Letter to the Editor - CMAJ

Philip G. Ney, MD, MA, FRCPC, RPsych

© May 2005

Culture of Killing

A death in the family ("Reflections on the Terry Schiavo case" C. Weijer, CMAJ 172(9): 1197-1198) necessarily evokes turmoil in family and friends, but also in the physician. Physicians cannot but be influenced by their patients and their practice. What they do to others soon rebounds upon themselves. In this tight bundle of life, nobody can avoid the consequences of another's actions, certainly not their own. Sadly, Dr. Weijer's commentary is an opinion not based on fact, but on his own cherished and well-rehearsed attitudes towards life and death. Terry Schiavo did not require "the artificial provision of nutrition and hydration" any more than any immature or dependent person requires food and water with the aid of someone who cares for them. If her nutrition was artificial, and so it is for many patients in the hospital, people with disabilities, and all small children until they can feed themselves. Terry Schiavo was responsive. Terry Schiavo was not a burden to anybody. Her parents were quite content to provide all she needed. What was startling, in fact astonishing to all people who love life, was that the judges would not allow her parents to care for her, but enabled medical staff to starve her to death, a lingering and painful way to die. There is nothing noble in this. Backed by a powerful 'right to die' lobby, the judge and some members of the medical profession murdered a disabled patient. There is real question whether Terry's husband Michael ever heard her state those words attributed to her. There is considerable evidence that it was quite the opposite.

Surely physicians from time immemorial have erred on the side of life when there was any question at all about the person being alive or dead. As a result, many of those presumably dead were brought back to life. This included my courageous, well-decorated father who at the age of seventeen commanded a company of soldiers in the muddy, bloody First World War. He was badly wounded and left to die, until espied by his general who ordered that his 'corpse' be taken to the field dressing. Those of Charles Weijer's ilk would have deprived me of my father. I have seen a picture of the CAT scan of Terry Schiavo's brain, and there was more cortex than has been found in others considered to be mathematical geniuses. Some day Dr. Weijer is likely to lie in bed looking in a confused state with one good eye at sage physicians shaking their heads and intoning, "It is time to turn off the machines." But he won't be able to communicate the fact that at this moment he doesn't want to die because he has not reconciled with members of his family, and he hopes that it would still be possible.
"I asked them to feed my mother. I guess the doctors had decided not to, and they knew best. It was awful to watch her die in such pain and distress. I feel terribly guilty for not insisting they feed her." Joe, an honest farmer, is struggling with pathological grief. He realizes, maybe better than some physicians, the impact of knowingly participating in the painful murder of somebody whose life is dependent upon him. In their death camps, the Nazis reserved death by starvation for those they really wished to torture. Although Joe's contribution is relatively small, he knows he could have done more to ensure his mother lived longer.

We have become so immersed in a culture of killing, that it seems the norm. There is plenty of evidence to show that once a person has contributed to the death of someone of his own species, killing a kin becomes much easier. The instinct to preserve life, particularly the lives of those of your own species, particularly members of your own family, particularly those who are dependent upon you, is one of the strongest instincts known to humans. Once having participated in a killing, either actively or passively by not protesting, that instinct is weakened, and that person is much more able to kill again in the future. This is happening wholesale to a profession (medicine) that once was entirely devoted to always preserving life. The world has become a very frightening place. Yours sincerely, Dr. Philip G. Ney, MD

Yours sincerely,
Philip Ney MD FRCP[C] Victoria BC