Pembirdie

Category: ethics

  • What price, a life?

    There’s the story about a guy who sees all these dying starfish washed up on a beach (why starfish? Probably because the name is cool) and sees a kid pick up a starfish and throw it in the water. “There’s no way you are making a difference,” the guy tells the kid, because he’s apparently a jerk. And the kid says that may be true but he made a difference for that one starfish. Inspirational lesson learned.

    Honestly, if you are in healthcare you kind of have to agree with the kid, because if you take a more utilitarian view you’d start advocating for all the dollars spent in the hospital to instead be allocated for buying mosquito nets and antiretrovirals and then you wouldn’t have a job. But the more I think about the story I do kind of feel what the kid was doing was pointless. I am that jerk sometimes.

    However, despite the temptation and my cynical tendencies, I am not a utilitarian. So I do have to say that throwing a single starfish back into the ocean makes a difference. (Maybe. Maybe the starfish was already dead. How can you tell? Obviously no experience with starfish here.) Using thousands of dollars of medical care to save the life of someone I’m caring for in the hospital is worthwhile, even when those thousands of dollars could theoretically save many more people in some underprivileged place. But… at some point, does it become too much?

    I struggle the most with this not when a saving treatment is really expensive, but when the “saving treatment” seems unlikely to be helpful or that it will have limited benefit. Active ninety-plus year olds choosing they want to be Full Code, when surviving a code situation would likely mean increased debility, dependence, hospitalization and an end to the healthy lifespan: that is hard for me. People with uncontrolled diabetes, end stage renal disease, and terrible blood vessels who cannot care for themselves who choose to go on dialysis for hours three days a week: that is hard for me. Cancer patients who have growing metastatic disease with chemo treatments that are sending them into the hospital every month with essentially zero chance of cure: that is hard for me.

    It is a good thing I am not in charge of medical gatekeeping, because I am not God. I do not know what the outcomes of our medical interventions will be, and when I guess I am more than often wrong. I do not know the value of a ninety-two year old living six more months, or a dialysis patient living three more years in a nursing home, or a cancer patient living an extra few weeks in the hospital. Where there’s life, there’s hope, at least from a spiritual perspective.

    What I worry about, however, is that we do not have endless resources. Sometimes I joke that it feels like practicing in the hospital is playing with fun money, because I can pretty much order any test I want and have it done, unlike in the outpatient setting. But the truth is, someone is paying for it. I worry that the people paying for it are maybe three years old right now. Will people in the future have more limited access to healthcare because we’ve already spent the money that was supposed to be for them? Will their insurance costs soar because the insurance companies are passing on their costs to the patients? It’s already happening.

    Thinking about these things leaves me frustrated, because I don’t have a solution. Maybe my personal solution is I need to be less judgmental about other people’s value judgments regarding their healthcare.

    SDG

  • How much is walking worth?

    On Monday, someone came from the wheelchair company to measure me for a wheelchair. He explained that the standard-issue wheelchairs are made in Mexico, but the fancy ones are made in Wisconsin. I’m not sure if he was implying that Wisconsinites make nicer wheelchairs than Mexicans or if that was his explanation for why the nicer wheelchairs are so much more expensive.

    While the insurance gods will ultimately determine what kind of wheelchair I get, we’ve decided to “try” for the fancy kind that has removable wheels and an extra light frame and comes in whatever color you want. (I’m going with candy red. It might be a mistake.) The man estimated that if we meet our deductible the wheelchair will cost around five hundred dollars. If that will allow me to consistently get to work by myself and diminish my fears of the wheelchair making me fall over as I try to get it in/out of the trunk — worth it.

    Even better, if, as per Murphy’s law, paying a lot of money for a fancy custom wheelchair would increase the chance of my hip problems spontaneously going away, that would be five hundred dollars extremely well spent.

    As I was thinking this thought to myself whilst driving home after almost falling over getting my wheelchair into the trunk at 11 PM at night, I kept on the same track and wondered, if I could pay money to make my hip problems go away, what’s the most I would pay?

    That is a tough question. Of course there are variables. Could the problem spontaneously remit on its own, or are we assuming there is otherwise no cure? Would this payment essentially keep me healthy for all time, or could I get another debilitating ailment the next year, or could the condition come back? Could other people contribute to the monetary amount?

    Ten thousand dollars, I would pay without thinking about it. Twenty thousand dollars (essentially our three-month emergency fund)? Mmmph… probably. Ninety thousand dollars (essentially what we have in our taxable account)? Yikes, that seems like too much. But we could probably afford it. Is ninety thousand dollars too much to pay for the ability to be able to roll around in bed without waking up to think about it, painless sex, being able to walk to Lindy’s grave, hiking?

    If there weren’t other options, I think I’d do it. If I wasn’t in a position of being blessed with monetary resources, then I guess it would be tough luck. Despite this being a hypothetical scenario, it seems problematic that I would be able to pay my way out of not being able to walk when someone without my resources would not be able to. On the other hand, my parents have paid me out of having to wear glasses or contacts (thank you, Lasik!) and smiling with crooked teeth, and that doesn’t seem so problematic. Maybe it’s because those “upgrades” seem more superficial, but I guess everything is on a sliding scale.

    SDG

  • When good advice can be bad, and other thoughts

    I am haphazardly reading through the Bible and have just started the book of Job. I find Job to be a challenging read. Today, I read the first reply of Eliphaz the Temanite, who has the dubious distinction of being the first of Job’s three friends to open his mouth. Despite being with Job for the explicit purpose of comforting him, his words are far from comforting. He implies Job is whining, wonders why Job is having so much trouble dealing with his problems considering that he’s given advice to people in bad positions in the past, suggests that Job must have done something worthy of punishment and deserved what happened to him, and ends by saying if Job simply repents and learns his lesson God will forgive him and bless him more than he did before.

    Yeah, no, if you have a friend going through hard times, this would not be the speech to emulate.

    However, despite Eliphaz being utterly wrong about things – the narrative has told us repeatedly that Job is a righteous man who has done absolutely nothing to deserve what has happened to him – he says a lot of things that are, at face value, true. For instance, in Job 5:17 he says, “Blessed is the one whom God corrects; so do not despise the discipline of the Almighty.” This is echoed in Proverbs 3:11: “My son, do not despise the LORD’s discipline, and do not resent his rebuke,” which is itself quoted in Hebrews 12:5.

    My dad taught us a saying about proverbs, which is not original to him: “Proverbs are principles, not promises.” Proverbs teach us about how the world works, the principles of how God has set things up. Most of the time, they accurately describe what life is like. Life, however, cannot be reduced to formulas. I think that is intentional. God wants us to live by faith and trust him. He intend for us to manipulate and control our lives through promises that work like magic spells.

    While Eliphaz was factually correct in saying God’s discipline is good, and we should welcome it into our lives, he applied this truth wrongly to Job’s life. He demonstrated knowledge of how life works, but not wisdom in applying this knowledge. Jesus does not do this. Solomon may have been the wisest man on earth, but he has nothing on Jesus, who knew Proverbs as well as anyone and also wisely interpreted the Law.

    On a broader level, how do we deal with situations where something is true on its own, but made false in context? In the above situation, many of Eliphaz’s statements were true, but they added up to a false argument for Job’s guilt when taken altogether. Would it still be ok to pull out the truths and use them, divorced of their context? I have never read Marx or Nietzsche, but I’ve certainly read a lot of quotes from their works and some of them ring true. Overall, I reject their overall arguments (or, what I understand their arguments to be, never having read them). But is it acceptable to pull out the parts I agree with and say, This is true? To do this, must I include a disclaimer explaining the context? Or is the “truth” irrevocably damaged by the part it plays in their larger arguments?

    Stretching the questions a little further, what if the stated truth is untainted by the context of the argument, but rather by the person making the argument? Attacking an argument by attacking the person making it is a logical fallacy, an ad hominem attack. You’re not supposed to do that. And yet, Jesus didn’t allow demons to address him as Lord. Is a shirt that says, “Jesus is Lord – Demon” going to convince anybody? Wouldn’t it do the opposite?

    I’ve read a few articles discussing this question, including one from The Gospel Coalition on Jonathan Edwards. Edwards still has a large influence on Protestant Christians today, and he was a slave owner. How does that influence how we interpret his writings? Does it?

    Although the context is different, there are similar questions about truth and its context in the medical field. In medical school, we learned about Wegener’s granulomatosis. But we don’t call it that anymore, our professor said, we call it granulomatosis with polyangiitis, because Wegener was a Nazi. On a more serious level, the scientific community didn’t know what to do with the discoveries made by Nazi scientists who experimented on people in concentration camps. Many of these findings cannot be duplicated because they were blatantly evil and unethical. But there have been blatantly unethical experiments run in the United States as well. Sometimes they resulted in knowledge that could improve people’s health. Is it ethical to use knowledge obtained through unethical means?

    I don’t have answers to these questions, and I’ve gotten pretty far away from Job’s friend’s words. Well, I’ll end on a piece of good advice. As Thumper’s father said, If you can’t say something nice, don’t say nothing at all.

    SDG

  • Mass murder in the science lab

    Recently, I read an article on NPR about how researchers were able to film a human embryo implanting into a uterus. Truly amazing stuff. But how did they do it?

    I didn’t have to search to find out, it was in the article. Scientists made an artificial womb-like substance, and then gave embryos the chance to implant in it.

    Let me expand on that a little bit.

    They took laboratory-created HUMANS and put them in an environment where they could begin to live but had no chance of long-term survival, and they FILMED it. They “created” human life and treated it no differently than an amoeba. These embryos could have grown up to be scientists themselves, movie stars, Subway sandwich makers, moms and dads. Instead, they were given the opportunity to start their lives on a substance that guaranteed their imminent deaths.

    I know embryos are purposefully destroyed all the time, and I believe that is an evil thing. But this – it seems so cruel. The lack of moral concern by the scientists and the author of the article (and, presumably, the readers) is stunning.

    Some of the most heinous sins in the OT involved people sacrificing their children to the fire, as an offering to their false gods. We are now sacrificing our children in the name of science, to the gods of knowledge, health, and beauty. The scientists say this could help our future children, but the utilitarian ethics are not convincing. Why are future children more valuable than the children destroyed in the lab last week? No future good can justify their deaths.

    SDG