The End of the Food Pyramid

If you read my recent post entitled “The Human Factory” you may have begun to suspect that I am quite interested in food and the food industry. Connected with this intense passion for food is my interest in nutrition as it relates to physical training. So, when I heard of the new initiative of the US gov’t to reshape the nation through the replacement of the food pyramid, I was overjoyed and bewildered all at the same time.

Here is why:

My reason for being overjoyed is obvious–the current state of America’s health is horrible. This fact has correlative effects upon our health care system (i.e. increased spending on health care and increased demand on physicians).

I am bewildered because I am not sure that these new initiatives will have any impact on American Culture…

What do you think?

Is MyPlate going to be just another trend that fades away with time?

Will this public health initiative help us get out of our current state?

 

Suicide Assistance for Sale

The Oregon Senate recently approved a bill to ban the sale of suicide kits.  It is interesting that this occurred in the first state to legalize physician assisted suicide.  The move was in response to the death of a 29-year-old Oregon man who suffered from depression related to problems with pain and fatigue and took his life using a helium hood suicide kit that he bought by mail order for $60.  The helium hood method of suicide was developed and promoted by Derek Humphry and the kit was sold by a follower of Humphry to whom he refers business.  Humphry, who lives in the same area in Oregon as the man who committed suicide, founded the Hemlock Society that was a primary force behind the passage of Oregon’s assisted suicide law.

Although the Oregon law he helped to pass limits physician assisted suicide to those with a terminal illness, Humphry made it clear in an interview with The Register-Guard, the local Eugene, Oregon newspaper, that limiting assisted suicide to those with a terminal illness is not important to him.  Speaking of this particular case, Humphrey said, “It may be very sad and tragic, but if this man had ongoing health issues and had struggled with that, I wouldn’t criticize his decision.  It was his right.”

The logic of assisted suicide is clear.  If we accept that ending the life of the sufferer is an appropriate response to suffering and that a person who is suffering should be able to request assistance to end his or her life, then there is no reason to limit that assistance to those whose suffering we think is intolerable or who are terminal or who request the assistance from a physician.  A mail order kit fits the logic just as well.

Suicide by Mail Order

Recently The Los Angeles Times reported on Sharlotte Hydorn, the 91-year-old woman who sells mail-order suicide kits for $60.  Her reasoning is that people commit suicide “by jumping out of windows and buildings, and hanging themselves.”  With her kit, the task could be made easier.  As described by Richard Marosi of the Times, Hydorn “peddles a product touted for its deadly simplicity. Inside her butterfly-decorated boxes are clear plastic bags and medical-grade tubing. A customer places the bag over his head, connects the tubing from the bag to a helium tank, turns the valve and breathes. The so-called suicide kit asphyxiates a customer within minutes (Los Angeles Times, May 30, 2011).”

Apparently there is a demand for Hydorn’s suicide kits; individuals, young and old, terminally ill or despondent, have requested the “exit bags” on average 100 per month.  Hydorn is driven, she claims, not by a desire to make money, but by compassion.  From her perspective, to end suffering by means of suicide is the humane thing to do.  It’s not about killing people, she maintains, but about helping people who desire to end their misery.

I must admit that if and only if one removes God from the equation, Hydorn’s point of view carries some force.  After all, as Ivan Karamazov (of Dostoevsky’s The Brothers Karamazov) insinuates, if there is no God, everything is permitted.

So the question is how to argue against the promotion of assisted suicide without simply invoking God as the reason to reject it.  In other words, in a pluralistic society that appeals to a strict separation between Church and State, are the non-theistic arguments against assisted suicide strong enough to withstand the forcefulness of the arguments for assisted suicide?

A Memorial Day Post

Today is the day our nation has set aside to commemorate its fallen warriors. It seems right and fitting that we diverge for a moment from a direct discussion of matters bioethic.

As the saying goes, “Freedom Isn’t Free,” and so, as we enjoy the blessings of liberty, we ought to acknowledge our indebtedness to those who have secured and defended it at great cost. Indeed, we do well to honor on this day those who have made the ultimate sacrifice in that effort and whose number well exceeds 1 million. Our commemoration, then, ought to be marked by a deep sense of gratitude.

We do well, also, to remember those who bear a disproportionate share of the burden of military deaths.  Long after the joy of a soldier’s safe return home subsides, the grief borne by families less fortunate remains. So as we honor the sacrifice of those lost in battle, we also bring attention to the loss experienced by those whose lot it has been to carry on without that son or daughter, that mother or father, that wife or husband, that sister or brother. Our commemoration, then, ought to be marked by a genuine sympathy for those grieving their lost warrior.

Finally, we do well as we reflect upon the sacrifices of past generations to consider the opportunity we have to work for the good of future generations. Some may be called to bear the sword as dutiful agents of the state as our fallen warriors have done, but most of us will not. Even so, as citizens we may all labor mightily to secure for our posterity a nation that embodies in its laws the great value God has placed on human life and liberty. Our commemoration, then, ought to be marked by a commitment to sacrificial service.

 

The Yuk Factor

Bioethics can bring up some interesting topics.  We already conceive children outside the body, and manipulating the brain via implants is becoming more commonplace.  Our bodies are very much part of who we are, and tinkering with them in unusual ways often elicits a reaction of aversion.  We sense that something is amiss, that maybe we shouldn’t be doing what we are doing.  Leon Kass termed this phenomenon, the “yuk factor,” a “deep wisdom” that’s hard for us to put our finger on.  The existence of such a “wisdom of repugnance,” he argues, is evidence of a more basic morality that lies beyond the reasoning we use to construct our code of ethics.  In his view, we should heed this intuition; it may indicate something important.

How do we distinguish this kind of insight from just a disinclination toward the new and different?  Many of the medical advances we enjoy today would never have come into being if someone had not challenged the contemporary thinking on the subject.  For instance, organ transplantation on the surface of things seems a bit bizarre.  If one considers the body–not just the soul–to be a part of the person, breaking its wholeness through the removal of an organ seems harmful.  Naturally, many objected to this new medical technology in its initial stages.  However, after the pioneering work of many doctors in the 1960s, the procedure has become common.  What about xenografts from pigs?  Human organ donation involves the sacrifice of another person, but using an organ from an animal is void of such noble motives.   The interspecies nature of the transplantation makes it seem all the more foreign, increasing the “yuk factor.”  Or, are we just resistant to something that is new, something that hasn’t been done before?  Perhaps decades from now we will find xenotransplantation to be the solution to the organ shortage we face now.

What do you think?  Is a completely rationalistic approach to ethics deficient?  Is the “yuk factor” a valid tool in the crafting of our ethics?  Is this intuition in some way analogous to the conscience?   Or the Holy Spirit’s prompting?  Is “deep wisdom” super-rational, irrational, or something else?  Which contemporary technologies are unusual but necessary and which present harms that call for us to prohibit their use?

 

From Eugenics to Genocide (A Short Walk)

Last week I wrote about the practice of eugenics in modern American obstetrics:  induced abortion performed because prenatal testing shows a potential chromosomal abnormality or birth defect.  This past week, the BBC News Online ran a series of stories under the headline “India’s unwanted girls.”  These stories tell of the practice in India of induced abortion performed because prenatal testing shows a particular unwanted chromosomal “abnormality”:  the presence of the XX chromosome pair, i.e., aborting a baby simply because she is female.  Because of long-standing prejudices and practices, in many parts of Indian society a female child is considered undesirable.  There is widespread availability of prenatal ultrasound clinics for sex determination, and so many parents  avail themselves of  these clinics’ services to guide abortion decisions that in some areas of India there are less than 840 female children for every 1000 male children.  Some Indian activists use the word “genocide” to describe this selective killing of girls.  Lest anyone suspect that Indian families thought up this novel use of medical technology on their own, the following quote from the story provides chilling evidence to the contrary:  “In 1974, Delhi’s prestigious All India Institute of Medical Sciences came out with a study which said sex-determination tests were a boon for Indian women.  It said they no longer needed to produce endless children to have the right number of sons, and it encouraged the determination and elimination of female foetuses as an effective tool of population control.”

Three observations:  First, given the rationalizations for the unfettered right to abortion that pro-choice advocates have promulgated in this country, they would be have to be mute in the face of sex-selective abortion.  They cannot say that it is wrong to abort girls, because if it is wrong to abort girls, then it is wrong to abort boys.  If they admit that it is wrong to distinguish — and extinguish — foetuses on the basis of an arbitrary criterion such as gender, then they would have to admit that it is wrong to do so on the basis of any arbitrary criterion — such as the presence of a disability.

Second, the term “genocide” used by certain Indian activists seems extreme, but it may not be such a long walk from eugenics to genocide.  The justification used to commit foeticide on the basis of gender can be employed to commit foeticide, say, on the basis of  a genetic predisposition to obesity (A 1993 March of Dimes poll found that 11% of parents said they would abort a  fetus whose genome was predisposed to obesity), and is not far from the justification used to commit murder on the basis of whether one belongs to the Hutu or Tutsi tribe.

Third, this tragic story shows yet again what happens when medicine abandons its Hippocratic ethos of commitment to the patient and instead uses its considerable power to pursue goals such as “population control,” social stability — or eugenics.

 

Roger Abdelmassih–Rapist, Trickster, or Doctor?

Did you hear about this?

Roger Abdelmassih [IVF Doctor in Brazil] is on the run from police after being convicted of sexually assaulting or raping 39 female patients at his clinic.”

I had nearly forgotten about this horrible story when it hit the news again after a few month lapse. But it never fails, every time this kind of news event (a corrupt caregiver manipulates his position) comes to the public eye, I begin to wonder:

What about the Hippocratic tradition/oath?

With the oath in mind, can “physicians” like Abdelmassih really be considered physicians at all?

After all, Abdelmassih no longer sought to heal, cure and care for his patients. He used his technical knowledge to his own advantage and abused the sacred bond between caregiver and patient. To say it bluntly, he manipulated and abandoned the nature of the craft.

Clearly he is not the rule in the field of medicine.

Nonetheless, this gives rise to a number of familiar concerns with the abuse of power/knowledge in an already complex relationship.

Do you think this has any resonating concerns within the entire field of medicine or is this just one extreme case?

 

Love and Respect

A fellow family physician who cares for people at a clinic in Central America wrote about the death of one of her long-time patients in an e-mail last week.  The woman came to the clinic barely able to breathe and with her heart failing.  As they tried to stabilize her to take her to a hospital for further care, she knew that she was dying and requested not to be taken there.  She said “I want to die here, with the people who loved and respected me, my clinic.”

She expressed the understanding that there are some things that are more important than having the ability to treat diseases effectively and extend people’s lives.  We should strive to provide high quality, effective medical treatment, but caring for people is more than that.  It includes loving them and showing them respect as sisters and brothers in the human family.

All of our patients eventually die.  When they do will they know that they were loved and respected by us as we cared for them?

Liberal Politics and the Failure of “Neutrality”

In America, liberal political philosophy has been the dominant political influence in almost every arena of public life including bioethics.  Liberal politics promotes the principle of “neutrality,” the notion that, in pluralistic societies (i.e., societies where there is widespread and deep disagreement about basic questions of morality), laws and policies should not support any particular vision of what is good.  This minimalist view of morality limits or dismisses any appeal to specific religions justification when making bioethical decisions.  Consequently, the suggestion of grounding ethical reflection on a particular belief system is deemed a bad idea because it favors one particular moral perspective over other perspectives.  The main concern of politically liberal society is to ensure social cooperation between diverse members of a society.

This creates an inevitable demarcation between public policies and private convictions.  Thus, anyone with religious convictions must maintain those principles in his or her own private sphere; public expressions of private beliefs are not welcome in the liberal society.  Unfortunately, liberal political philosophy’s principle of neutrality does not provide a way to settle ethical questions.  On the one hand, there is a crying need for moral direction; on the other hand, moral guidance from a religious perspective isn’t welcome.  Accordingly, we have medical questions that require resolution but, by reason of political liberalism’s support of neutrality, there is no particular point of view that can become the standard in bioethical matters.  The negative consequence of neutrality is an inevitable deadlock; medical ethical decisions have to be made but our laws and policies lack any defining understanding of what is good.  Yet in order for a society to function, it must devise some means to achieve a common ground.  It is thus a question as to how a pluralistic and polarized society should proceed in the absence of a moral consensus.

I honestly see no workable solutions to this predicament.  How do you think things will unfold in the coming years?

Confession of a Eugenicist

 

I have a confession to make:  I am a eugenicist.

 

I am a family physician who provides obstetrical care.  I love taking care of moms and babies.

It has insidiously become the Standard of Care to offer to all pregnant women testing that will inform them whether there is an increased risk that their unborn children have certain genetic abnormalities or birth defects.  If I do not offer these tests to all pregnant women, I am considered to have provided substandard care, and the wrath of a society that tolerates Nothing But The Best will descend quickly upon me.  If I do offer these tests, I am practicing “Good Medicine” — and eugenics.

 

How did eugenics become Good Medicine again?

 

I don’t want to practice eugenics.  Yet I am compelled to by the Standard of Care;  and the Standard of Care is shaped by the existence and marketing of these tests.  It’s the old story in our technophilic society:  we are constrained to use a technology merely because the technnology exists.

 

Why were such tests even developed in the first place?  Was it only for diagnostic purposes,  simply to provide information to prospective parents?  Of course not.  Clearly these tests were developed to help guide therapy;  and because the primary “therapeutic” option is induced abortion of fetuses who are not up to snuff, it seems equally clear that eugenic considerations drove their development.  So, the eugenic ideal drives development of eugenic technology, which, marketed and disseminated, drives the Standard of Care, which drives what I do in my office and provides the ammunition for the licensing board — and malpractice lawyers — who are looking over my shoulder.

 

Thus am I an unwilling eugenicist.  Thus am I compelled to do the dirty work for the eugenicists of our society.

(This is not to say that all parents who opt to undergo this testing do so for eugenic purposes.  I realize that some do so solely for diagnosis.  I am writing here about the development and mandatory offering of such tests.)

 

Maybe the time has come for a new  medical association.  Instead of the AMA, perhaps we should inaugurate the HMA:  the Hippocratic Medical Association, the members of which will adhere to a different Standard, who will pledge to uphold the ideals behind the Hippocratic Oath.  The members of this association would return to the ethos of that Oath which, according to anthropologist Margaret Mead,  marked one of the great turning-points in the history of the human race, because, “For the first time in our tradition, there was a complete separation between killing and curing . . . One profession . . were to be dedicated completely to life under all circumstances, regardless of rank, age, or intellect–the life of a slave, the life of the Emperor, the life of a foreign man, the life of a defective child . . .”