Archive for the 'ethics' Category



You can do better than me

I have of late developed something of an interest in theological ethics. So I figured reading some relevant material on the principles of philosophy and ethics might be useful.

Perhaps typing “philosophy and ethics” into the Trinity College library was a bit of a simplistic place to start but I figured it was a start.

I found this book – Philosophy and ethics of medicine – by Michael Gelfand.

Being published in the sixties by a guy who lived and worked in the country formerly known as Rhodesia didn’t make me that optimistic.

I was not to be disappointed. Or impressed.

It was kind of weak on the philosophy bit, and the ethics bit wasn’t too hot either, and I really wasn’t sure about a lot of the medicine…

Early in the book he defends “medical epistemology” as being best because it follows the scientific approach with no argument to justify why this might be best  approach. Or even that other approaches exist.

This was one of my particular favourite quotes

what should the doctors attitude towards telling his patient the true nature he is prescribing for him other risks invovled in an operation he has advised? The problem is a complicated one. Firstly the doctor should avoid, if possible frightening the patient or the family lest he refuse the treatment and so endange his life

It’s much better that the medical profession should endanger your life rather than let you endanger it yourself…
Truth telling is good as long as they do what we think they should do.
And the specific drugs he was considering warning the patient about in the above quote were named as emetine (a drug that eventually ended being used to induce vomiting and is now abandoned even for that purpose), arsenic (enough said…) and antimony (which used to be used for treating parasitic diseases but we gave up on it cause it behaved a little too much like arsenic…).
Hmmm

Suffering Presence – 1

[A few thoughts on reading through this collection of essays]

Hauerwas talks alot about how medicine as a moral act is difficult to sustain in a society as morally confused as the one we exist in.

To illustrate it I found this quote:

we blame physicians for keeping us alive beyond all reason, but fail to note that if they did not we would not know how to distinguish them from murderers.

Those of us who have been involved in talking about end of life issues, either in the church or in the public sphere, will realise how such conversations can go. The multitude of opinions found (and how uncomfortable we are with them and the language we use to talk about them) gives light to the moral confusion we live under.

 

Learn to live with what you are – 4

I’m not so much scared that theology will lead me to do things I know in my heart are wrong. Apart from the ones I’m already complicity in a modern health service that occasionally and even frequently struggles to give its patients dignity.

The Spirit does not just guide choices but makes us into people who make right choices.

It’s more that I struggle to fill in the theological gap between what I practise (and believe to be the best thing most of the time) and what I can articulate.

 

Suffering Presence – 1


I should have read this book sooner I know. Those who were at MCC’s forum a few weeks ago will remember me proposing exactly the question Hauerwas makes here (on the first page)

 

 

 

we may be able to keep an extremely premature child alive, but should we, since the very means to sustain may also injure

Me and Stanley – we’re like that (makes crossed fingers sign…)

 

Learn to live with what you are – 3

I’ve talked about the image of God a lot in these few posts. Though I’m still not sure quite that means. It is definitely something of significance just not clear what.

Yes we bear the image of God.

But we are broken images.

Does this then confuse our talk about being in the image of God?

Which bits of our humanity are fallen and which are in the image of God?

We tend to talk of sin and death when we talk of how the fall has affected humanity so do we view those who are considered to be in poor health to be less in the image of God? Do they reveal less of God’s image to us?

So the question is not just what does it mean to be made in the image of God but also what does it mean to be a broken image?

Learn to live with what you are – 2

As a follow on from the recent post, let me try to simplify where I’m at, or at least my confusion.

Perhaps using the example of a severely ill infant is too rare and specific a case to be useful in articulating a theology of medicine. My bigger interest lies in how we treat the frail elderly and care for people who may or may not be dying sooner than others.

Death is our enemy and a horrid thing, but it is not medicines job (and definitely not in our capability) to eradicate death. That is guaranteed elsewhere.

Anyhow.

If it is so that the severely ill infant of the last post – who by all appearances seems to be dying – should continue to be resuscitated and treated aggressively because they bear God’s image then it surely follows that we should continue to resuscitate the frail elderly with severe pneumonia (who will almost always have lost capacity to decide for themselves due to their acute illness).

My reaction to the severely ill infant is to aggressively resuscitate but to the elderly patient with severe pneumonia my reaction is to not aggressively resuscitate. I seem to be following a different ethic in each of those situations.

i find these two points that to be in conflict:

1) it is a good thing that you exist. You are in God’s image. Your existence blesses mine

2) it is good that you are not suffering. It is good a thing that you are not in pain

I cannot bring about 1) without going against 2) and I cannot pursue 2) without struggling to maintain 1)

Without bringing in harm/benefit ratios and a generalized utilitarian ethic I find it impossible to resolve them, though I am well aware I may be missing some fundamental point.

And I don’t mean to say that considering harm and benefit in the decision making process is necessarily a bad thing I just feel it dangerous to give them primacy.

There is no doubt a logical fallacy somewhere in there so help me out.

Thoughts people?

 

Learn to live with what you are – 1

In Church we have this little meeting sometimes on a Sunday night called Forum. We sit in the office and drink dodgy coffee and try to work out some theological topic relevant to the contemporary world.

A few weeks ago, I led a discussion about end of life and theological implications following on from our involvment with modern medicine. This blog summarises a lot of my take on it.

Last night myself and Mrs Steffi Knorn were leading one on the interaction of ethics, theology and modern medicine in issues pertaining to the beginning of life.

What follows is not exactly the minutes of the meeting, more like how the discussion flowed from my point of view and my reactions to it. Be aware that it contains some very distinct Christian assumptions about image bearing, and protection of the powerless and voiceless in society.

Bottom line we seem pretty bewildered and confused on the whole thing. On a spectrum from where we believe life begins to what we do with extremely tiny premature babies we struggled to articulate an ethic or theology that was somewhat separate from what modern medical ethics tells us to do.

We retreat to defining what is good based on a balance of harms and benefits with a presumption that survival is the positive outcome to be chased and disability (in the case of extreme pre-term births) is a negative thing that sways us against active treatment.

When it comes to defining when life begins most of our discussions resolved around various different scientifically defined points. When I think of where life begins it takes me a while to realise that this is a poor question when it is abstracted from a theology of relationship, image bearing, sex and community.

I struggle to know what it means to care for an extremely low birth weight 24 week gestation infant. I struggle to know if active and invasive intervention is the best way to love them and honour their image-bearingness.

200 years ago an extremely low-birth weight infant was fairly easy to care for. You kept them warm and the you buried them.

We now find oursleves in a bit of a different situation.

The question I find myself asking is that if we can do something why should we do something?

Followed to its logical conclusion this is kind of a scary question, cause it throws virtually all medical interventions in the air.

Hargaden’s point (which he was making up as he went so see it as that, rather than a finely tuned postion) was this (forgive me if I make a hames of it) – if we accept that all life is holy (which is the orthodox Catholic positon as I understand it) then life is inherently good and worth preserving. Therefore we should fight to preserve life. This has particular relevance for the powerless and voiceless (infants and those with severe disabilities) because if we acknowledge their lives as holy then we have a duty to protect their lives as no one else will. There is a risk that the powerless are silenced by the powerful and wiped from the earth. It is our repsonsibility to fight on behlaf of the powerless.

Follow this out and it seems that if life is holy then the right thing to do is to fight to preserve it, aggressively if necessary.

The situation for those with a voice is somewhat different as they are able to acknowledge and choose that their lives are not of ultimate value and therefore they can choose to forgo life-saving treatment.

It is at this point that I struggle.

I find it hard that an ethic that is designed to protect the powerless results in us causing pain and suffering.

It breaks the golden rule (do onto others as…) or Kant’s categorical imperative. If i was a 25 week premie with massive IVH (bleed into the brain) and bilateral pneumos (punctured lungs on both sides) and florid sepsis (an overwhelming infection) and had already failed multiple treatments I would not want further life-preserving treatment. This would be my choice.

So this ethic seems to need refinement. We cannot fight to preserve life out of fear (a reasonable fear) that we will silence the powerless, because in preserving life we will end up doing violence to them.

Indeed perhaps the whole problem with this, why we find it so hard is because we don’t really know what life is for.

We reach for medicine as the framework to answer these questions by because we have no better answers.

Medicine will at least give us some kind of an answer (though we still find it hard to swallow) that life is most flourishing when we are conscious, without pain, autonomous, and have many years before us.

This question will remain unanswerable in the church till we become a people with an alternative definition that values and understands all the image bearers that this world is peopled with.

Comments, criticims and rants welcome.


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