The Magazine


Jul 28, 1997, Vol. 2, No. 45 • By NELSON LUND
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Consider for a moment, as Smith does not, that medicine does not have to be administered with the high level of government involvement we see today. Health care used to be allocated, like most other services, largely by the price mechanism. Patients bought what they were willing and able to pay for, and the indigent were taken care of (less well than the rich, no doubt) at public expense or, very significantly, by a substantial network of religious charities.

Three large changes, all attributable to government, have transformed that system. First, government funding has helped create a large new supply of expensive medical tools. Second, government has largely displaced the religious charities in caring for the indigent, along with many millions who are far from indigent. Third, wacky wage-control policies adopted in the 1940s caused employers to take evasive action by offering additional compensation in the form of health insurance, and the tax laws ensured that this would eventually become the dominant source of private funding for medical care.

Market forces now have hardly any direct effect on consumers, and patients have diminishing control over their doctors. Trying to repair the resulting mess with more government spending and more government regulation will only heighten the politicization of medicine and increase the pressure to choose beneficiaries and victims according to the perceived worth of their lives.

Apart from his naive preference for governmental over market mechanisms, Smith's principal prescription for the underlying disease is a call for moral reformation: the creation of "true community" based on the "equality-of-human- life ethic." Perhaps because he wants to persuade the widest possible audience, Smith advocates a pretty innocuous reformation that is limited in scope and secular in nature. The youngest and most vulnerable are left out, for Smith mentions unborn children only to note that one can make legal and logical distinctions between abortion and other forms of euthanasia (without noting that one could construct similar distinctions among all the other stages "down the slippery slope). And the closest he gets to endorsing anything like religion comes with his invocation of a Zulu word he picked up from a friend.

In the end, Smith's allegiance to secular rationalism leaves him with a mere assertion -- in the face of contrary claims that a "true community" is perfectly free to encourage or require the sacrifice of the community's most burdensome members. This does not detract from the persuasiveness of Smith's thoughtful and passionate argument against the legalization of assisted suicide. But it does suggest that the rationalization of murder will not stop in the face of his compelling contribution alone.