Come, Sweet Deathnby Harold O.J. BrownnCulture of Death:nThe Assault on Medical Ethicsnin Americanby Wesley /, SmithnSan Francisco: Encounter Books;n•244 pp., $23.95nI n the spring of 1975, C. Everett Koop,nM.D., addressed a conference of Christiannlajinen in New Orleans on the topicnof abortion—more specifically, on the implicationsnof Roe V. Wade. Among thenchanges he foresaw were a growing acceptancenof infanticide as the “treatment ofnchoice” for defective newborns and an increasingnresort to euthanasia. All of thesenthings evolved within the context of anmodern/postmodern world that no longerntakes seriously the biblical teaching thatnhuman beings are made in the image ofntheir Creator (Genesis 1:26).nAfter Dr. Koop, the connection betweennabortion and euthanasia—whichnProf Hans Millendorfer of Vienna calledn”methods in which killing represents ansoluhon”—was stressed by other authorities,nsome equally eminent, others less so.nThe pro-abortion forces constantly deniednit—at least then. Now the infanticidenof “defective” newborns has becomencommon, usually by simple neglect andndeprivation of nourishment, and euthanasianis on the march. Britain legalizednabortion in 1968; soon afterward,nthe Spectator predicted that “The abor-nHon wave of the ‘sixties will be the euthanasianwave of the ‘eighties.” It maynnot have come to pass so quickly innBritain, but in the United States we cannfairly say that the abortion wave of then70’s has led to a euthanasia wave of then90’s. In the 21st century, the abortionnwave is still washing over us, and the tidenof euthanasia is rising.nIn Culture of Death, Wesley J. Smith,nan attorney for the International Anti-EuthanasianTask Force and a leading writernon medical ethics, identifies the growingnprevalence of euthanasia as a “treatmentnof choice” in an ever-broadening range ofn30/CHRONICLESnREVIEWSn”cases” (human beings), and demonstratesnwhat the acceptance of euthanasianhas already done to medical ethics andnwhere these developments are heading.nIn 1982, Prof Charies Liechtenthaler,na Cerman physician and historian ofnmedicine, wrote in “The Oath of Hippocrates”nthat “Our old ethical fixed starsnare no longer visible. We are wanderingnin an ethical no-man’s-land.” Mr.nSmith’s work shows us just how wide andnbarren this land has become. The HippocraticnOath, with its vow neither to performnan abortion nor to give a patient andeadly remedy (even on request), was alreadynrendered “inoperative” by the abortionnculture. Now, its even more fundamentalnprinciple, “Primum non nocere”n(“First, do no harm”), is all but forgotten.nThe former rationale for the promotionnof euthanasia was mercy, which seemednso plausible at the time that its advocatesndid not shun the term “mercy killing.”nRecently, as the term “killing” could notnbe purged of its unpleasantness, and asn”patient autonomy” came to be a watchword,n”physician-assisted suicide” hasnbecome the expression of choice. Ofncourse, Mr. Smith is aware of the connectionnbetween abortion and euthanasia,nbut he explicitly avoids all referencento the former topic, apparently in thenhope of gaining a hearing for his views onneuthanasia without entangling them innthe ongoing abortion debates.nOn visits to the United States, bothnPope John Paul II and the late MothernTeresa evoked the idea of a “culture ofndeath.” Smith, having adopted the termnfor his book, shows that what was anprophecy of doom not so long ago is nowna reality, and well on the way to becomingnroutine. Writing as though he hopes thatnhis book will reach a wide public, Smithnmakes use of many touching personalnanecdotes, damaged lives ready to be givennover to a convenient death by overworkednor overzealous health-care personnel.nSome of these lives were saved bynbucking the medical system, while othersnwere lost because the system prevailed,nor because their condition was hopelessnand further care was futile. Although henwrites soberly. Smith offers a gruesome visionnof the future, which may explain whynhe has dedicated his book to “Ralph Nader:nfriend, mentor, visionary.” (Perhapsnthis dedication will reassure concernednnnreaders that Smith is not just a garden-variets’,nreactionar}’ conser’ative.)nAccording to Dr. Koop, the study ofnmedical ethics during his medical-schoolndays consisted largely of “medical etiquette”—nlessons in how to treat one’sncolleagues. Back then, the HippocraticnOath was not merely a rote phrase recitednat medical-school commencement ceremoniesnbut was taken for granted acrossnthe profession — rather like the genericnProtestant-Catholic-Jewish ethics of thenlarger societ)’. Unfortunately, as has beennthe case in other areas of ethics (notablynthe sexual variety), things long taken forngranted cannot long withstand the corrosivenclimate of postmodern it}’. In the al>nsence of a powerful ethic based—like thatnof Hippocrates, Christianity, and Judaism—non the assurance of man beingnmade in the image of God, the patientnceases to be a person possessed of a divinelynendowed dignit)’ and becomes a meren”case,” considered in utilitarian terms.nThe old legal proverb “Hard casesnmake bad law” seems to have a medicalncorollary: “Hard cases make bad medicine.”nSeventy-five years ago, as a notednFrench hematolbgist has written, medicinenwas relatively inefiFective, but it was alsonrelatively inexpensive. Now, it is vasdynmore effective but immensely more expensive.nIn the United States, medicinenhas virtually ceased to be a liberal professionnand become just another aspect ofncommerce. Instead of being hopeless,nhard cases have become too expensive, encouragingnphysicians to cut costs. In medicine,nmany cases —and virtually everyncase near the end of life —is deemed anhard case, and hard cases cost cold, hardncash—lots of it. The commercializationnof medicine has led to an increased (if notnaltogether absolute) preoccupation withnprofit and, hence, with cost-effective practices.nTraditional medical ethics madenthe patient’s well-being the physician’snfirst concern; the commercialization ofnmedicine makes maximizing profit andnlimiting loss more important.nTo this end, in the last decades of then20th centur)’, a concept called “futile-carentheory” was developed. This concept drivesnthe current assault on medical ethicsnin America, as Smith effectively demonstrates.nThe old Hippocratic ethic acknowledgednthat it is neither obligator}’ norndesirable to perform on patients proee-n