Friday, April 01, 2005

As They Lay Dying

On the Vanity of Earthly Greatness
The tusks which clashed in mighty brawls
Of mastodons, are billiard balls.
The sword of Charlemagne the Just
Is Ferric Oxide, known as rust.
The grizzly bear, whose potent hug,
Was feared by all, is now a rug.
Great Caesar's bust is on the shelf,
And I don't feel so well myself.
--Arthur Guiterman

What a day of contrasts and contradictions!
It's April Fool's Day, clocks are reset to Daylight Saving Time in the next two days, Terri Schiavo died yesterday and the Pope is at death's door as I write.
And, Lord forgive me, I am feeling all too irreverent this morning.
All day yesterday I was chuckling to myself remembering that funny piece of dialogue between two robots arguing over "sentient meat." The counterpoint of that scene with it's grave implications against the backdrop of the dramas unfolding in Florida and Rome was a case of running from the ridiculous to the sublime. Anyone who has experienced the gift of laughter in church will understand, and the rest of you will just have to stand back and dismiss this morning's mood as the ravings of a lunatic.

This morning's find at Lean Left is already two days old.

First there is this:

Suppose technology were developed that could artificially keep a body alive indefinitely – even well after the mind is gone. That is, there would be a pulse, breathing, and brain stem activity, and not much else, and these could be preserved for an indefinite amount of time. In a “culture of life,” should we use this technology as widely as possible to keep as many people’s bodies technically “alive?”

I’m betting (hoping, actually), that most reasonable people would answer “no,” which leads to a follow-up question. At what point do you decide that the body should or shouldn’t be kept alive by artificial means? People who sided with the Schindlers seem to believe that you should always keep the body alive, if it’s possible, no matter what. But I have to think there’s something more complicated going on here. In the case of the Schindlers themselves, I’m inclined to think that they truly believed her condition wasn’t as bad as the doctors told them, and that she had a chance of getting better. (They were deluding themselves, but in that difficult situation I can’t say I entirely blame them). Nothing about their actions seemed to indicate otherwise.

These are realistic and reasonable questions we need to face and answer.
What are the implications for organ donations?
In the absence of clear directions left by the subject being sustained (which includes, and will for a long time, most cases) how and who decides? And when?
Do we really want this to become a federal issue?
Have the individual states addressed the issue responsibly?
Do we really want this to become a state issue?
Have individual people addressed the iddue responsibly?
I ask.
You decide.
My wishes are already in writing.

Here is the goodie for today.
Peter Robinson at NRO online posed the following question:

Do med school students still take the Hippocratic Oath when they graduate? If so, has anyone addressed the conflict between the Oath and physician-assisted suicide? Perhaps a medical board of ethics in Oregon (which of course already has an assisted-suicide law) and Vermont (which seems to want one)?

Kevin Keith replied in a long, well-done essay copied into the blog for the record.

Even if you are going to adopt an oath, there are strong reasons for rejecting the Hippocratic Oath in its original form. For one thing, much of it is simply inapplicable, or applicable only by analogy, to modern times. It contains, among other things: an explicit invocation of the Greek gods (rather unsettling for moderns of whatever religious persuasion); a prescription of misbehavior with slaves (well-intended, clearly, but not quite to the point today); an explicit prohibition on surgery (or at least surgery for bladder stones), which at that time was so barbaric that it was not considered part of the profession of medicine; an explicit vow to “live my life in partnership with” the medical teacher and “if he is in need of money to give him a share of mine” (not exactly the way medicine - no longer an apprenticeship discipline - is taught today), and so forth. There is much good in the Hippocratic Oath - an explicit statement that the physician must hold the patient’s good as the only purpose of treatment, several prohibitions on questionable acts, a vow that “in purity and holiness I will guard my life and art", a commandment to maintain confidentiality - but it comes in the context of these other precepts that are no longer applicable, or no longer acceptable. And some of its more famous passages are contentious: there is an ongoing debate whether the line about a “pessary” prohibits abortion, or merely one particular, unsafe method of, abortion; the same issue applies to the prohibition on surgery; the Oath also appears to prohibit women from practicing medicine.

He goes on to elaborate on variants of the oath that have been formulated over history, with observations and comments worth reading.

[Aside: I looked into some ancient references to abortion last year and came up with interesting finds. The practice of abortion was known and discussed even in antiquity, so references to prohibiting "an abortive remedy" may not be as primitive as modern readers might like to believe.]

He ends with a challenge to mdern thinking that merits reading. Taken together with today's puzzle about where we should draw a line sustaining life through any technological means available, this challenge is not going to go away.

At any rate, the Oath has not been “tossed aside” - it’s wrong. Parts of it are clearly immoral (women can and should be doctors, doctors can and should practice surgery, patients can and should have the right to request or refuse treatments according to their own values), parts of it are pointless today, and parts of it are arguably wrong in the moral perspective of many decent, thoughtful people who prefer to think carefully about right and wrong rather than adhere blindly to a random grab-bag of precepts by a several-thousand-years-dead Bronze Age primitive. We reconsider and revise our moral standards as we recognize our prior moral failings - as good an argument against conservatism as any.

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