Dialoguing with Chick and Tim
In my last article, “Ethics in the Mainstream,” I mentioned the book, Let’s Talk, An Honest Conversation on Critical Issues: Abortion, Aids, Euthanasia, and Health Care, by Doctors C. Everett Koop and G. Timothy Johnson. The book, an exchange of letters between “Chick” and Tim, is structured in a format that makes for easy and engrossing reading of some weighty bioethical issues. Published in 1992 by Zondervans, a division of Harper Collins, it sells for $8.99 in paperback.
Both authors are well-known. Koop picked up the nickname “Chick” at Dartmouth College from his buddies who decided that an unusual surname required a first name to match. He is known mainly from his eight years as the high-profile Surgeon General in the Reagan Administration. Tim, a distinguished and respected Covenanter, is the medical editor for ABC News on Channel 7. Koop, born in 1916, is 20 years older than Johnson. They share some common spiritual perspectives — both represent conservative positions within the Christian Church. Nonetheless, they defend quite different ethical perspectives on these vital issues.
Interviewed by Charlie Gibson on “Good Morning America” just before Christmas, Koop remarked that he and Johnson had originally entitled their book, One Heart, Two Minds. That title, rejected by marketing people, does capture the thesis of the book.
We have in this small volume a fine example of two mature thinkers, with sound medical backgrounds, of equally high intelligence, integrity, and spiritual commitments, who come out on very different sides of the same medical issues. These open and honest conversations will probably not be appreciated by those who think bioethical issues are easily resolved in a black-and-white fashion, through technology, prayer, or a Holy Book. However, for those who understand the inward agony that often attends physicians, patients, and loved ones when making tough life-and-death decisions, the book is a treasure.
Chick and Tim are not defensive; they do not quarrel or squabble or bicker. No placards or street demonstrations are suggested. Scripture is used as edification, rather than to prove something. They simply talk and listen, engage one another, and share alternative viewpoints and arguments. Whether or not they reach agreement, they do manage to open up all sides of the issues through their good-natured and cordial conversation. Reading their mail will lure the reader into reflection and personal involvement.
Of the four issues they address, I will summarize just one: Euthanasia. It will, I hope, provide both an illustration of how they proceed and a timely exchange, given the recent news of Dr. Kervorkian’s “medicide” assists and the recent changes in Dutch law. Their give and take on this issue is interesting, too, in that “Chick,” of Dutch extraction, has serious problems with his nationality’s solution, while Johnson is impressed with it.
The authors use Ecclesiastes 3:1, 2 — “There is a time for everything . . . . a time to be born and a time to die . . . .” to set the stage for their dialogue in Chapter Two. Tim kicks off the issue in his letter to Chick, saying:
I personally believe that helping someone die in peace and without pain, even if that might hasten the biological timetable of death by a few hours or even days, is not only acceptable but is mandatory for modern medical care. (39)
Physician-assisted suicide should be considered, he thinks, in situations when the illness is clearly terminal, in cases where there is no hope of ultimate recovery. It is unethical, however, to assist death when the patient is conscious and free of pain. He argues that physicians should be allowed, informally and responsibly, as in Holland, to give patients release in hopeless cases, without fear of prosecution. However, he is against giving such acts legal status.
Chick writes back:
I believe that the Hippocratic Oath has kept physicians on the right course for two thousand years and that we should not abandon the Hippocratic teaching affirming that physicians will never be involved in killing their patients: “others who call themselves physicians may suggest and do these things, but as for us, we are above such things and can be trusted to do no harm.” (45)
He recalls his pride in his Dutch ancestry when he heard that doctors chose death rather than taking part in Nazi euthanasia experiments. But he writes, “I am amazed and ashamed that today a growing number of patients in Dutch hospitals die by a lethal injection given by their physicians” (45).
Chick argues that to start killing people mercifully, sends one down a slippery slope to the Holocaust. In Germany in the 1930s, before Hitler came to power, the German euthanasia movement started with killing defective babies, moved on to the insane, then to those with senile dementia, to people with advanced TB, to amputees considered unproductive by the Third Reich, and to Gypsies, Poles, and Jews. Toleration led to sanctioning, legalization, and the “final solution,” the outrageous disregard for human life known as the Holocaust.
He asks, what does it mean to help someone die “without pain?” It could mean killing them, assisting suicide, or “standing back at an appropriate time and letting nature take its course while making the comfort of the patient of highest priority” (47). Only the last option, he contends, is feasible.
Chick is unwilling to withdraw food and fluids, which some class as “treatment” so they can be withdrawn under the guise of stopping “futile” treatment. “I think that amounts to death by starvation and dehydration, and it should be condemned.” (50).
In the next letter, Tim responds, telling Koop that he is far too hard on the Dutch. He says,
. . . I applaud the Royal Dutch Society for the Promotion of Medicine for attempting to develop careful guidelines regarding when it might be appropriate for physicians to aid in the suicide of their patients. By using the word “might” I mean to indicate that like the Dutch, I strongly believe we should never make physicians-assisted suicide a “duty” of physicians or a “right” to be expected by patients. But I do believe we should “allow” individual physicians and patients to come to mutual understanding on this matter without fear of inappropriate legal harassment. (p. 51)
He notes, too, that the practice has not led to abuse in Holland, where only about 3% of deaths occur as such. In other words, he finds Koop’s slippery slope argument unsound.
Having made the point that the practice, once accepted, will not lead to serious cultural abuses, he adds that he still promotes Hospice comfort care as a better way. He believes that much more needs to be done in providing such facilities. Most terminal patients considering suicide would opt for this. In fact, he claims, if we did an adequate job in providing hospice care, the issue of physician-assisted suicide would largely disappear.
Tim makes an important distinction between “life support” and “death support” —
I am not opposed to such withdrawal (of food and water) in certain circumstances, in which, they, too, along with breathing support, have become an artificial means of prolonging death rather than life. (53)
He concludes: “I would not personally be able to provide assistance (for someone’s death), but I want others to be able to do so without legal harassment” (57).
On the issue of abortion, Chick, as it is well-known, argues for a pro-life position. Johnson argues for what he calls an anti-abortion, pro-choice position. On AIDS and Health Care, the two have some differences but are not far apart. Space does not permit a discussion of these chapters here.
One point that becomes clear throughout the book is that the physician’s character, mission, and motivation are at the center of every medical issue. In Chapter Four on Health Care, Chick concludes with comments on the kind of doctor that is needed today and tomorrow:
The twentieth century doctor has served the twentieth century well, baut I think we need a new doctor for the twenty-first century.
I’d like doctors to be able to practice the art of medicine as well as the science of medicine.
We need to get medical students out into the community so that they can see firsthand the connection between illness and socio-economic conditions. We need to bring together pre-med students, med students, interns, and the residents on a regular basis so that they can discuss and experience together not only the problems of medicine but also that euphoria and enthusiasm that medicine brings at its best. And we need to train a generation of physicians to practice prevention in their own lives and to teach prevention to their patients. My doctor of the future will reflect humanitarian values rather than greed. She or he will be inclined more toward low-tech medicine than high-tech. My doctor of the future will seek to know what works in medicine and will strive to understand what patients want. (92-94)
I highly recommend the book, Let’s Talk. Two respected physicians share their disagreements and agreements, and Zondervan Publishing House, to its credit, put their gentle discourse into print. In Larry King’s words (from a blurb on the back cover), “This could well be the most important book published this year.”