On the Death of “Dr. Death”

This past Friday, Dr. Jack Kevorkian, the ardent advocate of “physician-assisted suicide” (PAS) whose preoccupation with death earned from his medical colleagues the moniker “Dr. Death,” died in a Michigan hospital after a protracted illness. On the manner of his death, his attorney, Mayer Morganroth,  reportedly commented, “It was peaceful, . . . He didn’t feel a thing” (cnn.com; 06/03/11).

If you ask most people their preference on how they hope their death will go down, you will, no doubt,  consistently encounter the anesthetic wish evident in Morganroth’s words. Who, in their right mind, would truly desire an intensely painful death? Not I, for one.

Yet, while we might all prefer a peaceful death, is it to be pursued at all costs? Kevorkian thought so, and so he risked his own freedom and reputation to provide for others a terminal escape from chronic pain and disability. Better it is, he reasoned, to take matters into our own hands by inducing a quick and seemingly painless end to life, than to endure the indefinite prolongation of an exceedingly unpleasurable experience.

In one word, Kevorkian was a hedonist – specifically, one tending to the order of Epicurus who viewed  the absence of pain and anxiety as sacrosanct.   Paradoxically, Epicurus took a dim view on suicide, but that inconsistency would be rectified by his followers who understood that if death is, as Epicurus had argued, the end of feeling (and existence), then it is to be preferred over a continuing state of unrelenting pain. Furthermore, there could be no fear of divine reprobation for those who ceased to exist.

As for the concern over divine judgment, Kevorkian, a self-professed agnostic, scoffed. How an agnostic can be so confident on a question of divine disposition is  a question for another post.  I’ll close this one with the observation that while  Dr. Death may be dead and gone, the push for PAS remains. Supporters are as determined as ever to harness the medical profession to the task of killing the disabled and infirm. The social barrier to “medicide” is fast eroding as a resurgent Epicureanism permeates our culture, and so, though a fringe figure at his death, Kevorkian may in the not-too-distant future be hailed as a national hero.

Your thoughts?

Your pharmaceutical company care$ about you (No, really, they do)

An editorial in the May 5th issue of the New England Journal of Medicine (NEJM) recounts the tale of Makena.  It starts back in 2003, when a landmark study funded by the NIH showed a decrease in preterm births for certain high-risk women who receive treatment with 17 alpha-hydroxyprogesterone caproate (17OHP).  17OHP is the only medication ever to have shown benefit for this problem;  therefore, on the basis of this study, it was used widely.  It was not a commercially available medication, but could be obtained from certain compounding pharmacies for about $15-$20 per weekly dose.


Many groups, hoping for a more easily obtainable and standardized drug, welcomed the FDA’s decision this past February to grant exclusive rights to Ther-Rx and KV Pharmaceutical Company to manufacture 17OHP under the name Makena.  Their welcome turned into astonishment when Ther-Rx announced that Makena would be priced at $1500 per dose.


Gregory J. Divis Jr., the pharmaceutical company’s chief executive, attempted to defend the indefensible by saying that Makena could help offset some of the costs associated with preterm birth, and that “These moms deserve the opportunity to have the benefits of an FDA-approved Makena.”  (The NEJM article estimates the total annual preventable medical costs associated with preterm births in this country to be $519 million.  At $15 per dose of 17OHP compounded in the local pharmacy, it would cost $41.7 million to attain those savings.  At $1500 per dose of 17OHP marketed as Makena, it would cost $4.0 billion to save that $519 million.)


The plot thickens.  On March 30th, the FDA issued a statement that it does “not intend to take enforcement action against pharmacies that compound 17OHP” when a valid prescription is written.  In other words, the FDA granted Ther-Rx a patent on the medication;  but when they saw the grievous abuse of that patent, they in essence revoked it!  (Was that an unethical reneging on a promise, or an ethically justified intervention to thwart pharmaceutical highway robbery?)  Ther-Rx generously reduced the price to a mere $650 per dose, and my OB colleagues inform me that Ther-Rx’s representatives have contacted many physicians’ offices and suggested that patients no longer have the option of using compounding pharmacies, but must instead use Makena.


It is not just Ther-X’s rapacity that is so breathtaking, but their audacity as well.  Has our society become so cozy with the idea of medicine as industry that a company actually has reason to believe it can commit such profligacy in broad daylight?  What part should the profit motive play in providing medical care?  Where’s the line between reasonable return on investment and unscrupulous opportunism?  Maybe it’s like what Supreme Court Justice Potter Stewart said about pornography:  I can’t define where the line is, but I know it when I see it.


I visited the Makena website, and read an online brochure that asserted, “Ther-Rx cares about you and your baby.”  I don’t doubt that they care;  I just wonder if they would still care if it weren’t so darned lucrative.


The End of the Food Pyramid

If you read my recent post entitled “The Human Factory” you may have begun to suspect that I am quite interested in food and the food industry. Connected with this intense passion for food is my interest in nutrition as it relates to physical training. So, when I heard of the new initiative of the US gov’t to reshape the nation through the replacement of the food pyramid, I was overjoyed and bewildered all at the same time.

Here is why:

My reason for being overjoyed is obvious–the current state of America’s health is horrible. This fact has correlative effects upon our health care system (i.e. increased spending on health care and increased demand on physicians).

I am bewildered because I am not sure that these new initiatives will have any impact on American Culture…

What do you think?

Is MyPlate going to be just another trend that fades away with time?

Will this public health initiative help us get out of our current state?


Suicide Assistance for Sale

The Oregon Senate recently approved a bill to ban the sale of suicide kits.  It is interesting that this occurred in the first state to legalize physician assisted suicide.  The move was in response to the death of a 29-year-old Oregon man who suffered from depression related to problems with pain and fatigue and took his life using a helium hood suicide kit that he bought by mail order for $60.  The helium hood method of suicide was developed and promoted by Derek Humphry and the kit was sold by a follower of Humphry to whom he refers business.  Humphry, who lives in the same area in Oregon as the man who committed suicide, founded the Hemlock Society that was a primary force behind the passage of Oregon’s assisted suicide law.

Although the Oregon law he helped to pass limits physician assisted suicide to those with a terminal illness, Humphry made it clear in an interview with The Register-Guard, the local Eugene, Oregon newspaper, that limiting assisted suicide to those with a terminal illness is not important to him.  Speaking of this particular case, Humphrey said, “It may be very sad and tragic, but if this man had ongoing health issues and had struggled with that, I wouldn’t criticize his decision.  It was his right.”

The logic of assisted suicide is clear.  If we accept that ending the life of the sufferer is an appropriate response to suffering and that a person who is suffering should be able to request assistance to end his or her life, then there is no reason to limit that assistance to those whose suffering we think is intolerable or who are terminal or who request the assistance from a physician.  A mail order kit fits the logic just as well.

Suicide by Mail Order

Recently The Los Angeles Times reported on Sharlotte Hydorn, the 91-year-old woman who sells mail-order suicide kits for $60.  Her reasoning is that people commit suicide “by jumping out of windows and buildings, and hanging themselves.”  With her kit, the task could be made easier.  As described by Richard Marosi of the Times, Hydorn “peddles a product touted for its deadly simplicity. Inside her butterfly-decorated boxes are clear plastic bags and medical-grade tubing. A customer places the bag over his head, connects the tubing from the bag to a helium tank, turns the valve and breathes. The so-called suicide kit asphyxiates a customer within minutes (Los Angeles Times, May 30, 2011).”

Apparently there is a demand for Hydorn’s suicide kits; individuals, young and old, terminally ill or despondent, have requested the “exit bags” on average 100 per month.  Hydorn is driven, she claims, not by a desire to make money, but by compassion.  From her perspective, to end suffering by means of suicide is the humane thing to do.  It’s not about killing people, she maintains, but about helping people who desire to end their misery.

I must admit that if and only if one removes God from the equation, Hydorn’s point of view carries some force.  After all, as Ivan Karamazov (of Dostoevsky’s The Brothers Karamazov) insinuates, if there is no God, everything is permitted.

So the question is how to argue against the promotion of assisted suicide without simply invoking God as the reason to reject it.  In other words, in a pluralistic society that appeals to a strict separation between Church and State, are the non-theistic arguments against assisted suicide strong enough to withstand the forcefulness of the arguments for assisted suicide?

A Memorial Day Post

Today is the day our nation has set aside to commemorate its fallen warriors. It seems right and fitting that we diverge for a moment from a direct discussion of matters bioethic.

As the saying goes, “Freedom Isn’t Free,” and so, as we enjoy the blessings of liberty, we ought to acknowledge our indebtedness to those who have secured and defended it at great cost. Indeed, we do well to honor on this day those who have made the ultimate sacrifice in that effort and whose number well exceeds 1 million. Our commemoration, then, ought to be marked by a deep sense of gratitude.

We do well, also, to remember those who bear a disproportionate share of the burden of military deaths.  Long after the joy of a soldier’s safe return home subsides, the grief borne by families less fortunate remains. So as we honor the sacrifice of those lost in battle, we also bring attention to the loss experienced by those whose lot it has been to carry on without that son or daughter, that mother or father, that wife or husband, that sister or brother. Our commemoration, then, ought to be marked by a genuine sympathy for those grieving their lost warrior.

Finally, we do well as we reflect upon the sacrifices of past generations to consider the opportunity we have to work for the good of future generations. Some may be called to bear the sword as dutiful agents of the state as our fallen warriors have done, but most of us will not. Even so, as citizens we may all labor mightily to secure for our posterity a nation that embodies in its laws the great value God has placed on human life and liberty. Our commemoration, then, ought to be marked by a commitment to sacrificial service.


The Yuk Factor

Bioethics can bring up some interesting topics.  We already conceive children outside the body, and manipulating the brain via implants is becoming more commonplace.  Our bodies are very much part of who we are, and tinkering with them in unusual ways often elicits a reaction of aversion.  We sense that something is amiss, that maybe we shouldn’t be doing what we are doing.  Leon Kass termed this phenomenon, the “yuk factor,” a “deep wisdom” that’s hard for us to put our finger on.  The existence of such a “wisdom of repugnance,” he argues, is evidence of a more basic morality that lies beyond the reasoning we use to construct our code of ethics.  In his view, we should heed this intuition; it may indicate something important.

How do we distinguish this kind of insight from just a disinclination toward the new and different?  Many of the medical advances we enjoy today would never have come into being if someone had not challenged the contemporary thinking on the subject.  For instance, organ transplantation on the surface of things seems a bit bizarre.  If one considers the body–not just the soul–to be a part of the person, breaking its wholeness through the removal of an organ seems harmful.  Naturally, many objected to this new medical technology in its initial stages.  However, after the pioneering work of many doctors in the 1960s, the procedure has become common.  What about xenografts from pigs?  Human organ donation involves the sacrifice of another person, but using an organ from an animal is void of such noble motives.   The interspecies nature of the transplantation makes it seem all the more foreign, increasing the “yuk factor.”  Or, are we just resistant to something that is new, something that hasn’t been done before?  Perhaps decades from now we will find xenotransplantation to be the solution to the organ shortage we face now.

What do you think?  Is a completely rationalistic approach to ethics deficient?  Is the “yuk factor” a valid tool in the crafting of our ethics?  Is this intuition in some way analogous to the conscience?   Or the Holy Spirit’s prompting?  Is “deep wisdom” super-rational, irrational, or something else?  Which contemporary technologies are unusual but necessary and which present harms that call for us to prohibit their use?


From Eugenics to Genocide (A Short Walk)

Last week I wrote about the practice of eugenics in modern American obstetrics:  induced abortion performed because prenatal testing shows a potential chromosomal abnormality or birth defect.  This past week, the BBC News Online ran a series of stories under the headline “India’s unwanted girls.”  These stories tell of the practice in India of induced abortion performed because prenatal testing shows a particular unwanted chromosomal “abnormality”:  the presence of the XX chromosome pair, i.e., aborting a baby simply because she is female.  Because of long-standing prejudices and practices, in many parts of Indian society a female child is considered undesirable.  There is widespread availability of prenatal ultrasound clinics for sex determination, and so many parents  avail themselves of  these clinics’ services to guide abortion decisions that in some areas of India there are less than 840 female children for every 1000 male children.  Some Indian activists use the word “genocide” to describe this selective killing of girls.  Lest anyone suspect that Indian families thought up this novel use of medical technology on their own, the following quote from the story provides chilling evidence to the contrary:  “In 1974, Delhi’s prestigious All India Institute of Medical Sciences came out with a study which said sex-determination tests were a boon for Indian women.  It said they no longer needed to produce endless children to have the right number of sons, and it encouraged the determination and elimination of female foetuses as an effective tool of population control.”

Three observations:  First, given the rationalizations for the unfettered right to abortion that pro-choice advocates have promulgated in this country, they would be have to be mute in the face of sex-selective abortion.  They cannot say that it is wrong to abort girls, because if it is wrong to abort girls, then it is wrong to abort boys.  If they admit that it is wrong to distinguish — and extinguish — foetuses on the basis of an arbitrary criterion such as gender, then they would have to admit that it is wrong to do so on the basis of any arbitrary criterion — such as the presence of a disability.

Second, the term “genocide” used by certain Indian activists seems extreme, but it may not be such a long walk from eugenics to genocide.  The justification used to commit foeticide on the basis of gender can be employed to commit foeticide, say, on the basis of  a genetic predisposition to obesity (A 1993 March of Dimes poll found that 11% of parents said they would abort a  fetus whose genome was predisposed to obesity), and is not far from the justification used to commit murder on the basis of whether one belongs to the Hutu or Tutsi tribe.

Third, this tragic story shows yet again what happens when medicine abandons its Hippocratic ethos of commitment to the patient and instead uses its considerable power to pursue goals such as “population control,” social stability — or eugenics.


Roger Abdelmassih–Rapist, Trickster, or Doctor?

Did you hear about this?

Roger Abdelmassih [IVF Doctor in Brazil] is on the run from police after being convicted of sexually assaulting or raping 39 female patients at his clinic.”

I had nearly forgotten about this horrible story when it hit the news again after a few month lapse. But it never fails, every time this kind of news event (a corrupt caregiver manipulates his position) comes to the public eye, I begin to wonder:

What about the Hippocratic tradition/oath?

With the oath in mind, can “physicians” like Abdelmassih really be considered physicians at all?

After all, Abdelmassih no longer sought to heal, cure and care for his patients. He used his technical knowledge to his own advantage and abused the sacred bond between caregiver and patient. To say it bluntly, he manipulated and abandoned the nature of the craft.

Clearly he is not the rule in the field of medicine.

Nonetheless, this gives rise to a number of familiar concerns with the abuse of power/knowledge in an already complex relationship.

Do you think this has any resonating concerns within the entire field of medicine or is this just one extreme case?


Love and Respect

A fellow family physician who cares for people at a clinic in Central America wrote about the death of one of her long-time patients in an e-mail last week.  The woman came to the clinic barely able to breathe and with her heart failing.  As they tried to stabilize her to take her to a hospital for further care, she knew that she was dying and requested not to be taken there.  She said “I want to die here, with the people who loved and respected me, my clinic.”

She expressed the understanding that there are some things that are more important than having the ability to treat diseases effectively and extend people’s lives.  We should strive to provide high quality, effective medical treatment, but caring for people is more than that.  It includes loving them and showing them respect as sisters and brothers in the human family.

All of our patients eventually die.  When they do will they know that they were loved and respected by us as we cared for them?