The World of Computer Software/World_Of_Computer_Software-02-387-Vol-3of3.iso/h/hpj01.zip/HPJ01.DOC

Text File | 1993-02-22 | 12KB | 277 lines

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     ┌───────────────────────────────────────────────┐
     │   Your Rights, Whether You Want Them Or Not   │▒
     │                  Editorial                    │▒
     │             by Stanley Schmidt                │▒
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"Human rights" is, of course, a tremendously important concept, and
one of the foundation stones of what we think of as civilization.
It's particularly fashionable right now: there have probably been
few times in history when people did as much talking about their
"rights" as they've been doing lately.  Which is probably, on the
whole, a good thing.  Much of history has consisted of one group of
people riding roughshod over what should have been considered
rights of some other group, and anything that reduces that tendency
is a step in a desirable direction.

The trouble is that "right" is also a slippery concept, hard to
define precisely or to get people to agree on.  As a result, the
word  often takes quite a beating.  People pushing just about any
cause have been known to appropriate it and twist it to describe
anything other than what they want as an infringement of somebody's
rights.  Proponents of book banning or imposing moral criteria for
artistic funding, for example, have been known to speak of people's
right to be protected from offensive material.  Militant feminists
have sought to stamp out "exploitation" of women as housewives or
Playboy centerfolds.  Among other arguments advanced against
allowing abortions, I have heard them characterized as "abuse of
women."

Never mind that when someone wants an abortion it is usually the
woman herself.  Never mind that some women like being housewives or
Playboy models.  Never mind that some people want to read or view
or listen to artistic work that others find offensive.  Such facts
are apparently irrelevant to those who use this kind of argument.
They've made up their minds what's good for you, and by golly,
they're going to see that your "right" to it is protected, no
matter what you think you want!

Naive as I am, I find it blatantly self-contradictory to speak of
protecting somebody's "right" to something that they quite plainly
do not want by forcing them to accept it.  A right that has to be
shoved down somebody's throat is no right at all; to say that it is
makes a mockery of the word and the concept.  The only thing that
could reasonably be called a right in my examples would be the
right to decide for oneself whether one wants to read Huckleberry
Finn, devote one's life to raising a family, or pose for Playboy
(or Playgirl).

In other words, the fundamental right is the right to choose, in
just about any case where there is not some overriding reason (such
as consequent harm to another person) why choice should not be
allowed.  That is the fundamental concept of individual freedom:
that every individual should, whenever possible, be free to make
his or her own choices about how to live.  (I don't think, by the
way, that it has ever been a really popular concept, despite
abundant lip service.  Most people want freedom for themselves to
do what they want, but balk at letting others do things that they
don't like.)

There is one especially fundamental category of such choices that
has been very much in the news, and in public and private debates
over "rights," in recent years.  That is the one that Hamlet summed
up as "To be, or not to be. . . ."  The question of not only how,
but whether to live, is considerably less simple now than it was in
Hamlet's day.  He and his contemporaries could, under duress,
consider stabbing or poisoning themselves; or they could do nothing
and live until "natural causes" caught up with them.  There was
relatively little that medicine could do to delay that, when the
time came for it to happen.

Now, however, there is a great deal that medicine can do to prolong
life -- and a steadily growing controversy over whether it should
always do so.  If any exceptions are to be permitted, who decides
what they are and when they are appropriate?  Medicine is in what
might be viewed as a transitional stage of development: good enough
to keep many patients alive, by at least some measures, for many
years; yet not good enough to make their lives the least bit
rewarding by normal human standards.

More and more patients spend years or decades in deep, unchanging
comas, getting nothing out of it themselves and draining the
financial and emotional resources of their families.  A growing
number of people who have not reached that state have thought about
what they would want to happen if they did, and decided that they














































would rather die completely than be artificially suspended in such
a limbo and thereby do what that would do to their surviving
families.  Living wills and "right-to-die" societies grow steadily
more popular.  More and more court cases deal with when it is
permissible to disconnect life support from comatose patients with
negligible prospects for improvement.  The Supreme Court, in the
recent case of Nancy Cruzan (a young woman kept physically alive by
an abdominal feeding tube since a car accident in 1983), cautiously
recognized the right of a "competent person" to refuse unwanted
medical treatment.

And some look on in horror that such "rights" are even considered,
claiming that they are assaults on a "right" to Life No Matter
What.  No matter, for instance, whether the person involved wants
that kind of life.

A particularly interesting case was that of Janet Elaine Adkins,
who last June quietly "put herself to sleep" with the help of
Michigan physician Jack Kevorkian's "suicide machine," a simple
device which, under her control, injected her with an anesthetic
followed by a lethal poison.  Newspapers and magazines were full of
the story, and I heard several people say, "Isn't it terrible?" or
words to that effect.

To which I could only answer, "Well, I'm not so sure it is. . . ."
Unlike Nancy Cruzan, who couldn't be asked, when the decision
needed to be made, Mrs. Adkins was, by all reports, a very
"competent person."  She was intelligent, with wide-ranging
interests and an abundant supply of joie de vivre -- and the early
signs of what was diagnosed as Alzheimer's disease.  She knew what
she could expect of the future -- the slow, steady loss of all the
things that had made her enjoy life so much -- and she consciously
decided she did not want to go through that.  She wanted to quit
while she was ahead.

I don't think I would have made the same decision she did --
perhaps never, and certainly not that early.  I think I would have
clung, at least for a while, to the hope that the diagnosis was
wrong, or that some unexpected breakthrough would make my
deterioration reversible before it went too much farther.

But what I would have decided is completely irrelevant.  It was not
my life in the balance.

It was hers.

I understand and sympathize with the dread she felt, and I respect
her decision to do something about it.  But that's irrelevant, too.

Even if I did not sympathize or respect her judgment, the fact
would remain that it was not my life (or yours, or anyone else's).
It was hers, and hers alone.

Mrs. Adkins knew what she was doing, and it was nobody else's
business.  Her family had a legitimate interest, of course, but she
worked things out with them.  I find it very hard to support the
claim that anybody else deserved any say in the matter.  Yet
thousands of outsiders were appalled and outraged that Dr.
Kevorkian provided a way for Mrs. Adkins to get exactly what she
wanted.

I haven't actually heard anybody say publicly and in so many words
that Mrs. Adkins' "right to life" should have been forcibly
protected, but her case is clearly in the same arena as the ongoing
controversy over patients who aren't in a position to express their
desires so unambiguously.  I did see one particularly interesting
comment by another doctor on Dr. Kevorkian's role in Mrs. Adkins'
suicide, judging it unethical on the grounds that all doctors have
taken the Hippocratic Oath, pledging, among other things, to "do no
harm."

I submit that the Hippocratic Oath itself may be due for
reexamination and possibly amendment.  The idea is not as radical
as it may sound.  No one even knows whether Hippocrates was one
person or several, and the oath bearing his/their name already
exists in several forms.  In practice, it has also already
undergone several changes.  Nobody seriously expects modern
doctors, for example, to "swear by Apollo the physician, by
Aesculapius, Hygeia, and Panacea, and take to witness all the gods
and all the goddesses," or to observe the ancient prohibition
against performing lithotomies.  Times change, and an oath
formulated more than 2400 years ago just may not cover everything
that it now needs to cover.

The basic idea of the oath -- solemnizing the principle that
physicians have strong and special ethical obligations to their
patients -- is one we still need.  And I certainly have no quarrel
with "do no harm" as its basic precept.  After decades of looking,
I know of no solider foundation on which to build a system of not
only medical, but general ethics.

The difficulty in putting such a system into practice lies in
defining exactly what is meant by "harm" -- and that is not only
difficult in any time and place, but can change with circumstances.

The ethics of using water, for example, are very different in a
desert and in a rain forest.  The detailed ethics of medicine may
be very different in societies which have or lack the ability to
sustain life long beyond its natural tendency to stop.

The medical ethicist who thinks that Dr. Kevorkian's making a
suicide machine available violates the Hippocratic prohibition on
"doing harm" may have to look a little harder.  I respectfully
suggest that forcing someone to live a life she no longer enjoys or
wants may be doing harm in a deeper and more serious sense, and
that eventually medical ethics will have to catch up with medical
technology in addressing such issues.

When you develop new abilities, you are inevitably faced with new
choices about how best to use them.  Refusing to make those choices
--  simply clinging to old ones as if the new options did not exist
-- amounts to refusing to accept the responsibility that comes with
expanded power.  Thinking through the ethics of a new situation
cannot be expected to be easy -- but it has to be done.

And in doing that thinking, it would be well to remember that a
"right" that has to be forced upon someone is a contradiction in
terms.