The Importance of Bioethics

by Chris Audino

Every time I am about to stand in front of a fresh batch of students in my undergrad Bioethics class, I am moved to ask myself the question: what’s the point in Bioethics? The reason I ask this question is because it is an important question.

It is important because the asking encourages the essential exercise of me remembering “the why.” Why am I doing this? Why do we reflect on the moral permissibility of certain behaviors (culturally accepted or not)? Why do we allow certain things to happen and not others as individuals and a culture? Who should be allowed to decide what is right and what is wrong?

This “why” speaks to the very heart of bioethics – to the point of bioethics, which, I humbly submit, is to think about health and medical issues, and their moral permissibility, with the goal of supporting human flourishing and dignity. Bioethics is the exercise of asking these questions before it becomes a hindsight question. You know, when we ask: what else could I have done, it seemed like the only choice?

The further we drift from asking these questions the less it seems like there is a choice. Because, the day to day is where these decisions happen. The tech in the lab creating a family (am I playing God?). The nurse sitting by the bedside watching a man agonizing through his last breaths (he shouldn’t have to suffer through this, what can I do?). The engineer who is trying to solve this simple problem (I don’t think this could be used to hurt someone, could it?). The mother who is watching her 6-year-old slowly die of cancer (wouldn’t it be easier if I could help him die?). The expecting mom who has been abandoned by her boyfriend to go it alone (what choice do I have?). The biological boy who identifies as a female and is sorting through pronouns to find the right fit for the moment (why do I have to go through this?).

Bioethics is important because it asks the question before the moment. In the moment, the decision seems like it has already been made.

Therapy vs. Enhancement in Real Life

When I am trying to give my brain a break I often peruse the pages of a magazine. This is a wonderful excursion into areas of interest that I rarely get to uncover. One such area is running. Much to my dismay, when trying to abandon deeper thoughts one afternoon, I was overwhelmed by the content of an article.

The article recounted some unfortunate events in 2011, namely: four masters athletes tested positive for performance enhancing drugs. (Masters athletes, for those of you who don’t know, are athletes over the age of 35 who typically compete in 5-year age group increments.) They were then disqualified from competition for 8 months to 2 years.

That’s what should have happened, right?

Well, here is where it gets a little hairy.

A number of masters athletes require PEDs to continue performing at the same competitive level. So, what are they to do? Throw in the towel. Quit. Give up on their hobby/pleasure/fun. It seems this is a perfect circumstance to acknowledge the ever-ambiguous line between therapy and enhancement. In the article the journalist asks a most poignant question: Is it ethical to give someone something they’re not making?

In most cases we would say a reserved yes.

But, what about this case? Are these athletes really the win at all costs type? Or, are they just athletes who are trying to compete? If they are not simply seeking a leg-up on other masters athletes and have a legitimate deficiency it seems a case could be made for allowing them to use PEDs.

Am I off base?

 

I guess I should read something else when I need a break.

 

 

Moral Absolutes and the Value of Human Life

I have been reminded –as of late– that many people do not believe that there are moral absolutes or, for that matter, truth. Everything is flux. Man is the measure of all things. Truth is relative. You have heard it all before.

After a little philosophical inquiry, however, it seems that it is not that people believe that there is no truth, but that when we find it we never really know what it is, what it smells like, what it feels like, etc. So then there is no proof, no evidence, nor any coherence to any claim made in an effort to establish (or recognize) even a single truth.

This is where I found myself a couple of weeks ago, circling the drain of purposelessness, in an Intro to Philosophy course (that I am teaching).

But suddenly, in the midst of discussing Plato’s discourses, one student stated that it has always been wrong to displace the rights of any humans! This was chasms away from the run of the mill cultural relativism that so plagues our classrooms (and society). This claim was made because every person has innate value–the majority of the class agreed. All of a sudden students were advocating a truth claim (though somewhat obscurely); they were acknowledging human value behind human rights as an Absolute.

From this I would deduce, perhaps brazenly, that Americans typically do not budge when it comes to the value of human life or the inalienable rights of every “man”. (This is true even in the case of life issues where rights-based arguments are made to advocate immoral acts).

And yet, being the obnoxious philosopher-type that I am, I began audibly wondering -as I  believe we must- what value is there in acknowledging the value of human life if there is no Value-Giver? I suppose it does create an economically and socially productive society… but to what end? The value of human life is valueless if only for dirt.

Without an acknowledged, caring Value-Giver, life is little more than vain monotony.

 

Part 3: Caution, Compassion and Wisdom in Policy

“We should measure welfare’s success by how many people leave welfare, not by how many are added. The so-called war is not over and welfare programs are just not working.”

Last week I made the claim that we should be careful how we choose to assist those in need. This was based on four “principles” that I derived from an anecdote from my life:  Just because you think what you are doing is helping somebody, does not mean it is; Helping people requires an effort on both parts; People you help will take more than you give them and they may not stop taking; and, Temporary solutions may offer no long-term resolve.

The purpose of this week’s blog is that you do not think of me as a heartless beast. I recognize that people have needs they cannot meet. I also realize that not everyone has been given the opportunities I have. However, supporting the needs of the needy must be done with caution, compassion and wisdom. As I stated last week, our good intentions are not good enough for the societal implications.

There are now at least 77 federally funded programs for poor and low-income Americans, and their need has not gone away. These programs range from giving food aid to those in need to giving medical care to children–all of which are ‘goods’ in and of themselves. LBJ’s declaration of war on poverty produced these programs (partnered with FDR’s programs in the 30’s), which offered some temporary resolve for the basic needs of the “others” of American society.  (I think that counts as a declared war that will see no end…) But just as in all ethical deliberation, we must look at the consequences of the action, and then assess the value of the act.

While the mid-90s reform of Welfare has offered some progress and growth, the reality is partakers are not being weaned off the system. It is a benevolent service that creates a co-dependecy and not necessarily to the fault of the recipients. For a quick look into what Welfare offers those who partake, go here. Additionally, “Researchers at the Dartmouth Atlas Project and elsewhere estimate that about 30 percent of Medicare spending does nothing to make patients healthier or happier… and Medicare grew at an average annual rate of 9.3 percent over the past decade!”

Above Welfare and Medicare, Medicaid costs have grown substantially. “Spending jumped from $118 billion in 2000 to $275 billion by 2010. And even before the 2010 Health Act was passed, spending on the program was expected to double in cost to $487 billion by 2020.The 2010 law will boost Medicaid’s cost by about $100 billion a year by 2020.”

The heart of my concern is that there is a frightful similarity in the way my college roommates chose to help a homeless man and the way our society is helping those in need, without cautious consideration for the consequences on the individuals who are receiving these so-called benefits and, ultimately, on the society in which we live.

 

 

Part II: Helping Those in Need

While I promised to address the problems of Medicare/Medicaid in NH a couple weeks ago, I am going to forego that to discuss a matter that is a necessary detour in this journey: How do we appropriately help “other” people? We all know that we should, but how?

“It is the church’s responsibility to tend to the poor, sick and needy.” “No, it is the government’s responsibility.” “I’m not going to give him money he will just buy a bottle of booze with it…”

It is my brazen contention that your answer to this question will make ripples in history.

This question is more prominent, I think, for those of us who are Christians. After all we have biblical mandates that encourage us to lend a helping hand to those in need. Nonetheless, the conundrum is universal. We all feel the urge to help “others” who are “underprivileged” or “disadvantaged” or “without”.

I believe we can glean some insights from this unfortunate experience in my own life. If nothing else, I think you will come to realize that there are right ways and wrong ways to help those in need.

 

An Anecdote (this is a true story with fake names to protect their naivete)

Many years ago my kind-hearted college roommate, Scott, brought a guest home from downtown Raleigh. This guest was a homeless man and crack addict who had been living on the streets for the better part of his life. Upon entering our small apartment Scott announced to me and my other roommate, Jim: “I am going to give him [as if he were not standing right there] a warm meal and a bed to sleep on for the night, and then drop him back off downtown tomorrow.”

 

A kind gesture, right?

 

I pulled Scott aside out of earshot and said, “I strongly encourage you to keep a close eye on him while he is here.” (I hope you sense the foreshadowing.)

 

The next morning I awoke early and departed for a long day of work and school.

 

When I came home that evening, my laptop had mysteriously disappeared from my desk… Of course, I did not want to jump to any conclusions, so I went to Jim to ask if he knew where my laptop was and if he had seen our guest leave. To that he replied: “No… and yeah, he came in here and asked for a book bag. So I gave him my ol’ one that was in my closet.”

 

To which I replied: “So, let me get this straight, you gave a homeless man, who came into our home with nothing, a bag…” At this point the picture was starting to come together for Jim.

 

It turned out that our guest, whom Scott was trying to help, decided to take some things with him before he left. Jim gave him a new bag (to store his hot laptop) and Scott gave him a ride back downtown—how nice?! My roommates were literally accomplices in a crime!

 

The Moral(s) of the Story

1.)  Just because you think what you are doing is helping somebody, does not mean it is… Our guest most likely sold the laptop and bought drugs (he told us he was a crack addict).  If this is true, neither Scott nor Jim did him any service.

2.)  Helping people requires an effort on both parts. It is rarely as easy as it seems. While giving a warm bed and a warm meal or a dollar in a can may be easy (and perhaps a good that God graciously blesses you for because He alone knows your heart) these gifts may not be beneficial to the person in need.

3.)  Very often, people you help will take more than you give them or they will not stop taking. You give an inch, they take a mile…

4.)  Temporary solutions may offer no long-term resolve!

 

Final Thoughts

Our intentions do not produce results, our actions do. The means by which we help people has greater consequence(s) than our good “hearts”. Therefore, we should be careful how we choose to assist those in need. I believe that this principle has broader applications than in our daily lives. It’s application extends beyond the individual into the community and into our society.

 

Later, we will assess how our society has chosen to “help” those in need.

 

 

 

Thoughts on America’s Medical System (series)

There are few things I would like to see more than the restructuring of America’s medical care systems and educational systems. And by restructuring I mean given back to the state and the people (more on this later). While the field of bioethics extends into many disciplines, I will limit my reach for the sake of this blog to our medical systems.

The medical systems to which I am referring are, broadly speaking, how we legislate, offer, provide and facilitate medical care. While the medical care patients receive from a physician may be good, the terrible system over, behind and surrounding that physician leave much to be desired.

Simply put, the US medical system is fallen.

Now I will admit that I operate from one marked presupposition: a lot of our problems have been caused by a small group of people trying to solve them. What I would like to see is a medical system that protects those who are in need, while preserving the constitution it operates under and through.

There are two problems today that were President Johnson’s solution to a problem yesterday: Medicare and Medicaid.  These are systems that had a good in mind­– to offer people in need a service they were not being given. However, they are no longer able to do what they set out to do, and instead have become an encumbrance to medical practice. With spending forecasted by the CMS to be $1 trillion in 2011 these systems are full of fraud, abuses overspending, and poor reimbursement rates to boot (more on this next week).

 

Next week I will be looking to my home state for some examples…

Abortion: Unbridled Democracy in Action

 

When reading a piece by Joseph Ellis on the founding of the US, American Creation, I came upon an insightful saying. I am not sure if this is a common saying and/or if I have heard it before and it just didn’t click. Whatever the case may be, it caught my attention.

The context in which Ellis wrote the phrase, “Unbridled democracy in action,” was concerning the gradual removal of Native American tribes by the expanding United States. However, is it not the case that we see unbridled democracy in action, perhaps even more than ever, in America today?

Here I am not necessarily referring to the destruction of a people as an exercise of liberty, although addressing that may be apropos. I am talking about the extension of liberty at the expense of morality and justice. While we all stand firmly on the preservation of liberty, is this not the very principle people use to justify all kinds of deeds?

 

One such deed is abortion under the guise of “procreative liberty”. This is portrayed best, perhaps, in the mistaken ruling of Roe vs. Wade delivered by Mr. Justice Blackmun:

 

“The principle thrust of appellant’s attack on the Texas statutes is that they improperly invade a right, said to be possessed by the pregnant woman [Doe], to choose to terminate her pregnancy. Appellant would discover this right in the concept of personal “liberty” embodied in the Fourteenth Amendment’s Due Process Clause; or in personal, marital, familial, and sexual privacy said to be protected by the Bill of Rights…” (Section V)

 

The ruling did two dangerous things: 1.) Extended the rights of woman based upon an abstraction of the language of liberty in the constitution (I understand Blackmun cited case precedence also), and 2.) Usurped state’s rights.

The first is true because of a soft/fluid interpretation of the constitution. And despite the claims of Mr. Justice later in his delivery of the opinion of the court,  the second is true because the ruling made abortion legal nationally, which demolished standing state legislation across our nation without legislative due process.

Not to mention that this ruling negated the foundational facet of a three-faceted ideal: the right to life, the right to liberty and the right to the pursuit of happiness. What about life?

End of Life Preferences

At the end of life, there are few easy decisions; especially as our ever-expanding capacity to extend life becomes, well, even more ever-expanding. Our ability to extend life is not without consequences. We must consider, among other things, the quality of life, the inherent value of life, the reality of death and, frankly, when enough is enough.

In a study published a couple of weeks ago in the European Heart Journal, a group of physicians set out to determine the “End of Life Preferences of Elderly Patients with Chronic Heart Failure.” The conclusions were not as they expected. Of the 555 patients who were asked if they would be willing to accept a shorter life span in return for living without symptoms 74% were not willing to trade survival time for improved Quality of Life.

If you were given the choice between a shorter life without symptoms and a longer life with them, what would you choose?

Response to Dr. Elkins: On Playing God

Please excuse my annoying pedantry to follow…

 

I have always had difficulty considering any medical decision-making, or for that matter, any decision to justify the use of the phrase “playing God”. Usually when we (those of us involved in ethical discourse) use this phrase we are speaking of some special power with moral consequence over oneself or another. Or simply, meddling with things that are not in our realm.

While I do like the idea of what you (Gary Elkins) say, “I think we play God when we make crucial medical decisions (i.e. decisions with moral consequences) without taking God into consideration,” I find the phrase inadequately addresses the idea we are trying to communicate and that it may be detrimental to our larger cause, for a couple of reasons:

1.)  It seems that we do not take God, that is, as we understand His whole essence, into consideration when we use this phrase.

2.)  It seems that when we use this phrase we are indicating, “playing something other than God” rather than we are “playing God”.

From a Christian worldview we understand God to be loving, just, omniscient (all-knowing), while being (omnipotent) all-powerful. The phrase in question only allows for one part of the being of God, His Power. When we strip away the other attributes of God, we are left with something other than God.

If we were truly trying to, or in actuality, play God in these major decisions of life, we would not just be invoking or abusing power. We would be protecting and preserving life justly.

What we ARE trying to communicate in these situations is that we are attempting to reach beyond our God-given boundaries in support of our interests.

In sum, I think we should use a different phrase to communicate the idea “playing God”. One that conveys our concern for possible abuses, for human dignity, and, ultimately, for the true character of God.

Please excuse the coarseness of my argument in that I don’t offer a real solution, but we need to find new language to communicate this old argument against abuse of power.

I look forward to any thoughts that you may have in response to this proposal.

The Price of Knowledge

Is it ever good to not know? Is all information good information? These questions, I would contend, are at the heart of some of the testing options during pregnancy. Now before I stick my foot in my mouth, I am not referring to any medically necessary tests or procedures for pregnancies. These offer options for therapeutic solutions.

What I am referring to are tests that are in an effort to uncover “birth defects”, such as Down syndrome and Cystic Fibrosis. These two happen to be the most contentious of diagnoses because knowing your developing child has either of them offers no therapeutic solution(s). (I say “therapeutic solutions” because abortions are rarely that and are definitely not in the case of either of these diagnoses).

Opting to receive this particular kind of information during pregnancy does not offer much resolve. There are only two answers that it offers. One is somewhat reasonable and the other is not.

The first answer is so that parents may prepare themselves. This foreknowledge gives parents an opportunity to say: “brace yourself”, but it offers no power or control over the things to come. (I would interject that having knowledge about temporal things we cannot change is often more enfeebling than it is empowering).

The second is to take the life of the child. This “solution” is the real concern. Parents are offered information/diagnoses that leave some feeling as if their only choice is to end the life of a person of potential. This is a travesty that neglects the inherent value of this person, which is abandoned in the act of placing value upon an external instead of the value given by God.