Does Medicine - and Medical Ethics - have a Pro-Life Bias?
18 Nov, 09 | by Iain Brassington
There’s an essay by Diego Gracia called “Palliative Care and the Historical Background” that I frequently use in classes about Care ethics, and there’s a passage in it that always gets a fascinating reaction from students. In this passage, Gracia claims that
the true goal of medicine has always been curing, rather than taking care of the patient. Caring has never been the goal of medicine.
In fact, in the context of palliative care, he takes this one step further:
Thus, if the type of care specific to medicine is curing, then palliative care has nothing to do with medicine…
I came across this essay a few years ago while preparing a session for students on Keele’s MA in the Ethics of Cancer and Palliative Care, when the cohort was split between doctors and non-doctors. More recently, it gets trotted out to my intercalating MSc ethics students here at Manchester: they’re all taking a year out from their medical studies. But the reaction tends to be similar: Gracia’s claim will be dismissed… and then one person will say, “Hang on, though…”, and a genuine and probing debate will emerge. The claim is not so easy to dismiss as would seem.
I mention this here because, in the replies thread to a post below, I mentioned the possibility that medicine displays a pro-life bias. By this, what I mean is that it is possibly built into medicine that death is seen as always being the outcome we’d most want to avoid - it’s not only a defeat, but an indication of the failure (or, at best, incompleteness) of the medical project. (Indeed, we might be able to go further, and say that even non-life is seen as something of an insult, which is why we try so hard to “cure” infertility.) On this account, a discipline like palliative care, just because it’s not concerned with cure, would seem to have an ambiguous relationship with medicine - which seems perfectly compatible with Gracia’s point. Moreover, the imperative that drives medicine does not seem to be the same imperative that drives palliative care - or, if it’s the same imperative, it’s very differently manifested.
If it’s true that medicine is somehow essentially about cure and about saving lives by curing, it’d go some way to explaining the opposition to euthanasia in parts of the medical profession. It’d also go some way to explaining the hostility that does appear from time to time to respecting refusals of treatment - one of the most extreme examples of which I’ve seen in the comments to this BBC article:
I am a doctor specialising in accident and emergency medicine and I have no intention of following any such instructions. I will continue to strive to save the lives of all my patients so long as I feel that there is a reasonable chance of recovery. That decision will be made on clinical grounds and I will not be influenced by any “right to die” card. It is my right to treat my patients as I see fit in accordance with Hippocratic principles, and the GMC would have to strike me off the Medical Register to stop me following my conscience in these matters.
OK: maybe that’s not exactly representative, but it’s the kind of response that I - and I suspect others - do see in essays, and it’s not exactly rare either.
Moreover, a couple of the standard objections to euthanasia are that a cure might yet be possible, or that the desire for death is actually a desire for better end-of-life care. I don’t think either of these is convincing, but they’re frequently trotted out. And it is, of course, fairly intuitive that death is, in most cases at least, the worst possible outcome. We’d also be able to explain why health outcomes are frequently measured in terms of survival rates.
Is this the only way of thinking about medicine, though? Lest I get accused of presenting a pro-death or anti-life bias, I’m proposing no such thing, and that would be a false dichotomy. Moreover, I don’t think that “bias” has to be seen as a pejorative term (yep, I’ve read my Gadamer, and am willing to bastardise what I found). What I am wondering, though, is whether there might be alternative ways of thinking about biomedical ethics that aren’t predicated on the notion of saving life as being the primary goal, and whether they might be cogently applied to conventional medical practice.
I think that it probably is possible to avoid a pro-life default. Palliative care shows a possible way: death here is not seen as a defeat, but as just something that happens to a person. The aim is not to preserve life, but to preserve its quality to the greatest extent possible. Strip away all the nonsense about “spiritual” needs, and I think that that’s quite an attractive way of thinking. But even if you take away that tacit pro-attitude there, you can still accept that it’s coherent and makes a lot of sense. What we see in palliative care is not the privileging of life in its own terms, so much as the desire to promote a particular kind of life. And I don’t think that anyone in the palliative care field would claim to be in competition with medicine “proper” - they’d claim to be doing something that compliments it.
Does the same attitude about complementarity work the other way? Increasingly, I suspect it does. Palliative care has become increasingly respected, and rightly so. Nevertheless, I suspect that there’s still a lingering sense that we should be trying to save lives. At risk of transferring the debate in the replies below to this post, some of the comments regarding Kerrie Wooltorton could, perhaps, indicate that much.
Other areas of medical practice might be interesting to examine through a “non-vitalic” lens, and the task may have been begun. I’m thinking here of Hursthouse’s account of virtue ethics and abortion, the important bit of which I take to be the idea that the moral status of the foetus, and its putative entitlement to life, is actually less important than understanding how the pregnancy fits into the mother’s life and her more generalised account of the good. The idea here might well be that it’s bad that a life ends, but that it’s also far from the whole story: the end of a life is a characteristic, but it’s not the central one.
But even away from an Aritotelian field, there might be things to say. For example, there’s a lot of utilitarian thought that has death as the greatest harm that can befall a person, and, implicitly, continued life as a way to avoid that. There’s a significant number of people, not all of whom are cranks, who’re seriously interested in immortality or something like it as a goal. But why should this be? Presumably, it has to do either with the idea that life is valuable in its own right - which I find implausible (and the Cumaean Sibyl agrees with me) - or with life as being the criterion for achieving any goal whatsoever - which I think is more likely to be right. But if it is right, then life as a default good doesn’t look tenable: it would make sense to ask a person what they want to be alive for, and life’s importance would be a function of this. Put another way, it would be the reason for being alive that did the important moral lifting. Our focus would be on projects, not on life. And if a person decided not to be alive any more, then the loss of that life would be considered to be correspondingly less of a loss. Finally, the focus of medical care when seen through these glasses would not be on saving a life, but on underwriting projects. We could still assume that most people would not want to die, and so it’s not as if I’m advocating no more life-saving medicine, but it wouldn’t be merely being alive that really counted. It probably isn’t anyway.
Granted, this is probably at best a rough-and-ready account. Any suggestions?
Iain - this is about as bright as observing that priests have a pro-God bias. Of course they do (and of course there will be exceptions, but in the main they do; otherwise, things just wouldn’t work).
You are also mixing up pro-life with curing. Sometimes, of course, the cure can kill. They are not the same thing at all - curing is a narrow and limited specific activity, being pro-life is much broader position.
As I have often quoted: good doctors cure sometimes, relieve often and comfort always. Although it may sound simplistic, it is actually a very sound description of what good medical practice is all about; as is the equally often quoted doctor’s duty to save life, but not to strive officiously to keep alive.
Dr No
November 19th, 2009 at 10:51 am
To a point, perhaps… but only to a point.
I’m not quite sure of what you mean by the claim that the cure can kill - I’m assuming that that’s something that medicine’d think deeply sub-optimal if it ever happened. While I take the point about being pro-life being broader, I’m still interested in how it acts as an impetus for the curing aspect, in how it informs the way that we - culturally, professionally, whatever - approach life-saving, and about the care/ cure distinction.
Why is it a doctor’s duty to save a life? And does this mean that palliative care “doctors” aren’t being doctors? That they’re failing in a duty? Could there be other, rival, duties that aren’t pro-life in the straightforward sense, but which a medic could still properly choose to discharge?
As for comfort… well, again: perhaps. However, I think that a lot of the thrust of medical science is about being able to zap any illness to shift it; caring for patients is only necessary - the story might go - when we don’t have the means.
Iain Brassington
November 19th, 2009 at 1:59 pm
Indeed, we might be able to go further, and say that even non-life is seen as something of an insult, which is why we try so hard to “cure” infertility
—-
I think the reason why ‘we’ try so hard to cure infertility is because ‘we’ still posess a small degree of ‘humanity’ ,which urges us to wish for others what we wish for ouselves .. or a bit of ‘compassion’- [look it up in the dictionary]
Once you found out that definition, the rest of your argument becomes just a philosphical piece tripe that has no meaning nor any benefit to anyone IMO
Me
November 19th, 2009 at 2:40 pm
Cures that kill - medicines have side effects, and operations can go wrong, and if the patient dies then the “cure” has killed the patient. There’s an old medical saw: “The operation was a success, but the patient died”.
Googling “iatrogenic” - the technical term - will get you over 800,000 hits. There is, as we docs are wont to say, a lot of it about.
Most if not all doctors will have killed patients inadvertently. Powerful drugs have powerful side-effects. Likewise, most doctors would consider iatrogenic death “deeply sub-optimal” - but it wouldn’t (usually) paralyse them in their practice, because it comes with the territory, and, as they say, life (sic) must go on.
To ask “Why is it a doctor’s duty to save a life?” is as I say about as helpful as asking why a priest promotes God - it is their raison d’etre. But - for doctors - it is not their only raison d’etre - hence the cure/relieve/comfort thing - which makes it clear we only cure some of the time. What palliative care doctors do is the relieve and comfort bits - all perfectly valid doctoring duties - so they are not in any sense failing in their medical duty.
Doctors are as a rule quite good at dealing with fuzziness - as in knowing that a primary duty is to save life, but that when that is not possible, then there are other priorities - such as relieving and comforting - that take over, and are equally valid duties for a doctor. Thus we do not need to go around worrying that we are “deeply sub-optimal” in our practice.
And even when curing is the primary focus, relieving and comforting remain important. It is what most people mean when they talk of a good doctor - the one who cares for the patient as a person and not just an illness to be zapped.
Medical science is only partly about zapping illness. Countless treatments are only palliative and/or aimed at symptoms, not the underlying disease. I suspect it is some of the the punters (and the Daily Mail) who still believe there is a pill for every ill. Chronic disease isn’t zappable - otherwise it wouldn’t be chronic - and so what medical science (and doctors) do there is relieve and comfort.
Dr No
November 19th, 2009 at 2:46 pm
I agree with some of what you say. But I am still concerned that what might count as a reasonable ethical argument could distort the everyday bias medics have toward ‘life-saving’. Obviously I am not using the word ‘bias’ pejoratively, and ‘bias’ is of course in a sense a bastardisation of Gadamer’s notion of ‘prejudice’ (‘pre-understanding‘ etc.) I find prejudice has even more baggage than bias within Anglo-Saxon thought.
Not sure what you mean by “…the idea that life is valuable in its own right - which I find implausible.” You appear to be viewing ‘life‘, or ‘existence,’ from the outside (a view from nowhere). To say that existence is valuable is a misuse of the word valuable. For sure we might say ’I value my existence’, but that is like saying ’I know I exist’. I certainly do not place a value on existence/life when I speak of bias/prejudice. When I consider another persons existence/life, I understand them from this bias/prejudice. Value does come in, but, as I have said before, I would rather keep ethics (in its traditional form) out of it as long as possible. Of course, much of medical ethics starts with the category of ’person’ as a theoretical category (there is no way back from that position).
I endorse the notion of “life projects”, but am little unsure about them being “the reason for being alive.” My life projects do not give be “the reason for being alive.” We need to centre upon life projects not as “the reason” for being alive - reason alone cannot do that.
I do think that people who are interested in immortality are cranks. Most of them want to fill their extended lives with projects that will give them a reason for living. Very sad.
Finally, to return to the medic pro-life issue, Gracia is talking rubbish. Caring has been and is ‘one’ of the main goals of medicine. A quick cure is another (four hours in A&E with a little care to make it all go well); the rest is a much longer mix of the two.
Most people receiving health ‘care’ are receiving just that, with little hope of being ‘cured‘. Like most medical ethicists you have forgotten that psychiatry, community care, longer-term disability and geriatrics form the great part of health care in this country. There is no ‘cure’ for most people; there is no return to ‘normality‘(whatever that might be). The division of labour means that doctors tend to be more engaged in ‘curing‘, but most people that work in the health service - nurses, cleaners, porters, cooks, social workers, administrators, etc. - are engaged in care. Of course good nursing in well run clean hospitals and nursing homes ’saves lives’ (nothing wrong in that I trust). I can assure you that the vast majority of nurses I have worked with see themselves as carers who may effect a cure. This ethos may be lost as nursing is increasingly technicalised (it was always the case that the fancier the hospital the bigger the pressure sores). It is an ethos doctor’s have had some difficulties in embracing, but much of that has to do with the class system, an over inflated opinion of the efficacy of medical science, and confusion over ‘normality‘.
One of the problems with medical ethics and law courses is that they have little or nothing to do with the real world of health care. Manchester is particularly divorced from reality, it being weighted to top-down doctors’ ethics. There are no units on profession ethics and medical complaints procedures (the Ombudsmen system is completely ignored), and whistleblowing is given a passing reference. As I have said before, medical ethics is an “applied” disciple. It might seem a bit everyday nitty-gritty, but medical ethics should help medics in their everyday nitty-gritty workaday lives. That means they should understand how the NHS and Local Government complaints procedure works because that is where the vast majority of complaints are dealt with (quasi-judicial systems are often more difficult to understand than judicial systems). The problem with institutions the size of NHS and Local Government can be found in Burke’s “The only thing needed for the triumph of evil is for good men to do nothing.”
The original ‘situational and case study’ foundations of medical ethics have been surpassed by an overemphasis on armchair theoretical ethics. (An understanding of the sociology of medicine might help; but that of course would mean ethics/law would have to giving up its monopoly.) I agree with Williams that “…neither the psychology nor the history of ethical reflection gives much reason to believe that the theoretical reasonings of the cool hour can do without the a sense of moral shape of the world, of the kind given in the everyday dispositions.”
Anyway, I am off on one of my life projects and will not be able to keep these rants going much longer.
Keith Tayler
November 19th, 2009 at 2:55 pm
@Dr No -
I’ve been reflecting on the pro-God bias analogy, and I think that it’s got something to it - but that might actually play into my hands.
You can evaluate what a priest does by looking at the pro-God bias and then asking whether it’s a bias that is (a) worth having (b) desirable (c) the only game in town, and so on. The same might apply here. If medicine (or medical ethics) has a pro-life bias, then we can productively ask questions about the necessity of that bias and so on.
Iain Brassington
November 20th, 2009 at 1:12 pm
@Iain
“…productively ask questions about the necessity of that bias and so on.” No you cannot, or at lease you should find it very difficult to ask questions about it. And by “very difficult” I mean you might damage the moral shape of the world.
Keith Tayler
November 20th, 2009 at 2:14 pm
Iain - the bias come with the function, and is indivisible from it. Train drivers have a pro-train bias, the police (we hope…) have a pro-law and order bias, etc. Without the bias, the function would cease to have meaning, and so, for that reason, the bias is (a) worth having and (b) desirable and, to the extent that the function becomes meaningless without the bias, it is (c) the only game in town.
Dr No
November 20th, 2009 at 2:55 pm
@Dr No
I cannot remember where I posted it, but earlier I referenced A.N. Prior who claimed that an ‘ought’ can come from an ‘is’. It was a functional argument - he used an example a sea captain, i.e. much about what we think about what makes a ‘good’ (inc. ‘good’ ethically) sea captain comes from their function. To be ‘good’ (knowledgeable, skilful, etc.)at their job they would need a ‘bias’ It is this ‘good’ (the ‘is’)we often understand as being the ethical ‘good’(the ought’. Being a ‘good’ doctor (in both senses), as you say, is not just case zapping illness (the public, hospital management, governments might like that way), it is far more than that.
Of course we can and should reflect upon such matters, but in most cases it is the only game in town, the moral shape of the world.
Keith Tayler
November 20th, 2009 at 4:11 pm
@Keith - I don’t understand your worrying about “changing the moral shape of the world”. Doesn’t that amount to the idea that there are some things about which we ought not to think lest we change our minds?
@Dr No - Neither your (a), (b) or (c) claims follows from your teleological claim…
Iain Brassington
November 20th, 2009 at 4:59 pm
@Iain
Of course I am worried about it. Not sure you get the point. As I said, I am not suggesting that we do reflect on such matters, but it is more complicated than just thinking that everything can be made transparent and changed by rationalisation and armchair theorising (the transformation of philosophy that Apel and Habermas describe - a form of rationalisation - I do give qualified support). I think I have made my position clear on these issues.
You seem to think that if we think about something we will or should change our minds. That is a form insanity not good philosophy.
Keith Tayler
November 20th, 2009 at 8:43 pm
Nonononono! Not that we will or should - it’s something more (oh, god: I’m about to say it…) deconstructive. Simply a matter of looking at a practice such as medicine or ethics from its margins and asking whether certain things we take to be axiomatic or inescapable really are so. It’s in this context that I think that Dr No is right with his priests being pro-god analogy; granted that pro-godism is built into what they do, that provides us with another set of lenses to examine what they do.
That might lead us to a radical transformation of some aspect of our lives or thinking; it might not. I’m indifferent either way…
Iain Brassington
November 20th, 2009 at 8:55 pm
Fine. So you agree that there is a moral shape to the world that must been seen from the inside, or through a set of lenses. Not going to get into the ‘frame problem’, deconstruction, or indeed the impossibility of making the lebenswelt a ‘problem.’
I think we have reached some common ground. Not sure about the “radical transformation” - Apel thought that it would do that but it just became ‘Wittgenstein meets Continental philosopy.’
Keith Tayler
November 20th, 2009 at 11:43 pm
I do not remember what I posted, but in the past I have mentioned before, stated that “it” may be “no.” It was a functional point of view - Use the example of the commander of the sea, to talk about what they think, what “good” (as “good” ethics) at sea, the captain of his action. Be a ‘good’ (knowledge, experience, etc.) from their work that a “bias” is that “good” ( “is”), often regarded as morally “good” (it should be. “Are” good ” medical (both directions), as you say, is not merely a matter of zapping of the disease (government, hospital administration, for example, governments can in this way), many more.
Allison Anderson
November 21st, 2009 at 9:57 am
@Allison
Do not understand.
Keith Tayler
November 21st, 2009 at 11:38 am
Nor did I - until I clicked on the poster’s name…
Dr No
November 21st, 2009 at 7:04 pm
@Dr No… Hmmm. Your smell spam? Yeah. Me too: I’d missed it earlier. You ought to click on her name now, though perhaps you should turn your speakers off if you’re at work…
@Allison: if I’ve done you a disservice, email me to let me know. But please try to make more sense!
Iain Brassington
November 21st, 2009 at 7:27 pm
i
Kate
November 21st, 2009 at 9:22 pm
Yes, but I still do not understand why people waste their time. Oh yes - we are all wasting time.
Keith Tayler
November 21st, 2009 at 10:20 pm
Pro-life stance of doctors is deontological, not teleological. It is of itself and in itself ethical and has no teleology. Nutters who wish to challenge this ethic by the only means available ie. through the law should be on a really sticky wicket since they cannot and should not be able to change the ethic.
What else can a doctor be but pro-life and treat the person so an illness hopefully does not get worse and save lives.
If a person is dying and nothing more can be done, then the doctor has a duty to make the patient as comfortable and painfree as possible with as much TLC as can be mustered.
The word euthanasia has become bawlderised - it’s true meaning is a “good” or “beautiful” death and should not be eused as a euphemism as in “euthanasia by the back door”
This is murder and as such is punishable by law.
For goodness sake Iain do try to make things explicable in good plain English. You would expect a doctor to explain any medical condition you have in terms you could understand, not throw the medical dictionary at you.
Kate
November 21st, 2009 at 11:35 pm
If the pro-life stance is deontological, what’s the norm it reflects? If you’re going to say that it’s “of itself ethical”, you’ll have to explain why and what you mean by the term. You’re also poisoning the well by suggesting that those who challenge that particular norm are nutters.
What a doctor can do besides strive to save a life is indicated by palliative care. But more fundamentally, your rhetorical question is just as likely to demonstrate the limits of your imagination as it is to tell us anything about ethics or medicine.
There’s nothing about the word “euthanasia” that’s been bowdlerised, though I agree that there’s a lot of scare-mongering about it.
I don’t think that there’s anything unclear about my English. Maybe I use terms with which you’re not familiar, but I can hardly be held responsible for that. This is an ethics blog, and, as such, philosophical terminology seems not to be out of place - just as medical terminology would have a natural place on a medical blog, and old English would have a place on a literature blog.
Iain Brassington
November 22nd, 2009 at 11:44 am
No I don’t mind the question you have FOS. I am referring to the interface between the law and ethics.
Philosophical terms are useful to philosophers.
Deontological stance of Medical ethics is this:
That the pro-life stance is intrinsic to doctorhood. As Keith says, if it were not, the doctor might as well go home. It is more. It is a necessary ethic and has ontological as well as ethical meaning. To be a doctor is not just to embrace the ethic it is to be the ethic. It is internalised. There are no consequences to this ethic (teleology). The only consequences that can be envisaged are within the scenario of someone or some group who desires to rob the doctor of his ethics by law for the sake of an ideology. It cannot and should not be done. Tell me if they did not have this ethic, and they were not Pro-life, then I ask you very seriously, how do you think the profession could operate?
I am not unfamiliar with philosophical terms, and it does not need much of an imagination to realise that if doctors abandon this ethic and are regulated by laws which are counter-intuitive to their ethics huge problems arise.I am not poisoning any well. Your question is very provocative,and it would be interesting to know why you asked it. I have plenty of imagination, that’s why I am able to see the problems that would arise if this ethic is dummed down or pressure put on doctors to abandon it. Problem is doctors cannot abandon it, However manipulative the argument is.
I am answering your question.
Kate
November 22nd, 2009 at 3:07 pm
Huh? Your “deontology” seems to be very close to teleology simpliciter - I still don’t see any deontology here - and I don’t see what ontology has to do with it. Altering their behaviour wouldn’t make doctors literally cease to exist.
I’m puzzled by the way you claim that there are no consequences and then describe the consequences.
Your general objection to my question is that the answer (which I’ve not given) would be disruptive, and that we ought to do what we do just because it’s what we do. That’s really not philosophically satisfactory.
Iain Brassington
November 23rd, 2009 at 10:40 am
Deon - means duty
The consequences do not belong to the ethic of duty to the patient and where possible to save life
The Teleology “the consequence” of this ethic is basically not what the doctor does, but what other groups who question this inherent ethic of the doctor may wish to change because they think doctors ought also to be able to end life as a primary consequence of a desire on the part of their patient and because of the doctors accessibility to treatments that can cause a person to die.
Because of the duty ethic of doing the best for his patient, and the deontology of the ethic,this can only be done by law or by amendments to the law.
e.g. a doctor may feel he can only end the life of a patient on life support if the law says so, and a Judge says so. That the law may or may not be adequate (or is inadequate) in this area is not to be blamed on the ethic per se or at the expense of the deontological framework of the ethic. The death of a patient may then be not a result of the doctors non-adherence to his ethical duty, but because the responsibility to the patient has been handed over to a Court of law and there is no change in abrogation of the deontological nature of the doctors ethic. He can still maintain and keep faith with his ethical stand.
The law understands this ethic, and it is a Court that will make decisions over life and death.That is why they are resorted to because the decision about bringing about a patient’s death is actually outside the deontology and is not dependent on it.
Yes I do l think medicine and doctors has a pro-life bias. Good job too.
Kate
November 26th, 2009 at 12:47 am
Kate - Interesting. If I understand you right, what you are saying is that some questions - like those of exercising powers of life and death - are too big for medicine and doctors, and in such situations the law, in the shape of courts and judges, takes over and makes the decisions, which the doctors then abide by.
If that is what you are saying, that would worry me. It presupposes that legal morals and ethics are superior to, and have sway over, a doctor’s morals and ethics; and it could also lead to a situation where the law (which might stem from a corrupt state) required doctors to do dreadful things. That, of course, is what happened in Nazi Germany.
Regardless of what the armchair fantasists might say, I, with that supreme arrogance that only a doctor can claim (!), believe that no authority can raise itself higher than the moral authority inherent in a good (ie sound) doctor-patient relationship. Sure many moral authorities can be equal - the Church, even the law, but none can claim moral superiority without opening the door to disastrous moral outcomes.
The doctor-patient relationship is sacrosanct, as are the principles that guide that relationship; principles based on respect for (not blind subservience to) autonomy, beneficence and non-maleficence and - last but not least - a general (but not always over-ridding) regard for the sanctity of life - which means, of course, a pro-life bias.
As I have said before, a doctor without a pro-life bias makes as much sense as a priest without a pro-God bias. Remove the bias and the role becomes meaningless.
Dr No
November 26th, 2009 at 10:45 am
@Kate - But that doesn’t answer the question of why saving a life is a duty, and what the limiting conditions (eg a refusal of consent) are.
The idea that a doctor’s duty is defined by the law is ludicrous. However, I really can’t make much sense of your third paragraph, so I may have got the wrong end of the stick.
You still haven’t explained why a pro-life bias in medicine (or medical ethics) is a good job.
@ Dr No - eep! I came perilously close to agreement for a minute - but you still need to clarify what it is that makes a doctor-patient relationship sound to begin with. I also think that the appeal to Germany is doomed, not least because it’s very hard for a law to force people to act. Had German doctors resisted the dictates of the Nazi state, they would have been unenforceable. The problem was that the doctors were only too willing to go along with those dictates. Oh, and congratulations on the Godwin award.
More generally - and granted that my initial question was perhaps vague - neither of you has addressed the theme of a pro-life bias in medical ethics, which is perhaps more important to my particular concerns (though the medical bias would indicate a line of ethical questioning…).
Iain Brassington
November 26th, 2009 at 12:57 pm
Iain,
It’s time to punt the ball back into your court. Will you tell us what you think is wrong with a doctor having a ‘pro-life bias?’
Julie
November 27th, 2009 at 2:21 am
@ Julie -
Nothing at all; however, it’s still a question worth asking for two reasons. First, ethics is (among other things) the study of conduct, and so it pays to understand what’s going on in a given set of actions. Second, it’d perhaps help us get to grips with the way that medics deal with situations such as when a patient refuses life-saving treatment: I know that, officially, doctors are supposed to respect such decisions; but I also know that, unofficially, they’ll ignore them or try to find some reason to label the patient as unable to make the decision.
Iain Brassington
November 27th, 2009 at 11:01 am
“I came perilously close to agreement for a minute” - Stroooof! What ever next?
I can’t do philosophy on what makes a doctor-patient relationship sound, but I can say what I think is necessary (but not necessarily sufficient) for a sound doctor-patient relationship:
1. A patient chooses to consult a doctor they trust
and
2. The doctor honours that trust, and acts in the patient’s best interests.
And that may be it: the rest being icing on the cake, as it were.
The Nazis and Doctors - I agree that the doctors were “willing executioners”, and so what I should have said is that the Nazi Laws enabled bad doctors (clearly neither (1) nor (2) above apply) to flourish. But my point still stands: whether the Law forces or enables, the end result is the same - bad medicine (and I don’t mean my blog!).
The title of this post is “Does Medicine - and Medical Ethics - have a Pro-Life Bias?” and I think we have all focused on medicine (and doctors) because it came first, and seems the more important (sorry!). When it comes to Medical Ethics, I am not sure it does have a pro-life bias - what makes you think it does?
“I know that, officially, doctors are supposed to respect such decisions; but I also know that, unofficially, they’ll ignore them or try to find some reason to label the patient as unable to make the decision.” - a bit disingenuous. We blogging docs (JD, Dr G, WD and me) have been saying quite openly we will not follow bad law when we consider it goes against our patient’s interests. There is nothing unofficial, behind-your-back or covert about it; nor are we sticking on labels. In KW’s case, for example, it was all about recognising the clinical (as opposed to legal) uncertainty (and for doctors, clinical uncertainty will trump legal certainty) - and if there was a label, it was “we don’t know” (and so need to buy time so as to get to a point where we do know).
And - furthermore - we do respect those autonomous decisions when they are soundly made and clearly expressed.
Dr No
November 27th, 2009 at 2:14 pm
Not ‘all’ doctors are pro-life. Many, I would say too many, are far from pro-life. I have met, worked with, and know quite a lot about the ones that are not pro-life. Most doctors - working as part of a team - express a pro-life tendency. Like most people, their working environment and epistemic enslavement can radically alter their behaviour. One of my interests lies in understanding and creating environments and systems that promote ethical behaviour. From this perceptive medical ethics has a role in understanding and, it could be argued, promoting a pro-life position. (Not going to outline this again as it all gets complicated with the enlightenment’s invention of ‘autonomous decision-making’ and contemporary efforts to balance this by expanding the scope and membership of a ’conversation‘. I see the role of philosophy and ethics as being more a question of identifying distorted communication)
So to answer the second part of your question - medical ethics (in its broadest sense) does not have a pro-life bias. Some medical ethicists do have a pro-life bias, others do not. I have already cited Williams in an earlier posting, but there is for example Anne Maclean who argues (with some justification) that the dominancy of utilitarianism in bioethics/medical ethics makes it ‘anti-life.‘ When it comes to so-called ’bioethics’ she is probably correct - it is anti-life. It would, in the interests of undistorted communication if nothing else, be helpful if bioethicists and medical ethicists clearly marked their domains. Bioethics and medical ethics are not the same (different histories, etc.), but there is a lot of bioethics (too much) that is passed off as medical ethics. Of course there will be those that will say they are the same, but they are and will continue to repeat the mistakes of the past.
Keith Tayler
November 27th, 2009 at 9:41 pm
I tend to agree with you that bioethics and medical ethics are not the same, though I think that the latter is a subset of the former. (I count myself as, variously, a bioethicist, ethicist, or philosopher depending on the conversation - “medical ethicist” is only my fourth choice.) I’m not sure about what I suspect may be a false dichotomy between pro-life and anti-life, though - notably, utilitarianism is pro-welfare, but doesn’t have to be concerned about life per se (though life may have an instrumental value as the vehicle of welfare).
I’m unsure about what you mean by “ethical behaviour”, though: don’t you need to flesh that out? I tend to be a bit socratic about this, thinking that noone does ill knowingly. That being the case, moral dispute is not about whether to do the right thing, but how to identify it. And the arguments are much more productive and interesting if you see it this way, too…
Iain Brassington
November 27th, 2009 at 9:59 pm
D’know,
The thing that keeps coming back to me in this is that a girl is dead because we would not intervene. She was 26. I wonder how her parents feel and I wonder if in all of this ethical/philosophical debate if we have forgotten how to be human. We have the luxury of moving the pieces round the board from our armchairs; Kerrie Wooltorton is dead. That’s it.
Julie
November 27th, 2009 at 11:52 pm
No: she’s dead because she wanted to be dead. Noone has intervened to prevent my death, either, but I’m still around.
I’m not quite sure what “forgetting how to be human” means, or what it has to do with anything…
Iain Brassington
November 28th, 2009 at 9:59 am
Iain - How do you know she wanted to be dead?
Dr No
November 28th, 2009 at 11:18 am
@Iain
I agree there is a problem of there being a false dichotomy; but, as I say, I think Maclean argument has some merits.
I am not a behaviourist but when analysing environments, institutions, systems, etc. we have to sometimes start by looking at human behaviour. Along with every other human on the planet, I have ‘knowingly’ acted unethically and unlawfully because of the circumstances I was in. The problem is how to promote the ethical behaviour of individuals and groups in the workplace, ICT systems, finance systems, transport, etc.. Hospitals and the ‘caring’ professions are responsible for creating some of the most corrupting of conditions. The point about the Milgram experiment was that people thought they were doing something ‘good‘ for a good organisation, i.e. volunteering in a science experiment. (Some bioethicists would make things worse by encouraging people to think they have a ‘duty’ to volunteer in scientific research.) As I said above, medical ethics could do a lot more to make all health workers more self-aware during their worker-day lives. But that of course does not make headlines and is not very sexy.
I think we should understand what is meant by “forgetting how to be human” and what it has to do with anything. Impossible to fully explain it here, but it might have something to do with ’existence precedes essence.’ This has always caused analytical philosophy problems. (Think of the misunderstanding the Tractatus caused because Wittgenstein opened it with his ontological statement and then moved to epistemology. He claimed that the Tractatus was a work on “ethics.” His remarks about Heidegger were censored from the records because it did not fit the ‘essence precedes existence’ party line…..etc.) Just because language and thought does not fit one particular philosophy does not mean it will not fit another. As I said above, philosophy should expand the scope and membership of a ’conversation‘, and that means it should welcome what might appear to be nonsense. To quote Witts., “Don’t for heaven’s sake be afraid of talking nonsense! But you must pay attention to your nonsense.”
@Dr No
Iain has studiously avoided the problem of how could we ’know’ whether KW wanted to die, and indeed the general question of how medical teams can quickly assess the state of mind and intentions of their patients. If KW had presented herself in any other A&E unit in the world - including all the US states and countries that have MCA type legislation - she would have been treated and her life saved. Her AD fell well below the requirements of all their legislation. It also appears to me that English common law might have been ignored. The so-called “golden rule” should have been applied (as it is in the US) and the “armchair principle“ might also need consideration.
Keith Tayler
November 28th, 2009 at 6:05 pm
‘She’s dead because she wanted to be dead..’
No, Kerrie Wooltorton is dead because she said that she wanted to be dead and a bunch of legalists took her at her word.
Julie
November 29th, 2009 at 12:50 am
The reason Iain is not answering my simple “How do you know she wanted to be dead?” question is that it is unanswerable.
In my eyes the fact it can’t be answered proves the uncertainty inherent in KW’s final presentation - and it was the uncertainty that meant it was unacceptable to let her die.
Keith - Iain and others will say the AD was irrelevant (because of the assertion she was capacitous at the time of admission). However, it does in my view provide circumstantial evidence to support our position, in that she had not taken the necessary steps to make sure it was binding. Would not someone who was resolute in their wish to die take the simple step of making sure their AD was binding? But she did not - and so we must ask, why not…and so back to uncertainty again.
As Julie points out, what happened was a bunch of legalists took her at her word. To them, the concept of a fluctuating mental state was too complicated, and so they just went ahead and said “You want it, you got it!”.
It appears that in KW’s case, in an extraordinary move, the doctors - the ones with a duty of care to KW - took off their white coats and joined the legalists - and the rest is history.
I doubt we shall ever know what mix of stupidity (I use the word deliberately, not as an pre-emptive insult), legalism, deontological tosh and passive aggression contributed to the absurd and unacceptable decision to let her die, for, whatever the mix was, it was profoundly sinister. I have written about this over on Bad Medicine at Snuff Medicine and Snuff Doctors (and indeed other posts) and so won’t repeat what I said there here.
Dr No
November 29th, 2009 at 4:14 pm
@Julie - Don’t you think that taking people at their word is admirable? (I’m assuming that you meant your comment in earnest, for example.)
@Dr No - No, the reason I’ve not answered your question is not because it’s unanswerable; it’s because I’ve been out having a life. But here goes with an answer: of course we don’t know the precise contents of anyone’s mind. I fail to see what difference that makes. We have no particularly compelling reason to doubt her desire, and that’s that. (Do you withhold buying birthday presents for family members because you don’t know with absolute certainty that their requests were sane? No? Right: so knowing doesn’t seem to be much of a criterion.)
Iain Brassington
November 29th, 2009 at 6:37 pm
Iain - perhaps you should stay in more often.
To answer your comment: I think you are back-peddling. Yesterday you made a bald assertion “she’s dead because she wanted to be dead”; now you are having a go with an answer. I sense a degree of tentativeness…
Of course no one knows the precise contents of another person’s mind (most people may not know the content’s of their own mind), but that is not what we are talking about here. What we are talking about is a very specific question: how resolute was she in her wish to die?
There are many compelling reasons to doubt her desire. Consider two patients:
(a) end stage terminal illness; no question of mental illness, plans and consistently says day in day out she will kill herself when the illness gets intolerable. She gets legal advice and draw up a valid AD just in case it is needed
(b) fertility problems; emotionally unstable; depressive episodes; one day says she wants to die, the next she says she does not; make numerous unsuccessful attempts in the last year; writes a “to whom it may concern” AD
Both turn up in casualty having taken a lethal O/D. At the time they are assessed the both appear - within the narrow limits of the test - capacitous. But the certainty that can be attached to their expressed wish to kill themselves cannot be the same, because their histories are very different. It is the history that provides the compelling reason to doubt.
Legalists and robots will allow both to die. Doctors and other humans will perhaps because they are human will allow (a) to die, but will/should manage (b) on a treat first/questions later basis. If (b) is resolute (highly unlikely but possible), she can always have another go, having first made sure she has got a valid AD just in case…
I’m afraid you’ve lost me on presents.
Dr No
November 29th, 2009 at 7:45 pm
Actually, I’m not sure I should stay in more often: my life is already perilously close to this.
There’s no backpedalling or tentativeness. In everyday terms, we’re pretty happy to make reasonable guesses about people’s desires, even though knowledge of their “true” desires is likely impossible for us (and possibly for them as well). My respose to Julie, though, was directed at the comment that she is dead becuase medics would not intervene. My claim is simply that there’s no causation there; medics have not intervened to save my life either, yet I’m still around. So simple non-intervention is not what killed KW.
Now, I don’t want this thread to turn into another wildly unproductive stand-off about her situation; still, I don’t see that resoluteness is all that important, since I assume that you’ll want to say that someone can still make a resolute but somehow inauthentic request, and I’ll want to say that there’s no evidence that at that time, in that case, her desire was inauthentic.
I’m not sure what you mean by a “legalist”, and I have no idea what you mean by the “doctors and other humans” comment. You seem to have utterly missed the point from the original post, though, which was that KW’s situation was ethically interesting just because it’s not as clearcut as you think it is. What you’re doing here is saying, in effect, not that you disagree with some people because they’re wrong, but that they’re wrong (and somehow ethically blind) because you disagree.
On that basis, it’s impossible to have any kind of proper engagement with you, because you’ve decided ab inition that anyone who’d enter the discussion against you is de facto not someone with whose position its worth your while engaging.
Iain Brassington
November 30th, 2009 at 11:26 am
Iain,
Let’s try and take this forward a bit.
Ever since Hume pointed out that in philosophy books that somewhere along the line there was a progression in the argument from ‘what is’ to ‘what ought to be’, ethicists have endeavoured to stay neutral. That is, they examine what is behind a decision. They do not say whether it is right or wrong. And that is the business of the ethicist; to understand what is behind a decision rather than to pronounce judgement on it. Now here’s the problem. Over the past few years, people like yourself have stepped out of that neutral area into the world where judgements are made, and where government asks for your opinion on what is the correct course to take. Sheila McLean is a very vocal supporter of euthanasia for example and she said some very unpalatable stuff about people with Downe’s Syndrome a while back. (I’ve been trying to find the article, it was in the Herald up in Scotland but it was some years ago.)Because you are ethicists you have the veneer of neutrality, but in reality you have discarded your neutrality when you do that. And this has consequences. For someone like myself that cares for a person with Alzheimers it means that every time my mum goes into hospital, I have to watch and make sure that she is getting fed properly, because ethicists like Sheila McLean argue for euthanasia in a case like my mum’s; the authorities take them at their word and neglect them accordingly. It means that resources for care of the elderly get diverted elsewhere; over the past few years, day hospitals, beds for continuing care and nursing homes have been decimated, and the amount of money for research into diseases like Alzheimers is laughable.It means that people like Kerrie Wooltorton die, because self-determination has been presented as having an equal worth to being alive.
Your profession has changed, Iain, and you have decide what you are going to do about that. It is no longer the neutral territory it used to be. Either you need to call the ethicists into line that are giving judgements and advising government on ‘what is right’ or you yourself have to make the shift from ‘is’ to ‘ought’ and give your own opinion on what should have been done in Kerrie Wooltorton’s case. That is why we are trying to appeal to your humanity here. As an ethicist, you can enjoy arguing the various strands of duties and assumptions in the decision; if you were Kerrie Wooltorton’s father, I bet that you would be pursuing the managerial idiots that thought it was a neutral decision to let a 26 year old depressed individual die, just because she gave them permission.
Julie
November 30th, 2009 at 2:37 pm
Huh? Ethicists have only recently started calling things right or wrong? Really? While I’m suspicious of the academic activist, it’s also true that neutrality and quietism are very different things. Besides - isn’t your plea for neutrality tantamount to saying that those whose profession is thinking about right and wrong are the last people who should talk about it publicly? That seems crazy.
I’m not going to get drawn into commenting on your circumstances, but there’s a world of difference between thinking or talking about whether and when euthanasia might be permissible or desirable and being a threat to people. Arguing for euthanasia as a right is miles away from arguing for it as a duty. The idea that taking a position on a matter such as euthanasia generates a permit to neglect is just incomprehensible; if there are occasions when a patient is not adeqately cared for, that has nothing to do with euthanasia. If Alzheimers research funding is low, that may be for one of a million reasons - but it’s unlikely that any of them has anything much to do with euthanasia either.
If the profession has changed, then so be it. Medicine has also changed since Hume’s time. Physics has. Literary criticism has. I don’t see why ethics should be different. Still, it’s more likely that the change has been more one of style than substance; both before and after Hume, philosophers have been examining the meaning of terms like “right”, and making normative claims. Your history of philosophy strikes me as being somewhat shaky…
Of course I do enjoy arguing about the various duties and so on. That’s why I do the job. I don’t see why it falls to me to call ethicists into line, but I don’t see that they - we - have fallen out of line at all.
I can’t presume to speak on behalf of KW’s family, but I’m not sure I have to, and - frankly - I’m not certain why you raised this. Still: why does going along with an instruction not to treat (NOT a permission - the difference is important, because the medics were not looking for an excuse not to intervene) make someone an idiot?
Iain Brassington
November 30th, 2009 at 3:10 pm
If you read what I said, Iain, I said that since Hume, ethicists have endeavored to stay neutral in their arguments; I did not say that ethicists have only recently started to call things right or wrong. If you want a proper debate, don’t put words into peoples’ mouths.
‘I can’t presume to speak on behalf of KW’s family, but I’m not sure that I have to..’
Are you sure of that? If an ethicist gives the advice to a governmental body that self determination trumps life, and the government acts on that advice, do you not share the responsibility for decisions based on that judgement?
‘Arguing for euthanasia as a right is a mile away from arguing for it as a duty’
I suggest that you pay a visit to Witchdocter and read her posts on ‘creep’. And I suggest you have a look at Holland and how euthanasia has progressed there from people who are terminally ill, to children of 12 being euthanised after consent is given by their parents and attending physician. That is the nightmare we are walking into and people like Sheila McLean give the government a cloak of liberty to hide their ‘money drives policy’ malice under.
Julie
November 30th, 2009 at 5:22 pm
I think this is all getting hopelessly confused.
Above Iain says (reply to Julie) that we should take people at their word - that it is “admirable” to do so. He then goes on to say (reply to Dr No) that “…of course we don’t ‘know’ the precise contents of anyone’s mind.” Obviously we do not take everybody at their word because we do not know the precise (or even approximate) contents of their mind. We no doubt accept those that we have learnt to trust, but in general we usually keep an open mind about what we are told by strangers and under certain condition we would expect them to convince us of the truthfulness of their word. I think Iain should look at how language and discourse works - thousands and thousands of books on the subject.
Anyway, I think I shall try to bring an end to this discussion by quoting at length a paper Iain wrote in 2007. He very kindly sent me a copy some weeks ago.
From ’Five Words For Assisted Dying,‘ Law and Philosophy (2008) 27:425-426
If someone seeks death, then there is an overwhelming reason to suppose that, de facto, he believes that he has a good reason to do so. Naturally. what counts as a good reason to Smith might not count as nearly so good a reason to Jones - but Jones’s failure to ‘recognise’ Smith’s good reason does not diminish its goodness in Smith’s eyes. Nor should it; and nor is there any immediately obvious basis for a claim to the effect that Smith has been led astray. Moreover, there is a sense in which ‘believing’ that one has a good reason to do something is just the same as ‘having’ a good reason to do it…if Smith believes that he has a good reason to seek death, then he will be motivated to do so, and that is all that counts.
[Obviously this argument does not do the work Iain wants it to do. Here we are being asked to accept anything Smith says as a “good reason“ (taking him at his word). Obviously that is absurd as it would render meaningless the term “good reason.” It is true that Smith might “believe” he has a good reason, but that is not of course the ’same’ as “having” a good reason. For sure his belief in his good reason might be well founded (i.e. he does have a good reason), but he might be completely mistaken. It is true that Smith’s belief in his good reason might well motivate him to kill himself. But let us assume that Smith wanted to kill himself because he believed his wife had been killed in an plane crash and that Jones knew that Smith had been “led astray” by a false news report and his wife was alive. I think we can all agree that Jones should inform Smith that he has not got a good reason to kill himself. In the real world things are more complicated, but, as I have repeatedly said, most people who survive suicide attempts go on to realise that their ‘good reason’ was not that good. (This is statistically the case and from my own work experience I know that most people pass through these dark periods of their lives.) In order for them to get to realise this, it usually requires someone, or a team of medics, to point out where they have been led astray in their reasoning and/or to give them the space and time to recover.
Anyway back to Iain’s paper. He immediately continues:
The proviso to the claim is based on the admission that, on occasions, people might be suffering from a depressive condition that leads them to kill or attempt to kill themselves and that such actions are, in effect, a symptom of their condition more than they are a reflection of what they would do if unaffected by the condition. (Note, of course, that a desire to be dead will not reliably indicate a psychiatric disturbance.) Given that this worry is not without foundation, though, there would still seem to be room within the system that facilitated assisted suicide for there to be a mechanism to filter our such people: some combination of a “cooling off” period, a need for repeated requests for assisted death to have been made, and a requirement that doubts about psychiatric wellbeing be answered might figure as components…But where we have a reason to suppose that the pursuit of death is made sustain and autonomously, we have a reason also to treat it as being for good reason.
[There now - that was not too difficult Iain. Is that not what we have been saying? Okay we might include a proper AD witnessed by at least one person (usually two) and possibly requiring the “golden rule” (i.e. signature of psychiatric professional), as is the case in every other country where there is assisted suicide. I would quibble over your claim that a desire to be dead is not an indication of psychiatric disturbance. Obviously there are a of people - usually very old or ill - where this desire is not an indication of a psychiatric disorder; but it is a fairly good indication in a lot of cases. If you include excessive use of drink and drugs as falling under psychiatry, you have immediately identified the main ’cause’ of suicide attempts. Of course the use of drink and drugs might be ’caused’ by an underlying mental and/or social condition. However, it is not that difficult to identify those with mental health problems and, surprise, surprise, most young physically fit people who have a desire to die have underlying psychiatric problems. I think under your “system” KW would have been treated and, as you put it, ”that is all that counts.”
Iain might have had a change of mind since writing this paper - what was a good reason then might not appear so now. What were we saying….
Keith Tayler
November 30th, 2009 at 6:42 pm
@Julie - I’m not so much putting words in your mouth as trying to make out your point; I may have got it wrong in the detail, but the thrust of what you’re saying is still mistaken.
@Keith - I don’t think that my position has changed all that much, but perhaps there’s scope for argument and refinement here… Nevertheless, while to having a good reason does not encompass believing that one has a reason, I do think that believing that one has a reason counts as having one (for reasons that I sketched in the paper you cite). As for the proviso, there’ll always be situations in which it’s pretty clear that a person’s decision is not “authentic” - but I don’t think that KW’s situation was that clear; and - again, I think I touch on this in the paper - I’m not sure that liminal cases are the best guide or able to provide the clearest moral lines. Note, too, that I was - I think - talking about assisted dying there, not refusal of treatment (I don’t remember talking about fatal refusals of treatment there). I think that there’s probably a reasonable gap between the two.
You also say
I think I shall try to bring an end to this discussion
Oh, for the love of crikey, if only someone would…
Iain Brassington
November 30th, 2009 at 9:16 pm
“You also say
I think I shall try to bring an end to this discussion
Oh, for the love of crikey, if only someone would…”
It is you - you need to shut up.
Dr No
November 30th, 2009 at 11:53 pm
You said, as quoted, “…kill or attempt to kill themselves…” That means ‘commit suicide or attempt suicide’ - does it not? Your “system” covered this class of self-killing and ‘assisted dying.’ It would appear to cover KW and she would have been treated.
We should be able to agree on this matter and then we can all get (and in some cases keep) a life.
I think it’s time to stop this as we all need to get a life and carm down. Anyway, I’m off to where there are no computers.
Keith Tayler
December 1st, 2009 at 10:27 am
@Keith - I honestly can’t remember exactly the wording, but I maintain that there is still a moral distinction between assisting and allowing death.
One other quick note about the qualification in the L&P paper - there are times when it’s wise, for the sake of keeping reviewers happy, to throw in the odd cosmetic qualification to an argument…
@Dr No - Hahahahahahaha! I’m being told to shut up by a reader of a blog that I edit? Jeeeeeeeez.
Iain Brassington
December 1st, 2009 at 11:11 am
Glad to see this thread has ended - but I cannot help making an aside.
You say “…there are times when it’s wise, for the sake of keeping reviewers happy, to throw in the odd cosmetic qualification to an argument.”
This brings me back to an earlier posting (somewhere) where I described the problems of my work being misreported by the media and ‘censored’ in journals like Nature. I gave up publishing any papers in journals and books many years ago because I do not think it is wise to keep reviewers happy. It is not necessarily the best career move if you wish to remain in academia, but it is nonetheless best not publish than publish something that keeps reviewers, editors and the critics happy. There is no reason why you or any other philosopher need journals. It is simple - publish all your work on the university website. Of course the university will try to prevent you from doing this as it has a vested interest in censoring, controlling and selling ‘information.’ It will claim you have to publish to keep the RAE rating up or some such nonsense. Obviously publishing in journals has little to do with academic excellence and has more to do with keeping reviewers (or cronies) happy and the publishing houses rich. But it keeps the bean counters happy and that is what really counts.
Keith Tayler
December 6th, 2009 at 3:05 pm
No thread is ever ended…just suspended…
Dr No
December 6th, 2009 at 9:38 pm
I am sure this thread will appear somewhere else, but it is difficult, if not impossible, for Iain to say much about it as he appears to be very confused about what he means, wrote, and indeed whether what he wrote was nothing more than a sop to the reviewers.
Keith Tayler
December 8th, 2009 at 5:48 pm
*bangs head on desk*
Woo-hoo. I can’t remember the exact wording of something I wrote three years ago on a related but importantly different topic, in a paper where I concentrated on advancing one idea rather than a whole rash of them. Quick! Tell the internet!
Really, though, I’m pretty sure about what I think on some things, and on others, I’m pretty sure that not having a quick and easy answer is what makes them interesting. (If you must, go back to the original KW post, the important part of which was that I think the coroner was morally correct, but it’s not straightforward, and not an easy call.
*takes deep breath*
Look: I can feel myself getting stroppy here, so I’m going to concentrate on (a) posting something else to distract me - it might even be related to your comment about peer review, Keith - and (b) doing my actual dayjob… You guys are free, of course, to play in this thread if you want. But I’m going to leave you to it.
Iain Brassington
December 9th, 2009 at 11:07 am
We all have dayjobs. I quoted you at length in order to remind you (there are other passages in your paper that repeat the same points). I still think you are confused about what you wrote and have said here. It might have something to do with not remembering, but - what ever the cause - I think it is worth pointing out. Who knows - you might have had a change of mind and regret your earlier reasoning.
Stop……
Keith Tayler
December 9th, 2009 at 12:18 pm
Iain,
Just returned to see that you have had a very interesting time with this “debate”.
I totally defend your right under Freedom of Speech to ask this question “Does Medicine & Medical Ethics have a pro-life bias”.
Ethics tends to deal with self-imposed questions.
There is really no need for you to bother yourself about this question because professionals in this case doctors, have their own ethics, and quite honestly umbrella ethics cannot play a part in this. I honestly cannot work out why you asked this question.
Doctors are not concerned about universality. They are concerned that the doctor/patient relationship is preserved on an individual basis. They have their own ethics common to all doctors and do not need the interference of purely theoretical ethicists.
There are very few situations in this Western Liberal Democracy of ours in which the individual matters, but medicine is one of them, and is highly valued.
Now I will exercise my freedom of speech, You have had your answer to your question from the best possible group of people you could ask - Doctors themselves. Doctors Doctor. To the question “Does Medicine and Medical Ethics have a Pro-Life bias” the answer is YES
As for myself, I do not think I have ever heard or read such a ridiculous question and would support Keith Taylor in that.
Re: KW Why not look at Dr Grumble’s Blog “Any Clinician will tell you”.
Kate
December 12th, 2009 at 12:48 am
Dr No is telling me to shut up, and Kate is giving me permission not to.
I’m SO confused. Nobody told me that Web 2.0 would be anything like this. Thank goodness Gregory Bateson is no longer fashionable.
Iain Brassington
December 12th, 2009 at 10:52 pm
Actually I am agreeing with Dr.No that you should stop. You clearly wanted the views of the medicalprofession or you would not have been blogging on the BMJ site. You have your answer. YES Medicine and Medical Ethics has a pro-life bias.
Don’t be confused, it is really clear - your question has been discussed and you have failed to persuade the doctors to conceive of anything else but a pro-life stand (as you call it.)
Kate
December 15th, 2009 at 9:58 pm
*bangs head repeatedly on desk*
Iain Brassington
December 16th, 2009 at 10:07 pm