As I got up to leave the conference room, I was nauseated. I was on an international meeting for neurosurgeons when a case was presented by my colleagues from the Netherlands of a 4-year-old who had suffered a severe spinal cord injury in a traffic accident, leaving her paralyzed from the neck down. It was in the early days after her accident that the subsequent tests and diagnostics revealed she had no other injuries aside from her spinal cord injury. The presenters concluded that the best advice to her parents was to end her life as she was unable to breathe without a respirator.
After hearing this case, there was a small turmoil in the room. The words ”playing God” circled around as the presenters defended their rational decision to not prolong suffering in continuing care for a child severely damaged and never being able to lead a life worth living. The doctors presenting the case were further arguing that our emotional uproar was not founded in logic or medicine but in our deep religious beliefs and values. A German colleague got up and said that these things could not be freely discussed in Germany as it awoke sentiments form the Third Reich. It was as if he agreed with their approach but couldn’t vocalize it in post-war Germany.
I was shocked. After all, with no certainty could we make such a decision in the first days after an accident. We didn’t know for sure that her life would be short or worthless. I was certain this would not happen in my home country, Sweden.
I left the meeting to meet a friend over a cup of coffee. Originally from Hong Kong, she had lived in Amsterdam for the past years. I told her about the discussion and, to my surprise, she wasn’t affected at all. “Oh, yes,” she said untouched by what I had just told her, “it’s the way it is here. In fact, some people argue that one shouldn’t be allowed to live for as long as possible because, at a certain point, you stop contributing to the society and become a burden. And they’re right you know.” I was astounded. Here I was, sitting with an educated woman who had fully embraced the norms of her adopted country with no questioning. It is with a bitter sense of recognition that I, several years later, watched the response of the country I am always so proud of, to COVID-19 and the arguments unfolding bearing a scary resemblance to the words uttered in that conference room that beautiful spring afternoon in Amsterdam.
Early this spring, the virus that had claimed many lives in China and Iran started moving closer to us. The overt denial of the spread of the virus had led to the death of so many. I wasn’t too worried for Sweden. After all, we lived in an open democratic society where we had the know-how, the means, and the resources to test, trace, and isolate with excellent healthcare. As a country, we also enjoy a relatively isolated geography and one of the world’s highest number of single households. Certainly, the virus would not pose a real threat to us! And that was the message from our authorities. Little did I know that we would had a different response.
Soon, the circus of the false dichotomies and bizarre causalities started. Death of the frail against lives of the young. Lives against economic recession. Lockdown against freedom. You couldn’t save both lives and the economy. The fall in economy was actually going to cost more lives than we could save with a potential lockdown. After all, only the old and frail who could not contribute to the society were to die in this mess. A number of professors emerged on TV making statements about how we should be thankful the virus only kills the old and frail; people who might have died a few months later anyway. This was all said with complete lack of emotions. Clinical doctors talking about death in a clinical sense. No moral or ethical considerations were done. Science had spoken. We were the rational. The unemotional. The secular. But who were we to decide who should live or die and when or for how long. Whose life was worth living and whose wasn’t? Can a society with certainty answer these questions?
As the death toll rose, the narcosis of indifference laid down like a thick haze above our cities, and the toxic fumes of nationalism, misogyny, and racism once again intoxicated the minds of thousands. The debate was soon centered around whataboutism rather than the main question of how we could ever allow this to happen. Early on, Jacinta Ardern stated that no New Zealander would accept the death of a fellow New Zealander, because, perhaps, a society’s wealth could be measured in its human capital in form of knowledge, experience, and diversity as well as in its embracement of the frailest. A society destitute of its humanism is a society moving on a dangerous slippery slope toward ideas that have led to the destruction of mankind throughout history.
As we walked through the corridors of a hospital, a Dutch colleague once asked me what would happen to the public health if all neurosurgeons caring for malignant tumors of the brain would die. Then he looked at me and said, “Absolutely nothing. We make no difference in public health because those patients have such short life expectancy.” But the truth was, we as neurosurgeons almost never knew which patient was a long-term survivor. A patient in which no money was invested was ultimately a dead patient. Translating human life into numbers and dollars meant that we were losing our most important values as a society. And the truth of the matter was that although we at times behaved like Gods, we certainly were far from it.