By James F. Drane
After World War II, the U.S. government invested an enormous amount of money in medicine; medical research, medical procedures and medical technologies. This investment made contemporary scientific medicine into American medicine, characterized by a continuing flow of new treatment possibilities.
These advances raised all kinds of ethical questions. Some were personal and individual, others were social and political. Both type questions are addressed by a new academic discipline called bioethics.
The first attempt to develop a scientific medicine took place in Greece in the 5th century B.C. It was called Hippocratic medicine. Closely linked with this first scientific medicine was a refined medical ethics which spelled out how medicine should be practiced. Today’s scientific medicine is radically different and raises new ethical questions addressed by bioethics, the new medical ethics. Some of the older ethical issues remain, like the limits imposed by human finitude, the need to stop treatments that are futile, the fear of death and dying, the need for healers to be committed to help others rather than to promote their own interests. The new bioethics reaches into law, politics, philosophy, religion, literature and science. It reaches into individual life, social life and the popular media. The issues that it addresses in one form or another literally reach everyone.
The Nancy Schiavo case provides a good example of how many different interests can come together around a particular medical case. Nancy had suffered a stroke which left her without consciousness, with only vegetative functions, and maintained by new technologies. Involved in trying to decide what to do there were individual interests, family concerns, issues of medical futility, political differences, and on and on. As this one case shows, there is an enormous public interest in the many different questions raised by contemporary medicine. Judges became involved, politicians intervened, groups organized around different perspectives, religious authorities made official declarations, and the struggle among the different interests was often uncivil, indeed violent.
This one case not only brings to light the many ethical issues embedded in a single medical case but shows as well how difficult it can be to bring about mediation and reconciliation of opposing perspectives. How are human beings to confront in a wise and peaceful way all the moral puzzles posed by today’s medicine, within today’s fragmented culture?
In the 1960s, the focus of bioethics was on problems at the beginning and end of life. Philosophical and religious questions were dominant. When does human life begin? What is the meaning of human existence? What is the place of human beings in the universe, in society, in the environment? Does suffering have a meaning? If so, what? How should we die? Is there a right to die whenever we want?
If we are free, can we do anything we want or are there limits imposed by psychiatry (mental health) and physiology (bodily existence)? Do scientists have a right to do whatever they can or are there possibilities that should not be permitted (e.g. making more destructive bombs or substituting robots for human beings)? What is the meaning of human dignity? Should suicide become legal for all who are tired of living? Is suicide the same as hospice which provides humane and pain-free dying?
These are questions not just for academic specialists. They are questions about who we are, where we are going and what sort of beings we should be. These are philosophical and theological questions that every individual has to face.
Then there are political questions. We hear them all being mentioned in the president’s campaign for health care reform, and in the responses he receives from those who oppose his reform. Does what is good and helpful for the poor count as a common good? How about children, the elderly, the unemployed, the immigrants? Abortion inevitably gets into politics and the political debate. Human life has to begin somewhere. Conception marks a clear point of beginning. Is beginning human life of the embryo, however, the same as developed human life which thinks, chooses and enters relationship? That human life at the beginning, it turns out, is a source of help for human beings with terrible illnesses which our scientific medicine promises to help. Whose good counts as a common good or a politically persuable goal?
If there are bioethical questions which are political, and if we are a democratic nation, then can these issues be excluded from democratic debate? Are those who label positions with which they disagree “communist” and “fascist” contributing to American democratic life? Is the current debate about health care reform legislation reflective of a respectful democracy or rather of a society increasingly driven by prejudice and intolerance?
Political debate about life and death issues will always be emotional and cannot always be intelligent. But serious debate does make a case for getting bioethical questions and bioethical arguments into classrooms and into newsrooms that take responsibility for intelligent discourse in our American democracy.
Drane is Russell B. Roth Professor at Edinboro University of Pennsylvania.
By James F. Drane
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