The Linacre Quarterly Volume 43 | Number 4 Article 9 November 1976 Progress in Medical Ethics: How the Ethicist Can Help Paul F. Camenisch Follow this and additional works at: http://epublications.marquette.edu/lnq Recommended Citation Camenisch, Paul F. (1976) "Progress in Medical Ethics: How the Ethicist Can Help," The Linacre Quarterly: Vol. 43: No. 4, Article 9. Available at: http://epublications.marquette.edu/lnq/vol43/iss4/9 Progress in Medical Ethics: How the Ethicist Can Help Paul F. Comenisch, Ph.D. In this article Dr. Camenisch (not just physicians) and the presents a plea for mutual under­ professional ethicists. standing between ethicists and Territoriality medical professionals. He is As­ The ethicist is often perceived sociate Professor of R eligious by the medlcal professional as an Studies at DePaul University and invader, a usurper who seeks to is a post-doctoral FellollJ at the bring under his own aegis terri· Texas Institute 0/ Religion. tory - problems, decisions, pre· rogatives - which has until now There would be some justice or belonged indisputably to the at least symmetry in the com­ medical profession. Thus resent· panion piece to Dr. Lisson's ar­ ment and resistance are often ticle being authored by a physi­ visited on the ethicist who seems cian. And in onc sense Charles B. bent on upsetting the status quo Moore has already done this.! or at least on further disturbing But there are also advantages to troubled waters by raising addi· critical reflections and gentle rep­ tional doubts in the minds of peo· rimands originating from within pie already uncertain about the the fraternity being addressed. quality of current medical care, We ethicists, often with the very the truly human benefits of cer· best of intentions, sometimes cre­ t a i n technologically advanced ate our own obstacles by our medical procedures, t he justice of mode of entry into medical areas having to spend so much money and by some of our unexamined in the attempt to preserve their working assumptions. We also life and health. often permit existing obstacles to The first and most obvious way stand by, fai ling to clarify the to defuse some of this resentment nature of the ethical task. Being and resistance at being "invaded" aware of these troublesome ele· is for the ethicist to state as ments and exorcizing them where clearly as possible that the ethical possible should facilitate progress issues being raised are not iden­ in medical ethics, especiaJl y at tical with questions of the per­ those points where such progress sonal ethics - honor, integrity, hinges on an adequate under· etc. - of the medical profession­ standing of the nature of ethics al. But this is not a simple issue, or on good will between the medi · and those ethicists who simply cal professionals and institutions toss off this distinction as a pan- November, 1976 269 acea for all such unhappiness the which most often serve only to medical professional feels have obscure the real issues when they simply missed the complexity of do become the focus of aUention. this issue. A more significant response to There is not space here to ex­ the medical profession's inclina­ plore the various levels on which tion to defend its "territory," the questions being raised in however, is to suggest that so medical ethics might relate to the long as ethicists are raising the moral/ethical integrity and sen­ right issues, the territory which sitivity of the medical profession­ would appear to be in dispute be­ al. But most ethicists, being tween the medical and the ethi­ teachers, can perhaps grasp some­ cal professionals in fact belongs thing of what medical personnel to neither of them. The territory under ethical scrutiny feel if they ---ethical questions about various imagine themselves in an analo­ areas of medical practice such as gous situation. How would we re­ whether some medical procedures spond to being accused of engag­ should be used at all, whether ing in practices, of employing in­ some medical research should go structional methods, of partici­ forward, and if so, under what cir­ pating in a system wh ich, in spite cumstances ,etc. - belongs either of our own personal integrity, in­ to the patient/ subject involved jure, even brutalize and dehu­ or to the public at large. [n the manize our students? (Many of first case, for example, the ques­ us, of course, were accused of pre­ tion of whether to elect radica l cisely this by black groups several and grossly disfiguring surgery to years ago when they aUacked combat cancer or to die probably the " institutionalized racism" of sooner but "intact" is the pa­ much of formal education.) In tient's question. not the doctor's such a situat.ion it is some com­ or the ethicist's. And the question fort, but not reall y enough, to be of whether proxy consent should told that one's personal morality be invoked to permit non-thera­ is not under attack. Such assur­ peutic research on children is a ances declare us innocent of the question of social policy requiring more obvious, the grosser viola­ a decision from society at large, tions. But they still imply that we however difficult that is to obtain have been party to other wrongs or to interpret. (This last state­ which we were not perceplive ment does not mean that morality enough to detect. And that is no is a question of majority vote, but compliment. only that neither doctor nor ethi­ Here the I;!th icist can only try cist can relieve society of the re­ to make sure that medical pro­ sponsibility to shape its own poli­ fessionals do not read into his cy. its own moral character in analysis, his questions and sug­ such matters.) Thus these mat­ gestions, personal accusations ters do not constitute territory to which need not be there and be awarded as a prize for excel- 270 Linacre Quarterly lence in disputation to either probings, their suggested resolu­ medical or philosophical doctor. tions should be no more, and no Both may and should make their less, than a responsible attempt own contribution to the discus­ to help the medical profession sion to aid the patient or the pub­ bear this heavy load. For exam­ lic in arriving at an informed and ple, the ethicist discussing in­ critical conclusion. But the ques­ formed consent with research tions, the territory itself, are not physicians should not be defend­ theirs to dispose of between them. ing some vested interest of his At most the professions deal own which must be mapped out with such matters as with a trust. and protected against medical The medical profession does not personnel. He should rather be own the human goods it is de­ offering the analyses, the insights signed to provide. These goods - of ethics to the researchers as health, long life, and the sci­ possible aids in their struggle to entific-technological a d van c e s discover precisely what society which are meant to contribute to has entrusted them with in this them-are not possessions which area and how it can be most re­ the profession is free to dispense sponsibly dealt with. or withhold at its own discretion.2 Clearly the ethicist ca n not These goods are public trusts stand in the physician's place which are most extensively dealt and decide when to operate, when with by the medical profession to resuscitate, or how to weigh simply because it has been en ­ the cost/ benefits of a particular trusted by society with what are therapy. But serious ethical re­ currently seen as the best means flection does aim at reducing the for securing and maintaining need at such points for medical them. personnel to draw only on their When me d i c a J professionals own past experience and their and institutions realize that these own hurried reflections. If the goods are public trusts, then the ethicist can lighten that burden, entrance of qualified and sensi­ it is not because of his own tive ethicists into the ethical dis­ moral/ethical superiori ty but be­ cussions which those goods gen­ cause of the traditions of sub­ erate should be met not with re­ stantive values and commitments, sistance and resentment, but with of critical analysis, and on rare relief. To those aware of their occasion the societal consensus own fallibility (humanity?) it he can make available to help in­ should be an awesome thing to form the decisions of the medical hold life and death, health/ professional. On this construction wholeness and their opposites in of the situation in medical ethics one's hands. And if ethicists can the ethicist is seen not as an in­ achieve the impartiality, the per­ vader of medical territory but po­ sonal disinterestedness they as­ tentially as one embodiment of pire to, then their analysis, their society's willingness to help the November, 1976 271 medical professional bear the swers which are also in appropri­ ethical, decisional burdens at­ ate. Such religious insights are taching to the goods he has been thought inappropriate because entrusted with. The mystery here they are perceived as deriving is why anyone bearing such bur­ from the values and commitments dens would shun any responsible of a limited group - a particular attempt to share and thereby to religious community - and as lighten that load. resting on some esoteric base The Nature of Ethics such as revelation or church au­ Part of the physician's feeling thority rather than on "reason." of being invaded by "aliens" de­ There are several important rives no doubt from his correct misconceptions in this response perception that ethicists are rais­ to the ethicist.