Moral medicine

The interview in the fall 1997 UC Davis Magazine with Dr. Loewy by Ralph Brave was great to see and to read. We, the School of Medicine Alumni Association, were happy to see the chair we funded getting publicity and the recognition which is so well deserved. How-ever, we were dismayed to find that the proper name of the chair was not used. The chair Dr. Loewy holds is the UC Davis School of Medicine Alumni Association Endowed Chair in Bioethics. By not correctly identifying the chair, you are doing a disservice to donors that made the chair and the recruitment of Dr. Loewy possible.

Richard Bernheimer, M.D.

Board Member, School of Medicine Alumni Association

Dr. Erich Loewy's comments gave me the distinct impression of someone trying not to let the cat out of the bag, at least not fully. I failed to see evidence of the "passion for social justice" the interviewer attributed to the doctor. Instead, I saw soft, comfortable words indicating the hard belief that it is perfectly appropriate for some people to be the final arbiters of whether the lives of other, innocent people have value.

Dr. Loewy advocates physicians acting as conductors to "orchestrate" the end of life. These soothing words not only suggest a disturbing elitism but also envision a situation that is ripe with the potential for wide-spread abuse. They are particularly disconcerting to the father of a child suffering from a serious, chronic illness. While I am certain Dr. Loewy would never conduct his orchestra to coerce the conclusion death is best, is he confident that other conductors (those who buy the instruments, for example) are so noble? His pointed criticisms of managed care suggest he lacks such confidence.

Armenia, Germany, Bosnia, Rwanda and China, to name only a few, vividly remind us that human beings, no matter how well educated, have repeatedly proven themselves incapable of shouldering the responsibility of placing value on 1

Christopher P. Staring

Tucson, Ariz.

Professor Loewy responds: The letter by Christopher Staring did, I believe, misunderstand my basic position. Let me be quite clear: judging the quality of another's life is not possible and the social implications of allowing this are, to say the least, perilous. What I was saying is that we are not a life-affirming society that values individual life above all other concerns: If we were, we would take better care of our hungry, our poor and our under-served. I am puzzled how my notion of orchestrating the end of life can be construed as being "elitist." I very specifically tried to show that, if the euthanasia debate leads to a better orchestration, fewer patients would wish to avail themselves of the option if it were to exist. I fail to comprehend how teaching physicians the proper uses of palliative care can be possibly construed that way. The fact that the drive to maximize profits for managed-care organizations presents a distinct danger to a just allocation of health-care resources does not suggest that such resources either are infinite nor that allocation of resources in today's world is not, in fact, necessary. It merely warns that it is the larger community that ought to be making such judgments.