Making Moral Decisions in Medicine

Our guest blogger this week is Matt Tabbut, a second-year med student (and Cedarville alumnus) at Chicago's Rosalind Franklin University.

At this stage of my medical education, I have begun to look at some practical ethics case studies. There are a few beacons, or waypoints, that I use to help guide me in making decisions. Consider the following.

1. Faith - As a Christian, my faith plays a vital role in moral living. This worldview based on Biblical principles and mandates serves as an anchor or foundation upon which to make ethical determinations. At the heart of Scripture is the concept of loving God and loving others. Thus, the Bible establishes immutable, transcendent, and absolute principles that serve as the ultimate authority in my moral and ethical dealings.

2. Reason - Reason is at the heart of all philosophical thought. However, reason alone (i.e. not tempered by a foundation based on principles - see point 1) is a slippery slope leading to consequences that we may not perceive or be willing to accept. But in my moral deliberations, I should not only be able to provide supporting arguments from faith, but should also be able to communicate arguments from reason that can be accepted more universally.

3. Precedent – A good argument can often be made from analogy, and history can help to clarify ethical dilemmas. Finding correlations with other related situations may shed light on the current problem.

4. Instinct - At least in the negative sense, this is sometimes called the "yuk factor," - another way of describing our gut reaction. Though decisions cannot be made solely on feeling, our gut reaction can give insight as we look other well-founded arguments.

Dr. Death is on the Loose

On June 1st, Jack Kevorkian was released from prison, after serving eight years of a longer sentence for second-dgree murder. A participant in at least 130 assisted suicides during the 1990s, he is still unrepentant.

Constrained by conditions of his parole, he can speak publicly about laws to allow doctors to assist in suicide, but he cannot counsel individuals. “You see, I’m still in prison,” he said. “I’m on a tether. I’m on a virtual tether. If you don’t behave, you go back to prison.”

It is interesting to note that the former pathologist has received some sympathy for his views. As a tribute to the public ambiguity about assisted suicide, the original Michigan jury that convicted him could not agree on a capital murder charge.

Think of it -- this was not a case of suicide, for it was Kevorkian who actually injected the lethal medicine that took the life of this particular patient, with the video cameras rolling. And what could be more premeditated than such an act, planned many days in advance, with calls to the press and TV stations?

Yet the jury could not agree on capital murder (murder in the first degree), which could have resulted in a life sentence. Instead, in defiance of logic, they convicted him of second-degree murder, as though this was a spontaneous act of passion.

So Dr. Death is free on parole, with his time shortened for "good" behavior.

New York Times Article

More on the Supreme Court's Ruling

On April 19th, the U.S. Supreme Court reached a landmark decision. In a 5-4 decision, the Court upheld the 2003 Partial Birth Abortion Ban Act as constitutional. There is much to rejoice about, yet much remains to be done.

The Court has struck a balance between a woman's right to choose to terminate her pregnancy and the "legitimate and substantial" federal interest to preserve fetal life. This balance was at the heart of the Planned Parenthood v. Casey decision of 1992.

Last week's decision is narrowly crafted to line up with Casey, and in no way signals an overturning of Roe v. Wade (1973). On the other hand, it signals a willingness on the part of the Court to consider federal restrictions on abortion for purely moral reasons. The fact that one option for terminating a pregnancy is no longer available does not significantly interfere with women's rights.

Both sides of the issue agree that this recent ruling will encourage states to craft more restrictions on abortion.

For more analysis, read the commentary by Wesley J. Smith.

Viable Thinking About Life

Back in 1973, Justice Blackmun in the Roe v. Wade Supreme Court decision said that states could not prohibit abortion until after "viability." This is the moment when the unborn child could possibly survive outside of the womb. According to Blackmun, "Viability is usually placed at about seven months (28 weeks) but may occur earlier, even at 24 weeks" (Roe v. Wade). Even then, Blackmun acknowledged that such a distinction was arbitrary.

Viability has always been suspect as a measure of the personhood of an unborn child. As Frank Beckwith has said, “Viability measures medical technology, not one’s humanity.” Indeed, advances in medical technology have pushed back the limits. The American Association of Pediatrics now places viability at less than 23 weeks gestation and less than 400 grams weight. According to the AAP, there's no reason to resusitate an infant born before that time.

Amillia Sonja Taylor is breaking all such rules. Born on October 24th, little Amillia weighed 280 grams and was just 240 centimeters long (slightly longer than a ballpoint pen). She arrived just a day less than 22 weeks after conception. Though she has had a few respiratory problems and received careful neonatal care, she is now out of danger, and is going home. It is expected that she will live a normal life.

This miracle story demonstates just how inappropriate the "Blackmun limit" was and is, and should further expose the serious flaws of the Roe v. Wade decision.

What else does tiny Amillia teach us? Perhaps that not all intensive care of preemie newborns is futile. Or perhaps that God is sovereign after all.

AP News Story

Of Babies and Body Parts

This holiday season is all about new life. But in a cruel parody of the Christmas story, grisly news has emerged from the Ukraine. According to the BBC News Service, it appears that healthy newborn babies have been slaughtered as a source of stem cells. Video evidence from actual autopsies reveals dismembered infants, and raises disturbing questions about how they died. According to the BBC:

Ukraine has become the self-styled stem cell capital of the world. There is a trade in stem cells from aborted foetuses, amid unproven claims they can help fight many diseases.

But now there are claims that stem cells are also being harvested from live babies.

A British forensic pathologist is "very concerned to see bodies in pieces," as might be the case if stem cells were removed from the bone marrow of these infants.

There is real value to using bone marrow as a source of stem cells; such treatments have been used with volunteer adult donors for many years. Yet the rich clients who pay to obtain them from dead babies cannot seriously expect that some sort of "ethics" will guide the Ukrainian doctors who are complicit with murder.

If this horrible story turns out to be true (and the early evidence is very worrisome), it will be just one more indication of the hype and hysteria over "stem cell research" that promises much more than it can deliver.

BBC News Story

Abandoning the Prime Directive?

In his Epidemics, the great healer Hippocrates gave this advice: 'As to diseases, make a habit of two things -- to help, or at least to do no harm.' The Roman physician Galen said it more compactly, as 'primum non nocere,' meaning, 'first of all, do no harm.'

Since the era of Hippocrates, the keystone of medicine has always been that physicians can be relied on to do their best for their patients. To borrow a phrase from Star Trek, this is the 'Prime Directive' of medicine: doctors are always to heal, never to harm.

Apparently, that may change, if the Royal College of Obstetricians and Gynaecology has its way. As reported in the Scotsman news service: "The College is arguing for 'active euthanasia' to be considered for the overall good of parents, sparing them the emotional burden and financial hardship of bringing up the sickest babies."

That a professional medical society would seriously make such a statement is rather disturbing. It is a sad commentary on the way the medical practice has changed since World War II. Instead of focusing on the goal of healing, modern medicine emphasizes relief of suffering. This subtle change tends to diminish the patient as person, and instead targets the disease process itself, to the detriment of the healing profession and society as a whole.

At least there are some voices of reason in the UK these days. Neonatologist John Wyatt has said it well: "Intentional killing is not part of medical care . . . [O]nce you introduce the possibility of intentional killing into medical practice you change the fundamental nature of medicine."

In the midst of the wonderful technological advances in health care, physicians must never abandon their Prime Directive.

Original news article: http://news.scotsman.com/scitech.cfm?id=1639102006