Culture of Death: The Age of Do Harm Medicine

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Smith, Wesley J., author.
Culture of death : the age of “do harm” medicine / Wesley J. Smith. — 2nd edition.
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ISBN 978-1-59403-855-6 (pbk. : alk. paper) — ISBN 978-1-59403-856-3 (ebook)
I. Title.
[DNLM: 1. Withholding Treatment—ethics. 2. Bioethical Issues. 3. Euthanasia—ethics.
4. Tissue and Organ Procurement—ethics. 5. Value of Life. WB 60]
R724
174.20973—dc23
2015028083
 OTHER BOOKS BY WESLEY J. SMITH

The Lawyer Book: A Nuts and Bolts Guide to Client Survival

The Doctor Book: A Nuts and Bolts Guide to Patient Power
The Senior Citizens’ Handbook: A Nuts and Bolts Approach to More
Comfortable Living
Winning the Insurance Game (co-authored with Ralph Nader)
The Frugal Shopper (co-authored with Ralph Nader)
Collision Course: The Truth about Airline Safety (co-authored with
Ralph Nader)
No Contest: Corporate Lawyers and the Perversion of Justice in America
(co-authored with Ralph Nader)
Forced Exit: Euthanasia, Assisted Suicide, and the New Duty to Die
Culture of Death: The Assault on Medical Ethics in America
Power over Pain: How to Get the Pain Control You Need (co-authored
with Eric M. Chevlen, MD)
Consumer’s Guide to a Brave New World
A Rat Is a Pig Is a Dog Is a Boy: The Human Cost of the Animal Rights
Movement
The War on Humans
To Ralph Nader, friend, mentor, visionary, great American.
 ACKNOWLEDGMENTS

No author writes a book in a vacuum. All of us who struggle to find the

right words, sentences, and paragraphs—whether writing nonfiction,
as here, or fiction—are assisted invaluably in our work by sources, col-
leagues, editors, friends, and family.
I want to thank everyone who willingly shared their ideas, perspec-
tives, and experiences with me, whether in the original version of this
book and/or this revised edition—many knowing that I would be critical
of their viewpoints. (Please forgive me if I have left anyone out.) These
include George A. Agich, Marshall Bedder, James L. Bernat, William J.
Burke, Ira Byock, Arthur Caplan, Eric Chevlen, Tom A. Coburn, Carl
Cohen, Diane Coleman, Marion Danis, Vincent Fortanasce, Roland
Foster, Renée C. Fox, Jeffrey I. Frank, Michael Franzblau, Lisa Gigliotti,
Carol Gill, Frederick K. Goodwin, Kathy S. Guillermo, Gregory Hamilton,
Kathy Hamilton, John Hardwig, Nat Hentoff, William Hurlbut, Dianne
Nutwell Irving, Jennifer Lahl, Albert R. Jonsen, Leon R. Kass, John
Keown, David Kilgour, C. Everett Koop, Kit Costello, George Krausz,
Richard D. Lamm, Herbert London, Tom Lorentzen, Joanne Lynn,
John Morse Luce, Nettie Mayersohn, Alice Mailhot, Mary Meehan,
Diane Meier, Gilbert Meilaender, Steve Miles, William Newsom, Mark
O’Brien, Adrian R. Morrison, D. S. Oderberg, F. Barbara Orlans, Robert
D. Orr, Edmund D. Pellegrino, Mark Pickup, David Prentice, Tom Regan,
Sharon M. Russell, Barbara Sarantitis, Dame Cecily Saunders, Cary
Savitch, Bobby Schindler, Amil E. Shamoo, Vera Hassner Sharav, D. Alan
Shewmon, Janie Siess, Dick Sobsey, Edward Taub, Nancy Valko, Robert
M. Veatch, Gregor Wolbring, Sidney Wolfe, and Stuart J. Youngner.
Also, thanks to those people who were so helpful but asked to remain
anonymous.
A hearty appreciation to my wonderful friends and colleagues
who do such good and important work combating assisted suicide and
vii
medical utilitarianism with the Patients Rights Council: Rita Marker,
Mike Marker, Kathi Hamlon, Robert Hiltner, Jason Negri, and Nancy
Minto. You have profoundly influenced my life in ways I can never repay.
My heartfelt appreciation to all my pals and colleagues at the
Discovery Institute, for the faith they have shown in my work and sup-
port over these many years: Bruce Chapman, Steve Buri, Steve Meyer,
John West, Richard Sternberg, Rob Crowther, David Klinghoffer, Ann K.
Gauger, Jay Richards, Janine Dixon, and the rest of the gang.
I want to thank everyone at Encounter Books, especially my publish-
ers past and present, Peter Collier (who also did a splendid job editing
the original work) and Roger Kimball, as well as Katherine Wong. Thanks
too for the great edit of this revised edition, Dave Baker at Super Copy
Editors.
Finally, my deepest love and gratitude to friends and family who
put up with me with such patience and eye-rolling good cheer, espe-
cially: Dean and Gerda Koontz; Mark and LaRee Pickup; Rita and Mike
Marker; John and Kathi Hamlon; William and Erica Hurlbut; Tom
Lorentzen; Susan Lauffer; Daniel and Jennifer Lahl; Bruce and Valerie
Schooley; Bradford William Short; Richard and Leann Doerflinger; David
and Diane Prentice; Bobby Schindler; my priest, Fr. John Karcher, and
Matushka Eva; and James and Patricia Shinn. My love to the Saunders
family, South Carolina, Connecticut, New York, Rhode Island, and
Florida Branches: Jerry and Barbara; Jim and Vickie; Jennifer; Jeremiah
and Sara and their children, Patrick, Connor, and Aidan; Stephen and
Leslie; Rebecca and Jonathan Shulman; Eric; and Joshua. Undying devo-
tion to my beautiful mother, Leona Smith—still going strong—and most
of all, to the joy of my life and the source of so much love and laughter,
Debra J. Saunders, wife and total sweetheart.
 TA B L E O F C O N T E N T S

Dedication v
Acknowledgments vii
Preface xi
Introduction xvii

Chapter 1: Harsh Medicine 1

Chapter 2: Life Unworthy of Life 33
Chapter 3: The Price of Autonomy 87
Chapter 4: Creating a Duty to Die 141
Chapter 5: Organ Donors or Organ Farms? 183
Chapter 6: Biological Colonialism 221
Chapter 7: Toward a “Human Rights” Bioethics 253

Endnotes 289
Index 319

ix
 P R E FA C E

This book had its genesis when the former editor of Encounter Books,
Peter Collier, approached me to write about the modern bioethics move-
ment. Immediately intrigued by the idea, I initially thought Culture of
Death would be a “policy” book. But as I entered the subject of bioethics
more deeply, it became quite personal. I should have known that it would
be. Bioethics, as philosopher Leon Kass told me at the time, is about
“ultimates,” by which he meant the meaning of life, the challenges of
mortality, the rights and responsibilities that flow from being a member
of the human family. How we deal with these ultimates defines who we
are, both as individuals and as a people.
It is a bit jaw-dropping to consider how prophetic this book turned
out to be. More than fifteen years have passed since the first edition,
during which time the trends and themes about which I warned have
accelerated. For example, in the original version I spent many pages
cautioning about how dehydrating cognitively disabled patients to death
by removing their feeding tubes was becoming normalized and a matter
of clinical routine. In those years, people were often shocked at the very
prospect. Then, Terri Schiavo burst into the headlines. In the aftermath,
not only are people aware that we cause these cruelly slow deaths, but if
polls are to be believed, most support so doing. Indeed, in the wake of the
Schiavo imbroglio, the resistance to dehydrating helpless patients has all
but collapsed. And what was once the ceiling has now become the floor
as the bioethics discourse now debates withholding spoon-feeding from
people with advanced-stage dementia—even if they willingly eat—if the
patient so instructed in an advance directive.
The first edition of Culture of Death also warned against the growing
euthanasia movement that threatened the soul of Hippocratic medicine.
When the book was published in early 2001, the discussion about assisted
suicide and euthanasia was mostly a caveat of what I thought was likely
xi
xii C U LT U R E O F D E AT H

to come. At that time, only one jurisdiction in the world—Oregon—

had explicitly legalized assisted suicide (although the Netherlands had
decriminalized the practice and allowed death doctors to go unpunished
if “guidelines” were followed). And, while the first edition of this book
discussed the assisted suicide campaign of Jack Kevorkian with much
concern, by the time the book hit the bookstores, he was safely impris-
oned for murder.
Today, Kevorkian is dead, but the moral values and practices he
so zealously espoused certainly didn’t succumb with him. Indeed, it is
tempting to conclude that we are becoming a Jack Kevorkian world.
Not only has the Netherlands formally legalized lethal injection eutha-
nasia, but so too has Luxembourg. In 2002, Belgium instituted an even
more radical regime of doctor-administered death than practiced by the
Dutch—and the country subsequently embraced euthanasia with a deadly
ardor that even surprised me. Meanwhile, Switzerland allows “suicide
tourism”—in essence turning the land of the Alps into Jack Kevorkian
as a country—to where many hundreds of suicidal people have taken a
one-way trip to die in legal suicide clinics.
Worse is yet to come. Just before this revised edition’s completion,
Canada’s Supreme Court imposed a very broad euthanasia license across
the country as a Charter right in the wake of Quebec legalizing lethal
injections as a form of end-of-life care known in the law as “aid in dying.”
Euthanasia will also soon be legally administered in Colombia; the coun-
try’s parliament recently effectuated an old Supreme Court ruling.
The line against doctor-prescribed death has mostly held in the
United States—despite scores of legalization attempts, including an
unsuccessful 2012 voter referendum in Massachusetts. But that may be
changing. Oregon legalized assisted suicide by a referendum in 1994. It
took a long time for the next domino to fall, but Washington State and
Vermont legalized assisted suicide in 2008 and 2013, respectively. The
American assisted suicide movement, bounteously funded and supported
by a boosting media, went into overdrive in 2015, a year in which more
than half the states saw legislation introduced to legalize assisted suicide.
That effort succeeded in California, capping more than twenty years of
intense efforts in the Golden State, from where activists hope their agenda
will sweep the country.
There is better news on the organ transplantation ethics front. In the
first edition, I worried that the dead donor rule—which requires that vital
 Preface xiii

organs only be removed from those who had died—was under threat. It
was and still is. But at least on that flank the moral line has held. While
advocacy for “redefining death” and allowing people to be killed for their
organs has intensified, as we will discuss, organ transplant medicine
remains—for the most part—an ethical and moral enterprise.
The same goes for (what I call) “futile care theory” (FCT), against
which I spent much effort inveighing in the first edition. Medical futil-
ity—which allows doctors to refuse wanted life-sustaining treatments—
remains a cogent threat, but it has not yet become normalized in most
jurisdictions. Still, that is not for lack of bioethicists trying, and so the
issue remains a matter of intense discussion and concern in these updated
pages.
This brings me to describing the major differences between the
original and revised editions. With so much having happened in the last
fifteen years in bioethics and public policies around health care—most
especially the passage of the Affordable Care Act—I had to make some
significant changes from the original text to keep up with the times. Yet I
also had to prevent bloating to keep the book intellectually digestible for
the popular audience for which it is intended. That turned out to be a far
more involved process than I thought it would be when I first undertook
the updating project.
Readers of the original edition will find two major changes. The most
sweeping is the deletion of the entire chapter on the ethical questions
surrounding animal research, despite much positive reaction about its
content in the years since the book was released. It isn’t that the issues
raised were not, and are not, important. Quite the opposite: I believe the
ethics and moralities surrounding the human/animal relationship are so
ethically portentous and crucial to human thriving that I wrote an entire
book, A Rat Is a Pig Is a Dog Is a Boy: The Human Cost of the Animal
Rights Movement, on the subject.1 Since that book dealt in far more detail
with the issues raised in the animal research chapter, among many other
matters, it seemed superfluous to retain the original material here.
I have replaced the animal chapter with a discussion on what I call
“biological colonialism.” The exploitation of human body parts and func-
tions—particularly gestation—is becoming a big business, sparking a cul-
tural whirlwind. The new material explores the contentious debate over
paying for organs—with special attention paid to the international black
market in kidneys—and decries how women, particularly the destitute in
xiv C U LT U R E O F D E AT H

developing countries, are used as “gestational carriers.” In short, I believe

that the bodies of the world’s poor are being exploited by the well-off and
powerful in much the same way that the original colonialists did to weak
nations’ natural resources.
For many of the same reasons, I also omitted the original section on
embryonic stem cell research and human cloning. Those issues similarly
remain important. Indeed, in the years after this book’s publication,
embryonic stem cell research became, for a time, one of the country’s
most contentious political and moral issues. That being so, I believed I
could not do justice to—nor adequately describe—the intricate contro-
versies involving our fast-emerging biotechnologies in one section of a
general chapter, like in the first edition. Indeed, as with animal issues,
I believed these issues to be so important I wrote an entire book about
them—Consumer’s Guide to a Brave New World2—to which I refer inter-
ested readers.
I have replaced the stem cell discussion in the original book with an
exploration of a related but distinct futuristic social movement gaining a
lot of steam in the last few years. Known generally as “transhumanism,”
this materialistic quasi-religion challenges traditional Judeo/Christian
moral principles about the intrinsic dignity and importance of human
life, as it pursues policies it hopes will culminate in our recreation into
a “post human” species. While I was unable to give the subject the full
attention it requires, I hope the reader finds the discussion sufficiently
provocative to stimulate further exploration.
Before we begin, a few words about the general approach I took to
upgrading and revising a book fifteen years on the shelves: Culture of
Death is not an “issues” book so much as one based on themes. I main-
tained that approach in this edition. That made the revision more chal-
lenging to me as a writer because I couldn’t simply append new stories
and cases like so many Lego© pieces onto old chapters. In other words, it
wouldn’t do to simply add new assisted suicide cases onto “the euthanasia
chapter,” as the issues involving doctor-administered death are discussed
across most of the book. This structure thus presented me with the cre-
ative challenge of weaving new material into the existing themes in a way
that I hope is both seamless and edifying to the reader.
But that required difficult choices. I could have deleted all the older
material and replaced it with newer stories and issues bearing on the same
 Preface xv

themes. Or I could have kept all the old material, adding in only a few
updates. I chose a middle ground, removing significant sections of dated
material but maintaining sufficient original text to show the continuity
between what I foresaw then, what has happened since, and the reasons
for my even greater alarm about where we seem to be heading now. I hope
I have integrated the old and the new in a way that illuminates how we
didn’t “just arrive” at our current peril but were brought intentionally to
this place step by intentional step.
That noted, here are the most prominent changes readers will find in
this new edition, beyond simple updating of case studies:
• Detailed material about the Terri Schiavo controversy;
• Updated text across several chapters on assisted suicide and
euthanasia, including a discussion of the new horrors out of
Belgium and reference to the late Brittany Maynard, who became
a media-driven celebrity at the end of 2014 for committing assist-
ed suicide;
• Continued and updated discussion of futile care theory;
• A more detailed focus on advance medical directives and a brief
discussion of a new form of advance health care planning known
as the POLST (physician’s order for life-sustaining treatment);
• Updating the question of health care rationing;
• A discussion of the impact the Affordable Care Act—also known
as Obamacare—could have on bioethics;
• A greater discussion of the abortion question while omitting the
issue of partial-birth abortion because a federal law was enacted
that banned the procedure; and
• New discussion of the question of medical conscience protections
and the threat of what I call “medical martyrdom” to health care
professionals.

My primary purpose in writing this book has not changed since its
original iteration: to alert readers to the subversive impact of bioethics
and other ideological agendas on the fundamental moral principles that
have long governed the practice of medicine specifically and our society’s
values and mores generally. In so doing, I hope to help make these crucial
debates about medical ethics and health care public policy accessible to
those beyond the so-called expert caste that not only dominates these
xvi C U LT U R E O F D E AT H

deliberations but also threatens to transform our health care system into
a sclerotic technocracy. Thus, I invite those who will be directly affected
by these matters—in other words, each and every reader—to enter into
these debates with the understanding that the decisions we make in the
next decade about issues such as euthanasia, medical rationing, end-of-
life care, and organ transplant ethics—just to name a few—will determine
both the future of Western medicine and—dare I say it—the continuing
morality of our society.
The hour is late. The cause is urgent. The risks are real. As a greater
writer than I once put it, ask not for whom the bell tolls, it tolls for thee.

Wesley J. Smith
Castro Valley, California
June 5, 2015
 INTRODUCTION (TO ORIGINAL VERSION)

This book is the product of two years’ worth of intensive research and
writing, but its genesis goes back much further than that. Since 1993, I have
been an anti-euthanasia activist, during which time I have researched,
written, appeared on national television and radio, lectured, and engaged
in behind-the-scenes activism, fighting not only the euthanasia agenda
but also the incursion of what I generally refer to as “related issues” into
modern medical practice. My last book, Forced Exit: The Slippery Slope
from Assisted Suicide to Legalized Murder [the title was revised in a sub-
sequent edition to Forced Exit: Euthanasia, Assisted Suicide and the New
Duty to Die] dealt primarily with assisted suicide and euthanasia, as the
title indicates. With this book, I explore related issues, many of which I
believe are as dangerous and urgent as—if not more than—the ongoing
public policy wrestling match over euthanasia.
Assisted suicide is just the tip of the iceberg of what has come to
be known as the “medical culture of death.” Unbeknownst to most
Americans, a small cadre of influential health care policymakers are
working energetically and unceasingly to transform medical practice and
the laws of health care away from the “do no harm” model established
by the great Greek physician Hippocrates and toward a stark utilitarian
model that would legitimize not only medical discrimination against
the weakest and most vulnerable among us but also, in some cases, their
active killing. To make matters worse, the first time many people become
aware of what is happening to modern medicine is when they or loved
ones experience a health care crisis and suddenly come face-to-face with
the monster that they did not even know was lurking in their very midst.
Why are the ethics of our health care system so threatened? Some of
it, no doubt, has to do with the times in which we live, in which objective
truths are passé and the very concept of right and wrong itself is under
assault. But make no mistake—more is at work than just societal drift or
xvii
xviii C U LT U R E O F D E AT H

passive cultural evolution. The challenges to ethical medical practice and

morality explored in this book are promulgated and promoted with great
gusto by a cadre of so-called “experts,” a genre of moral philosophers,
academics, lawyers, physicians, and other members of the medical intel-
ligentsia known generically as “bioethicists.”
How does one become a bioethicist? It isn’t hard. A bioethicist is
as a bioethicist does—no tests have to be passed, no qualifications met.
Indeed, practitioners are not licensed, as are other professionals such as
attorneys, physicians, real estate agents, or, for that matter, hairdress-
ers. And while more than thirty universities offer degrees in bioethics,
there are no standards of education or excellence that apply universally.
A Catholic priest can be a bioethicist just as easily as an atheistic col-
lege professor. Health care professionals, such as nurses or community
ombudsmen, can be appointed to hospital ethics committees, take a few
training courses, and then self-identify as bioethicists. Indeed, by writing
and lecturing extensively over the last eight years on bioethical issues,
including assisted suicide and moves to permit doctors to unilaterally
remove wanted medical treatment from dying and disabled people, I
could say that I am a bioethicist, too—but I won’t.
Being designated a bioethicist in and of itself is of relatively little
import. The title does not give one influence within the bioethics move-
ment or the ability to sway society onto or away from the bioethics path.
That is to say, there is a very big difference between being a bioethicist and
the ideology of mainstream bioethics, the tenets of which will be described
in the first chapter. It is the adherents to the ideology of bioethics—led
by a relatively small “insider” group of elite practitioners—who are the
bioethicists that hold a steadily increasing sway over the laws of public
health, the application of medical ethics, and the protocols that govern
hospital care. It is their agenda against which this book primarily warns.
As I began my research for this book, I had no idea the depth of the
task that awaited me. Yes, I knew that matters were going badly akilter,
but I really had little insight into how far bioethics has already helped
push the practice of medicine away from the ideals and beliefs that most
“regular” people count on to protect them when they or loved ones grow
seriously ill or disabled. Indeed, the more I learned about the present
being crafted by bioethicists and the future the mainstream movement
seeks to create, the more I felt as if I had fallen through Alice’s looking
 Introduction xix

glass into a Salvador Dalí painting. Our culture is fast devolving into a
society in which killing is beneficence, suicide is “rational,” natural death
is undignified, and caring properly and compassionately for people who
are elderly, prematurely born, disabled, despairing, or dying is a “burden”
that wastes emotional and financial resources. Perhaps most worrying:
Bioethicists are constructing a system in which the rights of people in
the medical system will be based on an explicit hierarchy of human life.
Culture of Death will tell the story of how these nihilistic attitudes
are dismantling traditional medical ethics and endangering weak and
vulnerable patients. The book will detail how bioethicists have gener-
ally abandoned the sanctity of human life ethic that proclaims the equal
inherent moral worth of all human beings. Most do not believe in the
Hippocratic Oath. Indeed, believers in what I call bioethics ideology
reject the very notion that there is anything “special” per se about being
a human being. Rather, they assert that being human is a relative thing
and what matters morally is whether a “being” is entitled to membership
in the “moral community,” which, as we shall see, each individual must
earn by possessing “relevant characteristics”—usually a minimum level
of cognitive functioning—that bioethicists claim give rise to significant
moral standing, including the right to life.
In the surrealist world of bioethics philosophy, those with sufficient
cognitive qualifications to achieve membership in the moral community
are often called “persons.” Ironically, many bioethicists assert that persons
may include “entities” that are not human. For example, animals are said
by some bioethicists to qualify for personhood, which would give these
beasts greater moral worth than some humans.
The influence of bioethics is pervasive. From their positions in the
academy, in medical and bioethics think tanks, in law schools, and as
editors of elite medical journals, financed by grants, honoraria, and book
royalties, bioethicists are changing the very face of American health care.
Here are just a few examples—a preview of coming attractions, if you
will—of some of the topics I will detail later in these pages:
• Dr. Marcia Angell, editor of the New England Journal of Medicine,
has editorialized that the definition of death be expanded to include
a diagnosis of permanent unconsciousness or that other policies be
implemented with the stated purpose of requiring that unconscious
people be dehydrated to death—even if their families object.
xx C U LT U R E O F D E AT H

• A peer reviewed article in the Lancet, one of the world’s most

famous medical journals, took this idea one step further, opining
that unconscious people should be lethally injected to allow their
organs to be harvested. This is not an isolated notion. The idea of
permitting disabled people to be killed for their organs is gaining
steam among many members of the organ transplant community.
• Peter Singer, an internationally renowned philosopher from
Australia with a worldwide following, has declared that parents
should have twenty-eight days in which to decide whether to keep
or kill their newborn children. Rather than becoming a pariah, as
one would expect of an infanticide advocate, he was appointed to
a prestigious, tenured professorship at Princeton University.
• Daniel Callahan, one of the country’s most influential bioethi-
cists, has called for a harsh system of medical rationing in which
research into the cures and causes of disease would be drastically
reduced and health care resources diverted from medical treat-
ment into public education programs intended to convince—and,
if necessary, coerce—people into healthy lifestyles.
• Some bioethicists want to create a market for the sale and pur-
chase of human organs. Others promote the creation of suicide
clinics. A few have even proclaimed a “duty to die” upon reaching
old age or becoming a financial or emotional burden.

That such discriminatory policies are ardently advocated in the

world’s most respected medical and academic journals would be enough
cause for alarm. But bioethics is about much more than intellectual
theory. Many bioethics agenda items have already imbedded themselves
into the bedrock of law.
The 1999 Montana Supreme Court’s decision in James H. Armstrong,
MD v. The State of Montana is just one example. The state had passed a
law requiring that only doctors perform abortions, which the court invali-
dated based on the Montana Constitution and Roe v. Wade. That should
have been the extent of the decision. But rather than limit the ruling to
the case at hand, a 6-2 majority decided to use the cultural flashpoint of
abortion as a pretext for imposing a radical and audacious philosophical
imperative on the people of Montana, unwarranted by specific facts of
the case and unnecessary to its prudent adjudication. As a consequence,
 Introduction xxi

the ruling’s extraordinary legal implications extend far beyond abortion,

opening a Pandora’s box of expansive litigation in Montana for years to
come and threatening the right of Montana to effectively regulate the
practice of medicine through the rule of law.
The scope of the majority ruling is almost unlimited: “The Montana
Constitution broadly guarantees each individual the right to make
medical judgments affecting her or his bodily integrity and health in
partnership with a chosen health care provider free from government
interference.” This is far more alarming than it may appear at first read-
ing. As the two justices who objected to this aspect of the ruling, Karla
M. Gray and Chief Justice J. A. Turnage, rightfully worried, the ruling’s
broad breadth and radical scope strongly suggests that “the Legislature
has no role at all in matters relating to health care to be provided to
the people of Montana” and “sweeps so broadly as to encompass and
decide such issues as the right to physician-assisted suicide and other
important health and medical-related issues which simply were not
litigated in this case.”
If, indeed, almost anything goes medically in Montana, so long as
a patient wants it and a health care professional is willing to do it—a
reasonable interpretation considering the expansive language and philo-
sophical thrust of the majority’s decision—then it could be construed to
permit a doctor to amputate a patient’s healthy limbs upon request when
the patient wants it removed to satisfy a neurotic obsession (a macabre
surgery that has actually occurred in England); allow patients to ask
doctors to kill them for organ donation purposes; permit infanticide of
disabled infants at the request of caregivers or parents; or allow people
to be experimented upon in dangerous ways that are currently illegal.
Indeed, the court’s ruling is so broad, it decreed that only “a compelling
interest . . . to preserve the safety, health and welfare of a particular class of
patients or the general public from a medically-acknowledged bona fide
health risk” warrants state involvement in medical decision making. In
other words, regardless of the individual or societal consequences, absent
extraordinary exigencies, such as preventing a plague, virtually anything
may be allowable in Montana if it can be construed to involve obtaining
“medical care from a chosen health care provider.” That’s an astonishing
result from a little-noticed ruling overturning a law that would have
simply required doctors to perform all abortions.
xxii C U LT U R E O F D E AT H

How did the court justify such an encompassing decision? Yes, the
court looked to Roe v. Wade and a smattering of other cases. But the pri-
mary authorities that the majority decision relied upon for the broader
context of its ruling were philosophical treatises. Indeed, the most fre-
quently cited authority was not a statute, a law case, or even a legal essay
but a philosophical discourse on the modern meaning of the “sanctity of
human life” contained in a book—Life’s Dominion: An Argument about
Abortion, Euthanasia, and Individual Freedom—written by the attorney/
bioethicist Ronald Dworkin in 1993. Dworkin’s thesis: A true adherence to
the sanctity of life ethic requires that all be permitted to “decide for our-
selves” about abortion and euthanasia and that such decisions be accepted
by society and tolerated by those who disagree; otherwise society is
“totalitarian.” The majority opinion cited Life’s Dominion so frequently
and applied its reasoning so enthusiastically that the Ronald Dworkin’s
philosophy may now be the court-mandated health care public policy of
the entire state of Montana without a single vote even being cast—quite
a triumph for a philosopher who is little known outside the world of the
academy and another step down the road toward the new medicine of
mainstream bioethics.
As this book will demonstrate, bioethicists and their allies are push-
ing the laws of the nation and the public discourse increasingly toward
accepting killing and death as a legitimate answer to life’s difficulties. This
is leading to a rising human toll:
• Oregon, which has legalized assisted suicide, decreed that the act
is a form of “comfort care” that must be paid for by Medicaid; this
in a state that denies some curative treatments under the state’s
Medicaid health rationing scheme.
• Desired medical treatment is refused in hospitals and nursing
homes around the country to patients who are dying or disabled,
with the intent that the patients die. This abandonment is justified
as ethical under a new theoretical construct known as futile care
theory (FCT), which proclaims the right of doctors (and health
care executives) to refuse wanted care based on their subjective
views of the value of their patients’ lives.
• Doctors, nurses, and other hospital staff in hospitals and nurs-
ing homes often pressure family members of stroke victims,
 Introduction xxiii

demented patients, and other cognitively disabled people to

permit their brain-damaged relatives to be dehydrated to death
by removing tube-supplied food and water.
• In New York, a man who smothered his wife with a plastic bag
after her purported assisted suicide attempt failed, and who then
covered up the crime with a falsified death certificate and a quick
cremation, was given a mere two-week jail sentence.
• In Canada, Robert Latimer was convicted of murdering his
twelve-year-old daughter by asphyxiation because she had cere-
bral palsy. Instead of receiving significant punishment, he was
embraced by a majority of Canadians as a “loving father,” result-
ing in his “mandatory” ten-year sentence being reduced to one
year by a judge who labeled the girl’s murder “altruistic.” Latimer
remains free on appeal nearly ten years after his daughter’s killing.
• In England, the parents of an infant born with Down syndrome
and the treating doctor who intentionally allowed the baby to
starve to death were acquitted of all criminal wrongdoing.
• In the United States, the requirements of the Nuremberg Code to
protect human beings in medical experiments are routinely vio-
lated without legal consequence. Indeed, thanks to the advocacy
of “animal rights” activists, animals often receive greater protec-
tion in medical research than do people.

This growing indifference to the value of human life within the health
care system and courts should be big news. Yet most people are but dimly
aware of what is happening. There are several reasons for this. Popular
culture promotes many of these practices as a positive, thereby camou-
flaging the evil that is taking place. Nonjudgmentalism reigns supreme
as the growing relativism of our culture increasingly incapacitates people
from “imposing their own beliefs on others” by making well-honed moral
judgments. The mainstream media neither cover these important issues
adequately (or sometimes even at all) nor place them in a proper and
understandable context when they do. Thus, while stories involving death
culture issues sometimes make the news, they are generally covered as
if they have occurred in isolation. The overarching themes that would
alert the populace to the bigger picture are generally ignored, and the