Psychiatric Darwinism

SURVIVAL OF THE FITTEST, EXTINCTION OF THE UNFIT

By Barry A. Bostrom, M.Div., J.D., Executive Editor, Issues in Law & Medicine

Editor's note. Issues in Law & Medicine is a peer-reviewed professional journal published three times a year by the National Legal Center for the Medically Dependent and Disabled, Inc. and the Horatio R. Storer Foundation, Inc. Published since 1985, Issues is devoted to providing useful information on recent legal and medical developments to assist attorneys, health care professionals, educators, and administrators on legal, medical, and ethical issues arising from health care decisions.

The first article in the current edition of Issues in Law & Medicine, written by Madeleine Pelner Cosman, Ph.D., Esq., is entitled "Psychiatric Darwinism, Survival of the Fittest and Extinction of the Unfit." Her work is a critical analysis of the American Health Security Act of 1993 (AHSA).

AHSA was soundly defeated when first proposed by Hillary Clinton's health care reform team shortly after President Clinton took office. But parts of it were enacted into law in 1996, with the prospect of further piece-meal enactment in the future, especially with Senator Hillary Clinton now in office. AHSA includes matters of critical importance to American mental health practitioners, to vulnerable citizens with psychiatric disorders, to their families, and to their few champions in medicine and law.

Medical utilitarianism is the unstated philosophical root of AHSA and its legislative progeny, i.e., whatever cuts medical costs and saves money is good, regardless of the impact on our most vulnerable patients.

Dr. Cosman, professor emerita of City College of the City University of New York, explains AHSA's mental health entitlements and, more importantly, its limitations of in-patient, out-patient, and other patient care. She enumerates a dozen major imperfections and dangers of this mental health law, especially its medical utilitarianism emphasizing successful outcomes and quality of life.

Dr. Cosman argues that the emphasis on holding down medical costs, providing benefits only for treatments that have a high rate of successful outcomes and good quality of life, and managed competition threaten the essential liberties, medical choices, and lives of older persons, persons who are chronically ill or terminally ill, and most particularly those who are mentally impaired.

She concludes that if limited money, medicine, and time are invested only in patients when medical success is inevitable, then America's medicine by law will be medical Darwinism encouraging survival of the fittest by requiring extinction of the unfit.

In the second article in Issues in Law & Medicine, Dr. Raphael Cohen-Almagor, senior lecturer, University of Haifa, Israel, provides a critical evaluation of Dutch euthanasia policy and practice in his article entitled "An Outsider's View of Dutch Euthanasia Policy and Practice." His research benefited from twenty-eight interviews conducted in the Netherlands during the summer of 1999 with some of the leading figures who dictate the decision-making process and take an active part in the euthanasia debates.

The article begins with a review of the two major Dutch government reports on euthanasia and the conflicting views and interpretations offered by the literature.

After providing data about the interviews, Dr. Cohen-Almagor's analysis goes on to demonstrate that the Dutch guidelines on the policy and practice of euthanasia do not provide sufficient mechanisms to protect against abuse.

Although Dr Cohen-Almagor previously supported a right to euthanasia, he changed his view after his visit to the Netherlands. He concludes that the Dutch Guidelines are inadequate and do not provide sufficient control over the practice of euthanasia.

Also published in this edition is the Canadian Supreme Court opinion in the case of Robert William Latimer v. Her Majesty The Queen. In its January 18, 2001, decision the Canadian Supreme Court upheld the conviction and sentence of Robert Latimer for the first-degree murder of his daughter, age twelve, who was disabled.

Latimer killed his daughter with carbon monoxide from his truck, he said, in order to end her suffering. The jury recommended a sentence of one year of imprisonment before parole eligibility. The trial judge granted a constitutional exemption from the mandatory minimum of life imprisonment, sentencing Latimer to one year of imprisonment and one year on probation.

However, the Court of Appeal affirmed the conviction but imposed the mandatory minimum sentence of life imprisonment without parole eligibility for 10 years. With a lengthy opinion, the Canadian Supreme Court affirmed the decision of the Court of Appeal and dismissed the appeal.

Be informed -- stay informed! Issues in Law & Medicine is a peer reviewed journal published three times a year. The annual subscription rate is $69 for individuals, $89 for institutions, for three issues. Single issues are $23.00. Requests may be sent to Issues in Law & Medicine, 3 South 6th Street, Terre Haute, IN 47807-3510.