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Question: What do you believe about the margins of life and death?

 

Peter Singer: Let me start with why I got interested in writing about it, I was directing a bioethics center in Australia and we were contacted by doctors who had ethical dilemmas, they were working in neonatal intensive care units, intensive care units for very small children and they have conditions, for example, Spina Bifida in which in their view, it was not really a good thing for these babies to survive. The babies, if they did survive would need multiple operations, would be severely disabled in various ways. And often the parents also thought, given the description of the condition, it was not going to be a good thing for the baby to survive.

So these babies were essentially being not treated. And the result of being not treated was that almost all of them died before they were 6 months old. Some of them died in the first week or 2, some of them in the first month or 2 and other gradually throughout that first 6 months.

And this was a very draining experience for the parents, the doctors, the nurses, you had this small babies in the hospital, but not being treated in order to make them live, but nevertheless, living for quite a long time.

And the doctor said, “Are we doing the right thing here? Is this justifiable?” S we, my colleague, Helga Kuhse and I, looked at it and we decided that yes, it’s a reasonable decision for the parents and doctors to make that it was better that infants with this condition should not live, basically the more severe variance of this condition should not live. But we couldn’t defend the idea that the right thing to do then was to let them die, this seems slow and painful and as I said, terribly emotionally draining on their parents and others.

So, we said, “Look, the difficult decision is whether you want this infant to live or not. That should be a decision for the parents and doctors to make on the basis of the fullest possible information about what the condition is. But once you’ve made that decision, it should be permissible to make sure that baby dies swiftly and humanely. If that’s your decision, if your decision is that it’s better that the child should not live. It should be possible to ensure that the child dies swiftly and humanely.”

And so that’s what we proposed.

Now, that’s been picked up by a variety of opponents, both pro-life movement people and people in the militant disability movement, which incidentally didn’t really existed the time we first wrote about this issue. And they have taken us the stalking-horse, the boogeyman, if you like, because we’re up front in saying that we think this is how we should treat these infants.

I can understand to some extent why the pro-life movement takes us that way, but I think the disability movement ought to be just as upset about letting children die because they have a disability, and since that’s a very common practice in many hospitals, I’m not so sure why they’ve gone after us in particular rather than after the doctors who were actually doing it. Because I really don’t see the difference between letting the children the die, and making sure that their death comes swiftly and humanely.

 

Question: Are the boundaries between life and death flexible?

 

Peter Singer: So I think that we actually should have a pretty strictly biological view of the difference between life and death. In that sense, I’m actually an opponent of the definition of death in terms of brain death. I don’t think people whose brains have ceased to function, dead. Not dead as organisms anyway.

If their hearts are continuing to beat, their flesh is soft and you know, the blood is circulating, their fingernails are growing and in the case of women who are pregnant maybe either even succeeding in gestating a fetus. I wouldn’t call that dead.

I would say that a person whose brain is irreversibly ceased to function, that their life is of no further value to them, you could say if you like the person is dead, although not the organism. But I think the least confusing thing to do in these circumstances. In order to separate what’s effectual judgment of whether someone is dead or not and the value judgment as whether it’s good for them if they keep living, I think it’s best to have strictly that biological basis of death so you’re dead when your heart stops beating and your blood stops circulating, that really seems good enough as a definition of death.

 

Question: How should we approach healthcare?

 

Peter Singer: Americans like to maintain the myth that they don’t ration healthcare. Of course, they do ration healthcare in a variety of ways that are actually less satisfactory than the way other nations ration healthcare.

So some nations, like Britain, might say, “Look, here’s a drug that costs $300,000 and will give some patients with terminal cancer an extra month to live but afterwards, they’re still going to die anyway, it’s not going to save their life. Given the constraints on resources we have, $300,000 is too much to spend on giving a patient an extra month of life which often will be a life of poor quality for the last month anyway.”

Americans tend to rationalize by saying, “Well, you don’t have any insurance so you can’t see a doctor or you can’t have this operation.” Which is a much more pernicious way of rationing healthcare. And I’d like to see us ration healthcare in a way that gives access to everyone for a good level of care but does have some standard about what is the ratio of cost to benefits.

A lot of people don’t want to look at that but I think you have to, you have to sort of say, “This drug has very modest benefits and it’s extremely expensive so maybe that’s a drug we’re not going to use or this other drug, though it also has modest benefits, it’s not expensive so we should use that. Well, this other drug though is expensive, has very significant benefits so we should use that.”

I think we have scarce resources and we should use them to produce the greatest possible increase in the benefits of healthcare.

 

Recorded on: March 16, 2009

 

 

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