Medicalization and Death

Three events recently converged: the mistrial in Lindsay Clancy’s trial for murdering her three children; Tennessee’s failed attempt to execute Christa Pike; and a book I’ve been reading, Unravelling MAiD in Canada. They have one common thread: the medicalization of death.

Lindsay Clancy’s strangulation of her children was blamed on a medical condition: postpartum psychosis. Christa Pike’s hospitalization to “save her life” followed a quasi-medicalized attempt to execute her by lethal injection. And Coelho et al.’s book carries the telling subtitle: “Euthanasia and Assisted Suicide as Medical Care.”

Medicine lends a veneer of respectability, nay, authority, to many things. In the midst of coronavirus, we were exhorted to “believe the science!” (I did not think science demanded an act of faith.) When German doctors spoke of the “scientific” value of “eliminating” Lebensunwertes Leben (life unworthy of living), it suddenly got a “nah ja.” White coats can make acceptable what brown shirts can’t. It is why the contemporary Polish philosopher Zbigniew Stawrowski speaks of “sleek barbarians”—because contemporary barbarism is advanced in power suits and medical coats, which seem suddenly to ease the barbarism. Nor is it necessarily that new. Eighty years ago, German physicians were using concentration camps as surrogate medical test laboratories, whether it be observing the speed of Zyklon B lethality in the gas chamber or cold-water experiments on naked Polish priests and Russian POWs in the middle of a Bavarian winter.

Baptist moral theologian Andrew Walker captured that symbolic confusion when he criticized how Tennessee (and, by extension, 26 other states) carries out executions. “When the state kills, how it does so should not look like an outpatient procedure. Therein lies an irony: The more the state attempts to medicalize killing, the more it risks unsuccessful and inefficient executions, and the more it obscures the full weight of what retributive wrath is meant to accomplish and signify.” (Of course, under current Catholic teaching, “retributive wrath” does not count among the legitimate purposes of capital punishment.) He has a point: the “visceral response” capital punishment should elicit ought to mirror the visceral response to taking an innocent person’s life. “Sanitizing capital punishment erases the deterrence it is supposed to evoke. … [T]he state bears the sword, not a syringe.” Whatever one thinks of capital punishment—and I accept Catholic teaching—we err by making it appear “therapeutic.”

Medical procedures are supposed to be healing, not harming: primum non nocere is one of the first principles of medical ethics. It’s why prison technicians, not physicians, perform lethal injections. The medical community recognizes the dissonance in taking a life.

But before we praise physicians, let’s examine another blind spot: the paradox in Coelho’s subtitle. How can practices intended to make the patient dead constitute “medical care”?

Writing about the expansion of euthanasia in Canada (because that’s what it is—most deaths occur by doctors effectuating them), the authors explore how the preferred term of art—MAID (Medical Assistance in Dying)—originated. Proponents of euthanasia recognized that the word “euthanasia” had become pejorative in many quarters, whether it be its Nazi antecedents or its more recent history in Belgium and the Netherlands that did not recommend it. “Medical assistance in dying” was sufficiently ambiguous that it might even be confused with palliative care: who could oppose, for example, pain management? Thus was born a new acronym that confirmed what journalist Paul Greenberg observed decades ago: “verbicide precedes homicide.”

The first effort to legalize euthanasia in Canada—in Québec—also co-opted medical terminology to empower the province to get away with the practice. Canada’s Criminal Code clearly defined causing another’s death to be murder, while facilitating another to commit suicide made one an accomplice. The criminal law in Canada is a matter of exclusively federal jurisdiction. The only way for Québec to evade that boundary was to reclassify killing as medicine, because medicine was a provincial competence. Now, with the federalization of MAID, Canada finds itself in the paradoxical situation of a country that criminalizes assisting suicide—except that some suicides, appropriately redesignated as “medically assisted,” are also constitutional “rights.”

The phenomenon of sanitization by medicalization is found across the board. Failure to cope with addictive substances leads to identifying the “medical uses” of marijuana, so that its growing use is approved as long as states provide for its sale (and collect their tax cut) in “dispensaries.” That this terminology is willfully deceptive is apparent from the double-faced treatment of addictive substances: what state will sell nicotine in “dispensaries”?

The phenomenon’s most prominent example is in the realm of procreation and childbearing. Something perfectly natural and normal is deemed pathological, to be fixed by “the Pill,” while problems of sexual responsibility, poverty, and child care are deemed soluble by a “procedure” or—today—more commonly another pill.

In one sense, this medicalization is a poor attempt to circumvent the doctrine of original sin. Man’s fallen nature, yielding to what is bad either by bodily weakness or spiritual arrogance, can be explained away as an “illness,” albeit one to which moderns hesitate to seek recourse with the Divine Physician. Human brokenness then becomes either something beyond my capacity to fix or, paradoxically, one where my all-powerful will asserts autonomy beyond good and evil (at least as Christianity used to define it). “I couldn’t cope with my kids—and I have the choice not to have to.”

The problem is that the pan-medicalization of human life is built on a faulty diagnosis. Not all human problems are beyond my control, nor can they all be fixed by a magic pill. The virtues don’t come by injection.