Hugh Heffner’s Legacy

Hugh Heffner died on Wednesday, September 27 in his Playboy mansion at the age of 91.  He was buried next to Marilyn Monroe, Playboy’s inaugural centerfold.

From the moment I heard that Heffner had died, I tried to process the significance of his life and death.  Part of me feels sadness and pity.  As a Christian, I can’t get one thought out of my mind.  What would it be like to stand before the Holy God and give an account of your life, when your claim of fame was bringing pornography into the mainstream?  Frankly, I’ve had to fight being too judgmental and too self-righteous.  After all, despite all my weaknesses, failures, and sins, Hugh Heffner makes me look good.  Yet, I too will one day give an account of my life before God.  Only by the grace of God, the blood of Jesus, and the cleansing of the Holy Spirit have my own filthy rags of unrighteousness been removed and replaced with the righteousness of Jesus.  Oddly, Heffner’s death has caused me to be more self-reflective and more determined to live righteously and to uphold high ethical standards.

Another part of me, however, is angry.  I’m angry because Heffner launched a magazine and an empire that pedals to our base, fallen, lustful desires and, in doing so, he bears the guilt of bringing thousands—even millions—of people into moral ruin.  For many men of my generation, Playboy was the introduction to pornography, a fascination that turned into a habit that turned into an addiction that resulted in personal ruin.  That fascination turned habit turned addiction is fueled even more powerfully today by easy access to internet porn that makes the original Playboy magazine look tame.  Indirectly at least, Heffner is responsible for aiding the destruction of the marriages, moral lives, and Christian walk of many friends and relatives of mine. Yes, I’m angry.  I pray my anger is “righteous anger.”  My heart breaks over the devastation that has been wrought by the sexual revolution of which Heffner’s legacy is a part.

Many authors of various news reports, articles, and blogs about Heffner’s life and death are not quite sure how to view his legacy.  For the most part, television news reports have been bland and blindly uncritical.  The obituaries for Hefner, even if they acknowledge the coarseness and unseemliness of his empire, have been full of praise for his great deeds as the conqueror of puritanism, as the advocate of progressive political issues, and as the successful businessman.

Feminists writers especially are at a wit’s end.  Take, for example, an article by feminist writer, Jill Filipovic (“No, Hugh Hefner Did Not Love Women”).  On the one hand, she commends Hefner for being “on the right side of many of the biggest issues of the modern era: free speech, reproductive choice, gay rights.” Personally, I don’t agree that Heffner and progressives are on the “right side” of these issues, but I concur that they are on the same side, as Filipovic notes.  While she upholds abortion rights as strongly as Heffner did, she does part company with him in one regard: “Hefner advocated for contraception and abortion rights, sure, but because those things benefited men’s sex lives, not because they were necessary components of female freedom.”

On the other hand, Filipovic condemns Hefner for reducing women to mere playmates, objects of men’s fantasies and unbridled desires.  I could not agree with her more on this point.  She observes, rightly in my opinion: “Hefner claimed to ‘love women.’ He certainly loved to look at women, or at least the type of women who fit a very particular model. He loved to make money by selling images of women to other men who ‘love women.’ He certainly met a lot of women, had sex with a lot of women, talked to a lot of women. But I’m not sure Hefner ever really knew any of us. And he certainly did not love us.”

Especially insightful is this point: “What Hefner and Playboy never did was present women as human, or consider us anything like men. Hefner made female sex objects more relatable and accessible — the Playboy centerfold was the girl next door, not the famous movie actress —but this wasn’t so much an elevation as a downward shift: social permission for men to look at all women through the zipper in their jeans, and not even bother to pretend it was otherwise.”

On this point, Filipovic is in agreement with conservative, Christian blogger Jon Bloom (“One Man’s Dream Destroyed Millions: The Pitiful Legacy of Hugh Hefner”): “Hefner and many others have become very rich by objectifying women and turning them into virtual prostitutes—mere bodily images to be used by millions of men who care nothing about them, who ravage them in their imaginations for selfish pleasure and then toss them in the trash. Hefner gave these women the fun name of “playmates,” a wicked mockery of both a person and play, adding a terrible insult to horrible injury.”

On at least this point, a progressive and a conservative writer can agree.  The objectification of women—the reduction of women to “mere body,” as if they were devoid of mind, emotion, and soul—is pornography’s ultimate evil.  I also agree.


Prayer and Health

Many readers are aware of several scientific studies in recent years that have sought to quantify the effect of prayer on patients’ health in medical settings. The studies have been variously conceived. Some have researched the effect on patients who know they are being prayer for, others on patients who don’t know they’re being prayed for; some studies involved prayers and patients who know each other, others involved prayers who are strangers to the patient. When positive effects were found, were they due to the Placebo Effect, the Hawthorne Effect, or actual divine intervention? The findings have been mixed. This does not surprise me since it’s difficult, if not impossible, to reduce all dimensions of religious faith and prayer to variables that are quantifiable and thus subject to scientific research. Overzealous attempts to do so will probably prove to be disadvantageous to both religious faith and science.

Though I find these studies interesting and sometimes insightful, my interest in this writing lay elsewhere. I wish to reflect biblically on the experiences of those who have prayed for the health of loved ones and, perhaps, have met disappointment instead.

Even in Jesus’s day, people seeking healing from the Lord often left empty-handed. In fact, on more than one occasion Jesus himself walked away from a crowd of people in need of healing.

Mark 1:29-39 is a case in point. At Peter’s house in Capernaum Jesus healed Peter’s mother-in-law who was ill with a debilitating fever. By evening, after word spread like wildfire throughout the small fishing village, “the whole city was gathered together at the door.” Jesus “healed many who were sick of various diseases, and cast out many demons.” The next morning, a great crowd of the infirm had already started to form. Everyone was hopeful. All morning they waited.  Morning passed into noon, and noon into evening. As time passed, they grew restless, then desperate, then defeated. Jesus never came. Unbeknownst to them, Jesus had slipped away even earlier in the morning, while it was still dark, to find a desolate place in which to pray. When his disciples found him, they told him, “Everyone is looking for you.” But Jesus said it was time to move on to the next towns, “that I may preach there also.” His departure from Capernaum left many seekers of healing disappointed and frustrated.

The disappointments of the Capernaum crowd which sought healing—but received none—are not unique. They are universal.  We have all prayed for healing that did not come, as well as for healing that did—let us not forget that! We have prayed for others even more fervently that we have ever prayed for ourselves. Some for whom we have prayed the hardest we lost anyway. Does this mean we should doubt – if not His power, then His love, His goodness? Does this mean we should give up on prayer? Does this mean we should cynically think what is going to happen will happen; that nothing, no one—not even God—can change what inevitably is going to happen?

Martha does not think so. In John 11 Martha sends Jesus word that her brother is seriously ill. Jesus stays put until Lazarus has died, explaining to his disciples (and to the reader) that He intends to raise Lazarus from the dead. He gives Martha no explanation.  In John 11.20-27, Martha meets Jesus on the outskirts of Bethany. Her first words are: “If you had been here our brother would not have died.” Jesus, before raising her brother, or even hinting that He would, asks her if she still believes: “I am the resurrection and the life; he who believes in me shall live even if he dies, and everyone who lives and believes in me will never die. Do you believe this.”

Her response is quick and sure: “Yes Lord, I believe completely that you are the Christ, the Son of God, who comes into the world.” Though Martha has questions and even doubt, her faith is sure. She believes with her head and her heart. Her faith is not disappointed. Such faith never is. Jesus has not come to Bethany to cure an illness, but to defeat death.

We must remember this. We have walked in the shoes of the crowd in Capernaum, our hearts filled with disappointment. We know the pain of our own diseases, as well as the pain of watching loved ones struggle with theirs. We know the disappointment of being told that there is no cure for our condition, but only partial management of the worst symptoms. We know the disappointment of having less energy and facing new limitations, of not being able to do things we once took for granted. We know the disappointment of watching our healthy friends and family carry on as usual while we feel we are being left farther and farther behind. We know the disappointment of our own body becoming our enemy rather than our friend. We know the disappointment of crying out to God, only to be met by deafening silence.

We must remember that questions and disappointments need not destroy faith. We must remember that faith involves a relationship with God who has proved his faithfulness to his people over and over and over again. Yes, the journey of faith is often from Mt. Sinai through the wilderness until we reach the Promised Land, but God is always with his people every step of the way. Not just at Mt. Sinai and in the Promised Land, but in the wilderness also!

We must remember that faith involves walking faithfully with Jesus. He also walked the way of pain, suffering, disappointment and rejection. He cried out on the cross, “My God, My God, why have you forsaken me?” But even in that moment of feeling real suffering and real forsakenness, his heart was drawn to the Father and to the Father’s love. And in that moment of heart-to-heart love, he knew that the Father had not and would not abandon him. That his heavenly Father was where he always is when his people suffer. God is there in their midst. Nowhere is that more evident than the cross. It was not simply the man Jesus who suffered on the cross, but it was God-in-the-flesh, God incarnate in Jesus, who suffered on the cross. That day, God’s love was written in red.

That love makes us able to believe like Martha: “Yes, Lord, I believe that you are the Christ, the Son of God, who is coming into the world.” And I believe you will turn my sorrow into joy. I believe you will turn all my disappointments into hope. I believe your love will never fail. I believe that in good times and bad, in health and sickness, in victories and defeats, in life and death, you will walk with me every step of the way. Amen.

Pray Tell, What Does Harvey have to do with Abortion?

Nothing brings out the true color of people as clearly as a national catastrophe such as hurricane Harvey. “Beautiful” has been the color of the vast majority of people who have been victims of, or responders to, one of the worst natural disasters in U.S. history. Many people who watched their houses and possessions float away, who must have wondered how they will ever recover from their losses, nevertheless are painting the beautiful colors of faith, trust, courage, and patience. Many people who have put their own jobs and lives on hold to go down to Houston to help strangers in need, to pluck them out of the flood waters, to feed and shelter them, and to give them the proverbial shirt off their backs, are painting the beautiful colors of love, service, and sacrifice toward fellow human beings in need. Yes, Harvey has brought out many beautiful colors, as the vast majority of people have displayed the best of what human beings are capable of.

However, tragedies also bring out the true “ugly” colors of other people. Looters have broken into business and private dwellings and have wantonly stolen what did not belong to them. On some occasions, first responders have been robbed and even shot at. And when the flood waters recede and flood victims begin to rebuild their homes and lives, be assured that scammers will make the rounds, taking advantage of people in great need to pad their own greedy pockets with ill-gotten gain. Yes, Harvey has brought out many ugly colors, as a few people have displayed the worst of what human beings are capable of.

In my judgment, hurricane Harvey has brought out the true colors of the ardently pro-choice organization, NARAL. Ugly and unconscionable are the kindest words I have for the tweets NARAL posted to its official twitter account. “In the wake of #HurricaneHarvey, Texans seeking abortion face clinic closures, canceled appts, & displacement.” NARAL also encouraged people to give money to the Lilith Fund which invited people to “join us in supporting Harvey survivors seeking an abortion but cannot afford it.”

Nothing like using a human tragedy for a desperate fund-raising appeal! After all, could there be anything worse than a slow-down in the abortion industry? Thousands of displaced people living in shelters, wondering how they’ll recover since they are without flood insurance to rebuild their houses. Thousands of people simply happy that they are alive, having been rescued from Harvey’s rage. Thousands of people emptying their wallets and giving generously to the Red Cross and other disaster relief organizations. And NARAL is worried it might not get its share of money to support the abortion juggernaut? In the midst of all the suffering inflicted by Harvey, evidently NARAL’s deepest fear is that some human fetuses might escape the death of abortion, having been “accidently saved” because the abortion-machine was unable to operate at full capacity in Texas during those terrible days that were hurricane Harvey. NARAL’s true color is evident. It is not so much “pro-choice” as it is “pro-abortion,” and it is not above taking advantage of a human tragedy to beg money to support its deathly cause.

Inherent Problems with Commercial Surrogacy in India

The degree to which financial incentives can muddle ethical deliberation and practice is evident in the commercial surrogacy trade in Indian. For years, “rent-a-womb” services to foreigners has been “big business” indeed, generating nearly $1 billion annually.

Would-be Western parents, many from the U.K. and Scandinavia, argue that commercial surrogacy arrangements are a win-win situation for everyone. They get the baby they’ve longed for and the Indian women receive significant financial compensation. Surrogates typically are paid $6,000 or more to provide their womb. In a country in which average monthly earnings are $215, this is an extraordinary amount. The financial incentives for Westerners to do business in Indian fertility clinics should not be underestimated either. Costs for a surrogate birth in India total $15,000-$20,000, approximately one-tenth the price that would be incurred in a California clinic. What’s not to like about people desperately desiring a baby receiving one at a bargain rate, while desperately poor Indian women receive several years’ worth of income for nine-months work?

There’s plenty not to like about these arrangements. One of the greatest concerns is the exploitation of the poor who comprise the vast majority of surrogates. Free and informed consent by Indian surrogates may not be as free as it appears. In her recently completed Ph.D. dissertation on commercial surrogacy in India, Kristin Engh Førde argues that financial desperation has the potential to override genuine personal autonomy: “They are forced to make money for their family and their chances for succeeding are extremely low…Some have a major debt to pay, such as a hospital bill…Many feel that surrogacy is a chance they have to take. And it’s important for them to distance themselves from the choice. It was not something they wanted; it was something they had to do.”

Julie Bindel contends that commercial surrogacy represents an exploitation of women generally, not simply of poor women specifically: “As a feminist campaigner against sexual abuse of women, and in particular the sex trade, I feel sick at the idea of wombs for rent. Sitting in the clinic, seeing smartly dressed women come in to access fertility services, all I could think about was how desperate a woman must be to carry a child for money. I know from other campaigners against womb trafficking that many surrogates are coerced by abusive husbands and pimps. Watching the smiling receptionist fill out forms on behalf of prospective commissioning parents, I could only wonder at the misery and pain experienced by the women who will end up being viewed as nothing but a vessel.”

Fortunately, the Indian government has taken notice of the actual and potential abuses inherent in commercial surrogacy. After all, what country wants to be known as the bargain-basement destination for the exploitation of women and the poor? As of October, 2016, foreigners are prohibited from “renting” Indian wombs, though it is doubtful this official action will shut down the trade completely and permanently. Big money talks, whether the market is officially opened or closed.

On a personal note, I am distressed by the effects of commercial surrogacy in India. Having travelled to India often over the years, I’ve come to love the country and its warm, friendly, and hospitable people. It is evident to this visitor that Indians highly value parenthood and family. I can hardly imagine a practice that has greater potential to destroy the wonderful family dynamics I’ve observed in my travels than commercial surrogacy marketed to rich Westerners. I applaud the India government for taking the first difficult step, at significant economic loss to the country’s economy. In the case of commercial surrogacy, market forces cannot help but impinge virtuous ethical decision-making.

No Place for Reasoned Discussion?

Current events have provoked personal concern that we are losing our ability, willingness, and even desire to engage in respectful, rational debate about the critical issues of our day, especially when significant disagreement exists.  Anger, threats, and violence have replaced cool heads seeking common ground in the pursuit of truth.

Officials at UC Berkeley, considered the birthplace and bastion of the Free Speech Movement, canceled a speaking engagement by conservative pundit Ann Coulter, arranged by College Republicans and scheduled for April 27.  Citing security concerns, Chancellor Nicholas Dirks said police had “very specific intelligence regarding threats that could pose a grave danger” to Coulter should she show up to speak.  Perhaps there were genuine reasons to worry about Coulter’s safety.  After all, the same campus suffered more than $100,000 in property damage caused by protestors expressing their displeasure over the visit of controversial former Breitbart editor Milo Yiannopoulos.   Of course, no one planned to force students, faculty, or guests to attend Coulter’s lecture, much less to agree with her.  Neither attendance nor agreement was required.  Even liberal comedian Bill Maher came to Coulter’s defense, likening the cancellation of her speech to “the liberals’ version of book burning.”

Even more disconcerting is the rise of an ideology that views “hate speech” as a kind of “violence” that deserves to be met with actual physical violence in the name of “self-defense.”  I’ll grant that there might be speech that actually qualifies as “hate speech.”  To what degree it should be silenced, when it falls short of making actual threats, is another matter and another discussion.  However, many people view “hate speech” as the expression of any viewpoint with which they disagree.  In the April 12 edition of the “Wellesley News” (Wellesley College), student editorialists ventured to make the case for using physical force to stifle free speech.  Offering an intellectual defense of a very narrow reading of the First Amendment, the authors argued: “The spirit of free speech is to protect the suppressed, not to protect a free-for-all where anything is acceptable, no matter how hateful and damaging.”  Yet, the “free-for-all” about which they express such vehemence may be nothing more than a reasoned viewpoint or an opinion on a critical issue with which they disagree.  It is as if someone (who the someone is always concerns me) has already been decided what viewpoint you must hold before you have a discussion about an issue.  To hold another viewpoint is in itself “hateful.”

I’m not exactly sure how we got to the point that actual physical violence in justified to protect people from exposure to words and arguments that they might possibly find objectionable or even wrong.  Words with which a person disagrees is “unjustified violence,” but actually breaking windows, torching buildings, and physically assaulting people is justifiable “self-defense” to save people from exposure to a viewpoint that has already been rejected before it is expressed or discussed.

In such a climate, I fear that reasoned, respectful debate will be less and less welcome.  Considering the important issues which warrant such debate, I am discouraged by the practice of silencing—by threat and actual violence—the voices that disagree.  To be honest, I am sometimes intimidated.  And that is frightening because it means raw power is winning out over respectful reason.



Which is It? “Tissue” or “Baby”?

I’m not a physician. I know next to nothing about biology or embryology. I’m confused. Will those who are trained in medical sciences please help me to understand?

In January 2017, Arkansas governor Asa Hutchinson signed into law Bill 1032 which prohibits a procedure, “dilation and evacuation” (D&E), that is used in a large percentage of abortions after the 14-week mark. Critics complain that making this “safe and common” procedure illegal effectively bans second trimester abortions. Declaring the bill unconstitutional, Rita Skylar, executive director of the ACLU of Arkansas, contends: “It’s an empty gesture that’s going to cost the state tens of thousands of dollars in litigation fees and costs.” Skylar is correct in at least this regard. The new law will be opposed stridently by Arkansas ACLU and various pro-abortion groups and will, more than likely, become hung up in appeals court, as is the “pain capable abortion” bill—banning abortions after 20 weeks—that was passed in 2013.

Ignorant as I am about surgical procedures, I looked up “Dilation and Evacuation (D&E) for Abortion” on WebMD. Admittedly, the procedure itself sounded rather dreadful to a person untrained in medicine and surgery like myself. I found especially intriguing the terminology used to described what is “evacuated” in this procedure. Repeatedly, the article referred to “tissue,” “larger pieces of tissue,” and “uterine contents.”

Granted, I do not know much about embryology either, but I assumed that at 14 weeks the fetus was more than simply “tissue,” even “large pieces of tissue.” Thus, I searched the same website and found a slideshow on “Fetal Development: Month by Month.” In light of the website’s description of D&E, the title of the slideshow was startling: “Your Baby’s Growth: Conception to Birth.” Consistently, the slideshow referred to the developing embryo-fetus as “baby.” Viewing pictures of the “baby” at 12 weeks, 14 weeks, and 16 weeks, I concluded that my original assumption was correct. In the second trimester, when this “safe and common” procedure (D&E) is used, much more is evacuated than “tissue.”

Surely, my confusion is easy to understand. When the website describes the abortion procedure that Arkansas seeks to ban, reference is always to “tissue,” “larger tissue,” and “uterine content.” But when the same website presents a slideshow on embryological development, reference is always to “baby.” So, please explain. Which is it? “Tissue” or “baby”? I’m confused.

From my non-medical perspective, is it as simple as I think it is? If the developing entity is not wanted, it’s “tissue.” If the entity is wanted, it’s “baby.” In such a case, the moral value and status of the embryo-fetus-baby is simply “assigned” or “attributed” by me or you. If you desire the developing entity, it’s “baby,” implying high value and status. If you do not desire the developing entity, it’s “tissue,” implying no value and status at all. If we want to justify abortion in the second trimester utilizing what appears to me to be a grisly procedure, I suppose we have to convince ourselves that the removal of “tissue” is all that is involved. Please tell me. Is this good medical science or self delusion?

Of Value Only if Desired

It’s becoming more and more apparent that conflicted cultural attitudes toward abortion arise from inconsistent—even contradictory—beliefs about the moral value and status of the pre-born human being. Consider two recent news items.

The whole world knows by now that wildly popular performer Beyoncé is pregnant with twins. Her performance at the Grammy Awards was dedicated to “birth and motherhood.” She’s even composed a poem celebrating the developing lives in her womb: “I’m watching life inside me grow; there’s life growing inside of me and I’m beside myself with dreams. Was it your voice I heard? You speak to me from inside me. I have three hearts.” Yet, just a few days earlier she proudly participated in the decidedly pro-choice women’s march in D.C. What is the entertainment industry to do? Beyoncé refers to the lives inside her as “children” or “twins,” not as products of conception, rapidly dividing cell masses, or even fetuses. On the one hand, the expectant mother of twins stands arm in arm with women seeking unlimited abortion rights. On the other hand, she is aglow over the “children” growing inside her own womb.

Less than a week ago, Eirianna Martins went home for the first time after four months of intensive care at Mount Sinai Hospital in Chicago. Her mother, Entitan, was only 23 weeks pregnant when she delivered Eirianna, a “micro-preemie” who weighed in at 13 ounces. Medical advances are allowing more and more tiny infants as premature as Eirianna to survive. Beckie Deir, a NICU nurse that helped care for Eirianna, remarked: “Oh, it’s great. I mean, she looks so good. She looks like she never was a little tiny preemie.” On the one hand, nearly incalculable amounts of medical expertise, technology and resources were expended to save the life of one very tiny infant born more than four months premature. On the other hand, pro-choice advocates clamor for unrestricted late-term abortion. In their view, there is nothing necessarily wrong about aborting a 23-week-old pre-born child.

It appears to be a convoluted situation. Beyoncé lends support to an avid pro-choice march one week, yet celebrates the lives within her own womb the next week. A medical team in one hospital fights successfully to save the life of one tiny micro-preemie at great cost, and another medical team performs an abortion of a pre-born the same gestational age, with the same chance of survival, at another facility.

At first, such seemingly contradictory responses make little sense. But, upon further reflection, they make perfect sense. It all depends on whether the pre-born is wanted in a given case. Beyoncé gushes over, and invites her millions of fans to rejoice over her “twins,” her “children.” They are “children” because they are wanted. Entitan was exuberant the day she took her precious Eirianna home: “It feels like a miracle, like a blessing. I’m just grateful that we’re both here. It’s been a long haul.” A long haul indeed, made possible by medical experts, advanced technology, and a mother and medical team who would not give up hope, but fought courageously to preserve the life of one tiny infant. Why? Because she was wanted.

For many in America today, the pre-born human being does not have inherent moral value and status. Consequently, the autonomy of the woman always trumps the right of the pre-born human being to live. In their view, the value of the pre-born human being hinges entirely on whether he/she is wanted. Not wanted? Abort at will. Wanted? Wildly celebrate the “child” that is in the womb, and expend all possible medical resources to save the life of a 13-ounce micro-preemie. I guess this attitude is not surprising in a cultural context in which personal autonomy runs amok.

Whatever Happened to the Instinct that ‘Doctors Must Not Kill’?

In a 1992 article in the Journal of Clinical Ethics titled, “Doctors Must Not Kill,” renowned physician and bioethicist Edmund Pellegrino reminded fellow physicians—with incisive logic and strong passion—of their historic duty to be healers, not killers. As one who is not a physician but will one day be a patient facing the end of his life, I would take comfort in knowing that my physician was committed to heal me and, if healing were not possible, to provide me comfort and care to the day of my natural death. Pellegrino’s plea that “doctors must not kill,” however, evidently is falling on the deaf ears of more and more physicians.

The notion that mercy can entail ending the suffering of a patient by ending his or her life, combined with an almost uncritical acquiescence to patient autonomy, seem to be the major factors behind the increasing acceptance by physicians of PAS (physician-assisted suicide). According to the Medscape Ethics Report 2016, 57% of physicians believe PAS should be available to terminally ill patients who request it, up from 54% in 2014 and 46% in 2010. This aligns with the increasing public acceptance of PAS. A 2016 Gallup Poll found that 68% of Americans support the legalization of PAS, up 10% from the previous year.

What happened to the instinct that “doctors must not kill?” One would hope that this instinct runs deeper than even the historic commitment of physicians to be healers first and foremost. One would hope that it is, at its most basic and fundamental level, a human instinct.

I personally know a young police officer who recently resigned because he experienced this instinct not to kill. Facing numerous tense situations over the course of five years, he had drawn his service weapon dozens of times but, thankfully, had never been forced to fire. That nearly changed when he was charged by a machete-wielding man sky-high on drugs. “Sir, drop your weapon,” he repeated again and again to no avail, as the man quickly closed the distance. For the first time in five years, he exerted pressure on the trigger of his Glock. Two more steps by the man and two more pounds of trigger pressure by the officer, and both lives would be altered forever. One would be dead and one would have to answer for a split-second decision to use lethal force. Fortunately for both, the man loosened his grip on the machete and it fell to the ground. The officer breathed a sigh of relief.

“Dad,” my son told me, “I wasn’t afraid. I would have pulled the trigger if he had taken two more steps. I knew I would have been justified in doing so. But he wasn’t a murderer, a rapist, a bank robber, or a terrorist. He was just a crazy fool out of his mind on drugs. And though he was an imminent threat to my life, I didn’t want to shoot him.” Waxing philosophic, he added, “In that moment, I realized how unnatural it is to take the life of another human being. The instinct not to kill was overwhelming. Yes, I would have shot the man had he taken two more steps. But then I’d have to live with that decision the rest of my life.”

Granted, the case of a police officer deciding whether to shoot is different in many important respects from the case of a physician deciding whether to prescribe lethal drugs where PAS is legal. What intrigues me now, however, is that very strong instinct my son felt that night; that taking the life of another human being – even when legally justified – went against the very grain of his humanity. What does it say, then, when physicians who have sworn historically to be instruments of healing are now willing to be instruments of death? What happened to that instinct and commitment that Dr. Pellegrino so forcefully affirmed, “doctors must not kill”?

Physician-Assisted Suicide and Canada…Again

Though a relative “latecomer” in the legalization of physician-assisted suicide (PAS), Canada seems determined to make up for lost time. Already the question of organ donation after PAS has been raised. Very recently, the medical “savings” made possible by the legalization of PAS in 2016 was brought to light.

The January 23, 2017 volume of the Canadian Medical Association Journal (CMAJ) published the results of a study by Aaron J. Trachtenberg and Braden Manns titled, “Cost Analysis of Medical Assistance in Dying in Canada.” The authors stated that the aim of the study was “to determine the potential costs and savings associated with the implementation of medical assistance in dying.”

The study found that the legalization of PAS will save the Canadian healthcare system between $34.7 and $138.8 million per year; a savings far exceeding the $1.5 to $14.8 million in direct costs associated with the implementation of PAS (physician consultations, drug costs, etc.). Following the lead of a study conducted in the Netherlands (where both PAS and voluntary active euthanasia are legal), the researchers considered the following factors in their calculation: (1) the effect of PAS on patients’ longevity of life (patients requesting PAS would not live as long as patients choosing palliative care); (2) the average cost of care for end-of-life patients suffering from various diseases, especially cancer; and (3) the expected number of PAS deaths. The conclusion was that patients electing PAS will “save” the healthcare system millions of dollars that otherwise would have been spent on their palliative care.

The obvious first question is why would the CMAJ, Canada, or the authors be interested in the cost savings associated with PAS? More than curiosity must have driven the study. Seemingly, the main impetus was to gain assurance that the implementation of PAS was not costing more money than offering palliative care: “Our analyses suggest that the savings will almost certainly exceed the costs associated with offering medical assistance in dying to patients across the country, and that the inclusion of medical assistance in dying in the services covered by universal health care will not increase health care spending.”

Nevertheless, the researchers must have felt some uneasiness about the perceptions this study might generate. Thus, they assure readers of the study: “We are not suggesting medical assistance in dying as a measure to cut costs. At an individual level, neither patients nor physicians should consider costs when making the very personal decision to request, or provide, this intervention.”

Alex Schadenberg, the executive director of the Euthanasia Prevention Coalition, doesn’t feel assured (“Awful Study Says Euthanizing More Patients Will Save the Government Money,” Ottawa, Canada, January 24, 2017). First, he points out that associating PAS with cost savings implies that it is a social good. I agree. When health care costs are covered primarily by the government, as they are in Canada, the prospect of “saving” tens of millions of dollars might easily be seen as best decision for the (financial) good of the country. Second, connecting PAS with significant financial savings pressures patients to elect PAS rather than continuing to live. Again, I agree that this is a legitimate concern. There is evidence that some patients, at the end of life, worry about being an emotional and a financial burden to their loved loves. If patients are aware of the findings of this study, they might also come to feel that their continuing existence is a burden to State as well.

The study might well assure Canadian power brokers that PAS will greatly strengthen the financial stability of the health care system. As Schadenberg points out, “Dead people don’t need palliative care.”

However, the study does little to encourage sick and dying patients to live out their remaining days, convinced that a willing and compassionate healthcare system will provide necessary and effective palliative care. When patients are struggling with the decision to request PAS or to continue living, I wonder if the findings of this study will ever rattle around their minds. Will any patients think at this very vulnerable moment, “But I could save the country a lot of money and my family a lot of trouble if I would just go ahead and die”? I hope not. But with the publication of the findings of this study, it is not unimaginable that they would.

Do Polls about PAS Tell the Whole Story?

By many indications, support for the legalization of physician-assisted suicide [PAS] is increasing. On November 8, 2016 Colorado voters passed Proposition 106, “Colorado End of Life Options Act,” by a 65% to 35% margin, making Colorado the sixth state to legalize PAS, joining Oregon, Washington, Montana, Vermont, and California. The following question appeared in a 2015 Gallup poll: “When a person has a disease that cannot be cured and is living in severe pain, do you think doctors should or should not be allowed by law to assist the patient to commit suicide if the patients requests it?” 68% of respondents answered “should” while only 28% answered “should not.”

That to which people are saying “yes,” however, does not always match the reality of the practice of PAS in the states in which it has been legalized. Note the wording of the question in the Gallup poll. The question pictures a medical situation in which: (1) The disease is incurable; (2) The patient makes a voluntary request; and (3) The patient is “living in” severe pain, which suggests constant, relentless, and untreatable pain.

Most likely, in my judgment, people are prompted by mercy in saying “yes” to PAS because they think that a large percentage—perhaps even a majority—of patients suffer unrelenting and untreatable pain, making PAS a compassionate option. If this is indeed what respondents are thinking, they are mistaken in large measure. Granted, pain is intractable and difficult to manage for some dying patients, but certainly not for the majority of patients, thanks to advancements in palliative care. Even the patients who avail themselves of legalized PAS tell us that. According to the official 2015 report on Oregon’s Death with Dignity Act, patients requested medical assistance in dying for these top three reasons: (1) Decreasing ability to engage in activities making life enjoyable (96.2%); (2) Loss of autonomy (92.4%); and (3) Loss of dignity (75.4%). “Inadequate pain control or concern about it” was in sixth place, mentioned by 28.7% of patients. Yet, even here, it is difficult to break down the percentage of patients who were actually experiencing inadequate pain control from the percentage of patients who were merely concerned they might. It seems likely that some patients request PAS on the basis of what they might experience in the future, not on the basis of what they are experiencing in the present.

Motivated by mercy, a majority of Americans are beginning to say “yes” to PAS. I wonder if the level of support would change if respondents realized that, in the vast majority of cases (though admittedly not in all cases), pain can be effectively managed. In no study that I’ve read has “relief from pain” been a top-tier reason patients give for requesting PAS in states in which it is legal. That to which respondents are giving a merciful “yes” does not seem to match the reality.