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Physician-Assisted Death and Lifeboat Ethics Pre-empt Oath of Hippocrates

Physician-assisted suicide (PAS) or physician-assisted death (PAD) are now receiving strong public support, writes Jeffrey Hall Dobken, M.D., M.P.H., in the winter issue of the Journal of American Physicians and Surgeons. He traces the history of the acceptance of PAS/PAD in public policy and law to the ascendancy of “lifeboat ethics.”

Read journal article: http://www.jpands.org/vol23no4/dobken.pdf

Dr. Dobken is certified in bioethics and is an adjunct assistant professor at New York Medical College. He states that “the bioethics enterprise claims ownership and authorship of a hierarchy of moral thinking designed to protect society’s interests and the victims of injustice,” and it tends to “characterize any opposing opinion or concept as ‘unethical.’”

Scarcity of medical resources is the primary theme of bioethics, according to Dr. Dobken’s analysis, and bioethical questions are generally framed as who should be thrown off the lifeboat “if some are to be saved.” Complex metrics are developed to determine, in an “ethical manner,” how decision-makers “must set priorities among competing opportunities.” 

The question bioethicists fail to ask is the reason for scarcity and how to remedy it. Instead, scarcity is assumed to be inevitable. Its existence is used as “a device to advance a progressive agenda, to enhance the relevance of the bioethics community as moral guardians of the public welfare, and to redistribute goods and services for economic and political purposes.”

In the presence of a crisis, Dr. Dobken argues, the optimal prioritization of available resources cannot be determined by medically untrained bioethicists based on relative social worth, age, prognosis, or other social, non-medical determinants.

“When replacing advocacy for the frail, the sick, and/or the dying, on the assumption that they are somehow undeserving of treatment based on cost accountancy, with what is generally called ‘assistance in dying’ rather than the abandonment that it is, the bioethics enterprise has clearly violated every tenet for which it supposedly stood or was created,” Dr. Dobken states.

“The state, rather than the needy individual, has become the patient,” he concludes.     

The Journal of American Physicians and Surgeons is published by the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties since 1943.

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