Do No Harm: Addressing the Medicalization of Violence and the Need for Human-Centered Healthcare

Do No Harm Addressing the Medicalization of Violence and the Need for Human-Centered Healthcare

By Odiraa Okala, Herb Geraghty and Aimee Murphy October 2018 Published by Rehumanize International www.rehumanizeintl.org

Table of Contents —

1 Part 1: The Medicalization of Violence 2 Embryonic Stem Cell Research 5 Abortion 9 Forced Sterilization 11 The Death Penalty 14 Euthanasia and Assisted Suicide 18 Part 2: The Consistent Life Ethic 22 Part 3: Human-Centered Medicine

Part 1: The Medicalization of Violence “To please no one will I prescribe a deadly drug, nor give advice which may cause his death.”

– Oath of Hippocrates, 5th Century B.C. The Hippocratic Oath has guided medical practice for centuries and have shaped the expectations of patients when seeking out a physician. However, the Oath of Hippocrates is not the global norm and is no longer widely adhered to, but many everyday folk likely have no idea that their physician makes no such abiding oath to “do no harm.”1 As we can observe throughout recent history, physicians are participating in medical violence in many forms: from embryonic stem cell research, to abortion, from forced sterilization to medical torture, from capital punishment to euthanasia and physician-assisted suicide. This white paper explores the aspects of medicalization of violence in all of these cases, the ethical solution to such lethal discrimination, and policy recommendations for building a human-centered model of healthcare.

What follows here before we enter the main body of the text is a brief discussion of the process of medicalization, defining violence, and the way in which that medicalization is based on authority held by physicians and other medical personnel.

What is Medicalization?

According to the Oxford English Dictionary, medicalization is the the “treatment of something as a medical problem, especially without justification.”2 However, there’s a much deeper phenomenon being captured by that short definition.

After all, as notable psychiatrist Thomas Szasz observes in his book The Medicalization of Everyday Life: The concept of medicalization rests on the assumption that some phenomena belong in the domain of medicine and some do not. Accordingly, unless we agree on clearly defined criteria that define membership in class called “disease”

or “medical problem” it is fruitless to debate whether any particular act of medicalization is valid or not. (Szasz, “Introduction,” 2007, pp. i)”3 In short, it’s the process by which we decide which problems are medical and which ones aren’t. After all, no one complains about the medicalization of AIDS, malaria, or cancer. Szasz had this to say in his book about the selection process behind medicalization: In practice, we must draw a line between what counts as medical care and what does not. What is a disease and what is not? The question is where to draw that line… where we draw the line between “health care” and “not health care” is informed more by economic and political considerations than by medical or scientific judgments.

Moreover, we must not only demarcate disease from nondisease, we must also distinguish between medicalization from above, by coercion, and medicalization from below, by choice (Szasz, “Introduction “, 2007, p. xiv). 4 The first section of this white paper will address the medicalization of violence and explore the questions above. Simply, I will examine various actions currently viewed as medical care and instead explore how they are violence. I will attempt to demarcate disease and non-disease where possible and necessary, and then explain where medicalization has occurred either through coercion or by choice. First though, it’s important to have a quick discussion of what constitutes violence.

What is Violence?

The World Health Organization (WHO) has defined violence as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation.”5 The element of intentionality is a most important part of this definition, in that it prevents unintended tragedy from being labeled as violence.

To be clear: just because an action results in injury or death, does not mean the action was violent. Con-

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“The labeling of an action as violence is independent of outcome and, instead, dependent on intentionality.”

versely, just because an action did not result in injury or death, doesn’t mean the action wasn’t violent.

The labeling of an action as violence is independent of outcome and, instead, dependent on intentionality. For example, in the case of malpractice by a physician, even if death or serious injury resulted, the action(s) taken by the physician would not be violent because death or serious injury was not the intended outcome. Likewise, if a risky surgery goes poorly and the patient dies while the physician is attempting to heal them, it is not violence despite the high likelihood of that surgery resulting in an adverse outcome.

However, when a physician intends to harm a human being, whether by surgery, lethal injection, dismemberment, poisoning or starvation, the process being medical does not preclude the action from being violent: because harm is intended, it is violence, regardless of who is the perpetrator.

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References and Notes | Introduction Advisory Board Daily Briefing, September 27, 2016.

“Why the Hippocratic Oath is disappearing from medical schools.” https://www.advisory.com/daily-briefing/2016/09/27/medical-schools-hippocratic-oath 2 Oxford English Dictionary. Medicalize. (n.d.). Retrieved July 6, 2018 from https://en.oxforddictionaries.com/definition/ 3 Szasz, T. S., M.D. (2007). The Medicalization of Everyday Life: Selected Essays. Syracuse: Syracuse University Press.

4 Szasz, “Introduction “, 2007, p. xiv.

5 Krug EG et al., eds. World report on violence and health.

Geneva, World Health Organization, 2002 1

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Embryonic Stem Cell Research As defined previously, the medicalization of violence has three components: the construction of a disease, the creation of a treatment, and the choice (positive consent of that treatment by an individual), or coercion (forcing of that treatment upon an individual).

Embryonic Stem Cell Research: Exploring the Reality Before delving into the issues with embryonic stem cell research, it’s important to know what a stem cell is and why they’re so vital in medical research. Stem cells are cells that have the potential to become a more specialized cell. They can divide indefinitely, so in our bodies they serve as a sort of internal repair mechanism for injury or disease. Potentially, they could provide the basis of therapies for a wide range of diseases, including diabetes and heart disease.1 Until recently, there were two types of stem cells scientists used in research: embryonic stem cells and somatic stem cells. Embryonic stem cells were first derived in 1981. Most embryonic stem cells are and have been taken from the embryos that were created in-vitro for couples experiencing subfertility, who were then abandoned and given as research subjects for medical experimentation when the parents were done bearing children. These cells can also be grown in a lab by transplanting preimplantation-stage embryos into a cell culture. 2 The second type, somatic stem cells, are more commonly known as adult stem cells. Their origin is more unclear than embryonic stem cells, but they are chiefly found in somatic (body) cells. Research on these

cells has been ongoing for more than 60 years. These types of cells have been used for more than 40 years in bone marrow transplants. Recently, research has discovered that these cells are found in more places than previously imagined, like the brain and heart, leading to exciting research possibilities.3 In 2006, a third type of stem cell was created. Known as induced pluripotent stem cells, these were a breakthrough in stem cell development. Created from adult stem cells, “successful reprogramming of differentiated human somatic cells into a pluripotent state would allow creation of patient- and disease-specific stem cells.”4 Dr. Kazutoshi and his colleagues at the Affiliations Department of Stem Cell Biology in the Institute for Frontier Medical Sciences at Kyoto University created an alternative to embryonic stem cells that could be used in an equally wide, if not wider, range of possibilities. As one article put it from the journal Nature put it, “The field of stem-cell biology has been catapulted forward by the startling development of reprogramming technology. The ability to restore pluripotency to somatic cells through the ectopic co-expression of reprogramming factors has created powerful new opportunities for modelling human diseases and offers hope for personalized regenerative cell therapies.”5

Constructed Condition: Unwantedness The central reason for pursuing embryonic stemcell research (ESCR) is that there exist innumerable diseases and infections and conditions that would benefit from cures, and this research is seen as a potential panacea. But the primary justification for using ESCR is that it is a better use of the unused or “excess” embryos that are a product of IVF. There are two counters to this point. The first: unwantedness or lack of “purpose” cannot be the justification for violence against another human. As will be argued in this paper, embryos have a distinct moral status as human beings, and therefore cannot be treated as mere means to an end, even if those ends are potential benefits to others in the form of pharmaceutical cures.

Secondly, embryonic stem cell research is ineffective. Although touted as potentially lifesaving research, the effectiveness of ESCR as a source of cures for real disease has come under question. For example, em-

bryonic stem cells are often claimed to be a potential source of cures for Alzheimer’s disease. However, Dr. Marilyn Albert, who was the chair of the Medical and Scientific Advisory Council of the Alzheimer’s Association had this to say about the potential for a stem cell cure for the disease in 2004: “I just think everybody feels there are higher priorities for seeking effective treatments for Alzheimer’s disease and for identifying preventive strategies.”6 This proved to be prophetic, as a literature review of stem cell research revealed that “Stem cell-based cell replacement strategies are very far from clinical application in AD.”7 In fact, the most recent breakthrough as of the writing of this paper actually came from adult stem cell research.8

What is at Stake: Evaluating Human Embryonic Development Milestones According to the Mayo Clinic, during the process of fertilization, the zygote has a genetically unique chromosome profile. After zygote formation and fertilization, the zygote travels down the fallopian tube towards the uterus. At this point, they are called a blastocyst, and will then implant into the uterine lining (the endometrium). The innermost group of cells in this blastocyst becomes the body of the embryo, while the outer layer becomes the child’s placenta, which is an integral organ to their development.

In the course of development, both before and after birth, they will pass through the stages of embryo, fetus, neonate, infant, toddler, adolescent, adult, and aged. There is no stark moral difference between the child in any one of these given stages. In the case of embryonic stem cell research, the embryonic human is prevented from implantation and is destroyed in research, thereby preventing their continued development into the remaining stages of growth and life.9 The rationale for this treatment of the embryos is that they would otherwise be destroyed because they are just the excess product of in-vitro fertilization; without the opportunity for implantation into the endometrium, they wouldn’t be able to develop properly.

But instead, the moral question should not be looking at them as “medical waste”, but should instead value them as the human beings they are, worthy of care; the killing of embryonic children through research on

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their bodies objectifies and dehumanizes them.

Embryonic Stem Cell Research: Medical Violence Violence, as defined earlier in this paper, is “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation.” Violence occurs when these unique human embryos are destroyed after or during research. The derivation of the useable human embryonic stem cells begins with the growth of the human embryo to the blastocyst stage, at which time there is an inner cell mass (ICM) surrounded by an outer layer of cells (trophectoderm).10 The ICM is removed from the embryo to allow for experimentation on the HES cells, thereby killing the embryo.11 Embryology reveals that an embryo is a human being, not just a “clump of cells.” Embryonic stem cell research necessitates the intentional deaths of thousands of tiny, embryonic human beings — it cannot be done without violence.

Medicalization from Above: Force Against the Embryonic Body Though there are plenty of concerns about medicalization from above and coercion upon the parents who “donate” their unwanted children’s living bodies to science, the primary form of medicalization from above that is at play within the completely dehumanizing rhetoric and legal language surrounding ESCR and embryonic humans and their rights. To begin, nearly all legal documents and decisions referring to embryos refer to them as “property”, or “material”, “products” of conception, or “non-persons”: these forms of dehumanization lie at the root of so much violence, and have been used to justify slavery and abuse for generations. Additionally, the term “donate” used in reference to parents discarding their unwanted embryonic children is itself problematic; if we examine our language, we realize that we use the word “donate” to refer to goods or property or services, never do we use “donate” to refer to the transfer of living human beings. Fertility clinic lawsuits have de-

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lineated time and time again that the child’s interests are not even considered in IVF — the only interests weighed are those of the parents.12 Even in the case of “embryo adoption”, the adoption is still treated legally as a transfer of property. The Embryo Adoption Awareness Center outlines this legal dehumanization as follows, Just to be very clear and transparent on all levels, in the U.S. embryo adoption is not considered a legal form of adoption because embryos are considered property, not people. Therefore the process is governed by property contract law, not by adoption law. We are applying the best practices of adoption to the whole process, but adoption law does not apply.13 Ultimately, the non-recognition of the embryonic human as a member of the human family who is deserving of all of the legal rights that are fundamentally human rights results in a very messy and inconsistent system of law that perpetuates violence against the weak for the sake of those larger and more capable.

The use of the ICM (even if they are undifferentiated cells) in ESCR is a violent theft of the body parts of the embryonic human by scientists who seem to be chasing after a mere illusion of success. This force, this killing through the theft of body parts, represents a medicalization from above against those tiny humans who do not ever have the opportunity to voice their lack of consent.

Conclusion Although to some it may seem innocuous, embryonic stem cell research is a form of medicalized violence. The destruction of embryos in the research process is violence against humans with a distinct moral status. Coupled with ineffectiveness of research and the potentially coercive nature of acquisition through IVF, embryonic stem cell research satisfies the criteria laid out for the medicalization of violence. All of this is broadly accepted by wider society because embryonic stem cell research has been touted as the future of medical research. However, this medicalization of violence against human beings, no matter how small or dependent they are, needs to end.

References and Notes | Embryonic Stem Cell Research 1 Stem Cell Basics I. (n.d.). Retrieved from https://stemcells.nih.gov/info/basics/1.htm 2 Stem Cell Basics III. (n.d.). Retrieved from https://stemcells.nih.gov/info/basics/1.htm 3 Stem Cell Basics IV. (n.d.). Retrieved from https://stemcells.nih.gov/info/basics/4.htm 4 Kazutoshi, T., Koji, T., Mari, O., Magumi, N., Tomoto, I., Kiichiro, T., & Shinya, Y. (2007). Induction of Pluripotent Stem Cells from Adult Human Fibroblasts by Defined Factors [Abstract]. Cell,131(5), 861-872. doi: https://doi.org/10.1016/j.cell.2007.11.019 5 Robinton, D. A., & Daley, G. Q. (2012). The promise of induced pluripotent stem cells in research and therapy.

Nature, 481(7381), 295–305. http://doi.org/10.1038/nature10761 6 Wired Staff. (2004, June 11). Alzheimer’s: Beyond Stem Cells. Retrieved from https://www.wired.com/2004/06/ alzheimers-beyond-stem-cells/ 7 Tang, J. (2012). How close is the stem cell cure to the Alzheimer’s disease: Future and beyond? Neural Regeneration Research,7(1), 66-71. doi:10.3969/j.issn.16735374.2012.01.011 8 University of Washington Health Sciences, & UW Medicine. (2018, March 01). Stem-cell study points to new approach to Alzheimer’s disease. Retrieved July 17, 2018, from https://www.sciencedaily.com/releases/2018/03/180301144157.htm 9 What moral status does the human embryo have? (n.d.).

Retrieved July 16, 2018, from https://www.eurostemcell. org/embryonic-stem-cell-research-ethical-dilemma 10 Thomson, James A. “Human Embryonic Stem Cells” in The Human Embryonic Stem Cell Debate, edited by Suzanne Holland, Karen Lebacqz, and Laurie Zoloth, 15-26.

Cambridge, Massachussetts: The MIT Press, 2001.

11 Thomson, J.A., et al. “Embryonic Stem Cell Lines Derived from Human Blastocysts.”

12 Currier, Joe. “Divorced St. Louis County couple’s frozen embryos are property, not humans, appellate court rules.” St. Louis Post-Dispatch, November 16, 2016. Accessed on October 4, 2018. https://www.stltoday.com/ news/local/metro/divorced-st-louis-county-couple-sfrozen-embryos-are-property/article_396ca794-e3d35166-9e29-485feff8e6d4.html?utm_source=dlvr.it&utm_ medium=twitter 13 Embryo Adoption Awareness Center. “The Legal Side of Embryo Adoption.” Accessed on October 4, 2018. https:// www.embryoadoption.org/2014/03/the-legal-side-ofembryo-adoption/

“The concept of abortion as necessary to women’s success and liberation stems from a worldview in which the wombless, cisgender male body is normative.”

Abortion

Exploring the Reality Medically, the term “abortion” carries two distinct meanings. The first, and most common, is: “the termination of a pregnancy after, accompanied by, resulting in, or closely followed by the death of the embryo or fetus.” In layman’s terms, this is known as an elective abortion. The term “abortion”, however, can also refer to the “spontaneous expulsion of a human fetus during the first 12 weeks of gestation.”1 Colloquially, this spontaneous abortion is commonly known as a miscarriage, but that is not what we are referring to within the scope of this paper. 2 In this paper we’ll be exclusively referring to the first definition, since, though the natural deaths of preborn children in miscarriage is tragic, it is categorically distinct from the intentional killing of the embryo or fetus by elective abortion.

The medicalization of abortion (like all of the issues examined in this paper) comes in both thought, word, and deed; it follows then, that an examination of the language used to describe abortion is in order.

If medicalization is the unjust treatment of something as a medical problem, it then follows that the first thing necessary is the creation of a problem for which it can be prescribed treatment. In the case of abortion, this is done through the language and societal paradigms used.

The Construction of Pregnancy as a Disease: Diagnosis Gravida While there are several legitimate medical conditions in which the fetus seemingly acts as a virus, most notably mirror syndrome (a.k.a. Ballantyne syndrome), none of these actually give the fetus the correct identity or function as a hostile pathogen. The concept of abortion as necessary to women’s success and liberation stems from a worldview in which the womb-

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less, cisgender male body is normative. This paradigm presupposes that wombs are aberrant and that pregnancy is an abnormal or diseased state of the body, and that non-pregnant bodies are the standard. In this tacitly pathogenic framing of pregnancy, the preborn child then becomes analogous to a virus to be treated.

Given the reframing of pregnancy as a disease needing treatment, this is reinforced in several ways.

Abortion is discussed and taught as a “treatment option” in medical school curriculums. It is seen as a standard medical procedure and included as part of normal obstetrics/gynecology training.3 Opposition to teaching or learning the procedure is then framed as an illogical restriction on a physicians’ ability to provide the broadest and best “healthcare” possible in treating the created disease of pregnancy.

Furthermore, the language used by physicians and medical personnel can turn pregnancy into a comorbidity. Often, even when abortion restrictions are legislated, exceptions are made for rape and danger to the life of the mother. This language implies, in the case of rape, that the pregnancy becomes a comorbidity for mental health distress.

Additionally, the the idea of abortion being necessary to “save the life of the mother” is frequently used to carve out exceptions in anti-abortion legislation.

This phrase implies that there are certain situations where pregnancy, in and of itself, can be physically dangerous to the life of the mother. However, medically speaking, this exception isn’t usually necessary.

Donald Sloan, a pro-choice obstetrician who performed many abortions himself said this: If a woman with a serious illness — heart disease, say, or diabetes — gets pregnant, the abortion procedure may be as dangerous for her as going through pregnancy… with diseases like lupus, multiple sclerosis, even breast cancer, the chance that pregnancy will make the disease worse is no greater than the chance that the disease will either stay the same or improve. And medical technology has advanced to a point where even women with diabetes and kidney disease can be seen through a pregnancy safely by a doctor who knows what he’s doing. We’ve come a long way since my mother’s time… The

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idea of an abortion to save the mother’s life is something that people cling to because it sounds noble and pure — but medically speaking, it probably doesn’t exist. It’s a real stretch of our thinking. 4 This quote explores the fact that most therapeutic abortions are elective in a certain sense: they target the preborn child for death in a case when there are nonviolent options available to treat an underlying pathology (that may be exacerbated or whose treatment may be more difficult during pregnancy). This action of abortion is distinctly different from other non-violent treatment options that seek to save the mother’s life and/or address the underlying disease; we are not opposed to medications and treatments (e.g. chemotherapy) to treat these diseases, even if they may very likely affect fetal development, and neither are we opposed to early induced labor or caesarean section in emergencies to save the mother’s life, so long as the physicians do what they can to attempt to save the child’s life upon birth. In both of these cases, the harm that is done is not the direct action, but is rather a side effect of the life-saving treatment. Yet, in none of these cases is pregnancy itself the pathology or disease.

What is at Stake: Evaluating Human Prenatal Developmental Milestones According to the Mayo Clinic, at fertilization, the zygote has a genetically unique chromosome profile. By the fourth week after fertilization, the neural tube closes and the heart and other organs are forming. By the end of the first trimester, the baby’s head, arms, and genitalia, and fingernails are almost fully formed, if not completely developed.5 Early in the second trimester, the genital sex of the baby becomes obvious, and halfway through the baby has its’ own circadian rhythm and movement patterns.

In week 23, the fetus’s fingerprints and footprints form. By the end of the second trimester, the lungs are developing surfactant to stop them from collapsing, and the preborn child can respond to the parents’ voice.6 Early in the third trimester, by week 29, the fetus can kick, make grasping movements, and stretch. This is also the trimester when the eyes open

for the first time. Over the following eleven weeks, the baby finishes in utero development, in preparation for delivery.7 Unquestionably, from the moment of fertilization, they are whole, distinct, unique, and alive.

Abortion: Medical Violence In the WHO definition of violence, there’s a requirement of physical force against another “person.” Often times, one of the arguments in favor of abortion rests on the idea that the fetus isn’t actually a person; they’re “just a clump of cells” or they’re a “parasite” or they “aren’t really human, until arbitrary developmental milestones are met.” However, we must consider the history of the social and civil construct of “personhood” that has been used almost exclusively to discriminate against “inconvenient” classes of human beings; from the dehumanization of indigenous peoples and Black people during the colonization and resettlement of the United States to the more recent dehumanization of immigrants, refugees, and preborn humans — our nation has a sordid history of calling human beings “non-persons” or “parasites” or some type of inanimate object in order to perpetuate unjust discrimination, hate, and violence.8 We instead would propose to the WHO an amendment to their definition that replaces “person” with “human being” and rejects the spurious discrimination between humans based on arbitrary factors like age, race, size, innocence, location, ability, etc. This would properly ensure that no human being would ever be excluded from those inherent human rights we all share in as members of the human family.

Abortion is medicalized in the way each method of murder is presented as a treatment option.

However, when abortion is listed as a “medical procedure” with several “treatment options” it belies the violence involved in the child’s death. This is particularly true, when examining how each of the methods of abortion are seen to result in a “high likelihood of injury, death, maldevelopment, psychological harm, or deprivation” of the separate human inside the mother.

When the “abortion pill” is taken (a.k.a. RU-486), it depletes the hormones necessary for the maintenance of the uterine lining or placenta. Effectively, the child is starved to death, having been deprived of the

means of acquiring nutrients necessary to survive.

In vacuum aspiration, the child is sucked out of the womb using a device 27 times more powerful than a household vacuum. A slightly different procedure is used for babies older than 14 weeks. In dilatation and curettage (D&C), the child is suctioned out of the uterus, and a small loop-shaped steel knife (called a curette) is used to cut the placenta & umbilical cord.

The uterus is then suctioned out to ensure that no tiny body parts have been left behind.9 The Dilatation and Evacuation method is commonly used in second trimester children. In Dilatation & Evacuation (D&E), the cervix is dilated substantially. Then, the attending physician uses forceps to twist a limb off. The spine is snapped, and the skull is crushed. Afterwards, the baby is reassembled for the grisly check that no parts of the victim have been left inside the mother.10 Finally, in the induction or prostaglandin method of abortion, digoxin (normally used in the treatment of atrial fibrillation) is administered to cause a heart attack. Labor is then induced to deliver the dead child.

In this treatment, the child is poisoned to death, delivered a lethal injection.11

Medicalization from Above: Perils of Reproductive Coercion and Abortion When examining medicalization, we also seek to examine whether it stems from coercion or choice. In her book The Walls are Talking, Abby Johnson details plenty of cases of implicit coercion of pregnant people. She details sex traffickers bringing in their victims to “treat their recurrent STDs, abort their babies, and send them on their way”12, despite clear evidence of physical abuse or maltreatment. There are documented and verifiable instances of adults sexually abusing and raping children and then bringing them to abortion clinics to cover up their crimes, as is mentioned in the cases of Roe v. Planned Parenthood Southwest Ohio Region, or Fairbanks v. Planned Parenthood, among others.

This coercion isn’t limited to non-medical actors either. In the chapter “Streamlining Murder” in The Walls are Talking, Johnson details the case of a young woman named Jessica who was 28-weeks pregnant.

Initially, Jessica had wanted to come in and have an

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abortion, but decided halfway through the three-day procedure to keep her baby. Rather than encouraging her to parent her child, and despite Jessica’s vocal demands to be taken to an ER, she was instead sedated and physically forced into an abortion by the attending abortionist and his staff. Rather than being anomalous, Johnson writes, “women in crisis who were unfortunate enough to run to us were too often manipulated into executing their babies under the guise of choice and convenience.”13 Later in the book, she notes, “It was not uncommon for parents to trick their daughters in order to get them in the doors and then coerce them to go through with an abortion despite their desire to continue with the pregnancy.”14 All of this is done is with grave and callous disregard of the grave risks to the mother’s health that are present in an abortion.

Anecdotal evidence isn’t the only evidence that coercion exists, however. Studies by both the Guttmacher Institute and the nonprofit Heartbeat International have shown that there is a real and present problem of coercion in the abortion industry. According to a study published in the Medical Science Monitor, up to 64% of women felt pressured or coerced into having an abortion.15 In another study, the number climbs to 83% when the question is whether or not women would have kept their babies to term or not.16 There was also a study conducted by the pro-abortion rights Guttmacher Institute, in which they found that “one-third to one-half” of women in violent relationships, as well as 15% of women in non-violent relationships have experienced “reproductive coercion.” The evidence is clear: most abortions involve some form of medicalization from above by coercion.

Medicalization from Below: Violence Chosen by a Parent Under Duress is Still Violence As mentioned in the introduction to this paper, diseases can be medicalized from below, by choice. Additionally, violence can be also be defined, in part, as the intentional use of force to harm another individual.

When taken together, it is clear that violence chosen by a third party under duress is still violence. Regardless of whether that choice is made by the mother or a third party, the process in question is still medicaliza-

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tion. Conclusively, then, violence visited upon the fetus via elective abortion, is still medicalized violence, regardless of whether is was chosen by the mother or by a parent, spouse, significant other, or another third party.

Conclusion The medicalization of the violence that occurs in abortion begins with the dehumanization of the fetus, despite the fact that science has proven that the zygote, embryo, and fetus that results from human reproduction is indeed a human being. It is then followed by the pathogenic labeling of preborn children and the pathologization of pregnancy. Coupled with the legitimization of abortion as a standard, “safe”, medical treatment, broader society is conditioned to accept it as the cure for unwanted pregnancies, dangerous or otherwise. Finally, women are then coerced, by others inside and outside the medical community to treat their constructed disease (pregnancy) and return to wellness (non-pregnancy). The next major section will review the philosophy and policies to counter this movement of medicalized violence.

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References and Notes | Abortion 1 Abortion [Def. 1]. (n.d.). In Medical Terms and Abbreviations: Merriam-Webster Medical Dictionary. Retrieved from https://www.merriam-webster.com/dictionary/ abortion#medicalDictionary 2 Note: These cases are often brought up when talking about abortion. Normally, advocates for abortion rights suggest that one of the reasons for legal abortion would be to ensure that miscarriages and ectopic pregnancies do not become criminalized. However, the criteria of intentionality resolves both of these manufactured quandaries. Miscarriages are the natural death of preborn children, with no harm intended by any of the parties involved.

Additionally, an ectopic pregnancy can be resolved without violence to the mother or fetus. An ectopic pregnancy is one in which the zygote implants outside of the uterus, normally in one of the fallopian tubes. There are several methods prescribed to treat this condition, including the use of methotrexate, or a salpingostomy. However, both of these methods constitute violence against the fetus, due the intentional use of physical force against the fetus. A non-violent method of resolving an ectopic

pregnancy would instead be a salpingectomy, where the fallopian tube is removed. While this would likely result in the death of the fetus, the intention of the procedure is not the death of the child, but instead the health and wellness of the mother — and the direct action is removing diseased endometrial tissue, not killing the child.

3 White, L. (2017, October 17). UW Medical School Warns Against Bill Limiting Abortion Training. Wisconsin Public Radio. Retrieved July 11, 2018, from https://www.wpr.org/ uw-medical-school-warns-against-bill-limiting-abortion-training-0 4 M.D. Sloan, Donald and Paula Hartz. Choice: A Doctor’s Experience with the Abortion Dilemma. New York: International Publishers. 2002. pps 45-46.

5 https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/prenatal-care/art20045302 6 Fetal development: What happens during the 2nd trimester? (2017, July 08). Retrieved July 9, 2018, from https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/fetal-development/art20046151 7 Fetal development: What happens during the 3rd trimester? (2017, July 06). Retrieved July 9, 2018, from https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/fetal-development/art20045997 8 Rehumanize International. “Bad Words Project: How Our Words Dehumanize”. Accessed September 2, 2018. https://www.rehumanizeintl.org/badwords 9 Levantino, A. (n.d.). Aspiration (Suction) D&C Abortion.

Retrieved July 10, 2018, from https://www.abortionprocedures.com/aspiration/#1466797067815-ef6545f9-db 0b 10 Levantino, A. (n.d.). D & E Abortion Procedure | What You Need To Know. Retrieved July 10, 2018, from https:// w w w. abor tionprocedures .com/#1 466802055946 992e6a14-9b1d 11 Levantino, A. (n.d.). Induction Abortion | What You Need To Know. (n.d.). Retrieved July 10, 2018, from https://www. abortionprocedures.com/induction/ 12 Johnson, A. (2016). A Special Place in Hell. In The Walls Are Talking (p. 51). San Francisco: Ignatius Press.

13 Johnson, A. (2016). Streamlining Murder. (pp. 55-70).

14 Johnson, A. (2016). A Touch of Grey. (96).

15 VM Rue et. al., “Induced abortion and traumatic stress: A preliminary comparison of American and Russian women,” Medical Science Monitor 10(10): SR5-16, 2004.

16 D. Reardon, Aborted Women, Silent No More (Springfield: IL, Acorn Books, 2002)

Forced Sterilization Exploring the Reality

Forced sterilization is the sterilization of someone without their knowledge or informed consent. Historically, various categorizations based on race, ethnicity, health status, or other factors have led to the coerced sterilization of men and women who were incarcerated, physically or mentally disabled, and lower-class.

While recognized internationally as a human rights violation, coerced and forced sterilization still occurs in various parts of the world: Asia, Africa, parts of Central and South America, and even in the United States.1 There are two options for castration: surgical and chemical. Chemical castration is usually accomplished using several compounds. The idea is that hormone therapy will forcibly reverse the biological inclinations they have for sex. The first use of hormonal therapy in the United States was in 1966 when a researcher, John Money became the first person to use medroxyprogesterone acetate (MPA) in the treatment of sex offenders. Although never approved by the FDA for that purpose, it has spread widely to diminish the sexual impulses and fantasies of sex offenders. In recent years, other chemicals have been used for this purpose. 2 Today DepoProvera, officially labeled for birth control use, is commonly used as chemical castration.3

Constructed Condition: “Undesirability” or “Criminality” In particular, the interest of public health is often cited when discussing forced sterilization. As an example, in California from 1909- 1979, approximately 20,000 operations were performed on patients in state institutions without their consent. According to a 1917 amendment of an earlier law that prescribed guidelines for sterilization, a diagnosis of “mental disease which may have been inherited and is likely to be transmitted to descendants” would trigger the sterilization process. 4 The logic was that forced sterilization was a public health good, designed to make sure undesirable traits didn’t get passed down in generations. Under the guise of medical treatment, this form of violence was allowed to continue for most of the 20th century.

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“...forced sterilization occurs in at least 27 countries around the world, usually under the guise of protecting maternal health and stopping the infection of future children.”

Extrinsic criminality has also been seen as a diagnosis worthy of forced sterilization. The most straightforward example is the castration of those who have been convicted of sex crimes. In the interest of “public safety”, sex offenders have often been offered sterilization as a way to reduce sentences. In fact, as of 2003, 17 states still had sterilization statutes that were targeted towards “mental incompetents” or criminals.5

Forced Sterilization: Medical Violence One of the criteria for determining violence is the “use of force” with a “high likelihood of resulting in injury, death, psychological harm, or maldevelopment.”

This is where the violence occurs in forced sterilization. According to one study conducted in South Africa, “sterilisation has devastating impacts on women, affecting them mentally and physically, and impacting on their relationships with their partners, families and the wider community. Many interviewees reported that being sterilised profoundly affected their perceptions of themselves as women. Involuntary sterilisations have grave social and emotional implications for already marginalised HIV-positive women.”6 Depending on the definition used, forced sterilization could even be thought of as a form of medical torture. According to Article 1 of the United Nations Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, torture is any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as… intimidation or coercing him or a third person, or for any reason based on discrimination of any kind, by… a person acting in an official capacity.7

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While perhaps not widely considered as notable as other textbook forms of medical torture, like the Mengele crimes of WWII or the Tuskegee trials, it fits the profile of torture. Forced sterilization is conclusively violent, and shouldn’t be part of any health or legal system.

Medicalization from Above: Perils of Reproductive Coercion and Sterilization According to Tamil and Albert, coerced sterilization “occurs when misinformation, intimidation tactics, financial incentives or access to health services or employment are used to compel individuals to accept the procedure.”8 Nominally, there are several reasons proffered for the necessity of forced sterilization. As previously noted, in earlier decades, the interest of maintaining public health was often cited as a reason for sterilization.

While the justifications for forced sterilization have changed, it still occurs in places around the world.

According to one study in China and Namibia, for example, HIV rates are still used as a justification for the forcible sterilization of women. The reasoning is couched in concern for public health; to stop HIV transmission to the next generation. In fact, forced sterilization occurs in at least 27 countries around the world, usually under the guise of protecting maternal health and stopping the infection of future children.9 As an additional caution against the prevalence of coercion in forced sterilization, a recent study found that voluntary sterilization can often be correlated with intimate partner violence.10 Additionally, this understanding of chemical castration as a treatment for undesirable traits has been imposed in law. Several states currently have laws mandating chemical or surgical castration for repeat offenders. In the state of Texas, offenders can elect to be surgically castrated provided they meet several conditions.11 All of these laws arise from the flawed assumption that the only effective treatment of sexual urges is a medical procedure.

Conclusion Forced sterilization and medical torture are violence.

They’ve been medicalized as legitimate medical pro-

cedures for the removal of undesirable characteristics and the general improvement of the human condition. The legitimacy of these treatments has been so broadly accepted that various institutions have coerced others into the acceptance of this “treatment” for various constructed illnesses. Rather than being based in any legitimate understanding of wellness or treatment, they are instead philosophically underpinned by racism, ableism, and eugenics. These philosophies run contrary to the ideals of human dignity, personalism, and consistent life ethic that should underpin all of medicine. These philosophies will all be explored in the next major section of this white paper. Finally, in the third major section of this paper, various policy initiatives will be explored.

— References and Notes | Forced Sterilization Kendall, Tamil and Claire Albert. “Experiences of Coercion to Sterilize and Forced Sterilization among Women Living with HIV in Latin America.” Journal of the International AIDS Society, vol. 18, no. 1, 24 Mar. 2015, p. 19462., doi:10.7448/ias.18.1.19462.

2 Scott, C. L., & Holmberg, T. (2003). Castration of Sex Offenders: Prisoners’ Rights Versus Public Safety. Journal of the American Academy of Psychiatry and the Law, 31(4), 502-509.

3 “Chemical and Surgical Castration.” Findlaw, criminal. findlaw.com/criminal-charges/chemical-and-surgical-castration.html.

4 Stern, Alexandra Minna. “STERILIZED in the Name of Public Health.” American Journal of Public Health, vol. 95, no. 7, 2005, pp. 1128–1138., doi:10.2105/ajph.2004.041608.

5 Scott and Holmberg, ibid.

6 Essack, Zaynab, and Ann Strode . “‘I Feel like Half a Woman All the Time’: The Impacts of Coerced and Forced Sterilisations on HIV-Positive Women in South Africa.” Agenda, vol. 26, no. 2, 21 Aug. 2012, p. 24., doi:10.108 0/10130950.2012.708583.

7 “OHCHR | Convention against Torture.” OHCHR | Convention on the Rights of the Child, United Nations Human Rights Office of the High Commissioner , www.ohchr.org/ en/professionalinterest/pages/cat.aspx.

8 Kendall and Albert, ibid.

9 Nair , Pooja. “Litigating against the Forced Sterilization of HIV-Positive Women: Recent Developments in Chile and Namibia.” Harvard Human Rights Journal, vol. 23, 4 Oct. 2010, p. 223.

10 Mccloskey, Laura Ann, et al. “Intimate Partner Violence Is Associated with Voluntary Sterilization in Women.”

Journal of Womens Health, vol. 26, no. 1, 2017, pp. 64–70., doi:10.1089/jwh.2015.5595.

11 “Chemical and Surgical Castration.” Findlaw, ibid.

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The Death Penalty Capital punishment, otherwise known as the death penalty, has been a part of the human justice experience since antiquity. It has more specifically been an integral part of the American justice system since the nation’s inception during the colonial era. While the methods have changed, along with levels of support for the punishment, one thing hasn’t: the violence of the death penalty.1

Capital Punishment: Exploring the Reality The death penalty is barbarically violent. However, the barbarity of this violence often isn’t apparent, unless you’ve witnessed an execution firsthand. Sister Helen Prejean, a noted death penalty opponent, has detailed the barbarity in several books including Dead Man Walking, and had this to say about lethal injection in a wide-ranging interview with The Sun: When you’re in the death chamber, you see when they have to jab the needle eighteen times into the arm of the condemned. You hear the stumbling last words of those who are killed: “Mama, I love you,” or “I’m so sorry.” Imagine an ordinary American family having their evening meal, and the news comes on, and the kids ask their parents, “Isn’t this murder too?” and, “Why are they putting antiseptic on his arm if they’re going to kill him?” It would not take long for people to cry out against this, and that’s why it will never be public. You have to keep it from the eyes of the people. 2 She also had this to say on what the horror of the electric chair looks like first hand: Then they put the leather mask over his face, so tight I worry he can’t breathe. How quickly they strap him in the chair and step away. It’s an oak chair. They put a cloth soaked with saline solution on his shaved head and then the metal cap. A thick, curled wire runs from the cap to the generator. And then the straps go across his chest. I didn’t look the first time, because I knew

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with the mask on he couldn’t see me anymore.

With lethal injection he can see me, but not with the electric chair. I closed my eyes and heard the sound of it. This huge, rushing, powerful, grinding sound of the fire being shot through his body.

Three times. They run 1,900 volts, then let the body cool, and then 500 volts, and then 1,900 volts again. What’s terrifying is that they’ve done autopsies of people who have been electrocuted, and the brain is mainly intact.3

factors for consideration was that it be focused on the “worst of the worst”; this implies that violent criminality is a trait that can be found in some criminals but not in others.

In Jurek v. Texas, the court found that there didn’t have to a set of aggravating and mitigating factors.

Instead, one of the elements that could be considered was the “future dangerousness” of an individual, along with whether they had a prior record of capital offenses (121).5

Additionally, the violence becomes immediately apparent when the “procedure” goes wrong. Although lethal injection was devised to be a more humane method of killing the prisoner, when it goes wrong it is torturous. On July 23, 2014, the State of Arizona’s execution of Joseph Wood lasted two hours; he was injected with drugs 15 times in 114 minutes. Furthermore, the AMA notes that if not administered correctly “the sequential use of sodium thiopental for anesthesia, pancuronium bromide for paralysis, and potassium chloride to cause cardiac arrest can go awry at any stage” with the horrifying realization that “a number of prisoners executed in California had not stopped breathing before technicians had given the paralytic agent, raising the possibility that they had experienced suffocation from the paralytic and felt intense pain from the potassium bolus.” There’s nothing humane about that. 4

Execution by Physician: Medical Violence

Constructed Disease: Violent Criminality The assumption made in the administration of the death penalty is that violence can be made humane.

Through the right combination of drugs and force, the taking of a life can be sanitized. Why is this humane killing considered necessary? Because the person in question has violent tendencies that render them existentially dangerous to society, they should be put down.

This distinction about criminality can also be seen in the brief look through legal history. In their book Deadly Justice, Baumgartner et al talk about the history of the death penalty in the American legal code.

They note that in the Gregg decision that reaffirmed the constitutionality of the death penalty, one of the

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The given answer to the constructed disease of the existentially violent criminal is humane execution.

Commonly, a lethal injection is used in most states to end the person’s life. Electrocution is commonly suggested as an alternative when lethal injection is unavailable.6 Even the term used “lethal injection” is a sterilization of violence under the guise of medicine.

One could just as easily say “poison to death.” This method of execution is one that was exclusively constructed by the medical profession.

In 1977, the medical examiner of Oklahoma Dr. Jay Chapman was asked to concoct a lethal cocktail of drugs. His warnings were that if not properly administered, a prisoner might not die. His warnings proved to be prophetic. Yet, this did not stop the medicalization of the procedure.

As Atul Gawande wrote in his article in the New England Journal of Medicine: Lethal injection now appears to be the sole method of execution accepted by courts as humane enough to satisfy Eighth Amendment requirements — largely because it medicalizes the process. The prisoner is laid supine on a hospital gurney. A white bedsheet is drawn to his chest.

An intravenous line flows into his or her arm. Under the protocol devised in 1977 by Dr. Stanley Deutsch, the chairman of anesthesiology at the University of Oklahoma, prisoners are first given 2500 to 5000 mg of sodium thiopental (5 to 10 times the recommended maximum), which can produce death all by itself by causing complete cessation of the brain’s electrical activity fol-

lowed by respiratory arrest and circulatory collapse. Death, however, can take up to 15 minutes or longer with thiopental alone, and the prisoner may appear to gasp, struggle, or convulse. So 60 to 100 mg of the paralytic agent pancuronium (10 times the usual dose) is injected one minute or so after the thiopental. Finally, 120 to 240 meq of potassium is given to produce rapid cardiac arrest.

Officials liked this method. Because it borrowed from established anesthesia techniques, it made execution like familiar medical procedures rather than the grisly, backlash-inducing spectacle it had become. (In Missouri, executions were even moved to a prison-hospital procedure room.) It was less disturbing to witness. The drugs were cheap and routinely available. And officials could turn to doctors and nurses to help with technical difficulties, attest to the painlessness and trustworthiness of the technique, and lend a more professional air to the proceedings.7

Medicalization from Above: Execution as State-Sponsored Coercion and Force Simply put, capital punishment is state-sanctioned and state-sponsored coercion into death. In several states, you even have the “opportunity to choose” your own method of execution.8 Additionally, long before that, in capital cases, juries are systematically rigged to exclude anyone who would be in favor of nullifying the capital sentence. This means that everyone who sits on a jury in these cases is to some degree in favor of the death penalty. Studies have shown that this leads to more capital convictions.9 Clearly, the state goes out of its way to coerce people they feel are incorrigibly violent into the treatment they feel is appropriate and just: execution.

Despite the state using this violent medicalization against prisoners, physicians are very likely to be conscientious objectors to it. A Gallup poll revealed that support for the death penalty is at the lowest point since 1972, with about 55% of Americans approving of the measure in an Oct 2017 poll. Americans also favored the death penalty over life in prison without possibility of parole. When asked about their reasons

for supporting the measure, 35% of supporters saw it as a retributive measure in line with the “eye for an eye philosophy.” 3% believed that it was justified because the person couldn’t be rehabilitated. 65% of people thought lethal injection was the most humane form of execution.10 This is in direct contrast the broad rejection of the death penalty of all major medical associations (of which there are 20). The AMA has articulated a view in opposition to all executions, with its Council on Ethical and Judicial Affairs saying this: “A physician, as a member of a profession dedicated to preserving life when there is hope of doing so, should not be a participant in a legally authorized execution.” They also go on to define participation as selection injection sites; starting intravenous lines as a port for a lethal injection device; prescribing, preparing, administering, or supervising injection drugs or their doses or types; inspecting, testing, or maintaining lethal injection and consulting with or supervising lethal injection personnel.11

Conclusion Despite physicians associations’ unequivocal opposition to the death penalty, states still recruit doctors to participate to increase the “humane” nature of it.

This effort to increase the humaneness of execution was based on a District Court ruling in 2006, where it was ruled that an anesthesiologist had to be present to ensure that the prisoner was unconscious enough to avoid the sequence of events, and successively, to ensure that the death wasn’t tortuous, and thereby would not violate the Eighth Amendment.12 The philosophy behind the death penalty will be explored in a later section of this paper. Finally, policy recommendations will be made to suggest alternatives to this medicalization of violence.

— References and Notes | The Death Penalty “Part I: History of the Death Penalty.” Battle Scars: Military Veterans and the Death Penalty | Death Penalty Information Center, Death Penalty Information Center , deathpenaltyinfo.org/part-i-history-death-penalty.

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Cook, David. “And Justice For All: Sister Helen Prejean On Why The Death Penalty Is Wrong.” The Sun, Aug. 2010, www.thesunmagazine.org/issues/416/and-justice-forall.

3 Cook, ibid.

4 Boehnlein, James K. “Should Physicians Participate in State-Ordered Executions?” AMA Journal of Ethics, Mar. 2013, journalofethics.ama-assn.org/article/should-physicians-participate-state-ordered-executions/2013-03.

5 Bessler, John D. The Death Penalty as Torture: From the Dark Ages to Abolition. Carolina Academic Press, 2017.

6 “Methods of Execution.” Battle Scars: Military Veterans and the Death Penalty | Death Penalty Information Center, deathpenaltyinfo.org/methods-execution?scid=8&did=245.

7 Gawande, Atul. “When Law and Ethics Collide — Why Physicians Participate in Executions.” New England Journal of Medicine, vol. 354, no. 12, 2006, pp. 1221–1229., doi:10.1056/nejmp068042.

8 Methods, ibid.

9 Bessler, ibid.

10 Gallup, Inc. “Death Penalty.” Gallup.com, news.gallup. com/poll/1606/death-penalty.aspx.

11 Bessler, ibid.

12 Gawande, Atul, ibid.

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Euthanasia and Physician-Assisted Suicide

unable to consent.

Assisted suicide can be defined as “intentionally helping a person commit suicide by providing drugs for self-administration, at that person’s voluntary and competent request.”2 While this is relatively similar to voluntary euthanasia, there is a difference. According to The World Federation of Right to Die Societies, the difference lies in the level of physician involvement and behavior. In physician-assisted suicide, or PAS, the physician merely makes the means available for the patient to take their own life. Currently in 2018, in the District of Columbia and six U.S. states: Colorado, Washington, Oregon, Montana, Hawaii, and Vermont, a doctor cannot legally be prosecuted for writing a prescription for a medication with the intent to hasten death. Contrastingly, in voluntary euthanasia, the physician takes a more active role in euthanasia by actively administering the medication, usually through lethal injection.3 This paper will intend to argue that active euthanasia, both voluntary and involuntary, as well as physician-assisted suicide, are forms of medicalized violence and should be opposed.

Exploring the Reality

Constructed Condition: “Needless Suffering”

Euthanasia is defined as “the act or practice of killing or permitting the death of hopelessly sick or injured individuals (such as persons or domestic animals) in a relatively painless way for reasons of mercy.”1 It is important to distinguish between euthanasia and physician-assisted suicide, and to discuss various types of euthanasia. They are both “deliberate actions taken with the intention of ending a life, in order to relieve persistent suffering.” However, the distinction between the two actions is a legal one. In euthanasia, a physician is legally allowed to end a patient’s life using “painless methods.” In physician-assisted suicide, the patient takes their own life, with the help of a physician.

There are also two types of euthanasia: voluntary and involuntary. Voluntary euthanasia is when the patient expresses the desire to die. This option is currently legal in several European countries around the world. Involuntary euthanasia is euthanasia that the patient did not request; the decision is usually made by another person because the patient was deemed

Geoffrey Chaucer once wrote “death is an end to every pain and grief in this world.”4 In both physician-assisted suicide and active euthanasia, the constructed illness is “needless suffering.” In fact, one of the definitional components of euthanasia is mercy, with euthanasia also being referred to as “mercy killing.”

Euthanasia laws generally tend to apply to the terminally ill, at least at first, for this reason. In the cases of both physician-assisted suicide and euthanasia, the implication is that death is preferable to the pain and suffering associated with the actual illness of the patient. Given that the illness is terminal, it is seen as a humane option to spare the patient the needless pain and suffering that comes with death. However, pain and suffering are not always involved in a situation where euthanasia or assisted suicide is sought. Additionally, both procedures seem to target the old. In fact, David Goodall, a proponent for legal aid in dying, stated before his death that euthanasia and assisted suicide should be seen “as an instrument of freeing the elderly.”5

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the idea that some lives are worth more than others. It creates a legal situation in which some (read: physiotypical) patients are given suicide prevention and others (read: disabled persons) are given suicide assistance in the form of a poison pill.

To be clear, opposition to the violence of euthanasia and assisted suicide in no way includes an opposition to palliative care that may be life-limiting. For example, the administration of opiates to ease suffering is acceptable even if that medication is likely to hasten the death of the patient. This is because the intent of the action is to relieve pain, rather than to kill.

“...nearly every major national disability rights group that has taken a position on assisted suicide opposes bills to legalize the practice.”

Euthanasia & Physician-Assisted Suicide: Medical Violence Violence is defined for the purposes of this paper, as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation.” Euthanasia which constitutes the act of intentionally killing someone fits this definition.

Physician-assisted suicide on the other hand, is a bit more nuanced. In this case a doctor will prescribe a lethal dosage that a patient will be expected to administer themself. On the surface this may seem less violent than an act of euthanasia in which the physician actually performs the killing directly, however it is still problematic. This is because of the lethal double-standard assisted suicide legislation creates in medicine.

In none of the states that have acquiesced to the demands of assisted suicide proponents does this so called “right” to die apply to all citizens. Rather, the patient must have some sort of illness or qualifying condition. It is for this reason that nearly every major national disability rights group that has taken a position on assisted suicide opposes bills to legalize the practice.6 They intimately understand that the way assisted suicide legislation has been drafted creates a clear contrast between the rights of the disabled and ill and the rights of the physiotypical. It is even more concerning when examining the mountains of research that establishes that mental health issues including suicidal ideation are frequently comorbid with disabilities, particularly terminal illnesses.7 Assisted suicide, like many acts of discrimination, relies on

Medicalization from Above & Below: Killing as Misplaced Mercy There is an inherent element of coercion in these end of life issues that must be addressed. Involuntary euthanasia, of course, by definition implies coercion and force against the patient being killed. However, in the cases of voluntary euthanasia and PAS, coercion is still a concern. For example external factors, such as financial burden of treatment, may influence whether other people, be them well-intentioned hospital administrators or less well-intentioned relatives, decide to keep someone alive. In the case of physician assisted suicide on the other hand, we are dealing with a population of patients who are experiencing suicidal ideation, typically considered a mental health crisis, and are therefore at a greater risk of coercion.

Looking closely at the specific case of the tragic death of David Goodall, there was a clear pattern of systemic coercion. He was forced out of his university research position, having been deemed too old to make the trek to campus, even though he showed no physical indication of being unable to work, although the decision was later reversed. When pressed about it, he said, “It’s depressed me; it shows the effect of age.

The question would not have arisen if I were not an old man.”8 In April of 2018, a fall left him immobilized for two days, and at the end of the month he announced

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his decision to pursue physician-assisted suicide. He had been implicitly and explicitly told that he was too old to be functional in society, and internalized these messages.

Coercion also can be much more explicit. In Belgium for example, recently three children were euthanized against their will. Belgium is an excellent case study in the harm that results from the societal internalization of these messages. From when the law was passed in 2002, cases of death by euthanasia have risen every single year. In fact from 2016 to 2017, there was a 14% rise in cases.9 Patients who asked for euthanasia because of “polypathologies”, comparatively minor and usually age-related illnesses such as hearing loss and incontinence, also doubled in the last four years from 232 cases to 444 cases.

Belgium, which removed nearly all restrictions on euthanasia in 2014, has euthanized three minors from January 2016-December 2017. In all three cases of involuntary euthanasia, a committee decided the children, aged 7,9, and 11 respectively, were terminal and should “die with dignity.” This coercion isn’t just limited to Belgian society. In the Netherlands, which also allows euthanasia at any age, committee members resigned in protest of the “unchecked killing of dementia patients.” Additionally, Dutch prosecutors are looking into ‘criminal euthanasia’ of elderly women, including one woman who was physically pinned to her bed by her family after she attempted to rip out the tubes administering a lethal cocktail of drugs.10

Broader Societal Acceptance Increasingly, euthanasia and physician-assisted suicide are being broadly accepted by a wide segment of Western society. According to a Gallup poll in May 2016, 69% of Americans believe that physician-assisted suicide should be legal. Yet only half of Americans (53%), think the practice is morally acceptable. In the last 20 or so years, this number has fluctuated between 45% and 56%.11 The broader societal acceptance of euthanasia and physician-assisted suicide stands in direct contrast to its’ lack of popularity among practicing physicians.

The incredibly influential American College of Physicians had this to say about physician-assisted suicide:

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As a proponent of patient-centered care, the American College of Physicians (ACP) is attentive to all voices, including those who speak of the desire to control when and how life will end.

However, the ACP believes that the ethical arguments against legalizing physician-assisted suicide remain the most compelling. On the basis of substantive ethics, clinical practice, policy, and other concerns articulated in this position paper, the ACP does not support legalization of physician-assisted suicide. It is problematic given the nature of the patient–physician relationship, affects trust in the relationship and in the profession, and fundamentally alters the medical profession’s role in society. Furthermore, the principles at stake in this debate also underlie medicine’s responsibilities regarding other issues and the physician’s duties to provide care based on clinical judgment, evidence, and ethics. Society’s focus at the end of life should be on efforts to address suffering and the needs of patients and families, including improving access to effective hospice and palliative care.12

Conclusion Euthanasia and physician-assisted suicide are forms of medicalized violence. They both act and intend to end the life of humans, as a response to a constructed condition like “needless suffering.” They carry philosophically abhorrent underpinnings of ageism and ableism. Coupled with the legitimization of them as medical procedures for the treatment of these diseases, these forms of violence have gained broader societal acceptance. However, as the American College of Physicians noted in their paper, the proper policy prescriptions should be focused on better access to palliative care and compassionate hospice care and will be discussed later in this paper.

References and Notes | Euthanasia and Assisted Suicide Euthanasia. (n.d.). Retrieved July 30, 2018, from https:// www.merriam-webster.com/dictionary/euthanasia 2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4776959/ 3 “What Is the Difference Between Assisted Dying and Euthanasia?” The World Federation of Right to Die Societies, The World Federation of Right to Die Societies, www. worldrtd.net/qanda/what-difference-between-assisted-dying-and-euthanasia 4 Tatlock, John S. P., et al. The Complete Poetical Works of Geoffrey Chaucer: Now First Put into Modern English.

Macmillan, 1936.

5 Bever, Lindsey. “This Australian scientist just turned 104.

Now he’s flying to Switzerland to die.” The Washington Post, 03 May 2018, https://w w w.washingtonpost.com/news/to-yourhealth/wp/2018/04/30/a-scientist-just-turned-104his-birthday-wish-is-to-die/?noredirect=on&utm_term=. ccd56aa8733d 6 Not Dead Yet. “Disability Groups Opposed to Assisted Suicide Laws.” Accessed on October 1, 2018: http:// notdeadyet.org/disability-groups-opposed-to-assisted-suicide-laws 7 Hee-Ju Kang, et al. “Comorbidity of Depression with Physical Disorders: Research and Clinical Implications.”

Chonnam Medical Journal. Published online April 14, 2015. Accessed at https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC4406996/#__ffn_sectitle 8 Joseph, Yonette, and Iliana Magra. “David Goodall, 104, Scientist Who Fought to Die on His Terms, Ends His Life.” The New York Times, 10 May 2018, www.nytimes. com/2018/05/10/world/europe/david-goodall-australia-scientist-dead.html.

9 Hodjat , Arya. “Belgium Approved Euthanasia of 3 Minors, Report Finds.” Voice of America, 25 July 2018, www.voanews.com/a/belgium-approved-euthanasia-three-minors-report-finds/4499976.html.

10 Caldwell, Simon. “Three Children Killed under Belgium’s Euthanasia Law.” Catholic Herald, 25 July 2018, www. catholicherald.co.uk/news/2018/07/25/three-children-killed-under-belgiums-euthanasia-law/.

11 Swift, Art. “Euthanasia Still Acceptable to Solid Majority in U.S.” Gallup.com, 24 June 2016, news.gallup.com/ poll/193082/euthanasia-acceptable-solid-majority. aspx. Polling data about euthanasia in America 12 Sulmasy, Lois Snyder, and Paul S. Mueller. “Ethics and the Legalization of Physician-Assisted Suicide: An American College of Physicians Position Paper.” Annals of Internal Medicine, vol. 167, no. 8, 2017, p. 576., doi:10.7326/ m17-0938.

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“The Consistent Life Ethic (CLE), is the philosophical answer to problem of dehumanization in healthcare.

It is a philosophy based on the inherent dignity and worth of every single human being.”

Part 2: The Consistent Life Ethic A Solid Foundation for Human-Centered Medicine

Introduction Having shown that various forms of violence have been medicalized, the next course of action before proposing specific policy initiatives is to review the philosophies that led to these current practices in medicine. Namely, racism, ableism, and eugenics all contributed to an ideology of dehumanization. Finally, We will explore the concepts of human dignity and a human-centered personalist philosophy that lead to a Consistent Life Ethic.

An Unholy Trinity: Ableism, Eugenics, and Racism At the heart of all of the violent procedures explored in the previous section of this paper are three dehumanizing philosophies: racism, ableism, and eugenics. This paper will briefly explore the historical origins of these philosophies and where they appear in medicine.

Ableism Ableism appears most evidently in examining issues of end of life care and abortion. More specifically, the arguments defending euthanasia, physician assisted suicide, and abortions for fetal abnormalities. Ableism could be defined as “discrimination or prejudice against individuals with disabilities.” Dr. George Wolbring, an abilities studies scholar at the University of Calgary argues that it’s a much broader idea than that.

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He argues that “Every ism has two components.

Something we value and something we do not. The subject of the isms can be negative or positive. For example, ageism reflects the negative labelling and treatment of the elderly. We could equally call ageism youthism, which values the abilities of youth. Racism carries a double meaning: a value of one race over another and the discrimination against another race.

Sexism describes (usually) the valuing of the male sex and the discrimination (usually) against the female sex. Ableism values certain abilities, which leads to disableism the discrimination against the ‘less able’.”1 When viewed with this broader lens, the ableist philosophy in arguments for these procedures becomes clear. Abortion, particularly of those children with disabilities, is rampant. The termination rate in Iceland for children with Down syndrome diagnosed in utero is virtually 100%. In Denmark, it’s a staggering 98%.

France aborts these children at a rate of 74%. Here in the United States, the rate is close to 67%. 2 The argument for those abortions is the same one used for euthanasia, and physician assisted suicide: that abilities are valued over life. While couched in the rhetoric of mercy and compassion, there is a chillingly ableist logic behind this view. If one is less “able” in terms of cognitive or physical ability than others, that makes them less desirable; so undesirable in fact, that death is preferable to a life in their devalued physical condition. Euthanasia and physician assisted suicide proponents advance the same argument; the underlying assumption is that a sick person’s life holds no value, and death is preferable. This is unacceptable for a profession that holds that members should “not treat a fever chart, a cancerous growth, but a sick human being”3 and is incredibly dehumanizing, as it re-

duces a person to their abilities or their diagnosis.

Eugenics As evidenced in the previous section, the natural extension of ableist philosophy is eugenics. It is a short philosophical step from deciding that people are too sick to be valuable to differentiating for other traits.

Historically, there have been several moments where the medical profession embraced eugenics, and several strands of that philosophy still linger today.

“Eugenics” was first coined in 1838 by a British biologist named Francis Galton. It refers to the now discredited science of selectively breeding for desired genetic traits. There were positive and negative eugenicists. Positive eugenicists wanted to encourage childbirth by those populations they thought were “fit” breeders. Negative eugenicists, in turn, wanted to discourage breeding by those they thought were “unfit.” While anachronistically abhorrent today, this philosophy was actually widely adopted in the 1920’s and 30’s by mainstream medical professionals. It was so popular, in fact that it provided the philosophical basis for Margaret Sanger’s work, who would later found Planned Parenthood, America’s largest abortion provider. 4 Recent hagiography of Margaret Sanger’s philosophy and ideology has sought to absolve her of the sin of racism, while conveniently explaining away the eugenicist nature of her ideology.5 Revisionists point out that her efforts targeting minority communities were not rooted in racism. Time Magazine had this to say in a piece on Margaret Sanger’s “complicated legacy”: Sanger’s stated mission was to empower women to make their own reproductive choices. She did focus her efforts on minority communities, because that was where, due to poverty and limited access to health care, women were especially vulnerable to the effects of unplanned pregnancy. As she framed it, birth control was the fundamental women’s rights issue. “Enforced motherhood,” she wrote in 1914,“is the most complete denial of a woman’s right to life and liberty.”

That’s not to say that Sanger didn’t also make some deeply disturbing statements in support of eugenics, the now-discredited movement to

improve the overall health and fitness of humankind through selective breeding. She did, and very publicly. In a 1921 article, she wrote that, “the most urgent problem today is how to limit and discourage the over-fertility of the mentally and physically defective.6 Margaret Sanger likely saw herself as a strong proponent of women’s and minorities’ rights; however, it is undeniable that at the heart of her work to promote birth control was a solid foundation of racism and eugenics.

Even feminists like Gloria Steinem acknowledge that this view of the world is the philosophical basis for forced sterilization movements. In her 1998 essay for time, she wrote that Sanger’s work “probably helped justify sterilization abuse.”7 It is also not that far of a stretch, if one at all, to see how if you trade in the concept of ability or race with criminality you could also justify forced sterilization of prisoners, or even their executions. Modern medicine perpetuates in this eugenicist legacy by advancing the idea of abortions, forced sterilizations, and executions as legitimate procedures, rather than violence against so-called “undesirable” individuals.

Racism It is impossible to ignore the thread of racism that runs through the procedures discussed in the first section. While Margaret Sanger’s work did not focus on abortion (in fact she, at least initially, opposed the practice), there’s no doubting the impact of her brainchild, Planned Parenthood, on communities of color.

According to a 2017 study by the pro-abortion Guttmacher Institute, black children are aborted at a rate of 27.1 per 1000, a rate that’s twice as high as those children of white women. Hispanics, and other minorities also abort at a higher rate than white women, at 18.1 and 16.3 per 1000.8 The death penalty’s application is inherently tinged with racial bias. The national death row population is 42% percent black, more than three times the proportion in the general population.9 In fact, one study noted that just the presence of a black judge can increase the probability that a defendant is not sentenced to death by 25 percent.10 No matter how you look at it,

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the death penalty disproportionately impacts minorities, particularly African Americans, who are convicted by a system demonstrably biased against them.

A closer examination of each of the issues in the first part of this report could show racism as an issue. In addition to ableism and eugenics, these three philosophies underpin the dehumanizing, violent procedures overviewed in the first part of this report. Having examined the problematic procedures in the first part of this paper, and explored the dehumanizing philosophies behind them, We will propose the alternative philosophies below and then in the third part of this white paper, suggest policy initiatives in with this philosophy.

would be professional success. That end, of success, dictates which actions we do and don’t take. Likewise, an example of a negative end could be self-preservation. We don’t produce self-preservation; we just take actions that conform to that end. Kant viewed humanity as a positive end, not in the sense that we produce humanity, but that it was something to be fostered and cultivated by our actions. Because it is also a positive end in others, we must do our best to further the humanity of others. According to Kant, nothing, not even the most heinous of misdeeds, could strip anyone of their humanity, and by extension, their dignity.11

What is the Consistent Life Ethic?

According to the Consistent Life Network,

Consistent Life Ethic and Human Dignity The Consistent Life Ethic (CLE), is the philosophical answer to problem of dehumanization in health care.

It is a philosophy based on the inherent dignity and worth of every single human being. First though, it’s important to take a brief look at the Kantian dignity ethic that provides the foundation for the Consistent Life Ethic.

A Dignity Ethic Immanuel Kant was a German philosopher who is widely considered to be the father of the modern dignity ethic and personalism. He contended that every person had a self-governing reason that then imbued them with intrinsic dignity. Additionally, Kant also proposes the idea that humans cannot be used as merely means to an end, in one of the earlier forms of the philosophical idea of personalism. Obviously, people can be used as means to an end; for example, a pilot’s skill can be used as a means to get from one place to the other as a form of transport. However, the pilot’s dignity and humanity must also be respected at the same time.

One further point to note about ends is that the term can be used positively and negatively. It can be used positively, meaning that the end in question is something that we actively try to cultivate or produce. Negatively, an end is something that impedes us from doing other things. For example, a perceived positive end

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The Consistent Life Ethic is the premise or theory that all human life is inherently valuable, and therefore, that all humans deserve to live without violence. Individuals representing all religious and non-religious backgrounds support and identify with the Consistent Life Ethic.12 When applied to policy issues, the ethic contends that there are a number of linked issues that threaten human life and dignity, including abortion, war, torture, euthanasia, physician assisted suicide, embryonic stem cell research, capital punishment, and others.

Conclusion While not all issues mentioned are equally weighted in urgency or gravity, they all matter because they are forms of violence against human beings. This violence is an affront to the inalienable dignity we all possess as part of our humanity. To this end, both personalism and a Consistent Life Ethic are the driving philosophies behind the third part of this paper where we make recommendations on various policies that policymakers, health care professionals, patients and their families, and others can implement to help create a nonviolent healthcare system that respects the dignity of all people.

“...violence is an affront to the inalienable dignity we all possess as part of our humanity.”

References and Notes | The Consistent Life Ethic 1 Wolbring, Gregor. “The Politics of Ableism.” Development, vol. 51, no. 2, 2008, pp. 252–258., doi:10.1057/dev.2008.17.

2 Quiñones, Julian, and Arijeta Lajka. “‘What Kind of Society Do You Want to Live in?”: Inside the Country Where Down Syndrome Is Disappearing.” CBS News, CBS Interactive, 14 Aug. 2017, 4:00 PM , www.cbsnews.com/news/ down-syndrome-iceland/.

3 Tyson, Peter. “The Hippocratic Oath Today.” PBS, Public Broadcasting Service, 27 Mar. 2001, www.pbs.org/wgbh/ nova/body/hippocratic-oath-today.html.

4 “Eugenics and Birth Control.” PBS, Public Broadcasting Service, www.pbs.org/wgbh/americanexperience/features/pill-eugenics-and-birth-control/.

5 Valenza, Charles. “Was Margaret Sanger a Racist?”

Family Planning Perspectives, vol. 17, no. 1, 1985, p. 44., doi:10.2307/2135230.

6 Latson , Jennifer. “What Margaret Sanger Really Said About Eugenics and Race.” Time Magazine, 14 Oct. 2016, time.com/4081760/margaret-sanger-history-eugenics/.

7 Steinem , Gloria. “Margaret Sanger .” Time Magazine, 13 Apr. 1998, content.time.com/time/subscriber/article/0,33009,988152-2,00.html.

8 Jones, Rachel K., and Jenna Jerman. “Population Group Abortion Rates and Lifetime Incidence of Abortion: United States, 2008–2014.” American Journal of Public Health, vol. 107, no. 12, 2017, pp. 1904–1909., doi:10.2105/ ajph.2017.304042.

9 Ford , Matt. “Racism and the Execution Chamber.” The Atlantic, 23 June 2014, www.theatlantic.com/politics/archive/2014/06/race-and-the-death-penalty/373081/.

10 Kastellec, Jonathan P. “Race, Context and Judging on the Courts of Appeals: Race-Based Panel Effects in Death Penalty Cases.” SSRN Electronic Journal, 2015, doi:10.2139/ssrn.2594946.

11 Johnson, Robert, and Adam Cureton. “Kant’s Moral Philosophy.” Stanford Encyclopedia of Philosophy, Stanford University, 7 July 2016, plato.stanford.edu/entries/ kant-moral/.

12 “Consistent Life Ethic.” Consistent Life Network, www. consistentlifenetwork.org/consistent-life-ethic.

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Part 3: Human-Centered Medicine Building a Culture of Non-Violent Healthcare

Introduction and Principles So far the previous parts of this paper have included detailed explorations of the problem of violence masquerading as legitimate medical procedures. While there hasn’t been an explicitly political definition of the problem at hand, that isn’t true when issues are looked at individually. From abortion, to the death penalty, to euthanasia, each issue and the way it’s framed has political consequences. In this final section of the paper, We will make recommendations for a variety of actors in the public, private, and nonprofit sectors. This list of recommendations are based philosophically on the personalist ethic and human dignity framework discussed in the prior section of this paper.

There’s a quote by Rachel McNair at Consistent Life Network that says “Build up the nonviolent institutions, so the violent ones wither.”1 By promoting nonviolent healthcare, we may hope to see nonviolence become the paradigm generally, and violence become stigmatized especially within the field of medicine. In reimagining healthcare as exclusively nonviolent, we are allowed the freedom and flexibility to act in a manner consistent with both individual dignity and subsidiarity, and the common good and solidarity.

Solutions may vary based on locale and resources at one’s disposal, but with inherent human dignity at the center of healthcare ethics as outlined in the Consistent Life Ethic, physicians will no longer be taking part in violence and will instead work towards authentic care of the whole human being. Of course, all recommendations are based on the current healthcare system where our organization resides (in the United States), but could be adapted fairly easily to non-US countries.

End Embryonic Stem Cell Research The violence in healthcare actually begins long before the child is born in the act of embryonic stem cell research. This form of violence goes relatively

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unnoticed in the name of scientific progress;however, it must be eliminated. Additionally, there are several ways to increase the respect for human dignity in conducting research. Here are a few proposals: •

•

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Stop federal and state funding of embryonic stem cell research. Instead, divert those funds towards much more promising pluripotent stem cell research.

Support enforcement of clinical trial registration.

FDAAA 2007 is a law that requires certain clinical trials to report results. Currently, though, less than 60% of all clinical trials results are reported. 2 When they are not, it is an affront to the dignity of the participants in that trial. In many cases, treatment options are irreproducible and ultimately worthless and incredibly risky. Putting people through worthless trials with ineffective cures creates a false sense of hope for dying patients and refusing to publish those results is an affront to the dignity of patients, who in many cases used their final weeks and months to try and advance an understanding of their disease or illness. That understanding isn’t possible if clinical trials are registered and results aren’t reported.

Eradicate embryonic stem cell research. Embryonic stem cell research isn’t illegal in the United States, as preborn humans are not protected as human beings by law. Laws should be enacted that recognize the selfhood of all human beings from the moment of sperm-egg fusion, which would precipitate the legal ramifications of disallowing any action that would kill or treat an embryonic human as property, and more human-centered and nonviolent medicine should be implemented.

Abolish Abortion Imagining a world in which abortion is not part of “healthcare” isn’t particularly difficult. As mentioned earlier in this paper, there are no medical reasons for an elective abortion. What then, remains is to wither away at the supporting structures that allow for abortion on demand. This involves weakening the social, political, and legal mechanisms that create the crisis atmosphere surrounding unintended pregnancies, and strengthening those mechanisms that allow for

actual, nonviolent health care during pregnancy.

•

•

•

Doctors should choose surgery in cases of ectopic pregnancy. While single-dose methotrexate administration is the common treatment course for ectopic pregnancies, there are several surgical alternatives. These include a salpingectomy, salpingotomy, and salpingostomy. In a salpingectomy, the entire diseased fallopian tube is removed, including the embryonic child. In a salpingostomy, the diseased tissue in the fallopian tube which allowed for the embryo to implant outside the uterus is removed, including the embryonic child.

These actions are not direct attacks on the preborn child, and feasibly could be used in junction with an attempt at surgical re-implantation into the healthy uterine lining.

Defund Planned Parenthood. Planned Parenthood is the nation’s largest abortion provider. From 2013 to 2015, they received over $1.5 billion in taxpayer funds. This is in spite of the fact that the scope and services they provide have declined over that period.3 Instead, direct that money towards Federally Qualified Health Care Centers (FQHCs). FQHCs are community based programs are community-based health care providers that receive funds from the HRSA Health Center Program to provide services in underserved areas. They must meet a stringent set of requirements, including providing care on a sliding fee scale based on ability to pay, and operating under a governing board that includes patients. 4 Primary care FQHCs provide comprehensive primary health care, including all of the health services that Planned Parenthood does, without performing the violence of abortion. Advocacy to defund Planned Parenthood can happen at the state and federal levels.

Rethinking crisis pregnancy centers. Crisis pregnancy centers serve a role as nonprofits that help provide women with pregnancy resources. However, if made part of a broader network of care, in conjunction with free clinics and other sliding scale medical services, they could provide a powerful alternative to abortion clinics like Planned Parenthood without inflicting violence upon their patients. Additionally, they would be an incredible

•

•

help to families.

Attack Planned Parenthood v. Casey. As pointed out by several legal scholars, Roe v. Wade has been dead for decades. Although often used as the rallying cry for anti-abortion advocates, Roe was actually shockingly weak as a ruling. Thus, in 1992, the Court essentially replaced Roe v. Wade with Planned Parenthood v. Casey. As one commentator put it, “Casey dug a second trench around the conditional right to abortion.” Going through that second trench is essential in overturning the right to an abortion.5 Abolish abortion. Every state in the U.S. has legal abortion under the Roe and Casey rulings. Laws upholding the inherent dignity of every human being from the moment of sperm-egg fusion should be enacted, laws prohibiting abortion should be passed, and more human-centered and nonviolent medicine should be implemented to aid those facing unplanned or difficult pregnancy situations.

Discontinue the Death Penalty and Fight Forced Sterilization The death penalty is not explicitly part of the healthcare delivery system. However, it is a form of state sanctioned medicalized violence and should be ended as soon as possible.

•

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Physicians should stop participating in state executions. The official code of medical ethics promulgated by the American Medical Association explicitly states that “as a member of a profession dedicated to preserving life when there is hope of doing so, a physician must not participate in a legally authorized execution.”6 Physicians should follow the directive as guidance for what actions qualify as participation and non-participation .

Pharmaceutical companies should stop providing drugs for executions. Many big pharmaceutical companies are already squeamish about providing drugs for executions. Several drug companies have already taken steps to keep their products out of the process of capital punishment, with one company already going as far as to stop making a product altogether to ensure it doesn’t get used to kill prisoners.7 These efforts should continue, as

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•

•

they force states to delay or stay their executions and limits the methods they choose.

Abolish the death penalty. Currently eighteen states and the District of Columbia have abolished the death penalty.8 In an additional 17 states, there are executions on hold or an execution has not been carried out in over 5 years as of the writing of this paper. The opportunity for state level advocacy and coalition-building is broad here as both conservatives and liberals are increasingly opposed to the death penalty.

Repeal forced sterilization laws. Several states have laws that encourage the forced sterilization of sex offenders. These laws should be repealed, forced and coerced sterilization should be prohibited by law, and more effective and human-centered rehabilitative measures should be implemented.

Eradicate Euthanasia •

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Refuse to participate in euthanasia. The AMA’s statement against euthanasia is clear. “Euthanasia is fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks. Euthanasia could readily be extended to incompetent patients and other vulnerable populations.”9 Therefore, physicians should oppose all euthanasia laws and refuse to participate in euthanizing patients or participating in suicide.

Ban euthanasia and assisted suicide. As we have reviewed in this paper, several states have laws that permit assisted suicide. These laws should be repealed, laws prohibiting euthanasia should be enacted, and more human-centered and nonviolent medicine should be implemented.

•

Conclusion These are just a few suggestions on how a healthcare system could be reconstructed that promotes the dignity of all human beings and the central principle of nonviolence; there are plenty of avenues beyond these suggestions to promote the rehumanizing of healthcare. At the heart of this work will be a paradigm shift: rather than broken body parts or specific illnesses and conditions, each human being will have

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to be viewed holistically and their healthcare will, consequently, have to become holistic and integrated in nature.

After all, there is more to recognizing the dignity of the elderly than simply not euthanizing them. Hospital care, hospice, and palliative care should be part of a system that appreciates the elderly and recognizes their inherent dignity, no matter how useful. Likewise, the same goes for children, the preborn, the disabled, and the poor. Despite the difficulty of shifting entire paradigms, it is entirely possible to have a healthcare system that serves all of humanity in a non-violent way. Creating a non-violent system of healthcare will be the work of all in the private, public, and nonprofit sectors, and we invite you to be a part of this solution.

— References and Notes | Human-Centered Healthcare 1 Secular Pro Life (@secularprolife). “Build up the nonviolent institutions, so the violent ones wither.” 23 June 2018, 1:19 P.M. Tweet.

2 FDAAA TrialsTracker. EBM DataLab. 2018. Available from: https://fdaaa.trialstracker.net 3 Burke, Monica. New Report Shows Planned Parenthood Raked in $1.5 Billion in Taxpayer Funds Over 3 Years. The Heritage Foundation, 12 Mar. 2018, www.heritage.org/ marriage-and-family/commentary/new-report-showsplanned-parenthood-raked-15-billion-taxpayer-funds.

4 “Federally Qualified Health Centers.” Health Resources & Services Administration, 1 May 2018, www.hrsa.gov/ opa/eligibility-and-registration/health-centers/fqhc/ index.html.

5 Von Drehle, David. “Attacking Roe v. Wade Means Going through Planned Parenthood v. Casey, Too.” Chicago Tribune, 4 July 2018.

6 “Capital Punishment.” HIPAA Compliance | American Medical Association, www.ama-assn.org/delivering-care/capital-punishment.

7 Berman , Mark. “Drug Companies Don’t Want to Be Involved in Executions, so They’re Suing to Keep Their Drugs Out.” Washington Post, 13 Aug. 2018, www.washingtonpost.com/news/post-nation/wp/2018/08/13/ drug-companies-dont-want-to-be-involved-in-executions-so-theyre-suing-to-keep-their-drugs-out/?utm_ term=.5aa90ea35caf.

8 “States With and Without the Death Penalty.” Millions Misspent: What Politicians Don’t Say About the High Costs of the Death Penalty | Death Penalty Information Center, deathpenaltyinfo.org/states-and-without-deathpenalty.

9 “Euthanasia.” AMA Code of Medical Ethics, AMA, www. ama-assn.org/delivering-care/euthanasia.

Š 2018, Rehumanize International.