Academic journal article The Hastings Center Report

Killing Machines

Academic journal article The Hastings Center Report

Killing Machines

Article excerpt

Killing Machines

The adoption of military metaphors by the medical profession is well known. Physicians aggressively combat disease on the front lines, using their armamentarium to destroy invaders of the body. The military also adopts medical metaphors, ranging from surgical strikes to antiseptic operations. Less commented on is the adoption of modern technology by both the military and medicine, and what the comparison of technologies reveals. In the midst of Operation Desert Storm, however, it is impossible to miss the striking similarities. In both cases, for example, we will pay double or triple for a small increase in efficacy. As retired Admiral Eugene Carroll put it, "the military always stresses performance at all cost." For a 10 percent increase in performance, the military will pay twice as much, and the new technology will be twice as difficult to operate and maintain.

One of the most intriguing parallels between military technology and medical technology is that some technologies, often the most efficient and effective, are considered either unethical or unfair. Western civilization, at least until 1500 A.D., seems to have considered weapons that allowed their users to kill "from a distance and behind cover" unfair, because "such weapons obscured the vital distinction between war and plain murder." [1] Thus, for example, both the long bow and the cross bow were regarded as "cowardly" and unfair. More recently, chemical and biological weapons have entered the unfair category, apparently because they are so feared and effective, but also perhaps because they have the capability to kill indiscriminately both civilian populations and military personnel.

Two days before American war planes attacked Iraq, the Public Broadcasting System aired a Nova program entitled "The Killing Machines." The program focused on the new technology of war. It ultimately cocluded that technology is only useful against technology, that the increased information available to commanders and their decreased time for decisionmaking increases the risk of human error. Whatever one thinks about these observations regarding war machines, their applicability to medicine seems beyond dispute.

Desert Shield was converted into Desert Sword within four months, and into Desert Storm two months later. Much of the country, probably the vast majority, felt themselves simply spectators in an event--sometimes described by administration officials and military experts as a "game"--that they were totally helpless to influence. Although much of the discussion is certainly coincidental, it seems that the debate about the "right to die" during this same time period is an attempt by a passive populace to assert at least some measure of control over their own lives, and the medical machines that might be employed to prolong their dying. Historically, for example, the Karen Quinlan case is often portrayed as a question of "turning off the machine." And the case that has occasioned the most heated debate has not focused on either a doctor or a patient, but on a machine itself: Dr. Jack Kevorkian's "suicide machine," used in the death of Janet Adkins. Kevorkian was hardly the first U.S. physician to assist in a patient's death. The difference is that previously deaths had been hastened by removing medical machines; this is the first case of a physician using a "killing machine" to produce death. Is it too far a stretch to think that what upset most ethicists was more the machine than the act itself? Is the machine seen as an "unfair" or unethical weapon that makes the distinction between murder and the practice of medicine difficult or impossible?

The Michigan Suicide Cases

Kevorkian, whose business card reads, "Bioethics and Obitiatry, Special Death Counseling, by Appointment Only," reportedly picked Michigan to showcase his suicide machine because he believed that assisted suicide was legal in Michigan. …

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