Terri Schiavo was dehydrated to death because she had supposedly told her husband and others that she would not want to live as an incapacitated woman. In other words, her food and water were taken away to honor her personal autonomy.

So, that must mean that seriously incapacitated patients who want to live also must have their desires respected, right? Wrong. In health care, patient "choice" is increasingly becoming a one-way street.

There are two kinds of "medical futility," and the difference between them is crucial to understand. If a patient or family requests care that will not work, it
is physiologically futile. As an extreme example: If I were to request that my appendix be removed to cure an earache, the doctor would--and should--say no. Why? The surgery would do nothing to cure my earache. Doctors can and should refuse physiologically futile care.

But this is not what Futile Care Theory is all about. Rather than refusing requested treatment because it will not work, the care is declined because it will. In other words, it is the patient--rather than the treatment--that is actually being declared to be futile. Thus Futile Care Theory involves personal values more than it does professional medical judgments.

According to articles in medical and bioethical journals, here is generally how bioethicists intend to impose Futile Care Theory on patients and their families in hospitals around the country:

• If there is a treatment withdrawal dispute between patient/family and doctors, the case will be referred to an internal hospital ethics committee "for adjudication."
• The committee members will hear from the doctors, family, nurses, social workers, and others involved in the case, as well as the patient or family.
• If the committee decides that the care should be provided, it will continue. But if it decides that the treatment should be withdrawn, life-sustaining care will no longer be provided in that hospital--even if another doctor volunteers to provide the care.
• At that point, the patient or family must find another hospital willing to provide the care. If that can't be done, the treatment will be withdrawn and the patient will probably die.

Nobody knows how many hospitals around the country have adopted Futile Care Theory as part of their end-of-life care protocols. But clearly, many have. An article published in the Cambridge Quarterly of Health Care Ethics in 2000 [Vol. 9, # 4, 2000, pp. 524-531] found that of 26 California hospitals surveyed, 24 accepted Futile Care Theory. Of these, all but 7 gave the final decision over withdrawal of wanted care to doctors or ethics committees rather than patients and their families.

If "choice" or patient autonomy is the foundational ethic of health care, none of this makes sense. But if the actual goal is the death of certain categories of "biologically tenacious" patients (in the words of one prominent bioethicist), then Futile Care Theory is perfectly logical.

These developments signal the creation of nothing less than a new medical ethic in which certain patients have a "duty to die", a concept explicitly under active consideration in contemporary bioethics discourse.

Human dignity...who needs it?

The London Zoo homo sapien exhibit, about which I blogged yesterday, is explicitly designed to induce our children to reject human exceptionalism. From this linked story:

"Caged and barely clothed, eight men and women monkeyed around for the crowds Friday in an exhibit labeled "Humans" at the London Zoo.

"Warning: Humans in their Natural Environment" read the sign at the entrance to the exhibit, where the captives could be seen on a rock ledge in a bear enclosure, clad in bathing suits and pinned-on fig leaves. Some played with hula hoops, some waved.

Visitors stopped to point and laugh, and several children could be heard asking, "Why are there people in there?"

London Zoo spokeswoman Polly Wills says that's exactly the question the zoo wants to answer.

"Seeing people in a different environment, among other animals ... teaches members of the public that the human is just another primate," Wills said."

This is not benign. This is not funny. This is misanthropic.

Most people take human exceptionalism for granted. They can no longer afford to do so. The great philosophical question of the 21st Century is going to be whether we will knock humans off the pedestal of moral distinctiveness and instead define ourselves as just another animal in the forest. The stakes of the coming debate couldn't be more important: It is our exalted moral status that both bestow special rights upon us, while also imposing unique and solemn moral responsibilities: including the human duty not to abuse animals.

Wesley J. Smith

Altered Nuclear Transfer and the Harvard research are two complementary approaches seeking a solution to the same problem. ANT could provide both a moral way to produce ES cells and a useful tool for studying the molecular factors for the direct reprogramming of adult cells ---what the Harvard scientists are trying to accomplish. With federal funding to support both of these approaches, we could move forward with ES cell research in a way that could truly sustain social consensus.

Dr. William Hurlbut

Medical Breakthrough: Scientist Fuse Skin Cells with Embryonic-like Stem Cells

Harvard scientists have developed a procedure to combine ordinary skin cells with embryonic stem cells to create stem-cell like properties - a procedure that might eliminate the need to create and destroy human embryos.

Stem cells are immature cells that can become any kind of tissue in a developing fetus. For years, the scientific community has seen stem cells as a way to create genetically tailored organs for transplants and to treat cancer and other diseases. But the best source of the cells is embryos.

This new process involves fusing an embryonic cell taken from a lab-grown stem cell line with a person's skin cell to create a new hybrid cell; one with the genetic material, called DNA, of the person who donated the skin cell but also the DNA and properties of the lab-grown embryonic stem cell.

The Harvard researchers say they were able to show that the fused hybrid cell was in their words, "reprogrammed to its embryonic state," showing characteristics of embryonic stem cells.

VOA News

In spite of Harvard's breakthrough, the Senate seems determined to authorize the federal government to kill innocent human life.

Monday's announcement that Harvard scientists had discovered a way to fuse adult skin cells with embryonic stem cells raised the possibility that someday, all-purpose stem cells could be created without harming human embryos.

Someday. But not soon enough to change the outcome of an emotional debate looming after Congress' August recess.

"We are right where we always were," Sen. Tom Harkin, D-Iowa, a co-sponsor of the bill with Sen. Arlen Specter, R-Pa., said by telephone Monday after reading of the advance by the Harvard team.

Senate supporters of more federal funding for embryonic stem cell research claim to have at least 60 votes for overturning Bush's policy. Senate Majority Leader Bill Frist, R-Tenn., added his support last month.

Frist's office said Monday a debate and a vote on the bill will still take place in September despite the scientists' announcement and pleas by conservatives to delay the vote.

"We should not rush this debate," warned Sen. Sam Brownback, R-Kan. "If we do not rush to kill innocent human life, we will find ethical, moral ways of solving this issue."

FOX News

ANT: An answer to the Embryonic Stem Cell Debate?

Certainly we must proceed with moral caution in these realms that are so close to the core of our central meaning as human beings. There is a certain 'radiance of respect' due to any human cells and tissues, but especially those of our procreative capacities. Nonetheless, for scientific projects with a serious purpose, we may proceed once we have drawn a clear line that defends human life at all stages of development. The recent proposal for ANT-OAR is receiving wide endorsement from scientists, moral philosophers, and religious authorities. I am hopeful that it will lead us to a genuine solution that can sustain the primacy of moral principle while opening positive prospects for biomedical science---that would be a triumph for our nation as a whole.

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