Thursday, December 23, 2004

The Doernbecher Principle...


Shortly after our first son was born, our attention shifted with friend's, to the arrival of their new baby boy. The day brought both joy and tragedy. Their son was alive, but had been born with a severe birth defect that threatened both his immediate survival and hope for a normal life beyond. I cannot imagine the strength that it took for them to endure the first few seconds of birth, through the perserverence of the weeks, months, and even years of care, pain and surgery. An easier decision might have been made elsewhere in the world for them, despite the strength of their character that would always fight fiercly for their children. For these parents, and Oregon Doctors there was only one decision. Right after birth, their son was transferred to Oregon Health Science Institute to the
Doernbecher Children's Hospital for the care that would save his life, and restore everyone's hope. Cooper is alive and well today, facing promising prospects for a healthy life in which he might never have to realize the struggle he faced in those first 10 months.

Not long ago, this blogger joined others in
focusing attention on a Hospital in the Netherlands, where compassion had taken a perverse twist. Cooper's story and the recent birth of our second son weighed heavy in my mind while considering the depths of European depravity. In October of this year, it was revealed that the Groningen Academic Hospital had been extending Holland's policy of adult Euthanasia to infants born with life-threatening conditions and defects. The Groningen Protocol establishes a professional committee of medical staff with complete authority over decisions regarding life (and death) and the critical care needed to sustain it. As I pointed out then (The Groningen Corollary) that the Dutch protocol - as morally depraved as it is - has an even more insidious corollary. When those charged with the responsibility for the maintenance of life, become the 'arbiters' of death, a moral contradiction is introduced within the relationship that undermines human respect. Existence is no longer a fundamental individual condition, but is reduced to a valuation of choices in social context. When a government sanctions the action, that contradiction is manifested in law. The notion of justice abandons inalienable precepts in favor of preferential necessity.

Oregon is the only State where doctor-assisted suicide is practiced legally. Given the nature of this State's progressive sensibilities and its neo-European fetish, there is an ever-present danger that American ethics could deteriorate here toward more consensual preferences yielded by a dominant state of moral relativism, where cultural imperatives have been abandoned to popular convenience. So I was heartened to read
this article, by Patrick O'Neil in this week's Portland Oregonian. The article begins with a perspective far removed from that of the Dutch.

The outlook for the tiny patient appeared hopeless. Born with spina bifida, a birth defect that affects the covering of the spinal column, the newborn also seemed to have a malformed brain.

The question facing Dr. Mark Merkens was whether to perform a lifesaving -- but possibly futile -- operation or to let the baby die.

Merkens, director of the spina bifida program at Doernbecher Children's Hospital, recalled that the infant's brain looked so deformed that "it was possible the child would not experience interaction with human beings or anything going on in the environment."

"I discussed the case with an experienced colleague," he said, "and he made a minor point about the anatomy of the brain and the accuracy of our projection. We provided the lifesaving surgery."

Today that newborn is a young teenager who attends public school and has normal mental abilities.

Merkens thinks the case illustrates the hazards involved in a proposal by a hospital in the Netherlands to euthanize terminally ill newborns. The Groningen Academic Hospital, which made the proposal last week, revealed it has euthanized several children.

The article goes on to highlight the Principles of Doernbecher as personified by Dr. Merkens, who serves as a clinical ethics consultant at Oregon Health & Science University.

Ethicists such as Merkens say a distinct but often misunderstood difference exists between actively ending a life and removing medical intervention, letting nature take its course.

In the United States, it is permissible to give dying patients enough painkilling medication to make them comfortable, even though a side-effect might be to shorten the patient's life. That so-called "double effect" of painkillers is a "seemingly small point,"

Merkens said. But from an ethical point of view, it is huge. "We do not provide euthanasia," he said.

"We do not hasten death. We provide comfort care, which would allow the natural course of an illness which ends in death."

There seems to be a profound distinction between the ethics guiding American medicine from that of itsr European counterpart. Doctor's like Merkens, recognize that their's is not the role of God, to bestow or retract life as they see fit. And that is a strong principle on which to found a legitimate medical ethos. Life has priority. It is a concept that is hardly isolated to Doernbecher, however, as the story further notes:

Dr. Joel Frader, a bioethics professor at the Feinberg School of Medicine at Northwestern University, said he has a great concern about euthanasia.

"The big worry I have is that lives are being ended because of judgments about the moral worth of the individual, as opposed to the experience of the individual," he said. "If what's happening in the Netherlands indicates an intolerance of difference and disability, I think we have a serious moral problem."

Another critical point is made here,

Arthur Caplan, chairman of the department of medical ethics at the University of Pennsylvania, says hazards abound in infant euthanasia. Like Merkens, Caplan worries about the possibility of unexpected recovery.

"Kids fool you," he said. Sometimes infants have a poorly understood condition called "failure to thrive," which can end in death.

"It's a common policy in neonatal intensive care units," Caplan said, "that you pull the technology off a child and,if the child hangs in there, you put it back."

Sometimes with treatment, the child will survive. But if euthanasia were available, the child might not get a second chance.

"You'd have a death," Caplan said. "There's no room for error in euthanasia. But babies prove you wrong more often than any other patient."

"Kids fool you!" It is a incisive way to say that no man posesses the omniscience to ascertain an outcome. And no committee consensus has the authority to circumvent fate. The true fools are those that pretend otherwise. While the victims pay the ultimate price with there blood which can never be washed clean from the hands of the culture that surrenders its souls to existential expediency.

For now, American medicine seems to be insulated from the malevolence that continues to pervade modern European culture, and seeping into its most critical institutions.
Hippocrates recognized the danger inherent when one's most precious possession is offered to the care of another. There must first be the presumption that both share the same value of existence before an appreciation of worth can be mutually understood. As with any institution, its legacy is established by its practices... not simply its promises. Clearly Groningen and Doernbecher are world's apart, as are the cultures of the old and the new world. One is obsessed with death, while the other still celebrates the primacy life.

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