A discussion paper given in Winnipeg at the Annual Directors’ Meeting of Campaign Life Canada – October 1986.
Dr. Everett Koop warned us of the Slippery Slope and he predicted that abortion, by taking away the value of the life of an unborn child, would lead to the diminishing value of all human life. Three and a half centuries ago the clergyman-poet John Donne said the same thing: “No man is an island…any man’s death diminishes me because I am involved in mankind.”
In the limited time allowed I should like to outline some ways in which human life is now under attack.
There is a strong movement to kill the handicapped newly-born baby not indirectly by refusing nutrition and/or medical treatment, but directly by lethal injection. Canadian lawyer Joseph Magnet recently openly advocated the legalization of this direct killing of handicapped newborns, and the book, Should the baby live? By professor Peter Singer and Dr. Helen Kuhse, two Australians, promotes the killing of babies of 28 days, or even up to three months, by lethal injection. Singer is a philosopher; Kuhse, believe it or not, is the deputy director of Monash University center for human bioethics. Monash, incidentally, claims to have the world’s larges deep-freeze for human embryos.
Mention of human embryos brings me to an overview of scientific experimentation since Steptoe and Edwards brought about the in vitro fertilization (IVF), of Louise Brown. With tiny humans specially created in petri dishes, scientist now have a whole new world to study and manipulate.
There is no legal protection in statute law for a human created outside the mother. It can be dissected, or deep frozen as at Monash. One Australian hospital I the State of Victoria has 400 abandoned embryos that parents no longer want.
Some seven years ago at the U.S. Congress Ethics Advisory Board ruled IVF and embryo research were “acceptable from an ethical standpoint” with two stipulations: no embryo should be sustained after 14 days; IVF should be only for married couples. Both stipulations were known to be broken and Father Richard McCormick S.J. defended the experiments on human embryos. What sort of experiments on human embryos and/or gamets are being performed or suggested?
Taking the ovum of a hamster and fertilizing it with human sperm is now fairly common place, the excuse is to test sub-fertility in men. Researchers say they do not keep these hybrids “hamsters” beyond the early cleavage state, but in point of fact they cannot, as yet, do so. When Prof. Roger Short of Edinburgh gave evidence before the U.S. Congress Advisory Board he said that only public opinion was stopping researchers from fertilizing human ova with sperm from gorillas, chimpanzees and orangutans. However, in the last two years there have been published reports that such experiments have been tried, for example, in Glasgow. What other animals are being used is being kept secret.
Identical twins can be produced in a lab by splitting the zona pellucida. This cloning has been done in animals, and there are claims that it has been done in humans. There are a number of suggested uses for this procedure. One such use is to deep freeze one twin embryo, “A,” the second twin embryo, “B,” is allowed to develop well beyond the implantation stage and is examined for any defects. If twin “B” appears to be satisfactory, it is allowed to die. Twin “A” is then defrosted and implanted in the mother. There are claims that this has already been done.
Implantation of Embryos for Study
One experiment that has been mooted by embryologists is to use women due to have the uterus removed, some in two weeks time; others in four weeks; still others in six weeks. The research team would implant the embryo (maybe already manipulated) and assess it after the uterus was removed.
As women are unlikely to co-operate, either willingly or knowingly, the next suggestion is that human embryos be implanted in animals, for example, in pigs. This experiment has already been tried (unsuccessfully according to reports) in Australia.
Embryos are already being used to test drugs, and scientists insist that, because tests on animals are not conclusive, they be allowed to test for teratogenicity, i.e., the development of abnormal structures in the embryo.
Mixing cells of different embryos has already been done on mice, and mice have been developed with three different colours of fur. Prof. Lejeune warns that mixing cells of human embryos is a distinct possibility. Indeed, Dr. Edwards (of Louise Brown fame) has suggested that, by manipulating embryos, babies might have four, or even six parents.
Today, DNA research, gene splitting, whole chromosomes replaced by others are in an experimental stage which is light years ahead of even three years ago. Indeed, Clement M. Arkott, Prof. Of Biology at Yale, told BBC listeners that he was “confident” that, “we can shortly preside over our own evolution and make new kinds of people.”
These types of experiments are worldwide. Dr. Phillippe Schepens of Belgium, the General Secretary of the World Federation of Doctors Who Respect Human Life said that one whole day of the General Assembly of the World Medical Association in Brussels, in October 1985, was devoted to explanation of experiments on human gametes, zygotes and embryos. He said that the general feeling was that what was not being reported – what was being kept very, very secret – was more frightening than what was told. He said that cases of parthenogenesis were reported – that is the reproduction of a biological individual without the participation of a human male gametes – by the melding (fusing) of two ovocyts. The individuals were left alive for 12 weeks.
The British public became very uneasy over questions such as IVF, surrogate motherhood and embryo research and so in 1982, the government established the Warnock Committee to investigate recent medical developments and to consider policies – wit the idea of appropriate legislation. When, in 1984, the Committee included amongst other recommendations that embryo research should be allowed up to 14 days after fertilization the public were outraged.
Before the government could act on the report by introducing legislation the pro-life groups SPUC (Society for Protection of Unborn Children) and LIFE, together with pro-life MPs went on the attack. Enoch Powell introduced his Unborn Children (Protection) Bill to outlaw any experiments on embryos; Lejeune, Nathanson, Brinkworth (head of the Down’s Syndrome Centre in Britain) al addressed MPs and the House of Lords; petitions by the millions poured into Parliament; and Pro-Life MPs turned up in force for the Second Reading of the Bill carrying the vote by 238 to 66. Because government manipulation the Bill died in the committee stage. But in the next session Ken Hargreaves introduced the same Bill, and if this fails there is another 200 more Bills to go.
To this Dr. Lejeune and Dr. Brinkworth replied that research is going on into spina bifida, genetically-transmitted anaemias and chromosomal fragility without embryonic experiment. Research needs a target and a 14-day-old embryo does not have muscles, therefore, cannot be used in muscular dystrophy research. Moreover, a 14-day-old embryo does not have pancreatic or lung buds – therefore cannot be of use in cystic fibrosis research.
It became obvious that 14 days was only a first step – and Dr. Ian Donald warned that labs could not be policed to ensure the rules were kept.
Next came a smear campaign against Lejeune (organized by some pro-abortion members of the Medical Research Council) but this backfired as scientists around the world backed his opinions, and demolished the arguments of the opposition.
Once again Enoch Powell, other pro-life MPs, and SPUC went on the offensive. The MPs went into the labs and said “Show us your experiments that our bill would stop.” None turned up. But Powell discovered from some Warnock Committee members that some experiments were suppressed in their report. So there are experiments going on but no one wants to talk about them.
However, MPs have discovered that big money is at stake. In research for contraceptives and abortifacients there are a number of questions to be resolved: what causes an embryo to implant; how could an antibody be developed to prevent implantation, or cause disimplantation? It is clear that the pharmaceutical industry finds it cheaper to test drugs on human embryos rather than on animals.
Recently SPUC and the MPs have gone a step further. They have formed a Parliamentary Scientific Advisory Committee with leading geneticists and medical men working with the MPs so they will be able and ready to counter any debate.
Turning from the beginning of life to the end, we come to euthanasia; and the present attitude towards euthanasia indicates how far we have slid down the Slippery Slope.
During the Second World War the doctors in occupied Holland defied the Nazis and refused to cooperate in the extermination of “unwanted humans” – thereby risking imprisonment and death. By contrast, last year one death in every six in Holland was caused by lethal injection, a direct killing by doctors.
Holland is the first country in the world where the National Medical Association, in consultation with the courts has drafted rules for the application of euthanasia, and where parliament has begun to debate on a bill to make euthanasia permissible.
To paraphrase a well-known advertisement, the pro-euthanasia groups can truly say “You’ve come a long way – baby.”
At the opposite end of the earth in Australia, Prof. David Kelly, Chairman of Victoria’s Law Reform Commission, has said that “legislation is needed to establish a right to die, and to provide protection for medical practitioners both civilly and criminally.” On December 19, 1985, the Victoria’s government set up a Committee of Inquiry into Options for Dying with Dignity. The terms of reference can be summed up as to whether there should be legislation establishing a right to die, a right to be assisted in dying, and a right of incompetent patients to be assisted in drying.
Dr. Allen, Medical Director of Queen Victoria Hospital in Melbourne and Dr. Duncan of Royal Children’s Hospital, Melbourne, have both testified that illegal withdrawals of treatment are practiced. Dr. Duncan, speaking of critically-ill children said “technical homicides occur in all public hospitals.”
Pro-life lawyers have criticized the way in which the issue is being clouded – deliberately – when doctors claim quite falsely that no treatment can be withdrawn legally. For those of us who saw abortion legalized, the whole scenario is familiar: quote all the hard cases; use double-speak ‘death with dignity’ and never killing; and, of course, make legal all the illegal acts going on in hospitals.
Meanwhile in the United States ‘Living Will’ legislation is flourishing. A living is a legally binding document, written at a time when the patient is competent, transferring to others the authority to withdraw life support if and when the patient is no longer competent to make decisions. California was the first state to pass Living Will legislation in 1976. By 1977, there were eight states, and by 1986, there were 36 states and D.C.
There is an interesting side-light on this rapid growth. In 1977, during the Carter administration, Robert A. Derzon, the Administrator of Health-Care Financing in the Department of Health, Education and Welfare (HEW), sent a memo to the Secretary of HEW – Joseph Califano. It read:
“The cost-savings from a nationwide push towards ‘Living Wills’ is likely to be enormous. Over one fifth of Medicare expenditures are for persons in their last year of life. Thus in the Financial Year 1978, $4.9 billion will be spent on such persons and if just one quarter of these expenditures were avoided through adoption of ‘Living Wills’ the savings under Medicare alone would amount to $1.2 billion. Additional savings would accrue to Medicaid and VA and Defense Department health programmes.”
Governor Lamm of Colorado would be enthusiastic about the cost saving. In 1984, he made headlines by saying that terminally-ill people have “a duty to die and get out of the way” and he called rising medical costs a fiscal cancer.
In the face of 37 different Living Will Statutes, the National Conference of Commissioners on Uniform State Laws met to draw up what is now terms “The Uniform Rights of the Terminally Ill Act.” This Act was published and distributed in January 1986. It is clear that any safeguards in the State laws have been removed, and the Act is a veritable minefield of dangers. TO mention but a few:
- Under State laws a signed, witnessed and proved declaration was needed before a doctor removed any life supports. Now all that is needed is a simple phone call to say one has been made.
- Most states require other physicians be consulted and a written statement certifying a terminal condition. Any one doctor can now decide.
- There are no witness qualifications now as to the competence of the declarer, or age of witness. Unlike other wills, witnesses can be people who inherit or have another claim on the estate.
- Life-sustaining treatment that can be withdrawn includes food and fluids “manually provided” e.g., by spoon feeding. It can include a removal of insulin or antibiotics.
Danger from the Courts
What is happening in the States will inevitably spill over into Canada – of this we can be sure – but dangerous as Living Wills may be there is a greater threat which lies with the courts.
Karen Ann Quinlan’s case was a watershed for all debates about the incurably ill. In her case the question was whether to remove a respirator. The present cases before the courts are for the withdrawal of fluids and all nutrition: Hilda Peters, Paul Brophy, Elizabeth Bouvia, Nancy Jobes, Clarence Herbert (Barber case), etc.
It is the considered opinion of legal experts in the States that these cases are, step-by-step, setting the stage for assisted suicide legislation (by lethal injection). Indeed one opinion in the Supreme Court of California ruling on the Bouvia case indicated that the issue was whether assisted suicide should be allowed.
The Case of Clair Conroy
The case of Clair Conroy perhaps shows best, through the actual judgments, just where we are heading.
Clair Conroy was an 84-year-old woman in Parklane Nursing Home in N.J. She was senile and confused with organic brain syndrome – but she was not comatose, not brain dead, not in a chronic vegetative state. She could follow movement with her eyes and even smile. However, in order to receive enough sustenance she was fed through a naso-gastric tube.
In 1983, her nephew (who had been appointed her guardian) asked the physician to remove the tube. The doctor refused, the nephew filed a complaint, and a trial judge, Judge Stanton, with some misgivings, ordered the tube removed. The judge frankly acknowledged that Miss Conroy would suffer a painful death by starvation but said that withdrawal of nutrition was appropriate due to her diminished “intellectual capacity.” He said, too:
“I have also had some misgivings about an inappropriate impact that a decision such as the present one might have on the treatment of elderly senile persons or on the treatment of retarded persons of all ages.”
Despite all these misgivings, he ordered the tube removed. The nursing home and doctor appealed the decision. Miss Conroy continued to be fed, but before the appeal could be heard Miss Conroy died.
The Appellate court rejected the argument that the death of Miss Conroy ended the debate. They stressed the fact that the case offered an opportunity to provide guidance to hospitals, families, etc. “the need for which extends far beyond this case.”
The judges were concerned that allowing a doctor or family to discontinue life-sustaining treatment simply because the person’s lack of intellectual capacity “precludes him from a meaningful enjoyment of life” established a very dangerous precedent. They rejected the notion that a naso-gastric tube was ‘medical treatment’ but said it was routine nursing care. “Nourishment…is a basic necessity of life whose withdrawal causes death.” The court did not proscribe withdrawal under all conditions, but said it should not be withdrawn where a patient was not comatose, not vegetative, not brain dead, and whose death is not irreversibly imminent.
The appellate court said that the first, the trial court, opinion actually authorized euthanasia because:
“If the trial judge’s order had been enforced, Conroy would not have died as the result of an existing medical condition, but rather she would have died and painfully so, as a result of a new and independent condition: dehydration and starvation. Thus she would have been actively killed by independent means rather than allowed to die of existing illness or injury. Instead of easing her passage from life the result of the judge’s order would have been to inflict new suffering.”
The court said that to allow such a precedent to stand would have “frightening implications” if a non-terminal patient’s quality of life could be judged “worthless’ by family or doctors.
Unfortunately the story does not end there. Early in 1985, the N.J. Supreme Court reversed the decision of the appeal court and allowed the withdrawal of nutrition – food and water – from elderly, incompetent nursing home patients. They rejected any differences between ordinary and extraordinary care, and between ‘treatment and care.’ Thus, as the earlier courts had warned, all the elderly and the mentally retarded are now at risk.
An article in the New York Times said: “It is unclear how the decision would apply to younger nursing-home patients in similar situations. It is also unclear whether the decision would apply to similar patients who are severely-retarded individuals living in homes for the mentally incompetent.” It may not be clear, but we can guess.
One final example is that of Ella Bathurst, a woman of 89 years who had lived alone until she broke her hip. She was in a nursing home and developed some difficulty in swallowing and was sent to hospital for re-hydration therapy. Her daughter insisted that treatment stop, and that all fluids and food including those given by mouth be withheld. After three days the doctor agreed, the intravenous was discontinued, and nutrition withheld. It is reported that the patient was alert and responsive, and she repeatedly begged for a drink of water. She died of dehydration and starvation after six days. There was an inquiry: the doctor was given a slight reprimand – not that his actions were questioned, just his record keeping. The board of enquiry reported that Mrs. Bathurst was cared for “appropriately, humanely and compassionately.”
I have merely given the tip of the iceberg. One could mention the effects of “wrongful birth” suits; the new anti-progesterone pill RU486; the changing age-structure of the population. There is no end to the threats.
I shall finish as I started by quoting John Donne.
“Any man’s death diminishes me, because I am involved with mankind; and therefore, never send to know for whom the bell tolls; it tolls for three.”