Bioethics Discussion Blog: April 2006





Sunday, April 30, 2006

The Rights and Wrongs of Rights

Continuing with the topic of rights, I would like to present a commentary about rights by Dr Erich H. Loewy, a physician and ethicist, who gave me pemission to post it on my blog. The questions are: what are rights, what are human rights, what rights do others who are not humans deserve and can a right be a wrong? ..Maurice.

What rights do humans have? May I re-phrase it? What creates a right, how is it created, how assured?

If one is a believer in natural rights than you believe in something you can neither verify nor falsify and will try your best (which may include force) to force others to accept these. This lends itself to any vision be it religious or secular. If we accept "rights" as something all of us together agree to call a "right" and to enforce it, then the story is somewhat different. To me rights are something which we as a community have decided to call a right (whether it is bed-time for Jon or speed limit for Dave) and then to enforce it. Such rights, I would argue, have to have several prior assumptions: (1) that everyone counts for the same; (2) that those who cannot speak for themselves have an appropriate number representing their interest present; (3) that we shall not resort to force, etc. This discussion take place (again in my view) in a framework of capacities and experiences we inevitably share. The building block of the frame are:

-----All of us want to exist (Being)
-----All of us want to have our biological needs vouchsafed.
-----All of us wish to have social needs met. These are different among societies but at the very least amount to medical care and education sufficient to maximize our goals (in our society at lest health-care and full education)
-----None of us want to suffer needlessly
-----All of us have a basic sense of logic. at least enough to know that you cannot be in three places at once
-----Pursue our own talents and interests.

In a discussion among us we would be able to reach some very broad agreements:

-----We cannot destroy or help to destroy this framework or its components.
-----We must have tolerance for other points of view so long as they do not destroy the framework itself.
-----Things like murder, allowing people to starve or go hungry cannot be permitted.
-----Health care and schooling up to any level the individual is capable and desirous of fulfilling, must be accessible to all.
-----We cannot stand by and watch people starving, going ignorant or suffering in ways that society can ameliorate.
-----Develop our talents to the fullest--something that society as well as the individual benefit from.
-----Have a decent livelihood for those who have retired assured.

In such a scheme animals that are sentient beings could not be slaughtered so as to please the taste-buds of these superior (at least in power) creatures called humans.Non-human animals have "moral standing" by which I mean that they have self-awareness, have their own interests, exhibit pleasure and pain, have the neurological substrate that humans have to feel pleasure and pain and somehow have to be figured into the equation. Let me hasten to say:

-----This does not imply that non-human animals lower on the scale then human animals have the same rights as human animals but that there is a transition and a hierarchy of rights and obligations.
-----The rights we as equal members of society we give out are (hopefully) appropriate to those to whom we give this right.
Dogs do not have the right to vote because we the public believe that they lack the capacity to make choices voters have to make. (I am not being sarcastic)
-----Sending an orangutan to college or allowing him/her to vote is obvious nonsense because they appear to lack those human neurological structures necessary to make a reasoned choice.
-----But they appear to have the same interest in living out their lives as human animals. They are self-aware, capable of making choices, capable of experiencing pain or joy, have a memory, etc.
-----It is probably the case that my dog when he sees some flickering light on the right is motivated by curiosity to turn and look and that her imagination than presents her with a number of options one of which she will choose. Humans--at least some humans--go on to puzzle about the nature of light and it seems probable that non-human animals do not.

But none of this would seem to give human animals the "right" to slaughter non-human animals whose interest in being alive so that they can have a life are far more probable than the opposite. In making decisions we are well advised to go with the most probable rather than the least likely. I personally will eat shrimp, crabs, etc. because they lack the substrate which would enable them to have a life. Am I sure that they do not "feel" in the sense that a mouse or I feel? Am I sure that spinach or cauliflower do not feel? No, of course I am not--there is very little if anything that I am absolutely sure of. But with a high probability approaching certainty I think that it is the case that they do not suffer. If someone will show me convincing evidence tomorrow that crabs do have the capacity to suffer or have pain it will do nothing to my theory but simply cause me to stop eating crab.

Research so as to potentially cure disease (of human and non-human animals) is quite another matter than eating flesh which one does because one likes the taste not because one must to survive. To use non-human animals after computer modeling, etc.have failed should be a somewhat lesser evil than using human-animals which not only are alive but have a life. This is the case, I would argue, because we ultimately reach a point at which animal models or research with lower organisms or lower hierarchical creatures failed to yield the vitally needed information. It would be ethically more appropriate (in my opinion) to use Human animals who meet the criteria for a "permanent vegetative or comatose state" (by two independent neurologists) and whose family knows that this is what they wish. Until lately we still had rather crude methods of trying to use in research. Our methods have grown ever more sophisticated and the need for non-human animals has increased.

One of the problems with using animals in research is that there is no way of obtaining informed consent and that this makes interaction with and supervision by a Bioethicist critically necessary. There are some things which arguably are prima facie ethically not acceptable: using animals to test cosmetics (often in their eyes), using living pigs strapped in the front seat of a car to test, etc. Using animals for our pleasure and to their pain (has anyone ever driven along "5" in CA where for several miles cattle are crammed into shed and stand in their own excrement to the knees) is at the very least problematic.

But again--rights are something which in a community and in dialogue with all concerned are given by a legislative body. Habermas communicative ethics gives an idea of what I mean. They may be legally correct but ethically clearly wrong, etc.

Thursday, April 27, 2006

Should Apes Get Human Rights?

From the Spain Herald, Tuesday April 26, 2006.

Socialists: Give apes human rights

The Spanish Socialist Party will introduce a bill in the Congress of Deputies calling for "the immediate inclusion of (simians) in the category of persons, and that they be given the moral and legal protection that currently are only enjoyed by human beings." The PSOE's justification is that humans share 98.4% of our genes with chimpanzees, 97.7% with gorillas, and 96.4% with orangutans.

The party will announce its Great Ape Project at a press conference tomorrow. An organization with the same name is seeking a UN declaration on simian rights which would defend ape interests "the same as those of minors and the mentally handicapped of our species."

According to the Project, "Today only members of the species Homo sapiens are considered part of the community of equals. The chimpanzee, the gorilla, and the orangutan are our species's closest relatives. They possess sufficient mental faculties and emotional life to justify their inclusion in the community of equals."

Though I don’t have any further details yet about this Spanish legislative act, I wonder what my visitors might think about the rationale for giving the simians such rights based on virtual genetic similarity and their "mental faculties and emotional life." ..Maurice.

Saturday, April 22, 2006

Little Boys and Hickory Trees Should be Immortal

In response to the question I posed on the issue of immortality on the
in January 2006 "I wondered if there was a common yearning between man and tree for longevity and/or immortality", my blog visitor, Moof, wrote the following:

My thoughts are: was that a rhetorical question?

Since I'm fairly certain that you're not anthropomorphizing trees - even with quoting Kilmer's stirring poem - I have to wonder exactly what you are asking.

In front my ancient house, is one half of a very old hickory tree. When my husaband's father was just a tiny boy, the hickory tree which had been there for generations before had been reduced by time to a dying old stump. From this stump grew flexible, firm shoots, which the children were loathe to ignore. They made fine bows, or whips ... or so very many entertaining things. This young fellow's mother finally "persuaded" him to stop cutting them down for use in his games with his brothers.

Two saplings grew, and as the seasons turned into years, became a very large double trunked tree, which provided shade for the house, and which scattered its hard, unbreakable fruit on the lawn every other year.

The little boy grew along with the tree, and became a strapping young man who fell in love with a beautiful young lady ... married, settled down, and had a son of his own. This little son, his namesake, played underneath the tree ... picked the nuts to be used in cookies. In time, he also grew into a fine, strong adult.

By now, the hickory tree was so large, that it covered the roof of the house, and had become a shelter from the storm for many tiny creatures.

The young namesake found a woman to love, and the cycle began all over again - all under the same tree.

And now we come full circle, and this latest young man's children have themselves become adults. One night, during a terrible storm, the 2nd namesake of the first little boy heard the tree come crashing down, shaking the ground in its final agony ... and taking with it the dreams and memories of 4 generations.

And then, less than a year ago, the first little boy followed the tree ... tired after a long life of bearing fruit for everyone in his shade.

Maurice, trees are no more immortal than little boys - but they're wiser than little boys. They "rejoice" in what they have, when they have it; they only ask for sunshine and rain ... and they hide any thoughts of immortality within the hearts of little saplings which are cut down to be used as a plaything by little boys.

And such is life.

Today, I received a followup from Moof along with a photograph of her tree. I thought it would be appropriate to share her story with my other visitors. ..Maurice.

Here is the mighty giant, a year to the month after "[...] the first little boy followed the tree ... tired after a long life of bearing fruit for everyone in his shade."

We miss the "first little boy" like a fire in our hearts. He was born 92 years ago, in the room the fallen tree seems to be pointing at. Before him, more than 200 years worth of little boys and girls were born in the same, ancient house.

You can see that half of the double trunked tree still remains, for at least a while longer. It's barely beginning to awaken in the sunshine and warmth of the lengthening days.

You know, I really believe that little boys and hickory trees should be immortal ... Moof

Friday, April 21, 2006

Is it Ethical to Deny a Pregnant Woman the Right to Refuse Unwanted Treatment?

From my currently inactive "Bioethics Discussion Pages", here is another topic that produced some interesting responses from my visitors. The less recent visitor comments are toward the bottom of this post. The ethical question seems to relate to whether the embryo and fetus which presently cannot develop into a baby without being an integral part of the anatomy and physiology of a woman should be considered part of the woman herself. If my blog visitors have their own personal view of the issue, they are welcome to comment. ..Maurice.

It is now a well established right of every competent adult to refuse unwanted medical treatment for their illness. This right has both legal and ethical consensus. This means that a competent patient can refuse to start a treatment or if a treatment is in progress can order that the treatment be terminated. The request can be made in an advance directive such as a Durable Power of Attorney for Health Care or in a "living will". If a patient is incompetent at the time of the treatment then the patient's legal surrogate or the advance directive written when the patient was competent can "speak" for the patient. Physicians must follow the request of the patient in this regard and if they can't, perhaps because of moral reasons, the physician must attempt to get the patient transferred to another physician who will follow the directive. The request to end treatment is valid even if that treatment is life supportive such as respirator treatment and that termination may lead to the patient's death. The one exception to this right is directed at the pregnant woman. In many states within the United States, state laws prevent a pregnant woman from either writing an advance directive or specifically preventing her from ordering termination of life support. Whether the pregnancy is either early or late is not a consistent criterion amongst these laws. An argument that is given as the reason for this prohibition is that states have an interest in the fetus and that interest is to allow the fetus to be born. This interest may be based on the concept that a fetus is a person and may have certain rights independent of the mother. Some have criticized the concept that a fetus is a person separate from the mother and that such a concept would make the mother only a "container" for the fetus. These critics argue that the mother and fetus are one, the fetus depending on the mother for life and development until birth and, indeed, needs a mother after delivery. Also whether "personhood" begins before birth or after delivery is another point of contention. The state's legal argument also may support religious concerns as expressed, for example, in Catholic religious directives. The question is whether this denial of a right of autonomous medical decision-making for a pregnant woman is ethically just or beneficent. What do you think?
Here is the question:
Is it ethical to deny a pregnant woman the right to refuse unwanted treatment including termination of life support while permitting refusal by all other competent adult men or women?


Date: Mon, Jun 21, 2004 5:35 PM From: To:
Although I can see valid points on both sides of the issue, my question is this: who will make medical decisions for the child once it is born? Chances are high the mother of the child. We are not arguing the mother's right to decline/refuse treatment once the child is born. Certain religions and personal convictions refrain individuals every day from receiving treatment for themselves or a family member. If the woman was planning to give the child up for adoption, signing parental rights away already, then the rights of the fetus/unborn child would be up to the adoptive parents/state. However, if the woman intended on keeping the child, it is her right as a parent to decline treatment for her child - regardless of how the medical community may feel about the issue. Our job in the medical community is to not only promote the well being of our clients, but also be an advocate for them without prejudice.
B.Lydick, Northeastern State University Student

Date: Sun, Jun 6, 2004 4:30 PM From: To:
I am a nursing student and also pro choice. My concern is that if we allow this to happen, women will be seen as baby carriers again only. It will put an emphasis on the life of the fetus over that of the mother, similar to the view by many pro life advocates. My fear is that, when this happens, Roe v. Wade takes a giant step backwards.

Date: Wed. Jan 21, 2004 10:38 AM From: To:
I question the term "refuse".
I would accept the term "decline" and regulary recommend that particular term. "Refuse" signifies a force has been directed and someone is having to respond to that force. I can decline to have sex with someone, it is quite another issue to have to refuse to do so.
The "Right to Refuse" has become a legal term of art, but no one has really examined the term from an ethical point of view.
Harold A. Maio

Date: Mon Jun 2, 2003 8:39 PM From: To:
Dear Dr., I read the article and got into a dilemma of my own. I am pro-choice and believe that the women has the right to determine whether or not to keep a pregnancy. If we give women the right to terminate a pregnancy, why would we deny her the right to refuse unwanted treatment? I believe that she should have the right and the doctor can not deny her that right since its violating the patient's autonomy. On the other hand, I believe that the fetus might have rights too. The mother is ready to give up, but what about the fetus who at this time has no voice? It is our job in the medical community to advocate for those who can not speak for themselves. As you can see, I have thoughts on both sides of the coin. How do we determine which side is the right side?

Date: Mon, Jun 2, 2003 4:37 PM From: To:
Greetings, I am a student at Salem State College in a medical ethics class with Pricilla Richardson.
In response to the question of a pregnant woman and her choice to refuse medical treatment, the following thoughts come to mind. The woman needs to decide if she wants to terminate the pregnancy or keep the baby. If she decides to keep the child it should be her obligation to seek prenatal care for many reasons. The care of her own health and the fetus that she is going to have are at stake when lack of health care is provided. The patient that refuses medical treatment during pregnancy should be evaluated to determine if they are competent to be their own guardian. Why should the child suffer because the mother refused to take care of her body during this crucial time?

Date: Wed, May 21, 2003 4:24 PM From: To:
Dear Dr.,
The pregnant woman should not be taken off life support until the fetus has reached sufficient development to be viable outside the womb. Then life support for the mother can be terminated.
Thank you, Mary T. McGuire, Student at Salem State College, Massachusetts

Date: Mon, Apr 14, 2003 3:24 PM From: To:
I do believe it is no longer the right of the women but of the baby from the time of conception on. Who is protecting the rights of the unborn child?

Date: Tue, Apr 8, 2003 11:03 AM From: To:
We allow women the right to have an abortion so what is the difference? Why not allow them to choose what medical treatment they will receive? I disagree with abortion, but for years people have fought for women to have the right of choice. Competent men and women have a right to choose so what makes a pregnant woman any different? We allow her the choice of terminating her pregnancy or continuing it, so why not allow her the choice of what medical treatment she will receive?

Date: Thu, Mar 21, 2002 4:26 PM From: To:
The answer here is strongly shaped by ones views on the beginning of human life. I must point out though that in many situations one persons life or health may hinge on another's but that does not automatically give one control over another's medical decisions. The right of any adult to the control of his or her own body must be considered the most basic of all human rights. If I do not have control of my own body then I control nothing. What if the treatment in question were painful? Would we have the right to insist that a woman suffer pain to allow her child to be born. What then of obstetric anesthesia which may have risks to the fetus. What of the pregnant woman who chooses to use drugs? Should she be imprisoned until she delivers? Yet prison is not a completely safe environment either. What of the pregnant woman who smokes? What of the pregnant woman who is a devout Christian Scientist? Once we start down this road we turn the adult human woman into a biologic incubator

Date: Mon, Feb 18, 2002 7:34 PM From: To:
This is a pro-life topic, looked at from a different angle.
I believe that everyone should be able to refuse unwanted treatment, but for a pregnant female who chose not to abort... I believe that she should do what is best for her fetus. She decided not to abort, to become a mother, and in choosing to be a mother she should put her child/fetus first.

Date: Sat, Feb 9, 2002 4:20 PM From: To:
I believe no one whether pregnant or not, should be denied the right to refuse unwanted treatment. It would be ethically wrong to do so. However, the pregnant women presents an ethical dilemma in that her decision could affect the viability of her unborn baby. This then leads to the question of when life begins and inevitably, the pro-life/pro-choice issue. When a parent refuses to seek medical care for their child , for whatever reasons, the court usually gets involved for human rights reasons and in many cases, becomes the advocate of that minor child. Does the parent then loose her autonomy as a result? Who advocates for the unborn child? At what point does an unborn fetus become a child? When the pregnancy is desired?

Date: Fri, Dec 28, 2001 8:35 AM From: To:
United States Law has consistently upheld that a pregnant woman has the right to terminate the life of her baby through abortion. To deny a woman the right to refuse unwanted medical treatment during pregnancy would be inconsistent with previously held decisions regarding her right to terminate, and would open the door for overturning the current abortion laws.
As far as I am concerned, forcing women, whether pregnant or not, to accept medical treatment is in violation of the 14th Amendment, and could not be defended constitutionally.
Thank you, Judie C. Rall, C.C.E., The Center for Unhindered Living,

Date: Sun, Sep 30, 2001 7:15 PM From: To:
Denying unwanted medical treatment is not a crime, it is a rational personal decision. If a woman is competent, and decides against treatment, she should be able to reserve her personal rights despite being pregnant. More importantly her decision isn't infringing on the rights of any other living person, only on her and her body (including the fetus which is biologically a part of her). Furthermore, to infringe on another person's rights is unethical, and to deny a pregnant woman her rights while allowing others to maintain them is just so.

Date: Sun, Sep 30, 2001 From: To:
If pregnancy automatically removes the autonomy of a woman in any respect, the consequence would be the right of others to dictate her actions in almost every respect, since she and her fetus are one. No adult human being can be ethically stripped of rights in any circumstance.
One might wish to force an unwanted Caesarean Section on a pregnant woman, when one anticipates death for the woman and her fetus if an abnormal labour is left to run its course. However, by extending the same logic, one would imprison a pregnant woman whose lifestyle could be said to put her fetus at aviodable risk, for example, a smoker. If you feel little sympathy with smokers, consider force feeding an anaemic vegan, or attaching a ball and chain to an inveterate hang glider.
We all owe our existence to our mothers. If some mothers do not choose to do as we see fit, we continue to owe them respect.

Date: Mon, Sep 3, 2001 7:38 PM From: To:
It is obvious to me that the issue of treatment refusal by pregnant women raises the same questions as the issue of abortion. It is often a misconception that the abortion issue centers on a woman's right to choose. The issue centers on whether a human being's life is being taken during the act of abortion, not on any right for a choice that could be made before conception. So, the question of whether a pregnant woman has the right to refuse treatment is mostly centered on this same distinction.
My personal opinion is that a woman's right to refuse treatment is overruled by the fetus's right to live. People often make exceptions when it comes to having the right to be free and do as one chooses. These exceptions usually come in when the action of a free person infringes upon another person or persons' lives. Given that I believe in the human status of a fetus, my conscience tells me that the willful destruction of this life is wrong. Although it's difficult to make a black and white distinction between right and wrong in many cases, it seems to me that refusal of treatment would be as murderous as shooting someone in cold blood.

Sunday, April 16, 2006

Physician Discomfort : Some Reasons Why They are Discomforted

If anyone thinks that physicians have some quality of training or experience that prevents them from experiencing or reacting to emotional discomfort, that person is frankly mistaken. The importance of considering physician discomfort is that such a reaction to an incident or condition may lead to the affected physician's temporary impairment of the intellectual function and clinical reasoning. The subsequent behavior and actions may not be appropriate for proper medical care.

The origin of the discomfort may be from many causes. It can range from something as simple as poor scheduling of patients with the physician having to feel rushed to unexpected patient demands or sexually suggestive patient behavior or even dealing with patient’s discussion about what they saw on direct-to-consumer TV advertising. Such acts as being required to perform unfamiliar examinations may discomfort physicians. For a physician to do evaluations, such as disability exams, writing excuses for school, work or jury duty or writing for disabled parking permits are also discomforting since these are actions where there are patient pressures along with legal consequences for the physician which cannot be ignored.

Physician discomfort can involve dealing with families after the patient’s death or in dealing with medical standards that suggest termination of life-support but which is in conflict with the family’s demands to continue therapy or that the physician may feel personally responsible for a patient’s death by signing an order for termination. As mentioned in prior postings, physicians may feel discomfort in being involved in medical management of medical colleagues, other physicians or even nurses or other “very important persons”. Even responsibilities such as attention to the minor health matters of family members may progress to situations where further self-medical management may be discomforting to the physician.

And there are more. There is no doubt that the overarching fear of being involved in litigation with financial and other consequences or loss of license to practice associated with some alleged unprofessional behavior is common to most physicians. This leads to the well-known practice of “defensive medicine” in an attempt to prevent these occurrences and to ease the professional discomfort. Such medical practice can lead to treatment delays, medically unnecessary additional consultations, increased costs and unnecessary risks to the patients.

I hope to write additional posts about physician discomfort and present some references to other writings dealing with this topic. ..Maurice.

Saturday, April 15, 2006

Some Random Thoughts by Ethicists on Truisms in Ethics

I put the topic of truisms in ethics up on a bioethics listserv and got the following responses. Read their commentary. They may stimulate some thoughts on a variety of topics. ..Maurice.

Ethicist and physician, Steven Miles, wrote about the topic of truisms in ethics:

Cloning humans is an bioethics problem. (A truism even the problem itself is unimportant.)

Respect for the principle of autonomy is the highest medical ethics value (True in describing the field but arguable at best as a moral position.)

Another ethicist and physician Dr Erich H. Loewy wrote this commentary about truisms.

If you have doubts as to what the ethical way of proceeding is an ethicist may give you the Answer: There are many false assumptions wrapped in that statement.
· First we must realize that Ethicists are no more "ethical" than others. They merely know what tools and how to deal with them in judging answers as appropriate or inappropriate and things in between.
· Secondly beware of an ethicist who gives you an answer. If there were a "good" answer there would be no problem. Answers in general are rather bad in themselves, words in themselves or simply God awful. Taking a patient off a vent and letting him/her die peacefully is not a good in itself. Curing them would be but that is not attainable. So perhaps this is still the least evil answer in an array of bad ones.
· If you have doubts that is the most important part--for at least you recognize that there is an ethical problem. .
· It really is the job of an ethicist to question prior assumptions, insist that good ethics begins with good facts, and keep raising questions "what makes you say that", "why do you believe such and such to be true", etc.
· Regrettably there is no such thing as a Bioethicist. People who have sat a year on an ethics committee call themselves ethicists. And how can we correct them: we have failed to credential, have failed to set minimum standards, do not police ourselves and fail to discharge our social responsibility (ie; we run a mutual debating society that discusses the problems of "rich man's ethics" but almost never does more than pay lip service to access to health care or to the conditions which breed disease--poverty, crowding, lack of education, a minimal wage under the poverty level, etc. Instead we amuse ourselves with the weighty issue of whom the sperm of a dead man belongs.

Cannibalism is evil: Cannibalism to start with was to symbolically take someone’s strength into ones body-in some cultures enemy in others relative. The missionary being boiled is a fiction. Those who are Christian commit cannibalism every time they take community: symbolic cannibalism in most Protestant sects, actual cannibalism of your group believes in transubstantiation. So, what is wrong with that? It is what I meant by saying we need to examine our taboos, presumptions, etc. and not yield to an ethical imperialism no prettier than any other kind.

Physicians should/should not participate in Capital Punishment:
· Personally I detest the very idea.of capital punishment. Belonging to a society that practices this I am guilty every time someone is executed and state-condoned or ordered murder is still murder. And I don't like killing people.
· But that is beside the point. If the physician believes that capital punishment is a good thing than he can participate in shooting, electrocution or hanging. He/she cannot participate with any of the intellectual or actual tools they learned in the process of their training and which were taught to benefit and if possible not to harm man. Declaring someone dead is learned in medical school and, therefore, should not be done as a regular (and necessary) member of a team which executes on a regular basis.

Friday, April 14, 2006

More on Truisms in Ethics

Continuing with the topic of truisms in ethics, I would like to discuss a couple truisms, which have come to my mind and which the public may be unknowingly assuming are true but like with all truisms, there is another angle when the all facts are presented.

All ethicists are ethical - All ethicists are human and they have all the failings other humans bear. They may have the capacity to analyze ethical issues as a mathematician can solve an equation but when an ethical issue faces them personally, considerations such as self-interest may play a role in their decisions. If bioethics is a professional discipline, it is interesting to note that there is no written code of ethics for this discipline. There has been discussion and concern in the literature about the personal ethics of those ethicists who are employed to provide organizational ethics for various companies including research companies. For example, one issue is whether their employment can effect their decisions.

In ethics, right always trumps wrong, good always trumps bad - But that isn’t always true. First of all, what is right or wrong and what is good or bad can sometimes be only in the eye of the beholder. Ethical decision making isn’t always black and white and often the best solution to an ethical dilemma is perhaps surprisingly..a compromise.

If any ethicists are visiting my blog, perhaps they can also comment on this subject and provide some other examples. ..Maurice.

Thursday, April 13, 2006

Truisms in Ethics And “Why Do Psychics Have To Ask You For Your Name?”

There are many things in life, we might call truisms, that we take for granted, seem so self-evident that we don’t pay attention or try to find out more about them or find another explanation. And when you hear about them, you may ask yourself “why didn’t I think about that before?” Wikipedia defines truism as “In philosophy, a sentence which asserts incomplete truth conditions for a proposition may be regarded as a truism. An example of such a sentence would be: ‘Under appropriate conditions, the sun rises.’ Without contextual support — a statement of what those appropriate conditions are — the sentence is true but uncontestable.” In other words, “there is more to that statement than that!” I think that ethicists are often faced with truisms and the job is to find another explanation. For example, some may say that “the act of a physician turning off life-support is simply killing the patient”. On the other hand (see about “on the other hand” below), maybe removing the life support, at the request of the patient, is simply allowing the patient to die from his or her underlying fatal illness. However, in the context of a relative intent on financial gain, the relative pulling the plug on the ventilator might represent killing. What do you think?

Hans Engel, M.D. has sent me an amusing list of statements which I think may contain within them truisms. Can you find them? ..Maurice..

1. Save the whales. Collect the whole set.

2. A day without sunshine is like....night.

3. On the other hand, you have different fingers.

4. Remember, half the people you know are below average.

5. He who laughs last thinks slowest.

6. Depression is merely anger without enthusiasm.

7. Support bacteria. They're the only culture some people have.

8. A clear conscience is usually the sign of a bad memory.

9. How many of you believe in psycho kinesis?...Raise my hand.

10. what's the speed of dark?

11. When everything is coming your way, you're in the wrong lane.

12. Everyone has a photographic memory. Some just don't have film.

13. How much deeper would the ocean be without sponges.

14. What happens if you get scared half to death twice?

15. I couldn't repair your brakes, so I made your horn louder.

16. Why do psychics have to ask you for your name?

17. Inside every older person is a younger person wondering what

18. Just remember---if the world didn't suck, we would all fall

19. Light travels faster than sound. That is why some people
appear bright until you hear them speak.

20. Life isn't like a box of's more like a jar of
jalapenos. What you do today, might burn your ass tomorrow.


Saturday, April 08, 2006

Ethics and Law: "Two Porcupines Making Love"

Ethics and law: how are the two related. Does one come from another? Does one (for example law) always trump the other (ethics)? Well, back in 2000 Erich H. Loewy, who is a physician-ethicist wrote the following to my now inactive "Bioethics Discussion Pages". I think that in his few words, he has helped me understand that relationship between the two disciplines. What do you think? ..Maurice.

Ethics and the Law
Dr. Erich H. Loewy
Professor and Endowed Alumni Association Chair of Bioethics
Associate, Department of Philosophy
University of California, Davis

In my view (and that is my view and, therefore, may well be wrong) one of the measures of civilization in a society is to see if its laws derive from ethics or if its ethics (or at least its ethos) derive from laws. In my view, the more civilized a society the more is the former the case. Another measure is the protection of the vulnerable within such a society, something which is closely related.

The Nazi example fits -- mark you, I am not saying the holocaust, I am saying the Nazi state. The ethos shifted with the Nürnberg laws so that what was formerly simply not done became doable. The reciprocal influence of law on ethos (not the same as ethics but still the way we feel comfortable behaving) and of ethos on law is evident.

The question, of course, is "how do you translate ethics into law?". As I tell my students: like two porcupines making love: very carefully!!! To translate ethical precepts into laws must, I think, meet at least two conditions. First it should be something about which a wide consensus exists in society (murder might be an example); secondly it should be the doing of which is not only held to be ethically wrong but "threatens the king's peace" (the origin of law, really: in other words something which seriously impacts the peace of the realm).

Example: Most of us would pay lip service to the statement that it is ethically inappropriate to lie to one's spouse. But it doesn't threaten the king's peace and few of us would want it made into a criminal offense (is the death penalty too harsh??)- Murder, in that it threatens the peace of the realm because of vendettas, falls in the same categories. So, in my view, is a social structure which provides all with basic needs: here you curiously enough have something which threatens the public peace but something that there is no wide consensus about (and hence no or no adequate appropriate laws).

Obedience to law is, in my view, not absolute. When important ethical principles are jeopardized by law citizens are confronted with an ethical problem. An attempt to alter the law and, if need be, civil disobedience remains one of the corner stones of democratic process.


(c) 2000,Erich H. Loewy. All rights reserved.

Thursday, April 06, 2006

What Can You Say to Mr. B?

The following is a recent response to the subject of euthanasia on my now inactive "Bioethics Discussion Pages". It is not unusual for a patient to come to the physician's office with a history similar to Mr. B., below. If you were Mr. B.'s new physician what can YOU say to Mr. B.? ..Maurice.

I've been fighting to live for the past 17 years and it hasn't been until the last 3yrs that I've started thinking about how to get it done with.I have periods where I get violently ill the doctors have no clue as to the cause of the spells,nor anything that they can do to help,stop,or treat whatever it is.The only explaination they have is it is a buildup of toxins,or the release of toxins,that are making me so ill.I have just gone through 12-14 weeks of it and more than one nite was spent praying/wishing for the end to come.To get any relief form the nausea,vomiting,aching,and the pain from the tumors/masses from as near as we've been able to determine is some type of bone disease.I've been to Mayo clinic,Johns Hopkins,and the state medical school and every medical facility that thought they might do some good.Not one has been able or willing to do anything to help and several have done more harm than good.I'm no fan of doctors and the games that they play.they should have to live a day in their patients body that are as ill or worse than I have it and then see if they have any doubts about wether they should assist the relief of someone that all they want is relief from the illness they have.I've read the letters from those who think they have any idea of what someone wants that nolonger has any control of themselves,or that is in unbearable pain like I have from the areas of soft bone that the surgeons have described as being like rubber,to areas that have collapsed like the 4 vertabra that partially collapsed 5-6 years ago.I lost 6 inches in height in 30 seconds.I don't dare even discuss the idea of euthansia with any of the doctors for fear that they will take away what little morphine I do get for the bone and tumor pain that I have to deal with 24/7/365.Another problem that I've developed is a resistance to the morphine and every other pain med that I've taken.I may not know what is best for everyone,but from my own positi! on and what I go through every day there needs to be an avenue of some type making availble for those who can't take the pain and sickness they bare some way to get the relief and somekind of end.I would never have let any animal that I've ever had go through the first year of the past 6-8 that I've been through,let alone go this far.We always treat our pets and livestock better than we do our ill family and friends,there is noway that any selfrespecting farmer/stockman would let an animal suffer like we do and those we claim to care about.I'm sick tired and out of any more to say,only that I hope that those who think they know what is best for anyone hasn't likely a clue as to what is best for anyone and sure as hell they've not a clue as what's best for me. B