The Magazine

A Kass Act

The chairman of the bioethics council steps down.

Oct 10, 2005, Vol. 11, No. 04 • By WESLEY J. SMITH
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Needless to say, some areas of discussion will cause controversy. Euthanasia activists will not be pleased to see mercy killing characterized--accurately in my view--as abandonment. Perhaps even more likely to raise a ruckus is the council's pronounced skepticism of the value of advance directives when decisions must be made about whether to accept or refuse treatment on behalf of an incapacitated patient. Rather than creating a detailed living will, which the council believes can never be fully "informed," the report suggests that we instead appoint a trusted loved one or friend to be our health care proxy. Our surrogate's ethical duty would then be to make decisions based "on providing the best care possible" for us rather than adhering strictly to our pre-stated wishes.

I was a little disappointed that Taking Care did not directly address specific bioethical controversies that are relevant to the proper care of aged and demented patients, issues that are even now boiling over into heated dispute in the public square. For example, should the decision to remove artificial nutrition and hydration be treated in law and medical ethics differently from decisions about removing other kinds of care, given the symbolism of nourishment and the fact that such a decision can only have one outcome? Does Futile Care Theory, in which hospital protocols grant doctors or hospital bioethics committees the power to refuse wanted life-sustaining treatment, violate the ethic of equality? How are we going to finance Medicare and Medicaid in the face of the coming elder boom?

The report doesn't pretend to answer these and other urgent questions. Rather, its ambitions are more limited, and perhaps more valuable--to get people thinking and talking about these issues before the time of crisis comes. And it points us in valuable directions: By placing such great emphasis on the essential human worthiness of demented patients, the council tips the benefit of the doubt in caregiving firmly in favor of life over death--but in a way that clears the way for caregivers to cease resisting natural death of their wards when the time is right. There is also a valuable chapter devoted to analyzing "hard cases" that seeks to help caregivers learn how to pick their way through the often excruciating difficulties of making proper care decisions for demented patients.

Taking Care is an important, and provocative, ethical document that belongs in every university and medical school bioethics curriculum. More important, it offers a starting point for a badly needed national conversation about a difficult topic that is too often avoided. Leon Kass and the President's Council on Bioethics deserve high praise for another job well done.

Wesley J. Smith is a senior fellow at the Discovery Institute and an attorney and consultant for the International Task Force on Euthanasia and Assisted Suicide.