Tuesday, January 13, 2015

4. Bioethics – Expression of Values

Ethics and Virtue Must Go Together 
Dedicated to the Holy Father, Pope Francis, on the occasion of his visit to the Philippines 

Dr Abe V Rotor
Living with Nature - School on Blog
Paaralang Bayan sa Himpapawid (People's School-on-Air) with Ms Melly C Tenorio
738 DZRB AM, 8-9 evening class Monday to Friday

He drew a deep breath and held it there as if forever. His eyes were wide open, glassy and welled with tears. He was in a pathetic look, his lips were agape, his whole body tensed. Then the inevitable moment came. He gave up fighting for life.

Immediately quick hands put the boy under the command of modern machines - a high voltage cardiac resuscitator, a lung machine that works on the principle of our diaphragm, electronic gadgets of all sorts to monitor pulse rate, body temperature, blood pressure, and the like. The sight of wires and tubes all over the young patient, with doctors working double time, reminded me of the six million dollar man who cheated death with the miracle of modern science and technology. In the rarefied hospital atmosphere the hero would emerge victorious into the waiting arms of his loved ones and to the world with one more notch to scientific feat. 

But my hero, Paolo – whom I likened after the boy Atrio, in A Never Ending Story - never woke up again. Which reminded me of the celebrated Karen Quinlan case - a young woman, a victim who remained in coma in a US hospital for more than a year. Since there was no progress in her condition, the question arose as to shut off the life-sustaining machines or not. The case became a long court battle. At the end, the patient was allowed to die.

The court’s decision had heavy leanings on the principles of bioethics, and it continues to exert influence on similar cases to this day, some thirty years after. Bioethics, or the ethics of the life sciences, provides the guidelines in the decisions and actions of people who are dealing with life such as doctors and biological researchers. The ethical principles involved are expressions of values, and the foundations of specific moral norms and rules.

In both cases of Paolo and Karen, we can not help but ask these crucial questions: What is natural death in modern medicine? Is the prolongation of life with machines – in spite of the fact that doctors have certified to the total hopelessness in the condition of the patient - justifiable? Is it ethical? Should respect for life and right to live – or say, freedom of choice and principle of consent – prevail over taking the painful, inevitable decision?

Here we analyze the situation not only in the light of bioethics but the interrelationships of ethical principles. Yes, the human person ought to be respected always, but in this situation the deepest respect one can give to the patient is to allow him to die peacefully and meet his Creator, which consequently allow the bereaved family to realize God’s sovereignty over life and all creation. It is said that while compassion grows in times of trial, its fruition comes with resignation to truth and justice, in love and forgiveness – all these come at the end of our journey in life.

Bioethics and Social Justice

Outside of the hospital are people waiting for their turn to be treated. There are patients who need immediate treatment. There are those who have been silent in prolonged agony. Mostly are poor. We are also aware that in remote towns and villages, having a doctor around is considered a luxury. The kind of healthcare these people generally know are traditional and unreliable, and associated with superstitious beliefs. What an extreme scenario with that of Paolo and Karen!

Thus bioethics and social justice must go hand in hand as we view the vast application of bioethics – the poor - millions of them all over the world who are dying everyday without the benefit of modern medicine - nay, without the comfort of dying, or the miracle of science and technology that prolonged the lives of Paolo and Karen.

And yet there are people who are privileged of “over treatment” as modern science and technology opens the possibility of cure to terminal cases. We question the science of medical cryogenics, its lavishness and extreme futuristic goal. There are a hundred rich people in America today whose bodies lie in cryonic tanks waiting for the day when medicine shall then have found a way to revive them. Sounds like Jurassic Park?
“In the real sense, the practice of virtue is what morality is all about, meaning lived morality, the morality that leads to self-realization and ultimately, happiness. After all, virtue is the road to happiness.”

Fr. Fausto Gomez, OP, STD, Relevant Principles in Bioethics

Here is another case on social justice. The US spends $1.5 billion daily on healthcare, even while more than a quarter of its population is deprived of such medical benefit. One can imagine the tremendous significance to social justice, its contribution to world peace and improvement in the quality of human life, if only a substantial part of the wealth of the resurrection believers and the extravagant healthcare budget of a very rich country could be extended instead to the alleviation of the plight of the world’s poor sector.

Bioethics and Disease Prevention

This leads us to the ethics of prevention rather than cure. Dr. Mita Pardo de Tavera believes in primary health care approach involving people’s full participation – people’s empowerment in health, as part in a strong program, particularly diseases such as tuberculosis classified as social diseases because of their high association with poverty. The solution is not merely dependent on medical approach but on a sound socio-economic program that deals with illiteracy, unemployment, inertia and the like, that spawn many ailments and diseases. 

Pillars of Bioethics

In the foregoing discussion I have merely pointed out of the broad domain of bioethics the pillars on which its essence rests, which are
§ Truth
§ Compassion
§ Beneficence
§ Justice

There is a source of goodness that springs from every righteous person when dealing with questions on bioethics. It is conscience - that inner voice that tells us what to do and subsequently makes judgment of our actions.

But how good is good enough? This brings us to qualify conscience as formative conscience. Fr. Tamerlane Lana OP STD, emphasizes the formation and education of conscience as a life-long task for everyone, especially professionals whose decisions directly affect the lives of people. The goal is for them to attain a well-informed conscience, which is upright and truthful, a conscience that does not merely rely on acquired knowledge, and even on ones personal capacity. It is conscience guided by the spirit.

Growing Application of Bioethics

Today with growing affluence and increasing complexity brought about by our pluralistic world, we find bioethics in the ever-expanding fields of science and technology that have direct or indirect consequences to human life. Thus we hear people raising questions on the morality and ethics of various areas of concern such as the following:

§ Euthanasia
§ Hospice management
§ Organ transplantation and rehabilitation
§ Contraception, abortion and sterilization
§ Social justice in the allocation of healthcare resources
§ The Human Genome Project and genome mapping
§ Genetic engineering and human Cloning
§ In vitro fertilization (test tube babies)
§ Surrogate motherhood and menopausal childbirth technology
§ Aging and extension of longevity
§ Pollution and global warming
§ Ecosystems destruction
§ Nuclear, biological and chemical warfare

These are some areas of concern in bioethics which constitute the course outline of a 3-unit subject, Bioethics for MS Biology at the De la Salle University. The expanded version of bioethics emphasizes its application outside of the field of medicine. These include the following cases:

Food Additives and Contamination

Equally vital issues are the manufacture and distribution of food laces with harmful substances like potassium bromide in bread, sulfite in white sugar, nitrate in meat, glacial acetic acid in vinegar, monosodium glutamate (MSG) in cooked food, aspartame in softdrinks, and many more. Many of these are linked to cancer, diabetes, loss of memory, and many other ailments.

Many of us may recall that some fifteen years ago unscrupulous local businessmen imported radiation-contaminated milk from Holland following the Chernobyl nuclear plant accident in nearby Kiev, Russia. Although banned for distribution on orders of the government, the shipment clandestinely found its way to thousands of Filipino homes. We do not exactly know how serious the tainted milk is on human health, but we know for a fact that the half-life of the radioactive material may last for hundreds of years, within which time it shall then have passed through the food chains and food webs repeatedly far and wide, invariably affecting every member organism, including man.

A similar case was reported during the peak of the Mad Cow Disease in Europe. That was three years ago when Makati-based food processing companies clandestinely imported beef coming from the British Isles near the center of the epidemic where scores of human victims succumbed to the disease. Mad cow disease scientifically known as Bovine Spongiosform Encephalopathy (BSE) has been found to be positively associated with a fatal human brain disease known as Cruetzen Jacob Disease or CJD. Victims of Mad Cow disease exhibit early symptoms of Alzheimer’s disease, a rapid degeneration of the nervous system that attacks people in old age. Reacting to surveillance, the government intercepted several container vans of the contraband meat at Manila and Cebu ports. The contraband was sent back to the country of origin – an order that is impractical to implement.

Clearly, in these smuggling cases the ethics of business and ethics concerning the health of people were grossly and blatantly violated, but unfortunately no one was convicted and punished.

Ecological Bioethics

Recently in a conference-workshop a participant asked me, being the resource speaker on ecology. “Is it a sin to cut a tree?”
Felled old balete tree, Lagro QC
The question is not to be taken literally, or jokingly either. It permeates into something bioethical. It is not the cutting of the tree per se – or similarly, the spewing of CFC in the air, or throwing mercurial waste in the river, that the issue should be examined. It is the destruction of the ecosystem, the disruption of the functioning of natural laws and processes, and therefore the integrity of whole system is the one that is at stake.

The unabated logging of the watershed of the once beautiful city by the sea – Ormoc City in Southern Leyte - led to massive mudflow that swept the central part of the community burying or drowning thousands of residents, and causing untold sufferings. Yet the ethics and morality of the actions of the loggers and their cohorts were never at all brought out as the major issue during the long investigation.

I would like to view the tragedy in the realm of theology, that of a paradigm of salvation. According of Fr. Percy Bacani, it is a sin to harm the environment, because it causes people to suffer. How could it be that the culprits of the Ormoc tragedy find salvation in mere act of contrition without plowing back their ill-gotten wealth for use in rebuilding the community and in helping nature regain its prior state and stability? Here we are saying that this paradigm touches deep into the roots of moral philosophy while we are guided by general ethical principles. There are specific professional guidelines. Here we encounter questions like the following?

§ When are we responsible for the consequences of our actions? (Indirect voluntary)

§ How far may we participate in the performance of evil actions done by others? (Principle of cooperation)

§ When may we perform ethically, an action from which two effects follow, one good and one evil? (Principle of double effect)

§ Are we the lords of our lives and creation, or only custodians (principle of stewardship)

§ Is the good of a part of the body subordinated to the good of the whole? (Principle of totality)

These are general ethical principles that guide us everyday as bioethicists, especially in analyzing situations, making decisions, and forecasting the consequences of our actions. These principles are used in law, philosophy, theology, management and other disciplines. They are used in case studies, and in actual situations, and their interpretations may vary depending on who is at the helm or talking, or that they apparently change with the march of time and progress. But one thing is sure to stay forever, and that is, the values on which they are founded, which in turn provide the virtues that guide the ethical acts of every person.

But why is it that we do not always follow the dictates of our conscience – nay, even us who undoubtedly possess formative conscience?

“Because we are weak, or blinded by sin or vice. Because we lack virtue and fortitude,” summarized Fr. Gomez. 

Man has yet to learn not to do a thing he knows to be evil, and to do the thing he knows to be good. As temptation leads one to sin, so do complacency and inaction.

On that fateful day, Paolo my hero, was the focus of a most crucial decision the doctors, my family and I had to make. The life-sustaining machines were finally removed and Paolo died in my arms. He was my son. He would be 37 today. ~

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