Dollars and Diagnoses

by Chuck Colson                                                                                       Vol. IX, No. 6, June/July 1996

An elderly friend was waiting to see a doctor when I visited her in the hospital recently. As the doctor arrived, my friend apologized for making demands on his time. His reply stunned me: With a sigh he said, "Hospital administrators say we have to see one patient every 12 minutes."

Now, I knew and trusted this doctor totally, yet his comment unleashed a flurry of questions in my mind. Wouldn't a grueling schedule like that affect a doctor's professional attitude? Could anyone give his best effort with one eve on his watch? With an elderly patient who may die soon, wouldn't some doctors be tempted to cut corners on treatment?

A few years ago such questions were unthinkable. Doctors were trained to do everything possible to keep people alive. But a volatile mix of trends threatens to change that, opening the door to a world where doctors are killers as well as healers.

The first trend is legal: Two federal court rulings recently steam rolled across our moral landscape, granting constitutional protection to assisted suicide and euthanasia. The Ninth Circuit Court of appeals on the west coast and the Second Circuit on the east coast have ruled that patients have a right to assisted suicide.

The Ninth Circuit's ruling is especially sweeping. The court faced the moral conundrums raised by assisted suicide but breezily dismissed them. It acknowledged that callous relatives might use the suicide option to place "undue influence" on patients – but shrugged off the risk. It acknowledged that patients who present an economic burden might "feel pressured to hasten their deaths" – but argued that economics is' a reasonable consideration in deciding when to die. It's remarkable that a court exquisitely sensitive to coercion in, say, school prayer cases finds no coercion in a passel of relatives hovering over the sick bed with their pockets turned out.

Then, in what will certainly become known as the infamous footnote 120, the court stated that when a patient is mentally incompetent, a surrogate may be appointed to give consent to assisted suicide. With a stroke of the pen, the court crossed the divide from suicide to euthanasia – from voluntary to involuntary death. In the words of Richard Doerflinger of the National Conference of Catholic Bishops, the court pushed us as far down the slippery slope in one day as the Dutch traveled in 20 years in making euthanasia accepted national policy. The surrogate may start as a family member, but may end up being a white-coated hospital accountant making cost-benefit analyses.

The second trend is medical: the rapid growth of managed-care health plans. As E. J. Dionne noted in a Washington Post column, in these plans "all the incentives are to cut costs." Hospitals are imposing quotas on the number of patients a doctor must see and how much time he may spend per patient – as I discovered in visiting my elderly friend. If the courts legalize assisted suicide, inevitably that will play into the cost-consciousness. As Dionne puts it, "What easier way to cut costs than to create subtle pressures on patients to kill themselves?" No managed health plan is likely to suggest the connection explicitly, but as medical care becomes more expensive, it's naive to think doctors will be immune to economic pressures.

The final trend is political: In this election year, both Congress and the president are covering over the desperate condition of Medicare. But by refusing to face the issue, we nearly guarantee that in a few years Medicare will go broke. America will have to start rationing medical care, just as the British do – creating additional pressures on the medical profession to cut costs, even if it means cutting lives short.

Medical practice is beginning production, with hospitals processing gets on an assembly line. Christians, convinced of the dignity of humanity as created in the image of God, must stand against this ghastly reductionism. The detached method applied to medicine has produced great benefits in terms of medical technology. But we must draw the line when it reduces human beings to objects to be manipulated, controlled, processed – and eventually discarded.

Make no mistake: If the Supreme Court upholds the Ninth Circuit's ruling, it will slam the door of the American legal system against Christian morality. And Christians may have to prayerfully consider whether our government has lost its moral claim to our allegiance

[Editorial Comment: These are extremely strong, solemn words of warning from Chuck Colson, the well known president of Prison Fellowship. By divorcing life from the Creator, modern culture destroys both the meaning and sanctity of life. Christians must educate ourselves as to what is happening, pray for our country and our leaders, and give serious contemplation to the possible future. This column was reprinted from Prison Fellowship's newsletter, Jubilee, June 1996.]