One of the foundations of medical ethics is the importance of truth-telling by physicians. The relationship between a patient and physician depends on the patient being able to trust the physician which depends on truth-telling. When I discuss this with students their expectations are for physicians to be fully and completely honest with their patients.
But what about patients being truthful with their doctors? Recently Time online referred to an article in The Arizona Republic about patients lying to their doctors. It talks about the ways that patients tend to be less than fully honest when they talk to their doctors, and how that can interfere with getting proper care.
It seems obvious that physicians should be truthful with their patients and patients should be truthful with their physicians, but we don’t always do that because it is hard. It is hard to tell a patient something the he or she does not want to hear. It is hard to tell your physician that you are not really exercising three times a week (or your dentist that you don’t floss every day). We want to please other people and have them approve of us, and we don’t want to make them feel bad.
Sometimes, though, we need to do what is hard to do what is right. 1 Cor 13:6 reminds us that love “rejoices with the truth.”
Lately I’ve been discussing infant euthanasia with some of my online students. They are impacted very strongly by the argument from mercy. When they consider an infant who appears to have “hopeless and unbearable suffering” as referred to in the Groningen protocol used in the Netherlands they are convinced that nonvoluntary euthanasia should be allowed if not required. Mercy includes a desire to relieve suffering and the argument for euthanasia says that suffering should be relieved even if that means killing the sufferer.
One of the clearest expressions of mercy in the Bible is Jesus’ parable of the Good Samaritan. In answering a question about how to love your neighbor Jesus tells a story about a man who would be rejected by those who were listening. He finds a man who is beaten and half dead and who has been abandoned by his countrymen. If he were a dog or a horse it would have been appropriate to put him out of his misery, but instead the man cares for his wounds and takes him to where he can receive further care. The man who cared for the other’s wounds is identified as one who showed mercy.
The mercy that Jesus described in the story and provided for others involved hands on care for the needs of those who were injured or ill. It sometimes involved bringing people back to life, but it never involved ending those lives. Paul Ramsey captured Jesus’ attitude well in his ethic of “(only) caring for the dying,” and those who followed in his footsteps expressed it as “always to care, never to kill” (see First Things, Feb 1992)
When we can see the importance of affirming the inherent value of every human life and search for the way to care for those who are suffering including optimal palliative care without violating the inherent dignity of that person we can be like the Samaritan that Jesus identified as a loving neighbor.
Last week I was in the “piney woods” of northern Louisiana. I had thought I would write a blog entry from there, but time and internet access were scarce, so I’m doing it this week. My wife and I were visiting her parents, Aaron and Betty. I have always enjoyed being with them and this trip was no exception. It was also a time to check on how they were doing. They are both in their 80s and have some significant health problems.
On Tuesday Betty’s visiting nurse came to see her, and it made me think of the part of the Hippocratic Oath that says “Into whatever houses I enter, I will go into them for the benefit of the sick.” Physicians don’t take care of their patients in their homes very much any more. There are good reasons why things have changed, but there are things that have been lost.
The nurse who comes out to see Betty is becoming part of the family. They offer her tea and cake and Aaron teases her like he does his daughter.
In the sterile environment of the hospital or office a patient can become a diabetic or an arthritic or a stroke victim. In her home she is the person she really is and it is harder to miss that. Those of us who care for the sick need to remember that what we are doing should be for the benefit of those we care for. Those who receive our care are real people with homes and families who are welcoming the physicians and nurses and others who care for them into their lives just like they would welcome us into their homes.
We need to enter into their lives as respectfully as we would enter their homes and realize we are being accepted as a part of their family.
Interacting with students often reminds me of the importance of some very basic things. Recently I was reminded of the importance of defining the terms we use in bioethics. In reading reviews of case studies by some of my online students I saw how their unquestioning acceptance of definitions influences how they think.
The terms involved were “abortion” and “passive euthanasia” and the definitions were from a textbook by Lewis Vaughn that we use in the course. Vaughn’s text, which I reviewed in the summer 2011 edition of Ethics & Medicine, is generally good at representing a wide spectrum of views on current issues in bioethics, but sometimes some less objective things slip in.
Abortion was defined as “the intentional termination of a pregnancy through drugs or surgery”, which sounds pretty straightforward. From the way a student was using the definition in a case review I realized that the definition would include and equate abortion with such things as the induction of labor for the delivery of a healthy term infant or a C-section to save the life of an infant in distress. The fact that an abortion is a termination of pregnancy that includes the intentional ending of the life of the fetus was left out. That part of the definition makes a big difference.
Passive euthanasia was defined as “allowing someone to die by not doing something that would prolong life.” That is how James Rachels defined passive euthanasia in his classic defense of active euthanasia that was based on there being no moral distinction between active and passive euthanasia. What that definition leaves out is the idea that any euthanasia involves the intent to end another person’s life. This definition of passive euthanasia includes all the times we allow a person to die by choosing not to initiate or continue any possible life-prolonging treatment, but there is a significant difference between allowing a person to die of his or her disease when treatment has become more of a burden than a benefit and doing something with the intent of causing the person to die. Intending another person’s death is the key to what is wrong with euthanasia and leaving that out of the definition makes a big difference.
What’s in a name? The difference between right and wrong.
As I continue to reflect on the recent CBHD conference one of the things that strikes me is the tension that was going on regarding the use of what Dennis Hollinger called thick and thin language in the communication of ethics by Christians. As Christians we have a rich store of moral values that God has revealed to us in scripture and in the person of Jesus Christ. We have access to that moral truth through the Holy Spirit who enables fallen but redeemed people to begin to comprehend these things from the mind of God. Those who are not in Christ cannot begin to understand this foundation of our ethics.
That leaves us with a dilemma. What should we do when we seek to communicate with those who do not have access to God’s resources?
We could strive to always communicate using the fullness of the scriptural and theological language that makes Christian ethics a rich source of moral truth. That is faithful to what we believe and could be a witness of a different way in our largely secular world. It would also be likely not to be understood by those outside of Christ and rejected without an attempt to comprehend it by many whose worldview has no place for the supernatural.
We could use the thin language of philosophical ethics and common morality to try to communicate what we believe about the moral issues of contemporary bioethics. That would stand a chance of being understood by those with a different worldview and could have an impact on issues that we care about. It can also be seen as an abandonment of the fullness of what we believe and have the potential of causing us to lose what is distinctive about Christian ethics in an attempt to be accepted at the table.
I would suggest that we could also use the thin language of common morality to try to bring those who do not accept Christ closer to him while we engage in the public dialog on bioethics. When we enter the public discourse on bioethics all the participants are acknowledging that they consider moral values to be important. They open themselves to the existence of those moral values that God has written on their hearts. If we can help them see the existence of those moral values that have been intuitively understood across cultures and across time, they may then be able to make the step to understanding that we all fall short of those standards and are accountable to the one who made them. That sets up the problem we all have that Jesus came to solve and the gospel can begin to make sense. That was the process used by C. S. Lewis in explaining Christianity in Mere Christianity. I think we can use it today.
The CBHD conference last week was one of the best since I began attending in 2007. One of the things that has stuck with me and that I am continuing to think about is Dennis Hollinger’s thoughts about living in the world in faithful presence, an idea he attributed to James Davison Hunter and his recent book, To Change the World. Hollinger said that the foundation of Christian bioethics is our Christian worldview which many in our society do not share and will not accept. When we look at how we can try to translate the bioethical good that we are able to understand from our Christian worldview into a world that does not accept that starting point he suggested living in the world in faithful presence.
He indicated that there would be several characteristics of that approach. We would focus on honoring God and loving our neighbor. We would have modest expectations of our impact on our culture consistent with the Biblical metaphors of salt, light and leaven. We would need to be bilingual, speaking in a thick fuller language to those who will accept God’s truth and a thin less complete language to those who will not.
I have been thinking about what it means to live in faithful presence in relation to bioethics in our society. For me it includes caring for my patients compassionately and trying to be better at preparing them for the difficult places in life. It includes helping my online bioethics students understand what a Christian worldview is and how it applies to the issues they will face in life. It includes helping students on the Taylor campus see how their faith and how they live fit together.
What does it mean for you?
I’m still thinking about Solomon. I keep coming back to the idea that when God told him to ask for whatever he wanted Solomon responded “give your servant a discerning heart to govern your people and to distinguish between right and wrong” (1 Kings 3:9 NIV). I wrote about the governing part last week, but I keep thinking about his request that God give him the ability to discern between right and wrong. That is the essence of what ethics is all about. Solomon was given that ability because he asked God for it and was considered the wisest person on earth.
The word we use for asking God for things is prayer. I think we sometimes forget the connection between prayer and ethics. It is true that ethics involves our ability to reason, and what we can learn at a place like Trinity is very valuable, but prayer is a key that opens a connection with the one who knows all things and is the source of all we can know about right and wrong. If we want to be able to discern what is right and wrong we should ask God for his help.
In light of the theme of the CBHD conference opening tomorrow let us remember that Christian influence in bioethics and our society will not come about solely by the power of our intellect, the persuasiveness of our arguments, or our political strength. We will influence bioethics and our society when God uses us and the abilities he has given us as instruments of his power in causing his will to be done.
Join me in praying for all those involved in the conference and all of us, whether we are able to be at the conference or not, who are Christians concerned about bioethics. Pray that God will give us the ability to discern what is right and wrong and help our society to do the same.
Sometimes today ethics is seen as a very personal thing. Autonomy is emphasized and morality is about a person making the best decision for his or her circumstances. Solomon’s request when God told him to ask for whatever he wanted reminds us that ethics undergirds the ability to govern well. Solomon’s response to God in 1 Kings 3:9 was “give your servant a discerning heart to govern your people and to distinguish between right and wrong. For who is able to govern this great people of yours?” He reminds us that governing well is based on being able to discern what is right and wrong (ethics). If those who govern choose to believe that there are no objective values and that everyone must do as they see best then it will be difficult to govern well.
May God help those who govern to remember that governing well is based on ethics and being able to discern what is right and wrong.
One of the reasons that I became involved in bioethics and pursued the Masters in Bioethics at Trinity was my concern that many people in the church did not seem to understand the moral issues that they faced when dealing with their own medical issues and those of their family. Abortion was seen as a significant moral issue, but many other important issues were ignored by the church. My approach to making an impact in the church has been to help students at a Christian university understand bioethics so that they can impact the churches that they will be leading in the future. John Kilner has added another way of impacting the church by editing the recently published book, Why the Church Needs Bioethics: A Guide to Wise Engagement with Life’s Challenges.
Attached is a flyer describing the new book. 1 Intro Flier
I want to express my thanks to John and all the others involved for providing this resource to help draw the church’s attention to the ethical issues we all face.
Recently I have been reading the account of David’s life in first and second Samuel. Although he had a close relationship with God, David had his ethical failings. Much of his problems started with his adultery with Bathsheba which he tried to cover up when she became pregnant. His first cover-up attempt failed when he called her husband Uriah back from battle, but he refused to spend the night with his wife while his companions were at war. Next he tried to cover it up by having Uriah killed and taking Bathsheba as his wife. The consequences in David’s life and in his family were devastating.
Cover-ups have been a part of the fallen human response to errors and wrongdoing from the garden of Eden to Watergate.
One of the common ethical issues in medicine is how to deal with medical errors. For most of us our first response is to cover it up. Explaining to a patient that an error was made that has had or could have a bad effect is not an easy thing to do, but reading about David reminds us how bad a cover-up can be.