The Analogy in Bioethnics Commentary by Nat Hentoff The Nazi Analogy in Bioethics To say that certain contemporary bioethicists and members of the laity sometimes approach the solving of life-or-death problems as the Nazis did in no way means they are Nazis. It is possible, however, with the very best of intentions, to think and plan in a way that would bring about results that were also the goals of the Nazis--from different motivations. For instance, beginning in 1933, the Germans began killing defectives of various kinds, in part because they were unproductive (useless eaters) and therefore were costly to the society. The pragmatic, cost-benefit dimension to the murders was illustrated in the widely used high school mathematics text cited by Dr. Leo Alexander. The text, Mathematics in the Service of National Political Education, included such problems, Alexander noted, as many new housing units could be built and how many marriage-allowance loans could be given to newly wedded couples for the amount of money it cost the state to care for the 'crippled, the criminal and insane,' (Medical Science Under Dictatorship, New England Journal of Medicine, July 14, 1949). Daniel Callahan readily admits that he wrote Setting Limits because of the acute and inexorably increasing problem of medical care costs, particularly with regard to the elderly. He does not advocate euthanasia for people past a certain age; but by having the state--through Medicare--refuse to pay for certain expensive life-extending procedures such as coronary bypass operations once that age has been reached, the result of his design is to shorten lives. For all that he talks about alleviating their pain and suffering and getting the society to provide them with decent home care or nursing home care, he is saying that the lives of the elderly are worth less--in terms of prolonging them--than other lives. This is a variation, as I see it, of the Nazis' lebensunwertes Leben, unworthy of In this case, life unworthy of being extended, according to cost-benefit analysis, by procedures he believes ought to be more available to others in the society. When Callahan is asked whether there is not a certain in sorting out people by age as to whether they can get certain treatment--not counting the elderly who can afford whatever they want and do not depend on the government to stay alive--he admits there is an unfair economic bias to his plan. But, he adds, the resulting injustice would not be for a very long time. A very long time by whose measure? The comment, and cost-benefit designs for dying by others, recall something said by Milton Himmelfarb: [I]s there not an argument that could be made...about a general coarsening of regard for life? There exists ... a certain kind of accountant's mentality or an engineer's mentality in dealing with the questions of life.... While it has nothing to do necessarily with the specifics of yet the Nazis too did not have the bias of awe toward life and dealt with life (certain kinds of life at any rate) as if they were dealing with mere things (Biomedical Ethics and the Shadow of Nazism, Hastings Center Report, August 1976, Special Supplement). In the Spring 1988 Concern for Dying newsletter, Dr. Ronald Cranford (Neurology Department, Hennepin County Medical Center, Minneapolis) is quoted as proposing that in the future, some instances of artificially shortening life--a most gentle euphemism--be exempted from charges of homicide. If someone, he adds, were in an irreversible persistent vegetative state, there is no personhood. Without personhood, there could be no act of murder. Aside from whether physicians are invariably correct in their diagnoses of irreversibility, Cranford has gotten to the basic question in the similarities, if any, between some current physicians and ethicists and the Nazi doctors. …
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