An interview with author and bioethics watchdog Wesley Smith

The Betrayal of Hippocrates (con't)

Wesley J. Smith

How did you learn of this case?

This desperate father called me because I had written a previous book, “Forced Exit,” about euthanasia. He searched me out, and he said, “Hey, what can I do?” So I gave him some tips, and guess what? He got treatment for his son.

You could have given him my phone number.

You would have had a different approach. I know what you believe in. The son came out of his comma, is learning how to walk and is now a counselor for at–risk teenagers.

An at risk–teenager being defined as any poor soul who had to be treated by Campbell's former doctor.

So you've got this kid now who is leading a very productive life, recovering and working hard to recover his physicality, because he had a pretty bad head injury. But this kid would be dead today because the doctor didn't care enough about his life to reduce a fever.

Sadly, Chris's story is not uncommon. Tell us about the 90–year–old who couldn't get her doctor to give her antibiotics.

A woman called me to say, “My mother is 92 years old. She has a terrible infection, and the doctor won't give her antibiotics.” So, I asked the obvious question, “Why?” To which she replied, “The doctor told me, 'Your mom's going to die of an infection anyway. It might as well be this infection.'”

Who or what gave that doctor the right or authority to make an arbitrary and capricious determination as to which infection he might or might not treat?

And that's what happens when you decide that we're not going to say “our patients have a sanctity of life,” but when we're going to judge, as doctors or health insurance executives, based on the “quality of life.”

But what about the essence of the Hippocratic Oath “Do no harm”? If they do or don't do something that does cause harm, are they not in violation of their sacred oath?

Only 13 percent of doctors today take the Hippocratic oath.

What? Is that documented?

I found that out in the research, and I was rather stunned myself. Thirteen percent — and that was some years ago when that study was done. It may be less now. They take an oath, but it is not the Hippocratic oath.

They take an oath to what? To serve and protect the HMO?

Basically, I guess. The bioethics movement has basically discarded the Hippocratic oath because they think it is paternalistic.

Oh really? Throw me a quote.

Out of the New England Journal of Medicine. This is by Sherwin Nuland, who wrote the book, “How We Die,” and is a big mucky–muck at Yale Medical School. This is the elite of the elite, and this is what he says about the Hippocratic oath with regard to euthanasia: “Many opponents of these practices point to the Hippocratic oath and its prohibition on hastening death. But those who have turned to the oath in an effort to shape or legitimize their ethical viewpoint must realize that the statement as embraced over approximately the last 200 years [was done so] far more as a symbol of professional cohesion than for its content.”

If Dr. Nuland wants professional cohesion, then he should join the Rotary Club. But the Hippocratic oath is not for the doctor; it's for the patient. It protects the patient. It requires the doctor to honor the life of each patient as an individual, to not harm the patient. And it is so important because we allow doctors to cut us, to poke us, to stick us, to drug us. And if we are not going to have a doctor who is going to be bound the by the 2,500–year wisdom of the Hippocratic oath, we're in big trouble. Yet at the New England Journal of Medicine, in an editorial officially sanctioned by that journal, Sherwin Nuland said the Hippocratic oath is just about professional cohesion —- it's just tradition.

Has anyone suggested to these academicians that perhaps it might be just a skosh pretentious on their part to try to abrogate 2,500 years of tradition with their own personal politically correct agenda?

That's what I'm trying to do with “The Culture of Death.” I'm trying to alert people that this is going on so that they can talk to their own doctors about these issues. I'm trying to alert legislators that this stuff is going on, so that when a bioethicist comes to testify before Congress and says, “Well, we've studied this very carefully and we have determined A, B, C. ...” that maybe the congressman might know to ask, “Do you believe in the sanctity of human life? Do you believe there is a difference between a human person and a human non–person?”

Find out where the bioethicist is coming from. And most of these folks will have to say, “I do think there are some humans who are not persons.”


Dr. Peter Singer would say newborn infants.

Geoff Metcalf would say Peter Singer.

He would say people with Alzheimer's disease. Do you know that most people in the bioethics movement would not believe Ronald Reagan is a person? And as you pointed out and I read from Tom Beauchamp, that means we may be able to take their organs. And there is talk, by the way, of redefining death to not be dead, but permanently unconscious. They are talking about that very seriously in the higher levels of organ transplant medicine.

Once the pretentious, arrogant, academician has determined that someone is a “non-person,” they are products, and it is a product that can and should be harvested. How close is this to happening, and who gets to make the decision?

Some of the things I write in the book are happening, and some of them are planned. We have to stop these plans from taking place. Let me tell you one of the things that is the most scary and will immediately threaten your listeners and readers. It's called Futile Care Theory.

Under Futile Care Theory, or medical futility as it is sometimes called, doctors are metaphorically putting signs above the intensive care unit, similar to what you might see in a restaurant: “We reserve the right to refuse service.” They are saying — and health insurance executives, too — that if you go to the hospital and you want your life extended — now I'm not talking about “them” forcing you to stay alive with tubes in you; I'm talking about when you want the medical treatment. You may want the respirator. You may want the feeding tube. You may want the antibiotics. Under Futile Care Theory, doctors are giving themselves, like Napoleon crowning himself emperor, the authority to say no. That if they think the quality of your life isn't worth the expending of the money and the resources, they can say no and unilaterally refuse it.

Who gave them the authority or the right to decide what in their estimation is a sufficient quality of life?

They are giving it to themselves. They are creating hospital protocols in which they give it to themselves.

Is this mitigated by HMOs' concerns about cost containment?

Of course! The bioethics movement helps the HMOs in many ways. The bioethicists consult with the HMO movement, and a lot of this has to do with money. It also has to do with bioethicists wanting a collectivist approach to health care. They want rigorous healthcare rationing. Futile Care Theory, by refusing care for the sickest and most disabled among us, is the first step toward a very rigorous healthcare rationing regimen.

How ubiquitous is this in policy? Or is it just incrementally getting its nose in the tent?

No, this is happening all over the country now. For example, I recite several cases that result in lawsuits in my book.

Tell us about Washington State's Baby Ryan?

Baby Ryan was born prematurely with bad kidneys. He needed kidney dialysis. Not surprisingly, the father was a Vietnamese immigrant and was not perceived to be a person of power. You know, they don't do this to the Clintons or the Bushes. You do this initially to people who can't fight back. But this father fought back. The doctors said to the father, “The time has come for your baby to die. We are taking him off kidney dialysis, even though you don't want him taken off.” The father got a lawyer and got an injunction.

And explain what happened to the father?

The doctors turned the father over to the Department of Public Social Services because he got an injunction, saying that the father, not the doctors, were hurting the child because he wouldn't let him die.

So what happened?

A different doctor came in and took over the case. He put the baby in a different hospital, and the baby got better. In fact, the baby did not require kidney dialysis after several weeks. The child eventually died at age 4, having nothing to do with the kidney. In fact, he had a very happy childhood. If it had been up to the doctors trying to impose their values and their morality on the baby, the baby would have died at age two weeks.

How widespread are these futile care protocols?

Recently, in the Fall 2000 Cambridge Quarterly of Health Care Ethics, they surveyed 26 hospitals. Twenty–four of them had futile care protocols in place. Why are the futile care protocols there? So that when you go to court, they can say, “Look, this is what we have decided. This is our health protocol.” Judges are often very reluctant to gainsay what the doctors say. So what they are trying to do is create a standard of care where they can say no if they want to.

And they also deny you the opportunity to seek out an alternative healthcare facility which does not have the protocol.

According to the Journal of the American Medical Association, in Houston, all the hospitals agree to honor each other's futile care protocol determinations. These things are going up in the Catholic hospitals in Philadelphia.

You're kidding?

No. If you read the Health Progress, which is the journal of the Catholic Health Association, they print a futile care policy that has been put into place in the Mercy systems in Philadelphia. Basically, what it says is if a hospital ethics committee says that the care shall not be approved in that hospital, even if you find a doctor willing to provide the care, they can't do it. That's in a Catholic hospital.

What can we do to put the brakes on this trend?

First off, when you go in the hospital, you make sure that there is somebody there that knows they may be giving you the bum's rush to cut off care. I'm not saying that if the doctor says it is time to go home and die a natural death, [that] the time has come to stop with the tubes and things, that you shouldn't do that. But when they recommend that you do that and you don't want to follow that recommendation, you have a right to stand up against the bum's rush you might receive, as the nurses and the chaplains and the social workers start trying to push you into making a decision you don't want to make. You have to have somebody willing to stand up for the value, the inherent value of your loved one's life.

Second, it used to be that people wanted to sign these advance directives to make sure that they didn't get hooked up to machines against their will. That used to happen 20 years ago. That happened when the economics of medicine were such that the intensive care unit was a big profit center for the hospital.

The old joke use to be they'd keep you on those machines until you die or your insurance runs out.

Yeah, but that is no longer true. Today, the economics of medicine says the longer you are in that intensive care unit, the more money they lose. So they want to get you out of there, and sometimes it is not appropriate to do that. So, what you may need today, and what I have signed, is a Protective Medical Decisions Document. It is put out by a group I work with called the International Anti–euthanasia Task Force, and it documents the kind of treatment you want. For example, it prevents them from taking away your food and water because you are cognitively disabled, which happens in all 50 states.

You have some awful stories in the book about intentionally dehydrating patients.

That's right. And it is a terrible situation — especially if you are conscious. You can heal dehydration. It takes 14 days to die. They take away your food and water, and it used to be based on the decision of family to do it. Now with these futile care protocols, it's a different story. For example, at a hospital in San Jose, Calif., I had a futile care protocol leaked to me that said you could not get those tube feedings if you were in a serious, cognitive incapacitated state.

Is there a website where people can get this protective medical decision document?

Yes. There is a website and an 800 number. It is http./// or they can call 1–800–958–5678 and ask for a Protective Medical Decision Document. They've got them for all 50 states.

If a doctor says you are going into ABC hospital, can you get a copy of their futile care protocols before you go in there?

You should be able to, but not always. When I was leaked that Lexion Brothers Hospital protocol in San Jose, I called the doctor who had signed it, and he lied to my face about what it had meant. He said it was about the right of a person to refuse unwanted medical treatment, which of course I support. But that isn't what it was about. I read him the part that proved that, and he hemmed and hawed and stuttered but never would give a straight answer. I've had people try to obtain futile care protocols at hospitals and some have been refused. Some hospitals have turned them down.

Time is insufficient to cover all of this, which is a good reason for folks to buy the book, "The Culture of Death."

We have just scratched the surface. There is a case in California involving Robert Wendland. Robert can roll a wheelchair down a hospital corridor. He can write the letter “R.” He can answer yes or no questions with the aid of buttons. He was in a terrible auto accident, and he is cognitively disabled. It is before the California Supreme Court now whether he can be dehydrated to death, which will take 14 days. The Court of Appeals said that he could be and said there is no presumption for continued existence in the law of the state of California.

That is a terribly frightening court ruling.

Luckily, the Supreme Court took the case, so the previous ruling is no longer legally binding, but we've got real trouble when courts and doctors and insurance executives create a disposable class of people.


Next page: Interview: return to Part I