doctors

Morning Ethics Warm-Up, 5/2/18: Dictators, Wizards, Liars and Abusers [Updated]

/ Jack Marshall / 44 Comments

Good morning!

1 Housekeeping matters. For some reason, I know not what, there was an outbreak of contentious discussion regarding Ethics Alarms administration in a couple of threads yesterday. I think everything covered or complained about is covered in the Comment Policies above, but just for the record:

  • I handle the moderation here. Only me.
  • Though it might appear otherwise to some, I do not spend my day glued to Ethics Alarms. Thus on days like yesterday, when I had an early morning CLE session to teach in D.C., followed by one  law firm client emergency after another, I did not see any comments at all from 1am to 6 pm. Thus the hysterical and indignant “Why did you delete my comment?” outbursts and the “How dare you allow that rude comment to stay on the site?” and the ultimata springing therefrom were especially silly, unfair, and ill-informed.
  • I am not your Moderation Monkey. Don’t command me on how to police my own site. Thank you.
  • As I have written many times, occasionally a comment from an approved participant gets spammed for no good reason. Sometimes WordPress, for no apparent provocation, starts spamming the comments of visitors here who have been commenting for years. Sometimes such commenters have had to change their screen names as a result. None of this has anything to do with me: I can’t control it, or predict it. The calm, reasonable commenters faced with this crisis generally e-mail me, then I search the spam archives, find the lost post, send it to moderation, and approve it.
  • I do not delete posts from approved commenters. The exception is when I ban a commenter permanently, or give one a time out, which is a temporary ban or suspension, in which case the commenter is always warned in advance.
  • I expect discourse here to be civil, but will excuse momentary and periodic lapses and outbursts from veteran commenters (and me, of course), in direct proportion to their time here, level of participation and constructive value to the mission. Individual quirks will also be taken into consideration.

2. Remembering the David Manning Liar of the Month: A commenter who hails from the old Ethics Scoreboard days recently referenced the feature there called the David Manning Liar of the Month. A David Manning-style lie is a statement that the speaker or writer can’t possibly expect anyone to  believe, thus raising the question of whether it is a lie at all. (Sony spawned the award by excusing its use of a fake film reviewer it named David Manning to rave about terrible movies in ads,  claiming that nobody believed such excerpts anyway.) If Ethics Alarms had the same feature, President Trump would obviously dominate it, as I was reminded this morning. The President’s ex-physician, Dr. Harold Bornstein. bitter over his ejection from the Trump Court, revealed that Trump himself had dictated the absurd letter in which the doctor attested, Continue reading →

Comment Of The Day: “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”

/ Jack Marshall / 20 Comments

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. Continue reading →

Morning Ethics Warm-Up, 1/15/18: Icons, Shitholes And Chianti

/ Jack Marshall / 144 Comments

Good Morning, and Happy Martin Luther King Day.

1 Priorities, priorities…Rep. John Lewis (D-Ga) has made his career out of the fact that he was an associate of Dr. King during the civil rights movement.  On Sunday’s”This Week” on ABC’, Lewis said on he would not vote for legislation that prevents a government shutdown if it did not first resolve the Deferred Action for Childhood Arrivals program. “I, for one, will not vote on government funding until we get a deal for DACA,” the alleged icon said.

That’s right: Lewis, and presumably many of his colleagues, would waste millions of dollars and interfere with life and daily needs of American citizens to obtain a path to citizenship for 800,000 currently illegal residents, and create a permanent incentive for foreign citizens to break our laws so they can get their kids an entitlement.  It’s more important to give illegal residents what they have no right to have, then to ensure legal citizens what their taxes pay for. This is the unethical result when ideology takes precedence over common sense.

2. Fake news also takes precedence, apparently. “Trump’s Words Eclipsing Deal For Dreamers” reads the above-the-fold headline on today’s New York Times. There are many other similar headlines on display. If, in fact, it is true that the President’s (alleged, disputed, reported initially via hearsay, denied by the speaker, and intentionally misrepresented by critics even if the alleged version is accepted) words have a decisive impact on a DACA deal, then the DACA adherents were posturing all along. What difference does it make to DACA what the President says off-the cuff in a private meeting? Apparently it is more important to Democrats and the “resistance” to denigrate the President than to accomplish substantive policy goals. Good to know.

UPDATE: I just read the opinion of conservative blogger Liz Shield after I wrote this. She said,

My position on sh!ithole-gate is this: It’s not appropriate for the President of the United States use this kind of language. Now, this was a private meeting and perhaps Trump did not think the Democrats would sabotage the DACA negotiations and, in this regard, Trump is terribly naive. There will be no good faith discussions on any policy because the policy of the Democrats is that Trump must FAIL, even at the expense of the Democrat constituencies they claim to be fighting so hard for. That is their position and I hope the president gets hip to this soon. Instead, the conversation we are having is not about policy but rather that Trump is a RACIST. Which is, coincidentally, the sole platform held by his political enemies.

Pretty much. The last sentence is unfair, though: their platform is that the President is a racist, senile, crazy, stupid, a Nazi, a traitor, a liar, a sexual predator and not really President. Continue reading →

Comment Of The Day (1): “Public Confidence And Trust (1): Observations On Gallup’s Trust In Occupations Poll”

/ Jack Marshall / 5 Comments

My post on the Gallup poll on public trust in various occupations and professions strayed into Charles Green’s wheelhouse, and the resulting home run comment enlightened us regarding why nurses keep “winning” the poll as the most trusted year after year after year.

Here is Charlie’s Comment of the Day on the post, Public Confidence And Trust (1): Observations On Gallup’s Trust In Occupations Poll:

Speaking just to the nursing angle: my work on trust has involved a diagnostic tool, the TQ (Trust Quotient), a self-assessment of the four components of trustworthiness in the Trust Equation:
(Credibilty + Reliability + Intimacy) / Self-Orientation.

70,000 people have taken it, and three results stand out above all others.

First, women are more trustworthy than men – a finding confirmed by informal polls in 397 out of 400 groups I’ve presented in front of.

Second, the most powerful factor of the four (defined as the highest coefficient in a regression equation) is Intimacy.

Third, the bulk of women’s outscoring men is their higher score on the Intimacy factor (again, intuitively true to the vast majority of groups I ask).

It’s in this context that I note the Gallup work (and other pollsters) finding of nursing at the top of the heap every year but 2002 (which was, not coincidentally, the year after 9/11 – and a year in which firemen, if only for that one year, took over the top spot.

Nursing is an 89% female profession. I ask my audiences, “Which of the four trustworthiness factors do you think nurses most embody: credibility, reliability, intimacy, or low self-orientation?” Most pick intimacy (with low self-orientation a frequent second).

Add ’em up: female, Intimacy, nursing – it’s a trifecta. Continue reading →

Ethics Quiz: The DNR Tattoo

/ Jack Marshall / 41 Comments

 Paramedics brought a 70-year-old man to the University of Miami hospital emergency room after finding him on the street, intoxicated and unconscious. Doctors tried to revive him got no response. Then they had an unusual problem: The man had a ‘Do not resuscitate’ tattoo on his chest, with a line under the ‘not.’ There was also something that looked like his signature. Tattoos are not legally-binding DNR orders, and in Florida, there are  very specific requirements for DNRs. to be legal.  Both a doctor and the patient must sign it, and they must be on paper, not on chests.

The doctors decided to respect the man’s tattoo. They did not try to revive him after the initial efforts failed

Your Ethics Alarms Ethics Quiz of the Day:

Was that the right call?

Continue reading →

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

/ Jack Marshall / 5 Comments

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 →

Observations On Britain’s Charlie Gard Ethics Fiasco

/ Jack Marshall / 40 Comments

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 →

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

/ Jack Marshall / 11 Comments

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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 →

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

/ Jack Marshall / 59 Comments
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 →

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

/ Jack Marshall / 50 Comments

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 →