hospitals

The Bioethical Dilemma Of The Mother’s DNR Revisited, And More Fetal Rights Ethics Confusion [UPDATED]

/ Jack Marshall / 14 Comments

In Part 2 of the New York Times editorial board’s examination of the ethical and legal complexities of conflicting laws protecting the right to kill a fetus, the rights a fetus does have, and the mother’s rights, the question is posed:

Katherin Shuffield was five months pregnant when she was shot in 2008. She survived, but she lost the twins she was carrying. The gunman, Brian Kendrick, was charged with murdering them. Bei Bei Shuai was eight months pregnant and depressed when she tried to kill herself in 2010. She was rushed to the hospital and survived, but her baby died a few days later. Ms. Shuai was charged with murder.

Both cases are tragedies. But are Ms. Shuai and the man who shot Ms. Shuffield really both murderers?

It is an ethical question, a legal one and a logical one. Unfortunately, and typical of the entire series, the Times cannot play straight, or begin with basic principles. No, the questions is asked with an assumption in hand: the right to abortion must trump everything, even logic and justice The editors go on:

“Ms. Shuai is one of several hundred pregnant women who have faced criminal charges since 1973 for acts seen as endangering their pregnancies, according to National Advocates for Pregnant Women, which has completed the only peer-reviewed study of arrests and forced interventions on pregnant women in the United States. In many cases, the laws under which these women were charged were ostensibly written to protect them. Ms. Shuai, for instance, was charged under a law that was stiffened after the attack on Ms. Shuffield.

These criminal statutes are results of a tried-and-true playbook, part of a strategic campaign to establish fetal rights, reverse Roe v. Wade and recriminalize abortion. The sequence begins with anti-abortion groups seizing upon a tragic case in which a woman loses her pregnancy because of someone else’s actions. Public outcry then helps to strengthen a state feticide law that recognizes such lost pregnancies as murder or manslaughter. It’s a backdoor way of legally defining when life begins.”

In other words, the Times relies on ideology to duck an ethics conflict that points in a direction that radical abortion advocates don’t like, and thus refuse to acknowledge, because they don’t have a good answer for it. Here’s my answer: Yes, they are both murderers. If a mother who is gestating a child that she and her husband intend to have, and the child is killed by the act of a third party, a human being has been murdered, and charges are just. In the Sheffield case, her twins were within the protection of abortion limitations, though I would hold that this doesn’t matter, if they were both going to be delivered. If you don’t call this a murder, then a manic could perform an involuntary abortion on a 9 month’s  pregnant women, ripping her fetus out of her with murderous intent, and still face no murder charges as long as the mother recovered. Were it not that all obstacles to abortion must fall, even logical ones, no woman, no human being would call such an act anything but murder. Once any rights are assigned to the unborn at all, however, such logic is impolitic. Continue reading →

The Ethics Incompleteness Theory, The Bigot Doctor,”The Hader Gotcha,” And The Apology Scale

/ Jack Marshall / 25 Comments

Yes, she actually has both arms. She’s also photogenic: the Democrats should nominate her for Congress.

I christened the Hader Gotcha last year after several athletes were forced to apologize for youthful social media comments that suggested a bigoted or insensitive state of mind. The ethics Alarms position on people looking through old social media posts to embarrass public figures and force them to grovel apologies to which ever group their comments offended was summarized in this post in the moderate, calm manner for which I am justly praised:

As I have written here before, searching for lingering social media idiocy that an athlete authored before he could drink or vote is despicable conduct, as is anyone making an issue of  what the deep Twitter dives expose. First, what a baseball player said or thought—they are often not the same thing—in the past has nothing to do with his job, which is playing baseball and not making social policy, and second, nothing anybody says or even does before their brain has matured should be held against them in adulthood, unless it is criminal, and even then the law urges us to be forgiving. I know that a lot of social justice warriors think that any racist, sexist or homophobic comments made post birth should be treated a crimes, but they are anti-democratic nuts, and hostile to free thought and speech, so to hell with them.

That post was largely ignored, because too many readers here still fail to grasp that ethics issues arising in baseball often, indeed usually, have broader wisdom to convey. Since I wrote it, the employment of the Hader Gotcha has been expanded outside the realm of sports, most notably the recent example of Kevin Hart, the popular comic who was attacked the very day he was designated as the host of the upcoming Oscars. Hart was forced to withdraw because a Hader Gotcah exposed old anti-gay tweets. This time, however, I agreed that the tweets mandated his withdrawal, writing, 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 →

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 / 5 Comments

“Hello, is this the Oregon hospital? Yes, I live in Mexico, and I need a liver right away. When can I schedule a time to come to the US and get a transplant? That sounds perfect! See you soon!”

The post about an Oregon hospital being publicly shamed into accepting an illegal immigrant for a potential liver transplant attracted the varies and thoughtful response here I hoped for. I have an unusual gut reaction to it, for me at least: I am sure that my position that the hospital is wrong (and that the ACLU is very wrong to bully the hospital into changing its policy) is ethically correct, but I feel badly about it anyway.

Here is what I told myself to make me feel better: Would anyone argue that the same woman would have any right or claim to an organ transplant from an Oregon clinic if she lived in Mexico?  Would the ACLU dare argue that she had a right to be placed on a waiting list? Would even an Oregon hospital think twice before rejecting such a request? Would the ACLU be able to create a public outcry against her rejection? Let’s see: No, no, no, and “you’ve got to be kidding.”

Yet logically and ethically, I see that alternate universe version of Silvia Lesama-Santos being more deserving of a transplant, and receiving a lifesaving organ that a citizen in similar need would receive otherwise, than the actual Silvia. The actual Silvia, unlike my theoretical one, broke our laws. The actual Silvia has already benefited unjustly from doing so. My compassion for the theoretical Silvia is not reduced by my objection to her conduct and disrespect for our immigration laws; given the choice between whether to give a liver to her or the real Silvia, I would choose her, and it wouldn’t be a hard choice. She is more deserving than the real Silvia, unless one reasons that breaking out laws and continuing to avoid accountability for doing so over 30 years is a positive accomplishment. And yet the alternate Silvia has no right to a liver at all.

There. I feel better now.

Here is JutGory’s 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: Continue reading →

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 / 42 Comments

There must be something wrong with me, for I don’t think this proposition is ethically obvious at all. In fact, I think it’s probably dead wrong.

Here is the story:

Silvia Lesama-Santos, 46, is a mother of four who has lived illegally here for at least 30 years. The transplant program at the Oregon Health and Science University denied her request to receive a new liver, telling her that she did  “not have documentation of lawful presence or immigration documentation,” which was required for her to be eligible for a transplant.

The ACLU of Oregon took on Lesama-Santos as a cause, and publicized her plight. The Oregon ACLU’s  head, Mat dos Santos, called the hospital’s policy “cruel and inhumane.”

The bad publicity, in turn, quickly forced the hospital to change its policy. “It was brought to our attention this evening that an archaic transplant policy was preventing an undocumented individual from being evaluated at OHSU,” the school said in a statement this week. “Upon learning of the policy, OHSU leaders acted immediately and terminated the policy. We deeply regret the pain this has caused the family. OHSU is committed to serving our entire community — all are welcome at OHSU, and this policy does not reflect our values.”

Flushed with success, the ACLU is planning  “to ask other hospitals to change similar policies,” ask, in this case, meaning “coerce.” 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 →

Oh, NO! ANOTHER Ethics Story That I Don’t Understand At All! EVERYTHING IS SEEMINGLY SPINNING OUT OF CONTROL!

/ Jack Marshall / 28 Comments

Emory University Hospital in Georgia had scheduled kidney transplant surgery for a 2-year-old boy to take place on October 3. The organ donor, however, the boy’s father, Anthony Dickerson, violated his parole. Hospital administrators then postponed the surgery until Dickerson could comply with parole requirements for an additional three months.

The boy’s mother, Carmella Burgess, received a letter from the hospital that said Dickerson would be re-evaluated as a donor in January after it receives documentation of his success.

What warped reasoning is going into this decision? The boy’s health care needs are the same. The kidney being donated is the same. The father is still a willing donor. Why would the hospital care whether Dickerson had violated parole or not? Why would anything Dickerson did change the hospital’s medical duty to his son, or warrant postponing life and death surgery? So the father was discovered eating puppies. So he was found to be a convert to Isis. So he is caught saying nice things about Harvey Weinstein, Donald Trump or Satan. In fact, Dickerson violated parole in September and was charged with possession of a gun. So what?

“They’re making this about dad,” Burgess told the Atlanta Journal-Constitution. “It’s not about dad. It’s about our son.”

That seems to be an accurate analysis.

If anyone can explain how this can possibly be ethical conduct by the hospital, please do.