BIOMEDICAL ETHICS — A “Hot Mess” but Essential

I am into week 8 of my Bioethics course at Cardozo Law School in NYC.  It is sponsored by my medical school alma mater, Albert Einstein College of Medicine as well as Montefiore Hospital and Medical Center where I did my Internal Medicine residency.

Fascinating, challenging, confounding, powerful, essential—these are but a few of  the descriptive terms I can quickly come up with. 

The class is an interesting mix of physicians, lawyers, social workers, psychologists and others interested in the complex are of biomedical ethics.  So far we have touched on areas related to the autonomy of patients, the doctor-patient relationship, the nature of “informed consent”, the right to refuse treatment, withdrawal of life support and who has the authority to make these decisions, reform at the end of life with more to come. 

The reading assignments are challenging  as well.  Some are written by philosophers/ethicists, others by physicians, still others are case law studies written by lawyers and judges with important decisions which become valuable precedents.  

Several of the students are actively involved in hospital-based bioethics committees.  They are called in to do real world consultations on patients with a host of complex issues.  The only way they can function is as a team composed of members from a variety of backgrounds.  The recommendations can be some form of a  consensus.  It is far from an easily achieved.

Various factors must be accounted for–the wishes of the patient if they are known, emotional family members who are themselves uncertain and conflicted about what decisions should be reached.  And what about family members who are seeking the quick demise of their relative for personal gain?

There are personal religious issues and beliefs to be dealt with as well as the attending physician’s religious/ethical belief systems.  There are the issues of abortion, of who makes decisions for minor children, or terribly disabled newborns that should or should not be allowed to die.

  One powerfully charged example is the issue of discontinuation of life support for a patient at the end of life.  What are the details of each particular case?  There is no place for standard protocols or formats to mandate what should be done for any one individual situation. 

What about the distinction between removing someone from a respirator and stopping hydration and nutrition?  Instinctively people make a distinction.  Yet legal precedent moving all the way to the Supreme Court in the Cruzan decision have declared that legally (and ethically) there is no difference.  Both are considered artificial life support.  Yet families often find it much more difficult to stop hydration and feedings.  There are too many cultural and emotional links to feeding and being fed.  Love and feeding are inextricably linked in the deepest recesses of our  psyches. 

And yet we as a society and our health care system as it exists must absolutely be capable of assisting families, physicians, hospital systems etc. reach difficult if not painful decisions.  Resources are not only limited but we cannot afford to misuse them, to literally waste them when they are inappropriately expended. 

This is where bioethics fits in.  It is completely immersed in the  “hot mess” of life, health and death.  But we ignore these issues at our own peril. 

I am interested in learning more about them.  It is an integral part of my own metaphysical journey.

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