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Comment Of The Day (1): “Observations On Britain’s Charlie Gard Ethics Fiasco”

I thought that the Charlie Gard story would stimulate some excellent thoughts on ethics and public policy from readers, and for once I was right. This is the first of two superb Comments of the Day it generated, and there were several others as well.

Here is Ryan Harkins’ Comment Of The Day on the post,  “Observations On Britain’s Charlie Gard Ethics Fiasco.”

The idea of the state telling me I could not seek medical aid for my child when I had both the money to pay for it and a provider willing to give me the services is terrifying. My sixteen-month-old daughter has been receiving the majority of her sustenance through a feeding tube for the past six months. Prior to that, we had been struggling to get her to eat enough calories so that she would gain just an ounce or two, only to find that weight gain vanish when she caught a cold or a stomach bug. Granted, the gastroparesis she suffers is not a severe condition, but without the feeding tube she would risk starving. The thought that the state might step in, tell me that they not only would not pay for my daughter’s tube and care any more, but also expressly forbid me from feeding my daughter through the tube, makes me shake uncontrollably. If I have to fight for my daughter without the state’s help, fine by me. But for the state to forbid me from fighting for my daughter? That is unconscionable.

However, at this time, I don’t have to face that issue. I live in a place and a time when I don’t have to contend with general threat, and my daughter’s condition is not terminal and readily treatable. I hope that my child-rearing and my fear for my daughter helps me to have empathy for the parents of Charlie Gard. I also hope that I can step back away from the emotional turmoil this issue raises and try to understand what is happening here.

The principle dilemma in the case of this poor baby boy lies in the fundamental tension between the fact that human dignity demands we do fight for life, while at the same time we know that we will all ultimately die. Because human life bears an intrinsic dignity, its wrong to deprive a human being of what it needs to survive. Because all humans ultimately die, it can become, through the use of extreme or unethical means, against human dignity to fight against death when death is inevitable.

Why would it be wrong, in some circumstances, to keep fighting against death? The most clear-cut examples are when the means of preserving life are unethical. Bathing in the blood of virgins, selling one’s soul to the devil, killing an innocent to harvest his organs, transferring one’s consciousness into the unwilling body of another — all these (fantastical as some of them are) represent tactics to extend life that obviously violate ethical principles.

What about less obvious examples? Let’s consider a man in a coma. His state is persistent, perhaps even vegetative, but his body is capable of processing food and drink, although he is incapable of eating and drinking orally. A feeding tube could provide him with all the nourishment he needs, and he could be kept alive for years in such a fashion. To stop feeding him through the tube would be to deliberately deprive him of sustenance he needs to survive, and thus would be unethical. Death is not inevitable in this case, except in the most sweeping sense.

In times past, a feeding tube would not have been possible, or if possible, not recommended because of infection, and thus this would not have been a serious alternative. Absent any means of delivering food to the man in the coma, no one could be faulted for not providing food. And if trying to use a feeding tube would actually kill him quicker, or have negligible effect, then the extreme measure of using a feeding tube would not be ethical. However, since we are at time with the technology that makes the use of a feeding tube fairly easy and safe, we no longer have that excuse to deprive a person of nutrients.

What about a slightly different case, when the man in the coma can no longer process foods even through a feeding tube? Then providing food actually causes harm without any gain. Perhaps nutrients could be provided through an IV, but one would be justified, and perhaps is even obligated, to stop providing food through the feeding tube.

Now, the most challenging cases are when a person is terminally ill, but there are procedures that exist that can extend life. To what extent are we obligated to provide care? It depends on the nature of the treatment, the cost of the treatment, and the effects of the treatment. A person is fully justified in accepting that death cannot be stopped and let the terminal illness run its course. A person is not justified in taking steps to deliberately end that life, but is justified in procuring palliative care that eases the pain of the dying, even if it hastens death. But one is not obliged to pay for or undergo an extensive, dangerous, expensive procedure that will not provide a cure, but only a short extension of life.

It should be clear, though, that just because one is not obliged to pay for or undergo extreme care, it does not follow that one is obliged to never pay for or undergo such procedures. If a person has the money and desire to attempt such care, and that care is available, that person should not be denied.

Is there any instance, then, when that person could be denied that extraordinary care? Again, we are assuming that the person can pay for it and the care is available, so we aren’t discussing an instance in which the terminally ill patient is displacing someone else’s care.

I personally cannot think of an instance in which we could rightly deny that care. What I do know is that, in Catholic theology, death does not mark the end of the existence of a person. The soul survives death, and the soul will be reunited with the body at the Resurrection. There is danger in pursuing treatments at any cost, and that danger lies in the denial of the afterlife. That has consequences for one’s eternal soul. Continue reading

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Filed under U.S. Society

Observations On Britain’s Charlie Gard Ethics Fiasco

A recipient of Great Britain’s national health care, infant Charlie Gard was born with  a rare genetic condition resulting in what is probably irreversable brain damage.  He cannot move his arms or legs, eat or even breathe without a ventilator.

After 10 months of being kept alive, Charlie’s caretakers, the Great Ormond Street Hospital for Children in London, announced that it was time for Charlie to die. Chris Gard and Connie Yates, Charlie’s parents, wanted to take him to the United States to try an experimental treatment available here. The doctors at the hospital refused to allow them to take the child, and vetoed their decision, even though the parents had received sufficient funds from donations to pay for the effort.  In  the resulting lawsuit, British courts sided with the hospital. The parents then brought the case  to the European Court of Human Rights, which declined to hear the case last week. The previous court rulings that it was in Charlie’s best interest to withdraw life support and that the state, not the parents, got to make this life and death decision stood.

The  parents, Chris Gard and Connie Yates, appeared on a video this week,, sobbing and saying their son would be removed from life support at the hospital. “He’d fight to the very end, but we’re not allowed to fight for him anymore,” Gard said in the video statement. “We can’t even take our own son home to die.”

Initially, the hospital would not delay the fatal  disconnection of the child from life support so family members could gather and say goodbye. It has since relented.

Observations: Continue reading

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Filed under Around the World, Bioethics, Childhood and children, Ethics Alarms Award Nominee, Ethics Dunces, Government & Politics, Health and Medicine, Law & Law Enforcement, Religion and Philosophy, Rights

Two Unethical And Unconstitutional Laws On Guns, One From The Right, One From the Left, Bite The Dust. Good.

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I.

As last year’s flat-out demagoguery about banning gun ownership for citizens placed on the FBI’s no-fly list proved, Democrats will never let the Constitution get in the way of an emotion-based attack on gun rights. A rule  implemented by former President Obama after the 2012 Sandy Hook shooting (“WE HAVE TO DO SOMETHING!!!”) would have required the Social Security Administration to report the records of some mentally ill beneficiaries to the FBI’s National Instant Criminal Background Check System. Those who have been deemed mentally incapable of managing their financial affairs — roughly 75,000 people — would have then been prevented from owning guns.

The American Civil Liberties Union and advocates for the disabled opposed the restriction, which was so broadly drawn that an Asperger’s sufferer could have his Second amendment rights taken away. And what, exactly, is the link between not being able to handle one’s financial affairs and violence? Hell, I can barely handle my financial affairs.

By a 57-43 margin, the Republican-led Senate voted last week  to repeal the measure, and it now heads to the White House for President Trump’s signature.

Iowa Sen. Chuck Grassley, a leading Republican critic of the rule, said that it was filled with “vague characteristics that do not fit into the federal mentally defective standard” that could legally prohibit someone from buying or owning a gun. “If a specific individual is likely to be violent due to the nature of their mental illness, then the government should have to prove it,” Grassley said

Sen. Chris Murphy, a Democrat from Connecticut where the Sandy Hook massacre occurred, and thus obligated to grandstand regardless of the fact that he’s on shaky 2nd Amendment, 5th  Amendment and also Equal Protection  ground, declaimed on the Senate floor,

“The [Congressional Review Act] we have before us today will make it harder for the federal government to do what we have told them to do for decades, which is to put dangerous people and people who are seriously mentally ill on the list of people who are prohibited from buying a gun….If you can’t manage your own financial affairs, how can we expect that you’re going to be a responsible steward of a dangerous, lethal firearm?”

Well, I guess nobody in Congress should own a gun either, right, Senator? Continue reading

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Filed under "bias makes you stupid", Childhood and children, Citizenship, Ethics Train Wrecks, Facebook, Government & Politics, Health and Medicine, Incompetent Elected Officials, Law & Law Enforcement, This Helps Explain Why Trump Is President, U.S. Society

The Doctor, The Emergency And The Flight Attendant: A Depressing Ethics Tale With No Ethical Resolution In Sight

Was it race, gender, youth, all of them, or none of them?

Was it race, gender, youth, all of them, or none of them?

Tamika Cross, a young OB-GYN flying Delta from Detroit to Minneapolis,  heard flight attendants calling for medical assistance when a passenger  man two rows in front of her was found to be unconscious. Dr. Cross raised her hand, only to be told, according to Cross’s subsequent Facebook post on the incident, “Oh no, sweetie, put your hand down. We are looking for actual physicians or nurses or some type of medical personnel. We don’t have time to talk to you.”

Cross says she tried to  explain that she was a physician, but was “cut off by condescending remarks,” from the attendant. A moment later, when there was a second call for medical assistance and Cross again indicated that she was ready to help, the same flight attendant said, according to Cross, “Oh wow, you’re an actual physician?” She then quizzed Cross  about her credentials, area of practice, and where she worked. In the meantime, a white, middle-aged male passenger appeared, and Cross, she says, was dismissed.

On her now viral Facebook post, Dr. Cross concludes:

“She came and apologized to me several times and offering me Skymiles. I kindly refused. This is going higher than her. I don’t want Skymiles in exchange for blatant discrimination. Whether this was race, age, gender discrimination, it’s not right. She will not get away with this….and I will still get my Skymiles….”

What’s going on here?

Stipulated:

1. This was an emergency situation.

2. Dr. Cross sincerely felt insulted and treated with disrespect.

3. She also feels that she was the victim of stereotyping,, bias and prejudice.

4. Her account can be presumed to be an honest recounting of how she experienced the episode.

5. The Roshomon principles apply. We do not know how the flight attendant perceived the situation as it developed, and will never know, since the incident is already tainted with accusations of racism.

6. This was an emergency situation.

7. There is no way to determine what the flight attendant was thinking.

8. Despite all of the above, observers, analysts and others will be inclined see the event as confirmation of their own already determined beliefs and assumptions.

9. This was a single incident, involving a set of factors interacting in unpredictable ways.

Next, some ethical observations…. Continue reading

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Filed under Ethics Alarms Award Nominee, Facebook, Gender and Sex, Health and Medicine, Journalism & Media, Professions, Race, U.S. Society, Workplace

KABOOM! An Unethical Quote Of The Week So Outrageous That It Made My Head Explode…By Ben Carson

headexplode

“If Melania’s speech is similar to Michelle Obama’s speech, that should make us all very happy because we should be saying, whether we’re Democrats or Republicans, we share the same values. If we happen to share values, we should celebrate that, not try to make it into a controversy.”

Dr. Ben Carson, making an absurd but original argument to justify Melania Trump’s plagiarism.

What?

WHAT???

Observations while I clean up bits of my skull and brain and get the superglue: Continue reading

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Filed under Character, Ethics Alarms Award Nominee, Ethics Quotes, Ethics Train Wrecks, Government & Politics, Kaboom!, Professions

What Lawyers Can Teach Doctors About Ethics

So THAT'S why they wear masks!

So THAT’S why they wear masks!

Sandeep Jauhar is a cardiologist, the author of “Doctored: The Disillusionment of an American Physician” and “Intern: A Doctor’s Initiation.”and a contributing op-ed writer for the New York Times. He recently penned a column for the paper that raised concerns about threats to doctor-patient confidentiality, specifically from the case, in Washington state, of Volk v. DeMeerleer.

Howard Ashby, a psychiatrist, was sued after his patient, Jan DeMeerleer, shot and killed an ex-girlfriend and her 9-year-old son before shooting himself.  The estate of the victims, Rebecca and Phillip Schiering sued Dr. Ashby, alleging that he breached a duty to warn DeMeerleer’s victims even though the killer had made no specific threats toward the Schierings during his treatment.  Last year, however,  that judgment was reversed by an appeals court, which held that doctors could be required to warn “all foreseeable victims” of their potentially dangerous patients in their care.

It’s a terrible decision, and Jauhar does a good job explaining why. Unfortunately, he also writes this..

“I once took care of a business executive in the emergency room who had hired call girls during a weekend drug binge. When he saw a police officer outside his room, he quietly handed me an envelope containing a large amount of white powder. I wasn’t sure what to do with it, so I discarded it. For the next several hours the patient eyed me suspiciously, probably wondering whether I had ratted him out. But it never occurred to me to do so.”

Well, it should have. Confidentiality is one thing, assisting in a crime is another. The Hippocratic Oath says“What I may see or hear in the course of treatment, I will keep to myself.” That only means, however, that doctors who learn about criminal activity a patient may be involved in is bound not to report it (lawyers have the same obligation).  Jauhar did more than not report criminal activity; he participated in it. He crossed the line by disposing of contraband. Continue reading

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Filed under Health and Medicine, Law & Law Enforcement

Disrespect And Assault In The Operating Room: Our Nightmares Are Real

clown-in-the-operating-room

“A few moments later, the anesthesiologist walks in the room and asks, ‘What do you got?’ Dr. Canby says, ‘Vaginal delivery. Uterine atony. External massage failed. Give her some ketamine.’”…I look at Mrs. Lopez—her eyes are half-closed and vacant. Dr. Canby instructs me to hold her knee. A fellow medical student holds her other knee….Canby then performs an internal bimanual uterine massage. He places his left hand inside her vagina, makes a fist, and presses it against her uterus. I look down and see only his wrist; his entire hand is inside her. Canby puts his right hand on her abdomen and then massages her uterus between his hands. After a few minutes, he feels the uterus contract and harden. He says something like, ‘Atta girl. That’s what I like. A nice, tight uterus.’ And the bleeding stops. The guy saved her life…But then something happened that I’ll never forget. Dr. Canby raises his right hand into the air. He starts to sing ‘La Cucaracha.’ He sings, ‘La Cucaracha, la cucaracha, dada, dada, dada-daaa.’ It looks like he is dancing with her. He stomps his feet, twists his body, and waves his right arm above his head. All the while, he holds her, his whole hand still inside her vagina. He starts laughing. He keeps dancing. And then he looks at me. I begin to sway to his beat. My feet shuffle. I hum and laugh along with him. Moments later, the anesthesiologist yells, ‘Knock it off, assholes!’ And we stop.”

This is an operating room anecdote related in an anonymously authored article published this week in the Annals of Internal Medicine, a respected medical journal. The publication says that the piece is intended to shine light in a dark corner of the medical profession. Oh-oh. The essay is anonymous, I assume, because the author is afraid that there would be professional repercussions from his revealing this—what? Bad habit? Dirty secret? Crime? Reason for us to go stark, raving mad? Continue reading

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