infection in her abdomen. A healthy widower, she lived independently with her sister prior to her illness. Emergency surgery was performed, and an abscessed kidney removed. Her medical condition deteriorated after surgery, with coma due to stroke and failure of her remaining kidney brought on by the infection.

The patient’s sister and living companion communicated the clear final wishes of the widower: a women of strong faith, she wished no extraordinary measures, such as ventilators or dialysis, to extend her life needlessly. She was comfortable with death, and not afraid. The staff prepared to allow her to die gracefully, comfortably, and in peace.

But such was not to be. There was no living will, and the sister did not have legal authority to make such decisions. But the widower’s daughter, a nurse living out-of-state with little recent contact with her mother, arrived in town demanding that aggressive measures be taken to save her. A nephrologist (kidney specialist) was called in. A superb physician, compassionate and dedicated, he had been successfully sued in a similar case after recommending that dialysis be withheld in a patient with a grim prognosis. This was a mistake he would not make twice: the widower was transferred to another hospital, placed on dialysis, and died 3 weeks — and a quarter of a million dollars — later, in an ICU. She never woke up.

The issues which these two cases bring up are numerous, complex, and defy easy answers. They touch upon the subjective measure of quality-of-life and what it is worth; the finite limit of economic health care resources; the relative responsibilities of physicians, patients, and their families in end-of-life decisions; the pressures placed on the health care system and its practitioners by after-the-fact second-guessing in an aggressive tort environment; and a host of others greater or lesser in weight and substance, up to and including the meaning of life itself.

All the players bear responsibility in this passion play. Physicians excel at grasping what they can accomplish, but are woefully inadequate for the task of deciding whether such things should be done. In the urgency of acute care, delay to consider the ramifications of a decision to treat may cost an opportunity to save a patient for whom such treatment is desirable; better always to err on the side of salvage. Pressured by family, potential litigation, or instinct, the path of least resistance is to follow your training and use your skills. And physicians themselves are uncomfortable with death, though inundated in its ubiquity.

Family members naturally resist the agonal separation of their loved ones, often harboring unrealistic hopes and expectations of recovery in the face of inevitable death. A curious dance of denial often ensues between physician and family, as each, unwilling to face the unpleasantness of the inevitable, avoids the topic at all costs. The physician hides behind intellect, speaking of blood counts, medications, and ventilators, or at best tiptoeing around the core issue with sterile terms like “prognosis.” Family members hesitate to ask questions whose answers they already know. Too rarely are the physician and family willing to place the subject squarely on the table, in all its ugliness and fearfulness. Decisions which need to be made are put off, unspoken and deferred. The clock ticks on, the meter is running, and only the outcome is not in doubt.

The tort system provides a ready outlet for the anguish and anger of death of a loved one. In such a period of intense emotional turmoil, the real or perceived indifference of physicians (often a mechanism of detachment by which doctors deal with the horrors of death and illness); the parade of unfamiliar medical faces as no-name consultants come and go during the final days; the compounding burden of crushing financial load from the extraordinary costs of intensive terminal medicine; the Monday-morning quarterbacking by the tort system of complex, often agonizingly difficult medical decisions in critically-ill patients: all present a toxic and intoxicating brew which impels the health care system forward to leave no avenue untravelled, no dollar unspent in prolonging life beyond its proper and respectful end.

This march of madness is not without resistors. Seizing on the high costs, the futility, and especially the lack of personal control fostered by impersonal, highly technical terminal care, the euthanasia movement is maneuvering into the gap. Cloaked in slogans of personal autonomy and “Death with Dignity”, active euthanasia proponents seek to replace the sterile prolongation of a now-meaningless life with the warm embrace of Death herself. Terrified by an out-of-control dying process, an end of a life which embodies all meaning, they seek to control death as their final act of significance. But Death will not be controlled, and those who dance with Death are seduced by her siren. Euthanasia starts with compassionate intent, but ends with termination of the useless. Man does not have the wisdom to control death; The Ringbearer is corrupted by its power.

Our discomfort with death is our confusion about life. Man is the only species cognizant of his coming demise — who then, in the ultimate paradox, lives his entire life pretending it will not happen. Our Western culture, enriched with a wealth of distractions, allows us to pass our living years without preparing for the inevitable. When the time arrives, we use all the weapons at our disposal — wealth, technology, information, law — to resist the dragon. We drive it back for a time — at enormous cost, personal, financial, physical and emotional. Death always wins — always.

I am not of course yearning for a return to the past, a passive resignation to the inevitable anabasis of disease and death. The benefits of medicine and the forestalling of death are precious and powerful gifts, which have greatly benefited many. But like all such great powers, they are useful for good or ill. When the defeat of death becomes an end in itself, detached from the meaningfulness of life lived, it has great destructive energy.

We must learn how to die. And to learn how to die, we must learn how to live — how to seek the transcendent, the power of love, and sacrifice, and giving which makes life rich and enduring. The selfish, the superficial, the transient all gratify for a time, but when this is all we possess, we grasp desperately to their threadbare fabric when beauty and health give way to weakness, fear and death. All great religions understand this: the meaning of life transcends life. In the Judeo-Christian view, life is an opportunity to draw ourselves and others closer to the light and goodness of God, with the promise of an even greater life and deeper relationship after death. Yet even for the agnostic or secular among us, service to others — personal and social — has the potential to endure long after us. None of us will be remembered for our desperate clinging to life in its waning days, but rather for the lives we touched, the world we made better when we lived.

The Children Whom Reason Scorns

You Also Bear the BurdenIn the years following the Great War, a sense of doom and panic settled over Germany. Long concerned about a declining birth rate, the country faced the loss of 2 million of its fine young men in the war, the crushing burden of an economy devastated by war and the Great Depression, further compounded by the economic body blow of reparations and the loss of the German colonies imposed by the Treaty of Versailles. Many worried that the Nordic race itself was threatened with extinction.

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.
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