For the Parliamentary Committee on Palliative and Compassionate Care
by Philip G. Ney MD, FRCP(C) for Mount Joy College 20/11/10
SUMMARY
The Essential Dilemma
Unlike any other species, episodically humans seem to want to destroy
themselves. They have come close to doing so. In fact there are at least 50
cultures of which there is now no trace; people, language, art are all gone.
Even now, humans are painfully aware they have the weapons of
destruction that could obliterate all life on earth. It will only take a nuclear
accident, some apparently unsolvable crisis, a nuclear weapon equipped
nation with a megalomaniac demagogue, to send us all up in atoms.
Yet it is the basic underlying life sustaining instincts opposing reckless
hedonistic philosophies that really decide the issue. It is a fine balance. At
this point in history the life sustaining mechanisms are rapidly being
dismantled and human life is dying out. The evidence is the exponentially
decreasing worldwide fertility rate and fairly obvious unstoppable
population implosion. Yet there is still a chance to rescue stupid, self
destructive homo sapiens.
This parliamentary committee is facing a major change that can
unbalance the whole structure of human life. One false move and the world
crisis of population will rapidly evolve into a total panic.
Are there legislators wise enough to see the roots of this dilemma and
courageous enough to rule in favour of protecting life.
Civilization
Civilization is not measured by any group’s technological prowess or
their blooming education, or their ornate self-governing systems. It is how
well individuals care for each other, especially those who appear to not
warrant that care. Is not the highest ethic, to do for others what you would
have done for you? That must apply to every person, regardless of their so
called quality of life. Quality of life is impossible to determine. We would
be extremely arrogant to try. Handicapped people enjoy their lives and have
a lower than average rate of suicide.
That ethic of loving can be cultivated but it cannot be legislated.
It can be encouraged. It cannot be enforced. Together with life sustaining
instincts, love truly makes the world go round. To ignore the basic God
given human instincts that function to protect humanity from destroying
itself, when all human reason, legislation, morality fail, is the epitome of
stupidity. This is already happening.
With deeply flawed philosophies, a few are insisting on more and more
legislation and policing that provides their particular brand of hedonism,be
given unique protection and privileges. Is this not the antithesis of loving
your neighbour? Is this not the undermining of vital self and species
preserving instincts? Can these people be enabled to understand what they
are doing before it is too late. It appears not.
Marked ambivalence
Ever since the earliest humans chose to imbue themselves with power by
knowing good and evil, humans individually and collectively have had
marked ambivalence to life and living. Individually it is not difficult to tilt
the balance in favor of self-abandonment and suicide. It is almost as easy to
promote species annihilation. The underlying ambivalence ultimately stems
from arrogance, “we can run our own show with no help from You.” running
counter to the inbuilt life sustaining instincts and desire to know the truth.
What makes people want to live?
a) Hope. Humans live in and with hope. Hope sustains their body, mind
and spirit. Without hope humans give up and die, even when there is no
apparent need to.
People lose hope when they feel trapped in a painful present and cannot
see any possibility of an improved future. Can there always be a real
opportunity to relieve present distress and realistically point to a
brighter future? Yes, even when dying!
Though the body is crumbling and the mind decaying, a person’s spirit
can tap into God’s power and light so that it is peaceful and it matures.
But not everybody can be convinced of this.
b) Children, particularly grandchildren evoke an indescribable sense of
peace and joy in the elderly. The people in an old folks home, watch with
envy when they see a neighbour being joyfully greeted by their
grandchildren. “You lucky old goat” they say to their neighbour, “I sure
wish I had grandchildren” “Well says the first, I will lend you a few of
mine, You old goat yourself” The first speaker sighs deeply. “It wouldn’t be
the same, but thank you anyways”.
People with children, plan and conserve for the future. This is hope.
Those without children become increasingly withdrawn and self-centered.
This is the beginning of despair.
People with hope beget children. Children make their parents hopeful.
What a lovely cycle. This cycle of hope sustains the species like nothing
else.
c) Joy. Most people frantically search for enjoyment. Yet in their worry
and hurry, they miss joy altogether. Joy cannot be found. You must let joy
find you.
To do so, you must remain still and quiet. Only in this way will you see and
enjoy the dew diamonds adorning the intricate cobweb outside your door.
Just 5 seconds is all it takes but no, you must rush to catch your bus for work
The discovery of Joy does not require the expenditure of money, time
or energy. It takes time. Older people have much of that. It is small wonder
you catch them gazing at a bright flower, for hours on end. There is no need
for elaborate excursions. What they elderly really enjoy is reminiscing with
family and reunions with their old buddies.
d) to z) and many other factors.
What inclines people to die?
a) Fear of punishment. “I know I’m an old rotter. I can’t expect the best
hereafter. So rather than this awful waiting, bring it on. I’ve got some
good veins left, Doc”
b) Existential guilt. “I realize my parents wanted me. They spared my
life but terminated my little sister. I feel so guilty about being alive, I
might as well die. But I’m afraid of death. So I’ll join the army and
get myself killed. At least in that way, I may do someone some
good.”
c) Despair from unremitting pain, aloneness, financial ruin etc. “By the
looks of things, I can tell it isn’t going to get better, In fact I’m sure it
will get much worse. Who wants to wait for that” Yet some part of
everyone can be made better. Everyone’s spirit can thrive and grow
right up until the moment their spirit departs their body.
There is no middle ground. One is either for or against life, for the
benefit of one’s most helpless neighbor or for trying to get ahead at his
expense. Why can’t people be convinced they cannot benefit at the
expense of any nieghbour, not matter how small or helpless.
Historic instances that heightened hope and striving for the future of all
mankind; a very few examples from which we all benefited.
Code of Hamurabi approx 3000 BC protecting children
Moses, limited retribution.
Hippocrates, 300 BC who’s oath allowed modern medicine to flourish.
Jesus Messiah, ”Let the little children come to me for of such is the
Kingdom of God.”
Bridge over River Kwai, one nameless soldier’s sacrifice for his comrades
Mother Teresa, one child at a time
William Wilberforce, abolition of trading, then of owning slaves.
A few examples of cruel neglect or killing for selfish motives
Patria Patistas. The Roman father’s privilege of killing imperfect children.
Almost universal slavery, owned, worked, abused from birth to death.
Children buried alive beneath the support columns of bridges for good luck
Child labour in coal mines and factories with inhuman conditions.
Genocide, gassing families because they were, “useless eaters”
Rene Guion Society, “sex before eight or it’s too late”
Children in the sex trade begging to be abused so they can eat.
Children paid well to act the part of the murdered in snuff movies.
Preborn children terminated because they are inconvenient and not wanted
We don’t really want to be reminded of human inhumanity to humans. It
shows there are always those who, cloaked with gentle concern or business
necessity, make a case for laws allowing the dehumanization of others at
least as good as themselves, for their unspoken use and pleasure.
When will we ever learn?
Why cannot legislators see it coming?
Where are the people of correct principle and courage to oppose the
incipient dehumanizing?
Palliative, compassionate care, which allows for one old person to be
“assisted” to die, will begin again the dehumanizing process, which soon
results in the vulnerability and death of all who are considered to be a
“useless eaters”, with low quality of life.. Can nobody see that no one wants
to be dead? Everyone struggles for something better. And there is always
some way to make it better for them.
The predictable effects of Doctor Assisted Death and Compassionate
Terminal Care.
a) undermining the trust patients have in their physicians and as a
result of this: — rapidly escalating medical care costs
— corrupting the medical profession, casting away an
amazing heritage of respect for patients and restraint of physicians
carefully constructed by great people over 23 centuries.
— It will allow those in the medical profession who have a mixed motive
of healing and destroying to usurp power to themselves. How can we
know this? It has happened in living memory. Binding and Hoche in
their innocent sounding treatise, “The Release for Destruction of Lives
Devoid of Value” in 1920, long before the Nazis came to power laid the
foundation and started the program of euthanasia and genocide for which
the German physicians will remain infamous. The practice of euthanasia
corrupted the German medical profession and those allied to them but
not the Dutch Medical Association of those days. The Dutch physicians
withstood threats of all kinds, to maintain their Hippocratic oath, “I will
not poison…” They were praised and honored for their courage. But
look what has now happened? Exactly the reverse. The Dutch are
leaders of euthanasia and the Germans won’t touch it. How you ask
could this have happened.
As in the days prior to Semmelweise, patients resisted being
hospitalized for they distrusted physicians and for good reason. Delays
in being properly treated means that the condition worsens and becomes
more difficult and expensive to treat.
As a result of the increasing mechanization of medicine, increasing
costs, unremitting demands and progressive dehumanization, doctors
listen less and more often miss serious illness. Add to this the
devaluation of old and slowly dying patients, time and empathy for
patients will diminish. At present most doctors are aware of these trends
and don’t like the way they practice, “I know I should spend more time
with my patients but what can I do under the present circumstances. I
am bound by the criteria of consensus management and usually end up
not listening but giving them more medication.”
Reader please review the mechanisms detailed above. It is now
happening because life-sustaining instincts are being undermined by
“progessive legislation” while hedonistic appetites are unloosed. It
happened rapidly in Germany because people of good will allowed the
erosion of all the constraints that governed their medical profession,
naively believing, “It couldn’t happen here. We are an honorable and
honored profession. None of us would stoop so low.”
After all, physicians are humans. Worst of all, they fail to see how
when they contribute to the destruction of a helpless innocent preborn
child, they have badly damaged their Species Specific Instinct
Restraining of Aggression. They can no longer be trusted with any
helpless life. They cannot trust themselves.
b) Pervasive dehumanization. As we treat others with less than full
respect due their individual humanity, so everyone becomes
dehumanized for everyone contributes, even those who are “not
involved”, “just standing by”. The observers in particular are
affected for their insistence of their innocence evokes a
rationalization that the perpetrators use to gain ascendancy.
Eventually now one feels safe. They must all watch their backs and
count hands to determine their approval ratings. For now wantedness
determines who lives and who dies.
c) Elder abuse will increase because the growing split in the minds of
physicians going back to pre-Hyppocratic times, between curing and
“compassionate” killing. The slowly dying and elderly patient is
dehumanized and devalued. The instinct to rid the race of those
considered defective or a burden will subconsciously arouse feelings
of disgust and anger which will result in attacks. As this becomes
more common, no amount of legal control will be able to restrain the
physician or nurse who believe they are doing the right thing and
besides, “no one will know”’
d) Growing economic chaos. It is not possible to run a free market
economy with a declining population. It has never been done. It
could only be accomplished at the expense of millions of
“expendable” lives and then only temporarily.
e) The death of democracy. Since no know economic program is
known to work and probably none can, people will panic as they see
their major asset, their home progressively lose value. “Help, anyone
help. Get us out of this mess they all cry.” “Of course I can help”,
says the brilliant megalomaniac, “but it may mean temporarily
suspending the government, freedom of press etc. Only of course
until we can straighten out this mess created by the so-called prolife,
profreedom people created. Maybe we should start our reforms by
gently getting them out of the way”
f) The pervasive avoidance of harsh truth. There are surely none so
blind as those who push truth away. They believe on the basis of
their philosophies that humans can always adapt and survive, for after
all, they argue, haven’t we evolved well so far. They ignore the fact
that since the description of entropy and the discovery of the big
bang, the theory of evolution is absurd. They are blinded by their
belief system, so they cannot recognize the harsh facts of human
ambivalence to life and death or how it is possible to destroy the race.
RECOMMENDATIONS
These are practical. They are necessary now.
1) Recognize the serious wide ramifications of any proposal
dealing with life and death. Know well the underlying mechanism
that affect us all.
2) Ask of any proposed legislation, is it Pro Life or Pro Death.
Does it result in hope for all? Does it interfere with any life
sustaining instincts and any life affirming legislation?
3) Does it work? Ask where and what is the evidence, hard good
science, that it will benefit individuals and our nation
4) Do not let the tear jerking human idealists persuade you, “But
surely we must do this out of compassion for the suffering”. Be a
realist and remember that part of our humanity is a persistent
ambivalence about life and living, coupled with an arrogance
stemming from our knowledge of good and evil.
5) Do everything to maintain the elderly person’s dignity,
codependence and helpfulness. Rather than increasing expenditures
for well staffed homes, (institutions), set things up so they can care
for each other as much as possible until they absolutely cannot lift a
finger to help.
6) Prevent conditioned helplessness. When kindly staff help
when they could let the person struggle, they inadvertently reinforce,
(reward) helpless behaviour. This is progressive and best explains
why “that dear stubborn old very lady” so quickly becomes helpless.
7) Facilitate the optimum effort to struggle to survive. Humans
need to struggle, just as animals do. It helps maintain their health and
self-respect. For example, instead of elevators, the elderly would be
expected to walk up a gently slopping ramp for meals. And those
with any extra energy can help push those in wheel chairs. Mind you
it will take a well-trained advisor to help the staff recognize when to
help and when to let struggle.
8) Curtail elder abuse by: i teaching institutional staff and
families to recognize that neglect and abuse occur within the Tragic
Triangle of which they are a part. There are no innocent bystanders.
Everyone contributes. Even a small percentage can tip the balance in
favor of abuse or careful care. ii teaching the more helpless to
appropriately assert themselves to protest and report.
9) Help families learn about grief, particularly the lesser known
aspects such as: anticipatory grief, guilt loaded grief and the wide
variety of feelings during mourning, not just sorrow.
10. Discourage the use of antidepressants. Grief is normal and
necessary and self-limiting. It is not any kind of depression although
it may have similar symptoms. Because one must experience all the
feeling of grief, and because antidepressants mute feelings and limit
dreaming sleep, they are contraindicated. If given they generally
prolong or truncate grief.
11.Change municipal bylaws so “Granny Cottages” may temporarily be
located, air lifted by helicopter, into a family’s back yard. It can
provide the right amount of contact for an old couple and their
children’s family. Being able to help with gardening often brings
great satisfaction to the elderly. It evokes respect in the younger
generation. “I’m really proud of my old grand mother and father. It
may have taken them a long time but they sure made a beautiful
vegetable garden back there”
12.Bring the practice of abortion under the rules and regulations that
govern the rest of medicine. Remove federal funding for performing
abortions until such time as it is scientifically established that
abortions are good medicine i.e.: are necessary, beneficial, have few
side effects, are done in good conscience, are performed only after
other less invasive, more reversible treatments have been tried and
only after fully informed consent. The current practice of abortions
fails on all these counts. It isn’t good medicine and it deeply
damages the physician’s SSIRA
13.Give Colleges of Physicians and Surgeons the responsibility of
ensuring every physician hangs a statement of his/her ethics which
state his position on the major ethical issues, on the wall on the
waiting room.
14.Help exabortionists to deal with the confusion and trauma of leaving
that part of their practice. Make the practice of doing abortions less
lucrative.
15.Highlight and honor parenting. Provide normal couples a better
understanding of pair and infant bonding. Change the tax structure so
single income families are not penalized.
16.Do further research into the relationship between population and
economic growth. So far the data clearly indicates that with falling
population, there are fewer taxes and greater pressure to cut corners
for the care of the aged and ill who are dying.
17.Provide adequate funding for the treatment of those suffering Post
Abortion Syndrome and the Post Abortion Survivor Syndrome.
18.Prohibit any form of Doctor Assisted Death.
19.Provide well trained people to teach families in accomplishing the 10
tasks of the dying. (Ref. Christian Principals for Palliative Care.) or
some other similar program.
20.For all concerned for the welfare of the elderly, enhance their value to
us all not only by their past contributions to our nation but also that
their dependency and frailty is a gift, bringing out the best in each
of us. They set up the conditions where we can learn to be truly
loving and civilized.
21.For all hoping to improve the social, physical, mental, and spiritual
care of the dying, must first learn how they contribute to the
problems. Any one who cannot see how they are part of the problem
can never be a part of the solution. They will tend to point fingers
and scapegoat.
22.Curtail all factors, particularly with respect to the SSIRA, that
interfere with the limiting of life sustaining instincts and morality.
References and Relevant Reading
a. It Never Happened and Besides They Deserved It, Opton EM
in Sanctions for Evil, Nevitt Sanford and Craig Com stock
eds. San Francisco, Jossey-Bass, 1971.
b. And I Am Afraid of My Dreams. Wanda Poltawaka, New
York, Hippocrene Books, 1964.
c. Abortion to Euthanasia: A Slippery Slope, Malcolm
Muggeridge, in The Zero People: Essays on Life. Jeff Lane
Hensley ed. Servant Books, Ann Arbor, 1963.
d. The “Discovery” of Child Abuse, Pfohi SJ, in Child
Abuse:Commision and Omission, JV Cook and RT Bowles
eds. Toronto, Butterworth, 1980
e. NEY PG. “Depression in Children”, H.K. J Mental Health
““6:21-25, 1977.
f. NEY PG. “The Relationship Between Abortion and Child
“Abuse”, Can J Psychiatry 24:610-620, 1979.
g. NEY PG, MULVIHILL D. “A Case of Parental Abuse”, J
Victimology 7:194-198, 1983
h. NEY PG, BARRY JE. “Children Who Survive”, NZ Med J
96:127-129, 1983.
i. NEY PG. “A Consideration of Abortion Survivors”, Child
Psychiatry Hum Dev 13:168-179, 1983
j. NEY PG. “Ethical Dilemmas in Psychiatry”, NZ Med J 96:939-
940, 1983.
k. NEY PG, JOHNSON I, HERRON J. “Social and Legal “““
Ramifications of a Child Crisis Line”, Child Abuse `Negl
9:47-55, 1985.
12. `NEY PG, HERRON JA. “Children in Crisis: To Whom
Should They Turn”, NZ Med J 98:283-286, 1985.
13. NEY PG, HERRON JL. “Mandatory Reporting”, NZ Med
J 98:703-705, 1985.
14. NEY PG, McPHEE J, MOORE C, TROUGHT P. “Child
Abuse: A Study of the Child’s Perspective”, Child Abuse Negl
10:511-518, 1986.
15. NEY PG, NEY PM. “Our Patients’ Seven Unspoken
Questions”, Can Med Assoc J 35:879-880, 1986.
16. NEY PG. “Does Verbal Abuse Leave Deeper Scars: A Study
of Children & Parents”, Can J Psychiatry 32:371-378, 1987.
17. NEY PG. “Helping Patients Cope with Pregnancy Loss”,
Contemporary Ob/Gyn 29:117-130, 1987.
18. NEY PG. “Transgenerational Child Abuse”, Child Psychiatry
Hum Dev 18:151-168, 1988.
19. NEY PG. “Triangles of Child Abuse: A Model of
Maltreatment”, Child Abuse Negl 12:363-373, 1988.
20. NEY PG. “The Treatment of Abused Children: The Natural
Sequence of Events”, Am J Psychother 46:391-401, 1987.
21. NEY PG. “Child Mistreatment: Possible Reasons for its
Transgenerational Transmission”, Can J Psychiatry 34:594-
601, 1989.
22. NEY PG, WICKETT AR. “Mental Health and Abortion:
Review and Analysis”, Psychiatr Univ Ott 14:506-516, 1989.
23. NEY PG. “Putting Your Ethics on Display”, Can Med Assoc
J 142:752, 1990.
24. NEY PG. WICKETT AR. FUNG T. “Causes of Child Abuse
and Neglect”, Can J Psychiatry 37:401-405, 1992.
25. NEY PG. “Existential Questions for Physics and Psychiatry”,
Journal of Philosophy of Medicine and Medical Psychology:
Medicine and Mind. 1991 – Vl,n. 1-2:13-29.
26. NEY PG. FUNG T. WICKETT AR. “Relationship Between
Induced Abortion and Child Abuse and Neglect: Four
Studies”, Pre- and Perinatal Psychology J. 8:43-63, 1993.
27. NEY PG. “Some Real Issue Surrounding Abortion”, J Clin
Ethics 4:179-180, 1993.
28. NEY PG. FUNG T. WICKETT AR. “Child Neglect: The
Precursor to Child Abuse”, Pre- and Perinatal Psychology J.
8(2): 95-112, 1993.
29. NEY PG. FUNG T. WICKETT AR. BEAMAN-DODD C.
“The Effects of Pregnancy Loss on Women’s Health”, Soc Sci
Med, 38(9): 1193-1200, 1994.
30. NEY PG. FUNG T. WICKETT AR. “The Worst
Combinations of Child Abuse and Neglect”, Child Abuse and
Neglect, 18(9), 705-714, 1994.
31. NEY PG. “The Universal Ethic of Mutual Benefit”, The
Turkish Journal of Medical Ethics, 2: 53-56, 1994.
32. NEY PG. “Abortion and Family Psychology: A study in
progress”, Canadian Journal of Diagnosis, 16(1): 113-119,
1999.
33. REARDON DC.,NEY PG. “Abortion and subsequent
substance abuse”. Am J Drug Alcohol Abuse, 26(1):
61-75, 2000
34. NEY PG. “Physician-assisted suicide.” Ann R Coll
Physicians Surg Can. 1999 Dec; 32(8): 458
35. REARDON DC, NEY PG, SCHEUREN F, COUGLE J,
COLEMAN PK, STRHAN TW. Deaths Associated with
Pregnancy Outcome: A Record Linkage Study of Low
Income Women. South Med J 2002 Aug; 95 (8): 834-41
36. REARDON DC, NEY PG, COUGLE JR, RUE VM,
SHUPING MW, COLEMAN PK. “Psychiatric Admissions of
Low-Income Women Following Abortion and Childbirth.”
CMAJ. 2003 May 13; 168 (10): 1253-6
37. NEY PG. “Abortion and Psychiatric Practice.” J Psychiatr
Pract. 2003 Nov; 9(6): 407
38. NEY PG, GAJOWY M, SHEILS CK. (2006) Post Abortion
Survivor Syndrome: Signs and Symptoms. Southern Medical
Journal. Dec 99 (12).
39. NEY PG. “Transgenerational Triangles of Abuse: A Model of
Family Violence”, In Intimate Violence: Interdisciplinary
Perspectives. Ed: Emilio C. Viano. Washington: Hemisphere
Publishing, 1992. pp.15-25.
40. NEY PG. PETERS A. Ending the Cycle of Abuse, New
York: Taylor & Francis, 1995.
41. NEY PG. Deeply Damaged (3rd ed), Victoria: Pioneer
Publishing, 1997.
42. NEY PG. “Christian Principles for Palliative Care”. Victoria:
Pioneer Publishing, 2007
43. Binding, Karl and Hoche, Alfred The Release of the
Destruction of Life Devoid of Value, Leipzig, 1920.
44. Wertham F A Sign of Cain: An exploration of human
violence, New York ,MacMillan.1966.
45. Brown, Harold, The German Court’s Decision, A Translation
of the Summary. The Human Life Review, Summer:75-85,
1975.
46. Brody, Sylvia. Patterns of Mothering, International
University Press. 1956 New York.
47. Cameron P, Van Hoeck,D,Weiss N, Kostin M, Happiness
and life satisfaction of the malformed, Proceedings, 79th
Annual Convention, American Psychiatric Association, `641-
42, 1971.