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Friday, August 16, 2013

Medical ethics: Introduction, and questions for Christians

Bioethics is a word derived from the Greek words for biology and ethics. Biology is the study of life. Ethics is concerned with right behavior. So bioethics is an academic, and applied, discipline, about to proper behavior related to living things. You might suppose that bioethics concerns such matters as protecting endangered species, and, from the origin of the word, it should, but that branch of ethics is usually called environmental ethics, and will not be considered further here. (For more on that subject, see this post on “Environmental Stewardship in the Bible.)

Bioethics, for this post, considers what behavior is right, in relation to health care. It is also called medical ethics.

Christians should be concerned with bioethics. Why? Here are some questions on the subject to consider:

1) Should a Christian seek medical treatment, or never do so, but trust in God to heal, in answer to prayer? Should a Christian avoid paying for health insurance, but trust in God’s provisions for financial needs?
2) Abortion, for some Christians, is the most important issue in society. Is this type of medical care ethical? If not, why not? Does the Bible clearly indicate that abortion is murder? If it doesnt (or even if it does), is abortion ever justifiable? Are any forms of birth control acceptable for Christians to use? Are various forms of apparent wrong-doing, from deceit in anti-abortion ad campaigns, through murdering doctors who work in abortion clinics, things that Christians can do without sin?
(Heres a more extensive discussion of abortion.)
3) What is a person -- that is, someone who should be treated as if they had rights? Is an infant a person, in that sense? A fetus? An embryo? A fertilized egg? A sperm? An unfertilized egg? A child? A person in a persistent coma or persistent vegetative state? A person who is temporarily unconscious? A person who has died within the past few hours? An intelligent animal, such as a dolphin, whale, chimpanzee or bonobo? A really fast computer with lots of processing ability and memory? A computer program capable of interacting in English with a human being such that the human cant be sure whether the interaction is with a computer or another human? An intelligent alien organism? (Note that these are not scientific questions, or at least not mostly scientific questions. They are moral, religious, legal, political and philosophical. There have been times when, to our shame, blacks or women were not considered persons, in many senses.)
4) Some types of procedures or treatments strike some Christians (and some others) as so unnatural that they shouldnt be allowed. Human cloning is one such procedure. Other types of enhancements, such as the use of drugs by athletes, are more common. Are there limits to what should be done to enhance the human body, including the brain?
5) Christ taught justice and concern for the poor, and Psalm 72 indicates that the government (in that case, King David, who was the government) has some responsibility for care of the poor. Is it right that the relatively wealthy, and seniors, should have access to expensive medical care, when the poor dont? If not, why not?
6) Should Christians oppose the current fee-based system of medical care in the U. S., as unfair and wasteful? That system has financial rewards for medical facilities that encourage expensive procedures, as opposed to more simple treatments like exercise and diet. It also has financial rewards for doctors who become specialists, as opposed to those who become family practice, physicians, or geriatric physicians. It gives insurance companies incentives for not paying for treatments, for delaying payment, or for not covering sick people, who need insurance most, at all. It makes it likely that patients who are unable to pay for care will go to emergency rooms, where care, which someone has to pay for, is more expensive, and where their care may be interfering with true emergencies. The system emphasizes treatment, rather than prevention, which would often be cheaper and more effective.
(As I understand it, so-called Obamacare would do little, or nothing, to fix most of these issues, or might make the problems worse.)
7) Many people in the US have no healthcare insurance. Currently (Obamacare may change this) such insurance is most often obtained through employment. This often results in employers hiring people on a part-time basis, so they dont have to pay for part of the employee’s health insurance, when, otherwise, that same employee might have been hired on a full-time basis. Also, health insurance costs for companies are high enough that it is difficult for them to compete with firms from other countries where health insurance is not a benefit of employment. Should Christians work to change this way of doing things? Do Christians have any special duty to advocate particular modes of governing, or of economics? Is trying to spread the gospel of salvation, which is important for eternity, compatible with trying to change laws, or trying to change those who have political power? Why or why not?
8) Research to bring new medicines and treatments to usefulness is expensive, and should be compensated, especially since the majority of such new treatments and drugs dont turn out to be useful, and it is usually impossible to know that without years of expensive testing. But drug companies charge considerably more to US customers, in many cases, than they do to others, and they keep patents on medications active by tweaking minor features, such as the color or shape of the pill, when otherwise such medications could be sold as generic. Is this fair? Should Christians oppose this?
9) Everyone, barring the second coming, is going to die. When should we let them go, and let someone die, if ever? Should everything possible be done to keep someone breathing? If not, why not? Is it ever all right to administer treatment which will hasten death? If not, why not? Does God ever allow Christians to take their own lives, or to engage in actions that will lead to their deaths? A lot of healthcare resources are spent in taking care of persons who are within a few days of dying. Is this legitimate?
10) Are psychoses, addictions, emotional illnesses and physical handicaps the result of sin in the persons life, or are they diseases, like, say, chicken pox, and the result of living in a fallen world? Should addictions and emotional illnesses receive any specialized treatment, other than prayer and care?
11) How do we deal with aging, or otherwise incapacitated, relatives and friends? Must a Christian put her life on hold to help such people? Is it ever right to act against their wishes, or even to deceive them?
12) Should there be differences in how people get health care, based on sex, age, income, ethnicity, religion, disability, and the like? If so, why? If there are such differences, should Christians oppose this?
13) Are we, as a society, spending too much on healthcare, at the expense of, say, public school education, or infrastructure?
14) Each Christian should examine her own life. Does she exercise properly? Get enough sleep? Eat healthful foods? Avoid exposure to UV rays, from the sun or tanning beds? Avoid harmful foods and drinks?

Where can we get guidance on such issues, and others?
There are several candidates for such guidance, among those who claim expertise in bioethics. They include:
1) Deontological ethics. This type of ethics holds that some things are always wrong, or always right, no matter what the circumstances. For example, it could be argued that it is never right to deliberately deceive a patient. Following deontological ethics doesnt answer the question of how to decide whats always right and always wrong. The Ten Commandments, the Bible as a whole, or the Hippocratic Oath, might be taken as guides for this, but they dont cover all questions in bioethics. (There have been many attempts to modify the Oath for our culture -- Hippocrates lived four centuries before Christ. Here is one such.)
2) Consequentialist ethics. This type of ethics holds that what is right and wrong depends on the consequences, so we should try to make as many people happy as possible, and as few unhappy. Perhaps the Golden Rule of Matthew 7:12 is a form of this type of decision-making. One problem with this approach is that we dont always know what the consequences will be.  Another problem is that this approach seems to deny the possibility of absolute moral directives.
3) Be virtuous. (See Virtue Ethics in the Wikipedia.)
4) Establish principles, and work from them. The book that was, for many years, the most important text in biomedical ethics was built around four such principles, in order from the most important to less so: Autonomy, giving the patient power over decisions; Beneficence, doing good; Nonmaleficence, not doing harm; Justice, treating people fairly.

If principles are to be the touchstone for medical ethics for Christians, the following is a proposed set of Christian principles which are relevant:
A. Treat others with unselfish agape love (1 Corinthians 13, and the Golden Rule); 
B. Treat ones body as if it were the temple of the Holy Spirit (1 Corinthians 6:19-20).
C. Treat resources as if they came from God, (1 Chronicles 29:10-14) as responsible stewards.
D. Remember that life and death are ultimately in God's hands (Deuteronomy 32:39).

This was originally posted on August 16, 2013, but has since been tweaked a little. Thanks to anyone who may read this post.


atlibertytosay said...

My personal opinion - where people sit comatose or immovable for 5, 10, 15 years (or more) is reprehensible.

I understand that people don't haave the ability to llok after some of their older family, I just don't think of happiness when I see such.

Martin LaBar said...

Thanks, atlibertytosay. Those are some of the issues, indeed.

Unknown said...

The Journal deals with ethical issues in treatment and management of diseases.History of Medicine and Ethics Journal provides a forum for healthcare professionals, theologians, philosophers and sociologists to exchange their ideas from several aspects in relation to Medical ethics and Bioethics