Sunday, January 4, 2009

The Tyranny of an Undisclosed Conscience

Displacing professional standards by an undisclosed conscience can only result in tyranny – and other undesirable unintended consequences of a new Federal rule are also inevitable!

Beginning January 19, you can go to a hospital that says it provides family guidance services yet be denied legitimate healthcare information without your knowledge or consent simply because of the conscientious beliefs of the clinician serving you that day.  For example, “for more than 30 years, federal law has dictated that doctors and nurses may refuse to perform abortions. The new rule would go further by making clear that healthcare workers also may refuse to provide information or advice to patients who might want an abortion.” (Los Angeles Times, 12/2/08)  

The BIG difference between the old and the new scenarios, as we will see below, is that when using a hospital that objects to certain services such as abortion, you used to know what to expect; but under this new rule you no longer know what to expect since what information you receive will depend on each clinician’s personal conscience. It really does NOT matter what the published literature of the hospital says anymore.  The conscience of the individual clinician prevails in every case.


Since this is a federal rule, it trumps local laws:

Many states currently have laws requiring that rape victims treated in hospital emergency rooms be offered the option of taking emergency contraceptive pills to prevent pregnancy. But she [president of Planned Parenthood] said that because providers who don’t believe in emergency contraception could now simply opt not to tell women about that option, “under this rule, we believe that in fact now women who are the victim of sexual assault either would not be guaranteed either information or health care access to emergency contraception.”(NPR, 1/3/09)


This rule has severe penalties:

The far-reaching regulation cuts off federal funding for any state or local government, hospital, health plan, clinic or other entity that does not accommodate doctors, nurses, pharmacists and other employees who refuse to participate in care they find ethically, morally or religiously objectionable. It was sought by conservative groups, abortion opponents and others to safeguard workers from being fired, disciplined or penalized in other way. (Washington Post, 12/19/08)


This rule extends to a wide network of healthcare workers:

The Bush administration announced its “conscience protection” rule for the healthcare industry Thursday, giving doctorshospitals, and even receptionists and volunteers in medical experiments the right to refuse to participate in medical care they find morally objectionable.  (Los Angeles Times, 12/19/08)

The final rule, however, affects a far broader array of services, protecting [pharmacy] workers who do not wish to dispense birth control pills, Plan B emergency contraceptives and other forms of contraception they consider equivalent to abortion, or to inform patients where they might obtain such care….  While primarily aimed at doctors and nurses, it offers protection to anyone with a “reasonable” connection to objectionable care — including ultrasound techniciansnurses aidessecretaries and even janitors who might have to clean equipment used in procedures they deem objectionable. (Washington Post, 12/19/08)

No More Basis for Trust

When you go to a healthcare organization such as a Catholic hospital that clearly states its ethical position, you know what to expect, and you know you will be served professionally within the bioethical beliefs of that organization.  So, for example, they will not offer you abortion services, though they are required to offer alternative options.

Rules already are in place to protect any person, doctor or pharmacist from going against their conscience by providing abortion or contraception information or services to patients or clients. But current practice requires people to inform people that other options are available elsewhere. (Pittsburgh Post-Gazette, 1/3/09)

As we have noted above, however, this new rule does not allow you to know you are not being denied certain services, which means you will not know what to expect.  “The provider can deny information and services to their clients without their knowing it is being denied.”  (PittsburghPost-Gazette, 1/3/09)

You will be under the total control of each clinician’s conscience regardless of their ethnic or religious background, or even any misguided confusion of a partially developed or guilty conscience they may be experiencing at the moment.  Some warn that “As written, the rule also would protect health care providers opposed to vaccinations or other medical procedures.”  (Pittsburgh Post-Gazette, 1/3/09)  It will take a long time to sort out because no one will know when it is being employed because clinicians who take advantage of it are not legally accountable for their actions.  This rule does not require anything from them; rather, it permits them NOT to do what other laws, professional codes, and ethical codes DO require them to do.  It is truly antinomian.  

When I think how many healthcare organizations are turning over ever more of their clinical functions to nurses and much less educated providers; when I think how narrowly educated these specialized medical technicians are; and then when I think how the mass media has made almost all of us highly vulnerable to every wave of pop culture thinking and current fads, I wonder what kind of conscience we are turning our future medical care over to?  Whatever the current movies are promoting?  What kind of social strategizing does the Bush administration have in mind?  Certainly not the good of the unborn – that is plain to see, since there have been no commensurate increases in social services to support the increased birth rate this rule is intended to accomplish.

This rule seems bound to create moral chaos. There is no basis for trusting one’s clinician since they legally do not have to tell you anything that offends their conscience. They are not compelled to give you as much respect as God gave Adam and Eve. They may even deny you your own right to refuse treatment by denying you the right to even know about it. If there ever was a place where the “house of cards” imagery applied, this is it. You can’t just say conscience takes priority in one clinical area but not in another. If it applies to bioethical issues, why should the underlying principle not also apply to alternative medicine, mental heath, and controversial medical treatments? It makes no sense to view this rule as limited in scope: the legal basis for justifying this one area must surely apply to other areas as well.  But my bet is that the whole thing will collapse because it makes no practical sense. 

 

Unintended Consequences?

No one can fully predict the legal implications of this rule if it stays in place since it supersedes other related laws and seems to sanction a kind of libertarianism in medical ethics as far as denying medical treatment is concerned.  As noted above, some are concerned about medical procedures not mentioned in the rule being included as matters of conscience for some clinicians. There are all kinds of matters of conscience that this rule will undoubdedly bring to light.  This rule is not simply a regulation – if it continues it will create a new ethical  paradigm – the belief that personal ethics trump responsibility to clients in the professional relationship.

From all reports, the creators of this law seem to presume a traditionally Christian-based bioethical stance as either the legal heritage of the USA and/or the proper direction which the USA should take.  It appears that they have their own minds made up since they have not adapted the rule based on widespread public input. (Huffington Post, 12/19/08)  They seem unconcerned about the need for people of various viewpoints to live together amicably in a multicultural society, and in a society that does not reflect their common moral viewpoint.

And curiously and in contradiction to the Christian tradition which they seem to represent, this rule appears to be another example of the Bush administration’s nietzschean approach to create social change. In more genteel new age terms, this tactic could also be characterized as an attempt to create their own reality.  This from a president who said Jesus was the most influential political thinker in his life!  Jesus, the one who said “the truth will set you free” (John 8:32).  Yet President Bush wants to be known as a president who promoted a culture based on hiding the truth? 


 


Posted by Jim Johnson at 04:50:32 | Permalink | Comments (2)

Monday, January 28, 2008

What do we want?


US scientists close to creating artificial life

Like all good science fiction, this story contains futuristic elements which have implications for today’s world.  If we can create artificial life, would there be a difference between these two options:  (1) killing off artificial life forms before they mature, and (2) aborting human embryos?

This story begins, “US scientists have taken a major step toward creating the first ever artificial life form by synthetically reproducing the DNA of a bacteria.”   

The story itself contains enough elements so that partisans can have great fun as they debate the propriety of this research.  My immediate reaction, however, is to look further down the road and ask about the ethical challenges that will be raised by this project.

Thinking in religious concepts, since someday these humans will have created these beings much as God created living beings, then in some sense these scientists will have become like God to them.  Like Moses was to Pharaoh, will they be God in a unique sense to these life forms they have created?

Reflecting back on Genesis 1 we see that most of the creating that was done there was accomplished by making use of pre-existing materials, just like the scientists who are now trying to create life.  Their theory is that creating life is a purely mechanical process.  Some readers will think no further because they assume that we will never have to worry about creating “real” life because only God can do that.  These are “peace in their own time” advocates who are willing to forfeit reaching a large portion of the educated world with the gospel message.

For the rest of us, there are two basic directions we can go when we want to explore our moral responsibility in this area.  The What is Life? direction is favored by most biblically-based Pro-Lifers at this time.  They basically want to argue that God breathing “the breath of life” into the human as described in Genesis means that life is much more than matter, but also consists of a spiritual substance.  We cannot debate this complicated issue here.  Suffice it to say that literary evidence indicates that this phrase simply indicates that the person or animal is alive in the usual sense.

Ethical arguments that depend on the definition of life become technical and legalistic, and inevitably lead to immoral behavior since people will always find a way to do what they want to do anyway.  The bankruptcy of this legalistic approach to social policy is illustrated, in part, by the track record of Pro-Life states according to one report…

Foster care payment rates are lowest in pro-life states. The willingness of the state to aid needy children who remained with their mothers was negatively correlated with pro-life content of the laws. In other words, pro-life states are determined to prevent women from having abortions but seem unwilling to provide a decent level of support for those children after birth.

The final measure of state willingness to aid children-the level of education spending per child enrolled in kindergarten through twelfth grade-also was negatively correlated with the pro-life content of state abortion statues. In fact, it appears that the pro-choice states are more committed to providing for the society’s weakest and most vulnerable than are the pro-life states.  (CET, 2001)

I think a more scientifically and biblically accurate, and a more helpful approach to this challenge is to ask:  
What Do We Want? 

  • Do we want all embryos to grow to maturity, regardless of whether they are being raised in families that want them?
  • Do we want every life that gets started to have to continue to exist as long as possible no matter what?
  • What kind of a world do we want to create?

These are the kinds of questions that should frame the debate about the ethics of life, about abortion, and about end-of-life ethics. 

It’s not too early to be answering these questions, because another recent headline tells us…

 Artificial Life Likely in 3 to 10 Years 

Besides that, we need the answers now.

Posted by Jim Johnson at 03:46:12 | Permalink | No Comments »

Thursday, November 29, 2007

Colorado’s Coming Population Explosion

 

Court Clears Way for Egg Rights Showdown

by P. Solomon Banda

Associated Press (Nov 13, 2007)

The Colorado Supreme Court has cleared the way for the anti-abortion group, Colorado for Equal Rights, to collect signatures for a ballot measure that would define a fertilized egg as a person.  If 76,000 signatures are collected within the next six months, Colorado voters will be forced to decide whether to approve a measure which would give fertilized human embryos the state constitutional protections of inalienable rights, justice and due process.

Nothing could be more obvious than to conclude that human cells at every stage of development constitute human life.  The question our society wants us to ask for legal purposes is at what point do these cells become a person. That point is when the power of the state will begin to enforce all the constitutional rights to which every individual is entitled.

As one supporter of the proposed Colorado amendment says, “If it’s a human being, it’s a person, and hey, they deserve equal rights under our law.”

This logic is based on the one-dimensional logic of ontology, with its assumption that the objective, physical status of the human being determines its human personhood and therefore its human rights.

Those who take the teachings of Jesus seriously would not uncritically accept this one-dimensional reasoning, however.

Jesus demonstrated that more that mere existence is needed in order to have the life God intended when he said…

“Not everyone who says to me, ‘Lord, Lord,’ will enter the kingdom of heaven, but only those who do the will of my Father who is in heaven. Many will say to me on that day, ‘Lord, Lord, did we not prophesy in your name and in your name drive out demons and in your name perform many miracles?’ Then I will tell them plainly, ‘I never knew you. Away from me, you evildoers!’ (Matthew 7:21-23 NIV)

To experience human life in all its dimensions one must experience life in relation to God; and even apart from God, we only experience our created life as human beings when we experience it in relationship with each other.  We must be valued by another in order to have value.  A baby that is not nurtured dies.  Our mere existence alone does not give us value: we must also be valued.  That is true beginning at our conception and remains so throughout our existence.  We will find our strongest identity needs fulfilled in our relationship with God; but we also have daily practical needs we depend on others to supply.

Jesus strongly emphasized our inter-connectedness when he taught his followers the importance of forgiveness, but then left it up to them to decide who would be admitted into his kingdom, assigning his followers the responsibility to serve as a virtual gateway to God’s forgiveness in their earthly community - “I will give you the keys of the kingdom of heaven; whatever you bind on earth will be bound in heaven, and whatever you loose on earth will be loosed in heaven” (Matthew 16:19; cf. Matthew 18:15-20).  Jesus wanted his followers to be known for their love for one another.

That we only exist in relationship, and therefore do not have value simply because we exist but because we are also valued may sound oxymoronic, as if the two aspects of value automatically go together.  But this is not so.

Mechanistic processes are not usually quite that preferential.  Natural processes apparently do not expend extraordinary effort to preserve every fertilized human ovum.  Many are lost at various stages after conception: “About 15 percent of all pregnancies end in miscarriage, most of which occur between the 4th and 12th weeks of pregnancy.”  If lost at the ovum level, they might never even be noticed.

All human beings must also accept the reality of separation from their loved ones by death at some point.  As health technology has improved, people are more and more forced into a position traditionally left to God and must make decisions that affect how long they or their loved ones will live.  As the Apostle Paul said, we still await the day when “the creation itself will be liberated from its bondage to decay and brought into the freedom and glory of the children of God” (Romans 8:20-21).  Death and many other consequences of sin are inevitable and unavoidable.

When we create a law such as the one proposed in Colorado, we are affirming our collective will to so value the independent human status of the fertilized ovum that we are committing ourselves and our collective resources to protecting it and to holding those who have created it accountable for maintaining it.  The Colorado proposal seems to reject the responsibility to make ongoing value judgments and instead attempts to make a once-and-for-all absolute value judgment that will supposedly resolve all those other moral conflicts. 

The proposed Colorado law makes heroic efforts to save every unborn human obligatory.  There is no other way to avoid this conclusion because by definition the law takes effect at the moment of conception, when the number of cells is at the lowest possible level.  Could babies with gross deformities that were not predicted before conception be aborted if they were identified shortly after conception?  Not if they were defined as human persons and therefore protected by the Colorado constitution.  But to their credit if they approve this amendment, Colorado voters will also be committing themselves to the medical and social services to pay for these lifelong dependent citizens.

Think what it would mean if every fertilized egg is considered a human person even though nobody in particular cares about it.  Society would still have an obligation to protect every fertilized egg as long as possible.  In this scenario every unused egg conceived for in vitro fertilization would be required to be preserved forever.  Fertilized embryos can be stored in liquid nitrogen for indefinite periods of time. People who recognize the absurdity of creating this legal responsibility most likely recognize that some specific humans must also value those eggs, or at least should value those eggs if they must be preserved.

However, by all accounts this proposed Colorado law appears to require the absurd conclusion that all fertilized eggs are human persons and therefore must be guaranteed full constitutional rights.  That means any fertilized ovums left over after the in vitro fertilization process would still be considered human beings under the Colorado constitution.

There are other possible complications of this Colorado law including creating conflicts of interest between the rights of the mother and the rights of the unborn fetus:

Treating the fetus as a legal entity separate from the pregnant woman creates the potential for an adversarial relationship between the woman’s health needs and those of her developing fetus and further confuses the issues of the health care provider’s duty to his or her “patient”…. (Smock, et.al., 2003)

Some are also concerned that certain types of IUD birth control devices might become illegal since they may prevent implantation of the fertilized cell in the uterus after conception.  That could be seen as a kind of murder if the fertilized cell is defined as a human person, for as one anti-abortionist put it, “Most methods of birth control kill babies in the womb by preventing implantation.”

It appears that the main immediate goal of the proposed Colorado law is to legally establish high moral ideals; but it also appears that the far-reaching legal consequences of the law have not been well considered or communicated.

The proposed Colorado law will obviously eliminate abortion in Colorado.  But it will also, as we have already seen, most likely create the requirement that all embryos produced by infertile couples during in vitro fertilization will be their responsibility to maintain forever, since these embryos are their offspring and therefore their responsibility.  These embryos will be “people” before the law forever, even though they are contained in freezers. 

Can you imagine the commercial possibilities?  I wonder if anyone has begun locking in patents, copyrights and .com names.  Given that the amendment is presented in an innocuous format completely unrelated to any controversial setting, it has a very good chance of passing simply because those who are not informed on this issue and see the proposal for the first time either on the petition or in the voting booth may not give it much thought and conclude it really does not matter, but must be needed for some good reason.

Considering that this would be a constitutional amendment, and that the future consequences of this law are so likely to be unwelcome and expensive, this proposal really does set a new standard for condensing extremism in a small package.  Hopefully the citizens of Colorado will sincerely and accurately count the cost before they cast their votes on this measure. 

Posted by Jim Johnson at 03:15:32 | Permalink | Comments (2)