I am backed up on Comments of the Day again, especially embarrassing after I announced that I would be posting one a day if possible. Getting one of the comments in the queue last night required trying to use my netbook while watching the Westminster Dog Show with my old Jack Russell feeling insecure and cuddling in my lap. The Update will be late today.
The post about the Oregon hospital being bullied by the local ACLU into placing an illegal immigrant on its transplant list simultaneously raised medical ethics issues and illegal immigration ethics issues, so I am grateful that Zoltar Speaks! resuscitates the topic with his comment. I am particularly greateful for his raising the question, “Is the perception of an action what makes the action ethical, or is it the motives behind the action that makes the action ethical, or does it take both?”
My answer, which I think I have made clear over 80,000 posts, is that it is what an action does or can reasonably be expected to do, within the intention and goal of the actor, that makes conduct ethical or not. Unanticipated and unanticipatable results don’t count, and neither does pollution by non-ethical and unethical motives mixed in with the ethical motives, unless they warp the conduct and the decision to engage in it.
There are exceptions, of course.
Here is Zoltar Speaks’ Comment of the Day on the post, Proposition: An Illegal Immigrant Is Entitled To Receive A Life-Saving Organ Transplant That Otherwise Would Go To A U.S. Citizen In Similar Need:
On one hand there is the Hippocratic Oath that directly implies that medical need trumps things like legal status, so in that regard the policy change is a direct reflection of the core of the Hippocratic Oath and it can be said that they changed their policy to reflect the ethical core of the Hippocratic Oath and present that argument to the public and their actions on the surface can be regarded as ethical. (Yes it’s a run-on sentence)
On the other hand there is the fact that illegal immigrants are literally taking advantage of a near “border-less” country and existing systems in place across the United States that ignore their legal status will allow them to do whatever they want regardless of the fact that they are in the United States illegally and some existing systems in place that actually help them do anything they want because they’re illegal immigrants. The United States has been, and still is, enabling illegal immigrants and this policy change is another system changed that enables illegal immigration.
This leads me directly to a topic that we’ve talked about on Ethics Alarms in the past: is the perception of an action what makes the action ethical, or is it the motives behind the action that makes the action ethical, or does it take both? If I remember correctly, I think the general consensus was that it’s the perception of the action that makes it ethical.
The perception of this action is two fold; first ethically complying with the intent of the Hippocratic Oath and second it’s another policy change enabling illegal immigration.
Using the Hippocratic Oath argument to change a policy is a very strong argument under certain circumstances, however this change was not done in a “vacuum”. If this policy change had been done in what I called a “vacuum”, meaning a full review of policies was done without outside influence and the policy was changed solely to better conform to the Hippocratic Oath, no one would have bated an eye at the change and it’s not likely that we’d be discussing it at all. In the vacuum both the motives of the action and the action itself could easily be considered ethical; this is not what happened.
This policy change was not in a vacuum, this policy change was done due to social justice warriors “attacking” the institution to publicly shame the the institution into changing their policy to advance one particular group of people beyond the reasonable expectations that were in put in place with the previous policy. I can easily look at this policy change and say that the motives behind the action far outweigh any perceived ethical value of the action. In this case, kowtowing to the outside pressure of illogical social justice warriors enable both social justice warriors and illegal immigration, the Hippocratic Oath argument in this particular case is nothing but a rationalization.
For what it’s worth; I am really angry that the United States federal government has turned a blind eye to illegal immigration for many years through many administrations and allowed this problem to get worse. Sure administrations and campaigns have mouth the words for years that something needs to be done about the illegal immigration but they’ve done nothing to actually solve the problem and the result is that the problem persists and has gotten worse over the years. Now we are in a hyper politically charged political environment inflamed by ignorant social justice warriors (SJW) that are completely blind to any logic outside their emotionally charged arguments and it doesn’t matter one bit what anyone does to fix the illegal immigration problem, the solution will be smeared by illogical SJW’s. This is the direct result of the deliberate dumbing down of America
EC wrote above, “I’d expect that even if doctors don’t care about legal residence, wouldn’t an illegal immigrant simply be deported once they were identified? Would that not remove them from the recipient list anyway?”
Therein lies just one of the real problems in the United States, this is not being done. If this were to be an active policy then illegal immigrants would catch wind that they will be deported when they’re identified and that will slow illegal immigration to a crawl and as illegals are deported it will start reversing the negative effects on our society due to illegal immigration.
If you are a reader who is an illegal immigrant, I have absolutely no sympathy for you, so stop your whining. You are the problem not the law(s) that you refuse to comply with. Take the legal steps to become a United States citizen or voluntarily get out of our country or be deported when you’re identified as being illegally here. The choices are yours not ours, comply with the law or suffer the consequences.
Ethics Alarms 
I had several comments, but for some reason, I’m going to listen to my macabre sadistic voice today to show my compassionate side.
New Rule: Illegal Immigrants can be added to the donation registry, however all illegal immigrants are 100% automatically, always and forever, organ donors.
Thanks for the COTD.
Jack wrote, “…it is what an action does or can reasonably be expected to do, within the intention and goal of the actor, that makes conduct ethical or not. Unanticipated and unanticipatable results don’t count, and neither does pollution by non-ethical and unethical motives mixed in with the ethical motives, unless they warp the conduct and the decision to engage in it.”
That is worded far, far better than the lacking general consensus I shared. Thank you for making that clearer for me and anyone else that might have been a bit foggy on that.
Overall I agree this is a great comment and I totally agree with the illegal immigrant aspect of it. I want to point out though, that it was the ACLU and not anything related to the Hippocratic Oath that generated the publicity that caused the Oregon Health and Science University to cave in and change their rules regarding eligibility for transplant. That was an administrative, not a medical decision. The Hippocratic Oath deals primarily with the obligations a physician has toward the patient. The Oath does not imply that medical status trumps legal status and says nothing about who must be accepted as a patient. It does imply that once someone is a patient their legal, financial, or other status should not change how they are treated. The Hippocratic Oath has no legal standing and should not be used as a basis for policy or law other than in the sense that some of the precepts of the Oath reflect good ethical values and appropriate medical decision making.
Just for information purposes, there are various versions of the Oath. The original Greek version prohibits a physician from causing an abortion, doing surgery, and giving anyone a lethal drug. The modern version, often called the Lasagna version after Dr. Louis Lasagna who wrote it, is the version most often used now. It leaves out all mention of abortion and there is no promise to do no harm or never to give a lethal drug.
I want to give a condensed version of a comment I made on the original thread about who should make the rules regarding eligibility for transplantation. My belief is that eligibility is not just a medical decision but must reflect what society wants. Doctors can provide guidance on who needs a transplant, how sick they are, their chances of surviving surgery, and other such medical matters but I don’t feel doctors alone should make the God decision of who lives and who dies. By the way, if Silvia were deported as she should be, it would not mean that she couldn’t have a liver transplant. There is a liver transplant program in Mexico.
I inserted the Hippocratic Oath part of the discussion here. At first it seemed like a valid point to insert into the discussion, then I thought more about it. I also heard someone else talking about it a couple of days ago saying that it was a Hippocratic Oath thing. The more I thought about it, the more I understood that the Hippocratic Oath was just being used as a rationalization.
John Billingsley wrote, “The Oath does not imply that medical status trumps legal status and says nothing about who must be accepted as a patient.”
Are you sure about that?
Not a lawyer, but I can’t read anything into either version that requires accepting any particular person as a patient. The closest I can come is in the Lasagna oath which has the statement “I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.”. This basically tells me I should use my skills for the benefit of mankind in general but doesn’t require me to individually treat any specific person. Not all physicians are even nominally bound by the oath because not all medical schools give the oath as part of graduation.
The reality is that the oath is not legally binding in any way other than that some laws might require the same things as the oath. The law always trumps the oath. For example, both versions of the oath prohibit a physician repeating information a patient gives in the course of treatment but the law can compel divulging most information and in some cases makes it a crime if one does not actively report certain information. While the Hippocratic Oath is important in the history of medicine and provides some good precepts, it does not govern the practice of medicine as some lay people believe it does. The “oath” all physicians must follow today is the statutes which govern medical practice in their state, applicable federal laws, and if they are employees, the lawful rules of their employer.
John Billingsley wrote, “…I can’t read anything into either version that requires accepting any particular person as a patient.”
Operative word “requires”.
I agree.
John Billingsley wrote, “While the Hippocratic Oath… does not govern the practice of medicine as some lay people believe it does.”
Very true.
John Billingsley wrote, “The Oath does not imply that medical status trumps legal status and says nothing about who must be accepted as a patient.”
John,
I put one phrase in that oath in italics because I think it does imply that the person taking the oath is to ignore anything except the medical needs of the sick person and the sick person shouldn’t be turned away.
It’s really is okay if we just disagree on the implications of that phrase, but it might be interesting to continue this discussion a bit further.
Zoltar,
I forgot to refresh before I posted the reply to your first comment. I agree that phrase implies that when treating a sick person a physician should ignore everything about that person that does not pertain directly to their specific medical treatment. But I don’t think it implies that no one can be turned away. If it means that everyone who is ill must be accepted as a patient, then no doctor can turn down anyone they are qualified to treat who is ill and wants to see them. But a doctor has only so much time in a day to treat sick people. If the number of sick needing treatment exceeds the physicians availability to see them (and for the majority of doctors I know it does), then someone of necessity must be turned away. The only question is how to decide who to accept and who to turn away. The law actually does not require a private physician to accept any person as a patient and provides that they can fire anyone they are seeing for any reason although there are some specific requirements about how it must be done.
John Billingsley wrote, “I forgot to refresh before I posted the reply to your first comment.”
No problem, I do that all the time.
John,
Although I think that “who must be accepted as a patient” and “no one can be turned away” are similar, I don;t think they are equivalent; I’m also not sure you were implying that they are.
“I will apply, for the benefit of the sick, all measures [that] are required” can easily mean that what’s required is to refer a patient to a doctor that is not overloaded with patients, or specialist, or even an emergency room. I really wouldn’t expect an Ear Nose and Throat Physician to accept a patients that are in need of knee surgery or a transplant surgeon to accept patients that are looking for a psychiatrist, etc. Many Physicians in the 21st century have become very specialized and they understand that this limits their capabilities outside their specialty, they in-turn refer and ask questions of other physicians when needed which is also covered by “I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.”
Sometimes accepting a patient, or not turning away a patient, simply means to put them on the appointment schedule waiting list, or if the need is more immediate, refer the patient to a unoccupied or better qualified physician to meet the immediate needs of the patient; I think that falls within “I will apply, for the benefit of the sick, all measures [that] are required”.
We are “kinda” saying the same thing, just from a different perspective.
Well I’m not sure where this illegal alien is from but there is now the option of going back to Mexico to get it done: https://mexiconewsdaily.com/news/liver-transplant-is-a-first-for-mexico/
Another item to add to the list of things those who are sick and tired of inaction by the federal government: Deport all who publically flaunt their illegal status. We all know now that 46-year-old Silvia Lesama-Santos is here illegally, where she is and what she looks like. INS has everything they need to act. Yet they’re not.
Matthew, INS (ICE) will NOT act against a “celebrity” (read “activist”) because of the bad PR. They will be accused of not being politically correct (racist).
Who will accuse them of racism?
And that is part of the problem. Put them in the shadows they chose.
Long years ago, during the younger Bush Admin, illegals were holding rallies in cities for some reason, I forget what exactly. One such was announced for downtown San Antonio.
I called INS and told them I would like to report a large number of illegals.
They were interested, mildly, until I gave the the date, time and location of the rally. Uhhh, we don’t do that…
Follow the efffin law, or change it.
Matthew B wrote, “Deport all who publicly flaunt their illegal status. We all know now that 46-year-old Silvia Lesama-Santos is here illegally, where she is and what she looks like. INS has everything they need to act. Yet they’re not.”
Deporting anyone that is actively under doctors care to literally save their life would be immoral. Deporting in such cases would literally be a death sentence unless arrangements have been made in the country being deported to to transfer all their treatments to an “equivalent” physician and medical institution.
Congrats.
“I am backed up on Comments of the Day again, especially embarrassing after I announced that I would be posting one a day if possible.”
I must’ve missed the post where you announced that. Dang. I better step up my quality.