Sunday, December 19, 2004

All in a day's work

It was remarkable, yes, nothing short of remarkable, with what frantic alacrity his thoughts could tumble, one upon another, in the little time it took for saline solution made its way from the plunger to the heart muscle. There! You could see it coming out of the syringe, like an army on the march, and commence its advance through the plastic tube in the lockstep stride of a crack unit on its daily drill. Such elegant efficiency is not without a certain austere beauty.

How did Dr. Liebestod find himself is such a position as this? It all seemed so long ago. And, indeed, it was. It began with debunking that old mythology about the imago Dei. For how very many centuries, millennia, in fact, had humanity been shackled to this primitive creed? Think, just think, I say, of how that backward belief had stalled the natural evolution of human society.

When Liebestod began his career in bioethics, it was a brave and lonely field. There were the usual run of religious fanatics who never saw an innocent life they didn’t try to save. In order to overcome this insensate hostility to progress, it was necessary to think strategically. The first step was a public campaign of judicious relabeling.

A lot of simple folks had a hang-up over words like "death" and "killing." The pairing of an adjective like "mercy" or "dignity" could soften up their resistance, but the controlling noun was still too negative. That was until Liebestod hit upon the phrase "life-reassignment therapy." Had such a positive, life-affirming ring to it, don’t you think?

Liebestod glanced over at the I.V. The solution was slinking down the tube.

Where was he? Oh, yes. Strategic thinking. The next step was to recast the issue in terms of freedom--freedom of choice, freedom of opportunity, freedom to do your own thing. "To be or not to be" and all that good stuff. In time, of course, this would mean the freedom to be done to, to be done in, but once the wedge was firmly a place, a little hammering would do the rest.

And it was a short step from the right to die to the duty to die. No one had a right to be a burden on anyone else. In order to get the law enacted, it was necessary to put in a temporary conscience clause for the overscrupulous physician, but these could be amended with a sunset proviso once the legislation was in force.

The final step was to repackage this question in terms of compassion. And you needed to illustrate this principle with a few well-chosen tearjerkers about having to put the family dog to sleep.

Once the scarecrow of religious extremism was taken down and tossed upon the dunghill of history, the way was clear.

Liebestod took another look at the I.V. The solution was now down to the bottom of the loop.

What was he thinking? Ah, yes! Emancipated man was a meat machine, and what a glorious meat machine was he! But just as there were gradations in the quality of steak meat, there were gradation in the quality of human life--as between a zygote, a newborn, and a grown-up. It all came down to simple, elementary biochemistry, you see. Mix up one batch of chemicals and you get a baby, another and you get a chicken, yet another and you get a Mozart. You mix them up for different reasons: a chicken for eating and a Mozart for hearing. Indeed, there were some cultures in which Mozart would be on the menu as well, and who were we to judge?

Oh, did I say "baby." This, of course, was not a term to be used in polite company. A cool, clinical, impersonal term like "zygote" or "fetus" was so much more serviceable. Made it sound like an old car part at the junkyard.

It is true that we have a soft-spot for the smile and the chuckle of a cute little kid. After all, he reminds us of--well--of us! When we look into his bright and trusting eyes we see ourselves staring back.

By the same token, there were children--grown children, mind you!--who retained an inordinate attachment to their elderly parents.

No doubt natural selection programmed us to feel this way--for the preservation of the species. But now that we know about evolution, we can improve on our own evolution. We can overrule our baser, familial instincts with an eye to the balance sheet. It would be irrational, quite irrational, I say, to let our primitive feelings get in the way of judicious human pruning and weeding of the ill-timed or suboptimal members of our species.

Liebestod looked over his shoulder. The solution was now crawling up the loop.

How did he get hear again? Forty-eight hours ago, Liebestod had checked into the hospital, complaining of abdominal cramps. A scan turned up stage-4 liver cancer. He was immediately transferred to the Haven of Rest ward, conveniently located adjacent to the morgue. The usual preparations were made for his "life reassignment."

One mildly irritating development was the subsequent discovery that he had been misdiagnosed. Seems that the scans had been inadvertently switched. What he really had were gallstones, not terminal cancer. They passed out of the system in due course, and he was fit to be discharged.

But once a patient was officially transferred to the Haven of Rest ward, no reprieve was possible. Originally, life-reassignment therapy required some sort of informed consent. However, experience had shown that candidates had the inconsiderate habit of changing their minds at the last minute.

Perhaps "inconsiderate" is too harsh a word. Such vacillation was only understandable. But to put their minds at ease, the onerous decision was taken out of their hands and given to the Board of Medical Ethics. After all, no one needed a consent form to shoot a horse with a broken leg. Indeed, Dr. Liebestod, until his unfortunate mishap, had been a board-member in good standing.

A bonus point of this minor readjustment is that life-reassignment therapy could now be scheduled to dovetail with limb reattachment and organ transplant surgery. If, say, an accident victim needed a new eye or ear, or hand or toe, or skin-graft, the Vivisection Team would pay a visit to the Haven of Rest ward.

At first, organ donation was voluntary, but as with life-reassignment therapy, it didn’t take long to find out that a promising organ donor was not always the best judge of the cost/benefit ratio, and could not be relied on in a crunch to act in the best interest of all parties concerned. Why, without some procedural safeguards in place, there was always the danger that a perfectly healthy organ donor might just up and check himself out of hospital, leaving an accident victim stranded on the operating table.

The equitable distribution of medical goods and services demanded the enforcement of a more predictable routine. And, after all, a life-reassignment patient could get along well enough with one eye or one foot. It’s not as if he had much more use for a full complement at this stage of the game.

On a busy day, like a holiday weekend, the Haven of Rest ward did a steady business as the Vivisection Team might even need both eyes, or a reproductive organ--to patch up the overflow of accident victims, gunshot victims, and the like.

And, after a while, it was found to be more cost-effective for area hospitals to share organ donors when high-priority items were in short supply. The burn unit of one hospital would swap organ donors with the cardiovascular unit of another--in case they needed a particular pigment or hair color.

And the procedure was reversible as well, for the best way of preserving an organ was to stow it inside a life-reassignment patient until the transplant patient was ready for surgery. Did you know that some life-reassignment patients had as many as two livers, three hearts, and four stomachs--all snuggled up inside, like a stuffed turkey?

Just as parts were replaceable, so were people. We all die sooner or later, so it’s only a matter of timing, and we can juggle the timing. As long as killing had no adverse effect on the body politic, it was the responsible thing to do.

Speaking of the time, Liebestod glanced over at the I.V. The solution was inching up his left ventricle.

It had been an uphill climb to arrive at this point--bioethics, I mean, not the saline solution. Liebestod looked back over his distinguished life with a certain contentment as he savored the magnitude of his achievement. He had beaten back the forces of superstition and ignorance--what with their blind, implacable opposition to progressive ethics and human rights. He was widely respected in his field.

Why, only next month he was slated to receive the philanthropist-of-the-year award for his humanitarian services. As luck would have it, he had been drafting his acceptance speech when the gallstones acted up. He was especially proud of the opening paragraph. How did that go again? Oh, yes, "My fellow physicians, I am honored tonight to re..."

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