Update: Why Ethicists Should Speak Out Against Torture

Additional articles have been published since my original post on February 8th.

For Further Study

“American Psychological Association Bolstered C.I.A. Torture Program, Report Says” by James Risen, New York Times, April 30, 2015.

“The involvement of health professionals in the Bush-era interrogation program was significant because it enabled the Justice Department to argue in secret opinions that the program was legal and did not constitute torture, since the interrogations were being monitored by health professionals to make sure they were safe.”

“The Disappeared: Chicago Police Detain Americans at Abuse-Laden ‘Black Site’” by Spencer Ackerman, The Guardian, February 24, 2015.

“The secretive warehouse is the latest example of Chicago police practices that echo the much-criticized detention abuses of the US war on terrorism. While those abuses impacted people overseas, Homan Square – said to house military-style vehicles, interrogation cells and even a cage – trains its focus on Americans, most often poor, black and brown.”

“Former CIA leader defends drone strikes, torture” by Ken Dilanian, PBS NewsHour (AP), May 4, 2015.

“While Morell says he is personally troubled by the harshest technique the CIA used on detainees, water boarding, he makes a case that agency leaders had no choice but to use what many consider torture in the years after the 9/11 attacks. He said such techniques saved American lives.”

 

 

Original post from February 8, 2015:

Sen. Feinstein of the U.S. Senate released a committee report two months ago on the use of torture by CIA interrogators in the 2000s.  While some have expressed outrage, many have been silent on the matter.  I think ethicists are obligated to speak on this issue, and Christian ethicists should be able to articulate the moral high ground regarding the treatment of prisoners or the fighting of wars.

I will mention a few areas that should be of particular concern to ethicists:

A Stance for the Healing Profession of Medicine

With the exponential growth of biotechnology in recent years, the profession of medicine has become too narrowly focused on its technical enterprise at the expense of its broader calling to heal.  At the heart of the Hippocratic tradition is the concept that the work of the physician is done for the sake of healing and is not to be misused in the service of some other agenda.  The ancients were wise in considering the possibility of medicine becoming a powerful tool in the hands of some enterprise unconcerned with its subject (the patient) or healing.

A program of torture developed by psychologists undercuts this endeavor significantly.  Medical practice of rectal rehydration to keep alive those who probably wish they were dead twists healing practice into an instrument of torture.  The overall agenda of a surveillance agency or government department may contradict the healing endeavor.

We might cover Kantian ethics in every university philosophy intro class, but it seems we are apt to use people as a means to an end.  Sometimes our rationale is about money (or “jobs”); sometimes it is about military power (“security”).  However, the philosophy is easy to see: we have no problem doing terrible things in order to accomplish our goals.  Ethicists of all stripes should speak out against this.

The Responsibility to Comment on an Inaccurate View of the Human Being

It is easy to note the use of the term compliance by the supporters of CIA activities. Examples of this can be seen in the Charlie Rose interview with former deputy director Mike Morrell and Judy Woodruff’s interview with former counterterrorism director Robert Grenier (“There were things in their head that we had to have, and these were the techniques that we used to extract them.”).  I had a rather lengthy discussion over a decade ago with a physician who advocated the use of the term adherence, rather than compliance, when discussing the patient’s use of medications prescribed by a physician.  He strongly felt that the term compliance promoted a form of paternalism that could even be extended to a form of manipulation.  Physicians and medical ethicists should take a clear stand for the viewpoint that medicine is a covenant between patient and physician and should not involve coercive philosophies.

As a student of psychology in my bachelor’s program in the 1990s, I saw how philosophical concepts concerning the dignity of the human being were slipping away.  Functional MRI was captivating the attention of researchers, and the computer model of the human being was moving from theoretical concept to dominant construct.  In light of these philosophical developments over 20 years ago, it is not surprising to see a government regard prisoners as neural databanks from which to draw information.  Such a low view of the human being can lead to all sorts of atrocities.

A Stance Against Authoritarian Government

Some may think that compliance is the proper goal of a government, but this is not the American tradition.  Certainly the assembling of a “We the People” government is outside this concept, but even our trial by jury and innocent until proven guilty traditions show that compliance is misguided when dealing with opponents and prisoners.

We, as the United States, are signatories to the Geneva Conventions.  These agreements concerning war and the treatment of prisoners were revised following the atrocities committed during World War II.  However, in recent years we have abandoned our leadership position on these subjects in favor of extending military and commercial power.  We should rediscover the moral position.

I would ask that Trinity and the Center for Bioethics and Human Dignity would take a firm position against the use of torture by our intelligence services.   This is the Christian position, and such a statement would be befitting a Christian institution of ethics.

 

For Further Study

“What I Have Said About Torture Since 2006” by David Gushee, Baptist News Global, January 5, 2015.

“’Do No Harm’: When Doctors Torture” by Julie Beck, The Atlantic, December 12, 2014.

“Detainee’s Diary Describes What It’s Like to Be Interrogated” by Hari Sreenivasan, PBS NewsHour, January 26. 2015.

“And then he’s subjected to this — called special interrogation plan, which is written out ahead of time, step by step, signed off all the way up to Donald Rumsfeld, secretary of the defense. And it’s a year of harrowing abuse that begins with extreme isolation, sleep deprivation, subjecting him to extremes of temperature, strobe lights, loud music, stripping him, subjecting him to sexual abuse and assault.” – Larry Siems

“Obama Won’t Return ‘Torture Report’ Without Court OK” by Josh Gerstein and Burgess Everett, Politico, February 7, 2015.

 

Rebuilding Trust

The Texas Tribune reported this week that legislators in Austin have proposed a bill that would forbid physicians from asking their patients about guns.  Joe Gibes has commented on this issue in this blog (“It’s Not Primarily About the Guns” on Sept. 12, 2014).  In Texas, this is set against the backdrop of Open Carry legislation, a change in rules for those licensed to carry a handgun that would do away with the requirement they conceal their weapons.

While this legislation is related to debates about guns and recent gun violence, I think this issue is more closely related to the lack of trust in the medical profession.  Take the vaccine debate of a couple months ago (and Senator Rand Paul’s tweet).  This is tied to concerns about autism, but it reveals a larger mistrust in medical science and healthcare policy.  I think this was exacerbated by the Ebola outbreak in Dallas and questionable management at both the hospital level and county/public health department level and even the federal CDC.

So, now more than ever, we need to rediscover the sacred patient-physician relationship.  Some patients may be wary of a doctor trying to make a buck off their care (see Lesley Stahl’s reporting on the revenue which comes from pharmaceutical companies in the course of cancer treatment).  Doctors may be concerned with the platoon of lawyers tagging along with some of their patients.  Or maybe it is that guy with the MBA running the hospital.  And, of course, there is the government.  A great cloud of mistrust hangs over Washington as Congress continues to float ideas about changing the Affordable Care Act and the Supreme Court weighs an ACA challenge.

I suggest that physicians take the lead on this.  A simple adherence to a Hippocratic or Hippcratesque Oath which emphasizes the patient-physician covenant before monetary reward (and accompanying “financial toxicity”), political agenda, or personal pride would do a world of good.  A simple commitment to “avoiding any voluntary act of impropriety or corruption” before a group of colleagues would lift medicine to another level.  The concept of “entering a home for the benefit of the sick” would inspire confidence in parents bringing young children to the clinic along with concerns about vaccination.

And draw a line.  Provide some clarity to the debate.  We’ll do business with these pharmaceutical companies and these hospital administrators.  If these medical equipment manufacturers hold to this same high standard, we’ll do business with them.  But no one else.  Period.  The doctor-patient relationship means that much to us.  I think they will find many patients interested in that kind of service, that kind of care.

And, wow, what a better environment in which to practice medicine.  I think even the receptionists will be lining up to work for these docs (Don’t have to answer those phone calls from those lawyers any more; Hallelujah.).  Who knows?  There might even be an insurance company out there that will say, “We always wanted to work with docs who wanted to get back to the healing art of medicine.  We might even come out with a fair insurance plan … no strings attached.”  Even one or two clinics that could carve out such a niche could get the medical societies to take notice.  When I was doing my grad work in Chicago in the 2000s, someone told me that Lawndale Church was getting many referrals from the public health department in Chicago because the church (yes, that’s right, the church) and its clinics were so much better as healthcare partners.  Lawndale decided long ago it was going to do certain things certain ways simply because it was right, it was Christian.  Eventually, Chicagoans began to take notice.

For Further Study

Peter Tyson, “The Hippocratic Oath Today” (From 2001), March 27, 2001, NOVA.

“Yet paradoxically, even as the modern oath’s use has burgeoned, its content has tacked away from the classical oath’s basic tenets. According to a 1993* survey of 150 U.S. and Canadian medical schools, for example, only 14 percent of modern oaths prohibit euthanasia, 11 percent hold covenant with a deity, 8 percent foreswear abortion, and a mere 3 percent forbid sexual contact with patients—all maxims held sacred in the classical version. The original calls for free tuition for medical students and for doctors never to “use the knife” (that is, conduct surgical procedures)—both obviously out of step with modern-day practice. Perhaps most telling, while the classical oath calls for “the opposite” of pleasure and fame for those who transgress the oath, fewer than half of oaths taken today insist the taker be held accountable for keeping the pledge.”

Ben Mitchell, “The Christian Hippocratic Tradition in Medicine,” Nov. 5, 2010, The Center for Bioethics and Human Dignity.

“Hippocratic Oath” and “History and Meaning of the Oath” from the American Hippocratic Registry.

 

Fools Rushing In?

Trevor Stammers is our guest blogger for today.  Dr. Stammers is the Programme Director for Bioethics and Medical Law at St. Mary’s University, Twickenham in London.  Prior to St. Mary’s, he practiced as a family physician for 27 years and was a senior tutor in General Practice at St George’s, University of London.  He is also the editor for the multidisciplinary journal The New Bioethics.  Thanks to Trevor for taking the time to provide a British perspective on an issue which is being debated in that country as well as in the United States. — CMC

 

As widely predicted, the House of Lords voted last week overwhelmingly to approve Regulations for 3 and 4 parent IVF to be permitted in the UK; already there is press speculation that the first baby from this technique could be born by October 2016. At least the debate in the Lords lasted around four hours whereas the Commons only took 90 minutes to pass it (compared to 90 hours of debate over banning fox hunting with dogs).   So the race is on for the UK to be the first.  So why am I, as a physician-bioethicist, not cheering enthusiastically with the crowd as the starter’s gun is fired?

Though I hope as much as those championing this cause that it will result in healthy newborns with no subsequent risk to them or their children, the haste with which the UK has rushed this through with so many questions unanswered worries me. The Lords debate did nothing to reassure me.

The lack of transparency over the language use has worried me for a long time, and the Lords debate was rife with it. Those in favour of ‘mitochondrial donation’ will already be criticising me for calling it ‘3 or 4 parent IVF’. “It’s not,” they say “because the amount of DNA from the donor egg is so small as to be negligible.” This argument seems untenable when the very fault in that “negligible” DNA in the intended birth mother’s egg is the very reason for the whole procedure being carried out in the first place. Is someone contributing directly to the DNA of a new blastocyst a genetic parent of the resulting child or not? If they are, then the amount of DNA contributed is irrelevant. Imagine things go wrong and an apparently healthy child is born who subsequently turns out to be say, autistic, would that child not want to know who donated the mDNA and regard that person as a parent in some way, especially if legal compensation was at stake or even if it were not?

The term ‘mitochondrial transfer’ is also very misleading. The mitochondria stay in the donor egg and it’s the nucleus from the patient’s egg that is transferred in a genetic manipulation which mirrors the first stage of SNT cloning procedure, despite the constant assertions that cloning has no relevance to the technique– another worrying denial. “Suggestions that mitochondrial transfer techniques are a form of cloning when they are nothing of the sort … are very unhelpful and not part of any reasoned discussion about the issues” one peer asserted. Methinks the Labour Lord doth protest too much!

Then there is the denial that this form of genetic engineering (for that is what it is to most of the public) will enter the germ line. Clearly it will– at least in females. The Lords’ responses that we should then still allow it for male children and that even in females the mDNA will be diluted down through the generations seem to be rather desperate attempts to deny that germline transmission is actually occurring.

We have been in a similar state of misinformation before in the UK. In 2008, when the very scientists now promoting 3 parent IVF were then promoting animal-human hybrids as the only way to obtain enough embryonic stem cells, which were promised to cure dozens of diseases. The lobbyists got their way then but science took another turn along more promising avenues and such hybrid research has withered away.

The difference with some of the ‘shroud waving’ in that debate and even earlier regarding IVF itself is that this time it is not part of a dispute between science and religion but between different scientists over the many unanswered questions about these techniques.

Why does one technique, MST (maternal spindle transfer) work in Macaque monkeys but the other (PNT, pro-nuclear transfer) does not? Why are scientists divided over the role of mDNA in things such as personality and character in the resulting child? Why are some researchers now beginning to mention that the donor will need to be chosen very carefully and haplotype matching may be needed? If the technique is merely “like changing batteries,” why won’t any healthy donor egg do?

Finally, though Lord Winston stated in the Lords that he has had no difficulty recruiting egg donors, these techniques are generally accepted to require dozens, maybe hundreds, of donor eggs before a normal live birth will be achieved. Where will all these donors come from, given that that egg donation is not a risk-free procedure for the donor? The debate about payment for and commercialization of women’s eggs can only intensify if these techniques are used in human trials.

British medical hubris is in overdrive to lead the ‘3 parent IVF’ charge against mitochondrial disease and is inevitably already prompting other countries such as the US to follow. One of my friends commented to me after the debate, “This could be a genetic thalidomide.” I hope he is wrong, but other nations might be wise to wait and see; that enthusiastic cheering might yet turn into the inchoate cries of Babel instead.

Trevor Stammers

Why Ethicists Should Speak Out Against Torture

Sen. Feinstein of the U.S. Senate released a committee report two months ago on the use of torture by CIA interrogators in the 2000s.  While some have expressed outrage, many have been silent on the matter.  I think ethicists are obligated to speak on this issue, and Christian ethicists should be able to articulate the moral high ground regarding the treatment of prisoners or the fighting of wars.

I will mention a few areas that should be of particular concern to ethicists:

A Stance for the Healing Profession of Medicine

With the exponential growth of biotechnology in recent years, the profession of medicine has become too narrowly focused on its technical enterprise at the expense of its broader calling to heal.  At the heart of the Hippocratic tradition is the concept that the work of the physician is done for the sake of healing and is not to be misused in the service of some other agenda.  The ancients were wise in considering the possibility of medicine becoming a powerful tool in the hands of some enterprise unconcerned with its subject (the patient) or healing.

A program of torture developed by psychologists undercuts this endeavor significantly.  Medical practice of rectal rehydration to keep alive those who probably wish they were dead twists healing practice into an instrument of torture.  The overall agenda of a surveillance agency or government department may contradict the healing endeavor.

We might cover Kantian ethics in every university philosophy intro class, but it seems we are apt to use people as a means to an end.  Sometimes our rationale is about money (or “jobs”); sometimes it is about military power (“security”).  However, the philosophy is easy to see: we have no problem doing terrible things in order to accomplish our goals.  Ethicists of all stripes should speak out against this.

The Responsibility to Comment on an Inaccurate View of the Human Being

It is easy to note the use of the term compliance by the supporters of CIA activities. Examples of this can be seen in the Charlie Rose interview with former deputy director Mike Morrell and Judy Woodruff’s interview with former counterterrorism director Robert Grenier (“There were things in their head that we had to have, and these were the techniques that we used to extract them.”).  I had a rather lengthy discussion over a decade ago with a physician who advocated the use of the term adherence, rather than compliance, when discussing the patient’s use of medications prescribed by a physician.  He strongly felt that the term compliance promoted a form of paternalism that could even be extended to a form of manipulation.  Physicians and medical ethicists should take a clear stand for the viewpoint that medicine is a covenant between patient and physician and should not involve coercive philosophies.

As a student of psychology in my bachelor’s program in the 1990s, I saw how philosophical concepts concerning the dignity of the human being were slipping away.  Functional MRI was captivating the attention of researchers, and the computer model of the human being was moving from theoretical concept to dominant construct.  In light of these philosophical developments over 20 years ago, it is not surprising to see a government regard prisoners as neural databanks from which to draw information.  Such a low view of the human being can lead to all sorts of atrocities.

A Stance Against Authoritarian Government

Some may think that compliance is the proper goal of a government, but this is not the American tradition.  Certainly the assembling of a “We the People” government is outside this concept, but even our trial by jury and innocent until proven guilty traditions show that compliance is misguided when dealing with opponents and prisoners.

We, as the United States, are signatories to the Geneva Conventions.  These agreements concerning war and the treatment of prisoners were revised following the atrocities committed during World War II.  However, in recent years we have abandoned our leadership position on these subjects in favor of extending military and commercial power.  We should rediscover the moral position.

I would ask that Trinity and the Center for Bioethics and Human Dignity would take a firm position against the use of torture by our intelligence services.   This is the Christian position, and such a statement would be befitting a Christian institution of ethics.

 

For Further Study

“What I Have Said About Torture Since 2006” by David Gushee, Baptist News Global, January 5, 2015.

“’Do No Harm’: When Doctors Torture” by Julie Beck, The Atlantic, December 12, 2014.

“Detainee’s Diary Describes What It’s Like to Be Interrogated” by Hari Sreenivasan, PBS NewsHour, January 26. 2015.

“And then he’s subjected to this — called special interrogation plan, which is written out ahead of time, step by step, signed off all the way up to Donald Rumsfeld, secretary of the defense. And it’s a year of harrowing abuse that begins with extreme isolation, sleep deprivation, subjecting him to extremes of temperature, strobe lights, loud music, stripping him, subjecting him to sexual abuse and assault.” – Larry Siems

“Obama Won’t Return ‘Torture Report’ Without Court OK” by Josh Gerstein and Burgess Everett, Politico, February 7, 2015.

 

The Importance of Ethical Standards

This week, banking regulators announced fines totaling over $4 billion against six banks from around the world, including Switzerland’s UBS and the USA’s JPMorgan Chase and Bank of America.  Some weren’t ready for a deal:

London-based Barclays Plc., which had been in settlement talks, said it wasn’t ready for a deal.

This seemed a little like déjà vu to me, since I was living in Houston when the Enron scandal broke.  Though many will recognize the “Crooked E,” perhaps some will not be familiar with the systemic nature of the scandal in Houston and the energy industry, particularly as it related to trading.  Some will note that the venerable accounting firm Arthur Anderson is no more because it was caught shredding Enron documents in the wee hours of the morning before investigators could arrive.  However, many other energy firms were involved—this is rarely discussed.

Probably the most important component in the implementation of ethical standards in medicine is the medical society.  Universities and clinics and hospitals play a role, but it is the medical society which forms an assembly of physicians and nurses who desire to perform the healing arts in a particular way.  If we want to legislate healthcare and have a bunch of regulations which delineate the paperwork of the medical profession, let the state medical boards be involved in that.  However, the medical societies should be about the profession itself, how medicine is to be practiced day in and day out.  Really, each profession should erect such a society in which to govern practitioners, whether related to business (oil & gas, banking), academia (research scholarship, writing), government (political parties), the arts (movie production, acting), or whatever.  What counts is that professionals are interested in the deep-down issues of philosophy and theology that undergird ethical standards.

For Further Study

Ring, Suzi, et al., “Six Banks to Pay $4.3 Billion in First Wave of Currency-Rigging Penalties,,” Bloomberg, November 12, 2014.

“Called to Account: Behind the Enron Scandal,” Special Report, Time.

 

Spiritual Matters and Bioethics

Halloween has come and gone, and as is typical in recent American history, it was a big deal and big business.  My town hosted a city-wide event last weekend, so a drive near the courthouse square was marked by all sorts of goblins wandering the streets (and packing the McDonald’s).

This past week’s episode of Sleepy Hollow on FOX featured police officers helping a young man who had the ailment of turning into a flesh-eating monster.  One of the officers procured organs from the local medical school in order to temporarily satiate the discharged Marine, a.k.a. man-monster (“Boy, the medical school ought to spend a little more money on security down there.”).  She delivered the organs in the classic, small, Igloo cooler  we see used by transplant teams in hospital dramas.  Of course, worldwide organ trade is not just the fantasy of TV dramas about the occult.  It is a real problem, Igloo containers and all.

One thing is for sure this Halloween, the somewhat-old adage about America is true: “We are spiritual, not religious.”

Some of these spiritual stirrings and battles not only look “medieval” but “Old Testament” as well.  The more things change, the more things stay the same:

  • Rachel and Leah and their mandrakes; Jacob and Laban and their livestock – Genesis 30.
  • The Mosaic law’s teaching concerning blood and the dead – Leviticus 17.
  • The Mosaic law’s prohibition of practices related to the offering of children in the worship of Molech – Leviticus 18:21.
  • The Mosaic law’s instruction on how you shall not do “as they do in the land of Egypt” or “as they do in the land of Canaan” regarding sexuality – Leviticus 18.
  • Of course, some practices within the church are “of a kind that is not tolerated even among pagans” – 1 Corinthians 5.
  • Prophets often addressed Israel’s intermingling within paganism, particularly as it pertained to worship practices and sexual practices – Hosea 1-3.

Of course, these pagan streams of thought regarding medicine and the body continued into the New Testament and into European and American history and continue into the present day.  It is the age-old battle of the endeavors of the human heart for spirituality (paganism) against the gracious redemption of men and women by way of faith in Christ (Christianity).  And this is not only an issue of salvation, but it is also about whether or not we will be new people with new ways of thinking (2 Cor. 5:17; Romans 7, 8, 12:2).  It is this new way of thinking that is critical in moving us away from an ethic of our own self-interest to an ethic based on the goodness of God.  Otherwise, we will not be equipped to understand spiritual renewal and maturity nor have the accompanying wisdom to make decisions about deeply spiritual aspects of human life such as sexuality or reproduction.  And a religious mandate that seeks to conform us to a model of behavior does no good either.  Wisdom regarding ethics and morality comes from nothing less than a new birth, something which comes from the New Adam.

Happy Reformation Day, ghosts and goblins.  Post tenebras lux.

 

 

 

 

 

 

 

The Price of Drugs

Lesley Stahl of CBS recently did a story for 60 Minutes on the high price of cancer drugs.  Physicians at Memorial Sloan Kettering and M.D. Anderson have been seeking to remedy the “financial toxicity” of cancer drugs, something which has been mentioned in this bioethics blog as well.

In Stahl’s story, Dr. Peter Bach of Sloan Kettering relates how a simple op-ed in the New York Times revealed the nature of the drug-pricing scheme:

“Because it was irrefutable evidence that the price was a fiction. All of those arguments that we’ve heard for decades, ‘We have to charge the price we charge. We have to recoup our money. We’re good for society. Trust us. We’ll set the right price.’ One op-ed in the New York Times from one hospital and they said, ‘Oh, okay, we’ll charge a different price.’ It was like we were in a Turkish bazaar. … They said, ‘This carpet is $500’ and you say, ‘I’ll give you $100.’ And the guy says, ‘Okay.’ They set it up to make it highly profitable for doctors to go for Zaltrap instead of Avastin. It was crazy!”

Much of the support for high drugs prices comes from physicians majoring in the drug business:

“Another reason drug prices are so expensive is that according to an independent study, the single biggest source of income for private practice oncologists is the commission they make from cancer drugs. They’re the ones who buy them wholesale from the pharmaceutical companies, and sell them retail to their patients. The mark-up for Medicare patients is guaranteed by law: the average in the case of Zaltrap was six percent.”

Dr. Leonard Saltz: What that does is create a very substantial incentive to use a more expensive drug, because if you’re getting six percent of $10, that’s nothing. If you’re getting six percent of $10,000 that starts to add up. So now you have a real conflict of interest.” (from the transcript)

Most startling is the case of the very successful treatment for chronic myeloid  leukemia (CML), the tyrosine kinase inhibitor imatinib (sold as Gleevec by Novartis).  Considering the drug has been on the market for over a decade, one might think that Gleevec would be an inexpensive cancer treatment in 2014, especially in a marketplace which includes several similar competitors.  Actually, the price has gone up significantly in recent years.

And Gleevec is a very helpful drug, a grand champion of effectiveness as far as cancer drugs go.  It is a shame that it’s price causes such a burden to those who are trying to recover from illness.

It seems that we do a lot of things that are toxic to ourselves and our society.  Maybe we ought to get back to the art of healing.

 

The Religion of the American Immortal

Penn bioethicist Dr. Zeke Emanuel has been a lightning rod in the health-care field for some time.  He has been the subject of a flurry of media reports on so-called “death panels” and has even received attention in this blog.  Recently, in an interview with Judy Woodruff of PBS NewsHour he related how he wants to “stop living at 75.”

In the interview, Emanuel mentions his brother, “the American immortal” (I’m not sure if he is referring to Chicago mayor Rahm Emanuel or his other brother).  He describes him as:

“The American immortal are people who want to put off death as long as possible, want to live as long as possible and get every day out of it.  They take all these, they change their diet.  They exercise like mad, they take protein concoctions and all sorts of other supplements, and it’s almost a religion for them to live as long as possible, when I think in their mind they think they will be as vital as when they were 50 all the way til the end, but of course we all do deteriorate, we all do slow down, we all do get disabilities.”

Dr. Emanuel makes a good point.  A main driver in American health care is a thirst for immortality.  It affects end-of-life care, stimulates a therapeutic industry which manipulates hormones in the pursuit of the fountain of youth, and fuels health food and supplement commerce.

However, Dr. Emanuel, a man of medical science and a man of the data, sees things differently.    Instead of a “compression of morbidity” in old age, there is in fact an expansion; and one’s years after age 75 tend to be less productive.  Insightfully, Judy Woodruff in the interview brings up the concept that productivity (“contributing”) might not be the end all be all; later years could be a time of reflection and interpersonal relationships.  In his response, Emanuel recognized connections with family and friends but indicated that you just can’t do a whole heck of a lot after 75.

Indeed, productivity is very important to Americans.  Perhaps this is the true “religion” of the American.  Or perhaps addiction is a better term.  Nevertheless, this Seventy-Five mile marker hints at another important chronological concept:

For all our days pass away under your wrath;

we bring our years to an end like a sigh.

The years of our life are seventy,

or even by reason of strength eighty;

yet their span is but toil and trouble;

they are soon gone, and we fly away.

Who considers the power of your anger,

and your wrath according to the fear of you?

So teach us to number our days

that we may get a heart of wisdom.

Return, O Lord! How long?

Have pity on your servants!

Satisfy us in the morning with your steadfast love,

that we may rejoice and be glad all our days.

Make us glad for as many days as you have afflicted us,

and for as many years as we have seen evil.

Let your work be shown to your servants,

and your glorious power to their children.

Let the favor of the Lord our God be upon us,

and establish the work of our hands upon us;

yes, establish the work of our hands!

— Psalm 90:9-17

Woodruff pointed out that Jimmy Carter is about to turn 90 and, ah, is still productive.  My great aunt is approaching that birthday as well.  And my grandmother lived to be 93 (and lived in her own home by herself until a few months before).  Perhaps we ought to consider the goodness of God’s grace in the span of our lives.

 

 

Fair-minded Medicine

“Let us therefore celebrate the festival, not with the old leaven, the leaven of malice and evil, but with the unleavened bread of sincerity and truth.” – 1 Corinthians 5:9

I attended a funeral this past week, and I spoke with a relative who is an attorney practicing patent and intellectual-property (IP) law.  Since he works closely with science and technology, I mentioned Joe Gibes’s post on the “duping” of American patients seeking a medical cure in antidepressants.  I went so far as to say that we might have a whole segment of medical literature that misrepresents the nature of the human body and medical science.  This attorney nodded in agreement, knowingly.  As long as business interests drive research and political interests sway agencies such as the FDA, the profession of medicine in the United States is vulnerable.

Many of the debates in our country indicate that a healthy dose of fair-mindedness would do us good.  In fact, that is the entire of premise of ethics no matter what the field: there is a manner of practice that is good and beneficial to people and we should hold each other to that standard.  If the ethical disciplines—be they medical, business, governmental, or whatever—are reduced simply to the exertion of one’s will (and accompanying fundraising) then we truly are left with something George Washington U. law professor Jonathan Turley calls “raw, muscle politics.”  In turn, consumer choice becomes a pillar in medical ethics, and the house serves little for refuge but becomes a hazard.

Restoring the philanthropic underpinnings to medicine would be a big help.  Universities historically have provided safe havens for such research and training, but today they too are seduced with corporate sponsors for buildings and fat TV contracts for football.  And we might even want to wait to invest philanthropy until the donor has passed over the River Jordan so that Class of ’50 alum doesn’t try to funnel university developments to his cash cow company.[1]

We might also consider forming a new medical association, which is truly a vehicle for physicians and nurses who desire to practice medicine in a particular manner.  From a medical ethics standpoint, there really is no point to a medical association if it is merely a trade association for business interests or a quasi-agency that advances a particular philosophy of governance.  The Hippocratic tradition began with a particular understanding of a way of practicing medicine which was beneficial to patients and reflective of principles pleasing to the Deity, first and foremost.  The use of the oath then allowed those who held these views to stand together for the sake of advancing good medicine and sometimes to stand against their opponents and harmful practices.  Such a medical association, whether at the county level or on a national basis, would provide medicine with an ethical standard that would restore a sense of fair-mindedness in the USA.

It’s become the American practice to go into Washington or Austin or Kandahar or Fallujah with a suitcase full of cash to “get things done.”  This strategy reveals the superficial nature of our policies: we cannot win support with argument; greenbacks are the only things that win people over to our side.

 

 

 


[1] Postscript:  Under philanthropy, it might be appropriate to mention church-sponsored hospitals.  However, the Christian exodus from healthcare is almost complete.  Even this summer, the most venerable hospital in Waco, Texas, dropped “Baptist” from its name.

“Enhancement” and Moral Development

Oxford ethicist Julian Sevulescu and Swedish philosopher Ingmar Persson argue in their book Unfit for the Future: The Urgent Need for Moral Enhancement that now is the time to introduce neurological and genetic changes in people so they are willing to go along with various agendas.  They note that climate change is a big issue, but when a number of people are apathetic about the cause, it might be helpful to change their thinking by altering their biology.  In their words in a 2012 article in the Sydney (AU) Morning Herald:

”Our knowledge of human biology–in particular genetics and neurobiology–is beginning to enable us to directly affect the biological or physiological bases of human motivation, either through drugs, or genetic selections or engineering,”

It is rather common in both scientific and philosophical circles to find proposals for altering the biology of people as a good way to change people and their thinking.  Tom Garigan recently addressed these technologies in “What Should We Forget?” on Sept. 9th as they relate to modifying memories:

“To argue that memories should be “extinguished” or excised is also to forget the purpose of memories. We need memories, even the bad ones. In the research cited above, the memory extinguished was that of an electric shock repeatedly received in a specific chamber. How “therapeutic” is it to the mice to forget that they should not venture there again?”

Indeed, it might be helpful to remember that someone is administering an electric shock.  This comment emphasizes that the deeper issue at hand is the concept that being human is more than just the aggregate of brain processes.  I would say there is very much an immaterial, spiritual part of each human being, an aspect which interfaces with the brain chemistry and processing which we examine in the medical sciences but which cannot be wholly contained or defined by physical analysis or terminology.  This is what many religions have termed the soul, or the spirit, and I believe it is the realm of the particular discipline we know as theology.

Classic, Christian concepts of moral development emphasize that morality and ethics stem from the character of God Himself and therefore a person’s moral development is dependent on a human being’s relational activity with the Deity.  In turn, relationships with other human beings who are also soul-ful (likewise bearing the Imago Dei) are essential.  For instance, these types of interpersonal relationships are at the heart of the university experience, specifically that which is commonly termed as liberal arts education.  These disciplines are liberal in that they are freeing, allowing graduates to pursue the profession of their choosing.  It is an education of the human being so as to produce mature persons who not only are equipped to acquire technical skills for jobs but also possess the moral development of adulthood so as to be spouses and parents, citizens and neighbors.

To think we could take a pill and achieve Huxley’s “Soma” bliss or plug in a cerebral flash drive in order to acquire a semester’s coursework is wrongheaded to begin with.  The great learning of higher education is in the development of the person.  This includes the wisdom and insight of colleagues, the difficulty of trials and obstacles, the mentorship of a professor, and the calling of God in Heaven (the vocatio of vocation).

There are real brain diseases out there.  Perhaps we should save our expensive MRI machines and tailored pharmaceuticals for the neurologists working on those problems.  Let’s leave the social engineering to the annals of history.

For Further Study

de Brito, Sam. “Maybe It’s Time for a Little Human Enhancement.” Sydney Morning Herald (AU), December 23, 2012.

Heller, Nathan. “Poison Ivy: Are Elite Colleges Bad for the Soul?” New Yorker, September 1, 2014.

Scott, O. A. “The Death of Adulthood in American Culture.” New York Times, September 11, 2014.

Moral Enhancement, Uehiro Centre, Oxford University

Transcendence starring Johnny Depp (2014)

 Lucy starring Scarlett Johansson and Morgan Freeman (2014)