11/3/99
7:16 PM BST

Ann Bradley

Live and let die

Dr Nigel Cox has been convicted by Winchester crown court of attempting to murder his patient, Mrs Lillian Boyes. Rheumatoid arthritis had reduced her to a physical wreck. Her bones were deformed, her tendons destroyed and the steroid used to treat her had reduced her skin to such a fineness that any touch was unbearable. By the end, she suffered from blood poisoning and massive internal bleeding. Even massive doses of heroin brought her no respite from the pain. Unable to quiet her agony in any other way, Dr Cox injected his patient with potassium chloride, with the full knowledge that it would cause her death in a matter of minutes.

From a legal point of view the court verdict was inevitable. Dr Cox deliberately hastened his patient's death. But the cut-and-dried legal case did not make it any less controversial. In the week of the trial every single quality daily paper ran leaders examining the case for and against euthanasia. The terms of the debate have been astonishingly naive.

The Independent summed it up like this:

'High technology now enables hospitals "to strive officiously to keep alive" an increasing number of patients in agony or in limbo. The law should offer complete protection to doctors who - at the request of their patients - decline to give such treatment.'

However, the paper conceded, 'the relationship between a gravely ill patient - frightened, perhaps disorientated by heavy medication, often in severe pain - and his consultant is an unequal one. A request to put an end to suffering could easily be induced or assumed. Dr Cox merits sympathetic treatment, but the case against euthanasia remains powerful.'

Wise words - who could disagree? But while the moral and ethical niceties of euthanasia are being debated, one basic, undeniable medical fact is forgotten. Doctors already make daily decisions about who will live and who will die.

Dr Cox has good reason to be bitter about being branded a criminal. His decision to kill a patient was based on compassion; yet every day doctors are forced to make life and death decisions motivated by cash.

The decisions about who receives kidney dialysis are not made according to some principled ethical code, but according to hard economic facts. Ethics may dictate that everybody should receive treatment, but it comes down to how many dialysis machines are available. In principle all life is sacred, but in practice somebody decides which of two premature babies is put into the one incubator available to give it a chance of life. And in taking the decision in favour of one baby, that doctor condemns the other to death before it's even had a chance to experience life.

Every day consultants see patients die who, in principle, could be treated if medical resources were made available. While the courts debated the ethical integrity of Dr Cox, health chiefs in London announced the possible closures of four teaching hospitals. You can't help but wonder how many deaths will result from that.

The real world of medicine, the one that you and I experience, has no room for morals. It's economics rather than ethics that determine the fate of the sick.

Is the minister of agriculture one field short of a farm? One sheep short of a flock? One cow short of a herd?

Following the discussions about the ethics of the human genome project, John Gummer has announced his intention to set up an expert group to advise on the ethics of genetically engineered food. While I can understand the concerns about tampering with human genetic material (even if I don't share most of them), the ethics of the genetic manipulation of wheat fly by me.

The potential for biotechnology is tremendous. In Holland, maize has been developed that is resistant to a common herbicide. It allows farmers to spray against weeds without killing the crop, so increasing the yield. Other future genetic manipulations could enable plants to survive droughts or frost, increase resistance to pests and disease, and make them longer-lasting or more nutritious. The Japanese are already working on soya beans and rice with extra vitamins and amino acids.

But while you're fantasising about the potential of such developments, Gummer is worrying about the consequences. And he's not alone. According to the Times (26 September) 'advice on the morality of new foods is crowding in from every side'.

The campaign against genetically engineered plants has already taken off in the USA. Around 1500 American chefs have signed for the Pure Foods Campaign, a Washington-based pressure group whose stickers adorn the fronts of politically correct restaurants: 'We do not serve genetically engineered food.'

In fact nobody in the USA serves 'Frankenfoods', as they have been affectionately labelled. There are none on the US market. But that hasn't stopped the hysteria. Nor is it confined to the States. In Holland the resistance to these scientific advances borders on the lunatic. Dutch researchers working on the above-mentioned maize have been plagued by the vigilante group Het Vurige Virus (literally, 'the flaming virus'). These basket cases have managed to raze whole fields of the new crops before they can be harvested.

The opponents of biotechnology argue that it's unnatural and immoral to interfere with the genetic inheritance of a species - even a species of plant. It's a crazy argument. We have been tampering with plants for centuries. That's what cultivation is! God didn't make wheat - we did. And we've been improving it for thousands of years. So why the sudden urgency for an enquiry-- unless it's to investigate why so few resources are devoted to this kind of research?

Reproduced from Living Marxism issue 49, November 1992

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