Monday, July 25, 2005

Arthur Caplan finds the Hitler zombie in bioethics

In the most recent issue of Science, bioethicist Arthur Caplan points out how common flawed and overblown Hitler or Nazi analogies are during debates about stem cell research, end of life care, and clinical trials:
Sadly, too often those who draw an analogy between current behavior and what the Nazis did do not know what they are talking about. The Nazi analogy is equivalent to dropping a nuclear bomb in ethical battles about science and medicine. Because its misuse diminishes the horror done by Nazi scientists and doctors to their victims, it is ethically incumbent upon those who invoke the Nazi analogy to understand what they are claiming.

I couldn't have said it better myself. (Of course, Arthur Caplan does this kind of thing for a living and I don't; so it would be shocking if he couldn't say it better than I.) The Hitler zombie will not be pleased by his words, as biomedical debates have proven a fruitful hunting ground for him to find brains to snack on, and not just in the debate about thimerosal and autism. there are also the issues of stem cells, human clinical trials, genetic engineering and gene therapy, and end of life issues.

On a more serious note, let's look at one example in particular that Dr. Caplain mentioned, the Terri Schiavo case. How many times did you hear that the way authorities were rushing to "execute" Terri was reminiscent of Nazi Germany or even a step onto the "slippery slope" to a new Holocaust? There was apocalyptic imagery of "jack-booted" Gestapo coming to end her life. Indeed, it makes me wish I had come up with the concept of the Hitler zombie a few months before I did, as he would have had a field day with this case. Here's one example:
As Schiavo starves to death, we are entering a world last encountered in Nazi Europe. Prior to the genocide of Jews, Gypsies, and Poles, the Nazis engaged in the mass murder of disabled children and adults, many of whom were taken from their families under the guise of receiving treatment for their disabling conditions. The Nazis believed that killing was the highest form of treatment for disability.
And this article about Schiavo:
It was also used in Auschwitz, Bergen-Belsen, Treblinka and the Soviet gulags. Stalin used starvation as a means of control. Nazi doctors experimenting on unwilling "patients" adopted all kinds of cruel techniques. One of those techniques was starvation and dehydration. It is recorded in the records of the Nuremberg Trials.
And this one:
Even before the rise of Adolph Hitler's Third Reich, the way for the gruesome Nazi holocaust of human extermination and cruel butchery was being prepared in the 1930 German Weimar Republic through the medical establishment and philosophical elite's adoption of the "quality of life" concept in place of the "sanctity of life." The Nuremberg trials, exposing the horrible Nazi war crimes, revealed that Germany's trend toward atrocity began with their progressive embrace of the Hegelian doctrine of "rational utility," where an individual's worth is in relation to their contribution to the state, rather than determined in light of traditional moral, ethical and religious values.
Yet another article about Schiavo invoking the Nazis:
Because evil has no reason, we once again see its ugly head in the shameful decision by people dressed in black like the Gestapo of Nazi Germany, giving way to the execution by starvation without a jury trial, required in all capital death cases.
And, finally, of course, such a discussion would not be complete without the gratuitious, outrageous, and overblown dropping of the H (for Hitler)-bomb (Mary Labyak apparently runs the hospice where Terri Schiavo was being cared for):
While Mary Labyak is not a leader of armies of soldiers and is not known to be targeting ethnic groups as Hitler did, she is actively involved in making hospice a place where the severely disabled can be eliminated, with government approval. Hitler also targeted the severely disabled, killing over "200,000 handicapped, mentally ill and other institutional patients who were deemed physically inferior" and used his government to accomplish that goal. Labyak uses her hospice to accomplish the same goal.

Labyak sits on the board of national level policymaking organizations which decide the future of hospice and health care. Labyak agrees with Hitler that there is a rationale for intentionally ending the lives of the NON-terminal, severely disabled and is pushing that agenda. Labyak sits on the board of an organization (Partnership for Caring) with DIRECT historical roots in the Euthanasia Society of America, founded in 1938 in New York, during the HEIGHT OF THE NAZI agenda of killing off the disabled, mentally ill and other ethnic groups, shortly thereafter to become THE HOLOCAUST!

If you do a Google search, you can easily find thousands of articles making or discussing that analogy (although at least one pointed out how dubious it was). And, indeed, if you don't know a lot about Nazi Germany and its euthanasia program it can all sound pretty persuasive. The problem is, it doesn't add up, as Dr. Caplan points out, and I'll try to expand upon a bit.

Nazis justified the T4 euthanasia program on two main grounds. The first and foremost purpose of the program was eugenic, to remove undesirable genetic traits from the Volk. Consequently, the Nazis killed the deformed, the disabled, and particularly the mentally retarded or those with mental illnesses. They used multiple methods, including starvation, intentional overdose with narcotics, lethal injection, and then ultimately gas chambers to achieve this end. (Of course, given that genetics was in its infancy, the Nazis not infrequently misidentified conditions as being genetic when in reality they weren't, one example being cerebral palsy, which is often due to birth trauma or cerebral anoxia.) Consistent with this vision was the mandatory sterilization of adults deemed to have "undesirable" genetic traits, a group that expanded to include Jews and other "racial undesirables," who as groups later became the victims of mass murder during the Holocaust. The second justification was to eliminate what the Nazis perceived as drains on the Volk in order to "free up hospital beds," "increase the food supply," and "free up personnel for the war effort," among other specific reasons they would group under this rubric. Indeed, some of the terms for the disabled the Nazis would use to justify this killing were "life unworthy of life" and "worthless eaters." Removing them by killing, according to Nazi ideology, would allow the "healthy" members of the Volk to devote themselves to pursuits that would contribute to society and the war effort, rather than "wasting" their efforts caring for the disabled.

Consider this in relationship to the Terri Schiavo case. What was at the very core of the arguments made by those advocating removing her feeding tube? Personal autonomy and the right to self-determination, about as un-Nazi-like a justification as you can make! (Indeed, referring to such analogies, one commenter in a blog said sarcastically about such comparisons: "Yep: Adolf Hitler, famous advocate for patient autonomy.") In essence, the state of Florida spent nearly a decade and millions of dollars trying to determine what it was that Terri herself would have wanted for herself if she ever fell into a permanent coma or the persistent vegetative state she found herself in, and even ordered the feeding tube reinserted when an appeal was made. Implicit in that search was the accepted right of an competent human adult to refuse medical care. Nowhere in the arguments for letting Schiavo die were appeals to wasted resources being used to keep her alive or threats to the genetic health of the nation. Consider further, then: What would the default have been if Michael Schiavo had failed to convince the courts that he was not lying when he reported that Terri's wishes were not to be kept alive in a coma or persistent vegetative state? It would have been to continue to keep her alive, as she had been kept alive for years before that. In contrast, in Nazi Germany, the justification for letting Terri die would have been that she was a drain on the Volk, and not a second thought would have been given to withholding food and water or even helping her along with a lethal injection as soon as it became clear that she was never going to recover.

Besides being a bad analogy, such arguments rely on a logical fallacy, that of the "slippery slope." In essence, this logical fallacy seeks to convince one that, if the proposition in question occurs, then it will set into motion a chain of causality that will lead to something truly horrific; in this case, if Terri Schiavo is allowed to die, it will lead to widespread involuntary euthanasia of the disabled. The reason that the slippery slope is almost always a logical fallacy is that the chain of causation is usually vague and it is not proven that if the disputed proposition were to become reality that the feared outcome would have a high probability of resulting. Given that the very basis for letting Terri Schiavo die is not anything like the justifications the Nazis used for involuntarily euthanizing the disabled, there is no strong evidence or reason to conclude that allowing her to die would move the United States towards the horror of the widespread involuntary "mercy killing" of the disabled, as some advocates of the disabled have claimed.

Does this mean that all Nazi analogies in the realm of bioethics are dubious? No, but I would argue that the vast majority are. I've addressed this issue before with respect to bad Holocaust/Nazi/Hitler analogies in politics, and I'll paraphrase what I said before for biomedical Nazi analogies: Whenever someone makes a Hitler or Nazi comparison, be it "Bush=Hitler" or "killing Schiavo=Nazi euthanasia" or a questionable Holocaust comparison, don't just accept it. Pin down the person making the analogy. Make him justify the analogy with history, facts, and logic. Ask him what historical events lead him to make that analogy. At least 95% of the time, you'll get either no answer (and you'll hopefully make the idiot making the analogy very uncomfortable); a meaningless answer or an obviously fallacious answer. The other 5% of the time you may actually get an answer that makes you wonder. In any event, when examining a particular bioethical issue, what should determine whether such an action is ethical or not should be the facts and ethics of the case, not any distorted Nazi analogy.

As Arthur Caplan argues:
There are many reasons why a practice or policy in contemporary science or medicine might be judged unethical. But the cavalier use of the Nazi analogy in an attempt to bolster an argument is unethical. Sixty years after the fall of the Third Reich, we owe it to those who suffered and died at the hands of the Nazis to insist that those who invoke the Nazi analogy do so with care.
I wish I could have put it so succinctly. When considering a bioethics issue, to determine what is and is not ethical should rely on the facts of the case and the ethics of the policy, not a bad analogy to a historical event.

5 example(s) of insolence returned:


At 7/25/2005 3:38 PM, Anonymous Jeff Z said...

The comparison of Hitler and Natiional Socialism with almost any other phenomenon is absolutely enraging, but, aside from the practitioners of this slanderous trope who are actively malicious, cynical, or insane, ignorance is, as you cite, the culprit.

However, as impressive and indispensible as your detailed educational work in this post and others are, they are still inadequate in confronting this problem's true foundation, of which, with the exceptions noted above, these endless absurd and shameful analogies are merely an inevitable result.

In the current (lamentable)state of popular discourse, the only identifiable evil which people are prepared to universally acknowledge as objectively true is Hitler, National Socialism, the Holocaust, etc. All other evil is subjective; i.e. a difference in "values," in the literal Weberian sense. Simply look at one cretinous facet of the debate about terrorism, summed up in the inane, but oddly credible, statement, "One man's terrorist is another man's freedom fighter," as if the morality of the tactic, terrorism, is related to the aspiration of the goal, "freedom fighting." (And never mind what the terrorist in question means by "freedom.") I trust that with an educated audience there is no need to illustrate the morbidly risible semantic knots that various prominent news organizations tie themselves into when attempting to call one who commits terrorism something other than a terrorist. Their problem is not that they do not see them as terrorists; the problem is that the terrorists do not see themselves as such, and there is no objective truth that these media organizations believe they can appeal to to settle the matter one way or another.

Hence, if you want to paint something as evil in a manner that will be credible and accepted, you have no alternative to rounding up the usual suspect: Adolf Hitler. The truth of what National Socialism was becomes merely an interesting obscurity, such as it has become with words such as "boycott" and "sadism," while the meaning of words like "Hitler," (what you called your gym teacher), "Nazi," (soup nazi, anyone? And yes, I thought it was drop-dead funny too), and "Gestapo" (organization that the waiter who told you not to use your cell phone in the restaurant works for) become generic adjectives for evil, repression, humorlessness, etc.

 

At 7/25/2005 5:06 PM, Anonymous ADR said...

While I take Jeff Z's general point, the refusal of some media outlets to use the word "terrorist" is actually not an instance of the phenomenon he describes (or, at least, not necessarily so). "Terrorist" is becoming as much a pejorative as "liberal" -- quite apart from what the word actually means, it's deployed to attack rather than inform or express. "Suicide bomber", "armed hijacker", "kidnapper", etc. are as much evaluative as "terrorist" used strictly, are informative, and also don't seem to have the pejorative underpinnings. Or, to put it another way, why use a word that injects emotions into what should be a sensible (and fairly easy) ethical debate? If the result of any word is to obscure evaluative discussion, then said word has apparently lost its ability to function in that context. This seems to be happening with "terrorist"; it has certainly happened with "liberal".

Incidentally, there's an odd comment in one of the posts Orac cited that struck me... what exactly does Nazism have to do with Hegel (besides the fact that both were German)?

 

At 7/26/2005 3:42 AM, Blogger OutEast said...

Jeff z

... if you want to paint something as evil in a manner that will be credible and accepted, you have no alternative to ... Adolf Hitler.

Um, I believe the issue is precisely that this becomes non-credible and unacceptable. In fact, it becomes meaningless... Frankly, you sould educated but this seems belied by your claim that 'The truth of what National Socialism was becomes merely an interesting obscurity - there is a major qualitative difference between using 'nazi' as a mere perjorative and using the word 'boycott' without reference to Irish landowners. If you can't see it there must be some major holes in your understanding of history.

Moving on...

Orac,

I noticed an appearance of the Hitler Zombie's Soviet cousin on the scene of a recent unfair dismissal case; the plaintiff, a christian who lost his job (evewntually) because he refused to work on Sundays lost his appeal:

At the appeal court in London, Mr Diamond said: "There are striking similarities between this case and the treatment in Soviet Russia of Jewish refugees and Christians who sustained economic hardship for practising their faith."

Regardless of the rights and wrongs of the case (personally I think that while sabbaths per se should not be protected a compulsory 7-day working week should not be legal) this is an absurd hyperbole on a similar level to those which nourish the Hitler zombie. (Living as I do in one of the nations east of the erstwhile Iron Curtain I find myself as sensitive to the Soviet zombie as the Hitler one.)

 

At 7/26/2005 9:55 AM, Anonymous Jeff Z said...

ADR: Terrorist has neither a pejorative nor complimentary denotation. It is a description of a military strategy. We find it reprehnsible; the terrorists and their supporters do not.

Outeast: Of course I condemn the use of the "Hitler Zombie" trope in a manner deracinated from its original meaning; I hope that is clear. I'm proposing a hyopothesis of the causes and results of the phenomenon. Is the comparison of the mass murder of millons of innocent people comparible to a strike tactic to get absentee landlords to lower rents accpetable? No! Has it been accepted? Well, in the problem under discussion, the severing of words from their orginal meanings, it certainly been accepted, which is the whole point of Orac's article.

And thanks for the compliment about my education! I knew those three years in eighth grade weren't a waste, and now I have written proof.

 

At 7/26/2005 9:59 AM, Anonymous Jeff Z said...

2nd half of 2nd paragraph with typos corrected (Ugh!): Is the comparison of the mass murder of millions of innocent people comparable to a strike tactic to get absentee landlords to lower rents acceptable? No! Has it been accepted? Well, in the problem under discussion, the severing of words from their original meanings, it certainly has been accepted, which is the whole point of Orac's article.

 

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