COMMENTARY

Culture of Death Letter to the Editor -- Response

Matthew K. Wynia, MD, MPH, and Arthur Derse, MD, JD

Disclosures

October 10, 2001

Introduction

Wesley Smith represents our critique of his book as "angry and emotional." Neither is the case. It is true that we used the words "outrageous" and "unfair" to describe his contention that mainstream bioethics would fit comfortably within Nazi ideology -- but we believe these harsh terms accurately describe this especially egregious proposition.

We also didn't say that he focuses "almost exclusively" on 2 bioethicists, Joseph Fletcher and Peter Singer. We did claim that he purports them to be representative bioethicists, when they are considered by many in bioethics to be far outside the mainstream.

With regard to Smith's proposed bioethics "orthodoxy," his letter raises another interesting contradiction. Within this purported orthodoxy, Smith claims that favoring physician-assisted suicide and supporting futility theory are "first cousins." If that is so, quite a few bioethicists haven't gotten the message. Many bioethicists who oppose physician-assisted suicide also believe that physicians should, in at least some cases, be allowed to determine which interventions are futile (indeed, this is the position of the American Medical Association).[1] Other bioethicists view physician-assisted suicide favorably, on grounds of promoting patient autonomy, but, for similar reasons, are opposed to physicians determining futility.

In short, we stand by our contention that Smith's claim that there is a bioethics orthodoxy dedicated to a culture of death is a misreading of the diversity and discourse in the field. Smith's arguments are even fueled by quotes from bioethicists, whom he admittedly identified with titles other than bioethicists to maintain an appearance of uniformity of thought.

Smith says that he grows weary of a ''constant whine" that he paints with too broad a brush in his alleging a uniform bioethics orthodoxy. If this is a constant theme by his critics, perhaps he should re-examine its merits. Ironically, though, even if he fails to do so, Smith surely knows that he is always welcome within the robust, if contentious, bioethics family. No cigar is necessary.

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