BOOK REVIEW
Heleen M Dupuis: On the edge of the knife , Good and evil in health care. (in Dutch)
Publisher Balans, Amsterdam 1998. ISBN 90 5018 388 3

      Heleen Dupuis is professor of Medical Ethics at Leiden University. She wants to show that in and around modern medical thinking 'fundamental thinking errors' are being made that cause 'damage to the individual person and to society'. The booklet stands in the public library. That's why I think that an outsider like me is supposed to be able to form an opinion on the headlines of the contents. We catholics cannot leave medical ethics to non-catholics without criticism.

      To begin with, she draws a parallel between modern uncritical belief in medicine, caused by a need for security, and 'traditional' belief in religion. The doctors of today are the priests of yesterday. Meanwhile she shows prejudice against religion. For instance, she says that religion is a reaction caused by mortal fear, and that young people suffer under the sexual morality of the churches.

      Dupuis demonstrates that too often doctors apply a medical treatment that is insufficiently thought out. She says that, often, they'd better omit any medical-technical treatment. For this over-treatment she mentions the following causes: the uncritical attitude to medicine mentioned above, the one-sided professional knowledge of the specialists, financial stimulants given by the research sponsors from medicine industry, and (especially in the USA) the menace of juridical damage claims. This sounds all sensible. Indeed, it happens too often that patients get one-sided information and 'choose' a treatment that is hard but ineffective.

      But then, the unchristian starting-point of Heleen Dupuis becomes evident. She gives examples of 'undesirable medical actions' (as she calls them), like giving antibiotics to a baby that has severe handicaps but is capable of living, when it gets infections. In case of  'doubt' she wants no treatment ('in dubio abstine'). But if an unborn child has severe handicaps, she wants to give to the parents the right of having the child aborted. Then, they can 'try out' a new pregnancy. She wants to give to aged people pills to kill themselves. Where is now her reservedness? Dupuis unjustly speaks about 'low quality survival', and she pretends that 'prolongation of suffering never can be considered a success'.

      What must we think about this? Of course, there are limits that technics should not surpass. That is true in cattle-breeding, and in medicine as well. But Dupuis doesn't properly indicate where these limits should lie. One should reflect upon the effectiveness and the noxious side-effects of a treatment. On the level of country government, one should also consider the costs. I think that we should give more money to organisations that give good help to poor countries. We should reserve more money for medical care and much less for technology.
But we are not allowed to have a low opinion of the life of a handicapped fellow-man. And, although we should palliate the suffering of our fellow-man in most cases, we are not allowed to be too averse from suffering. In the suffering and in the care for the ill fellow-man we honor God as Creator, and follow Christ in bearing the Cross. Thus we become better people. Human life is a gift for eternity, and hereafter we shall have to justify how we have accepted our life. Reasoning like Dupuis we come in practice on a sort of hill, where it is difficult not to glide down: for instance, the life of a blind baby will soon be considered inferior. And an annoying aged person will be pushed to step out of life.

      Heleen Dupuis treats of many examples. She seemingly is concerned about the suffering of the sick. But she walks over the broad way, and she joins too easily people like you and me that are often too easy-going and too unbelieving. Eventually, it becomes evident that she is afraid. Not of death itself, but of life and suffering and dying in surrender to God. Of course, we all have that fear. But then, there are better counsellors than Dupuis, even if we leave Christ out of consideration. A good example is our holy Theresia of Lisieux, who offers all her suffering to God, and trusts in Him 'like a child that walks blind, relying on the love of its parents'.

Done at Maastricht in november and december 1999 by dr HFH Reuvers.