the glory and the horror

Some questions that I’ve been asking of some people in medical school and applying to medical school:

Why are you in medical school? If you weren’t in medical school what would you be doing, if you could pick anything else?

What is the purpose of medicine?

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Is it good to be unbiased? Is it ever possible to be totally unbiased? Why or why not? If it is possible, how?

What does it mean if someone is biased? Is bias ever good?

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How do you define “people in need?” Are they poor or rich? In the US or not?

What does it mean to take care of the sick? Does it mean curing illnesses? Does it mean stopping death? What does it mean for people to be ill? what about when we can’t cure illnesses? What is medicine’s role then? What do you mean by “not just live with them but survive them?” How is “living” different from “surviving”? how do you define “more bearable” in terms of the last days? Is it no pain? Is it to have closure? Is it to be at peace? Something else?

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Is medicine inherently moral? Why or why not?

Are there ideals in medicine? What are they? Why?

I’m not normally one to just start watching a TV show, but one grabbed me tonight for no reason, and I ended up finding it incredibly fascinating.

This week’s Law & Order: SVU involved a mom that loses her husband and daughter in a car accident, and then becomes delusional, thinking her daughter was kidnapped. She hires a couple PIs to snag a girl that looks JUST like her daughter would have looked if she didn’t die. Then, DNA tests show that the nearly abducted child IS biologically the mom’s daughter. Investigation shows that at the root of this is an unethical fertility doctor who used mom’s fertilized eggs without her consent, and implanted them in this other woman, and that child she saw was her biological child, but the second mother was the one who gave birth to the child.

So the case goes to court, and the defense lawyer makes a compelling argument for how mom A was just following her maternal instincts, which no law could stop. The prosecuting attorney feels like she’s already lost the case, since she perceives the jury to already emotionally be on the defendant’s side. After all, how can one be guilty of kidnapping her own child? Especially since that child was “produced” against her will, and without her consent.

So the kicker is that a colleague of the prosecuting attorney brings up Solomon, and explains the story of the two women who are arguing over the child. The prosecuting attorney takes this advice to heart, and then lights into the child during the trial, repeatedly trying to get the little girl to realize that mom A really is her “egg mommy.” The child loses it at this point, and the judge even wonders where this line of reasoning is going. The child can’t stand this, hates it, doesn’t want to hear that her parents aren’t her real parents, and so mom A breaks down, and refuses to go on, pleads guilty, and for all intents and purposes, the case, and show, ends.

Yikes! Talk about some crazy means and ends. No one is going to ever be the same after this, and all because of an unscrupulous doctor. I don’t know what would happen if this really happened. This would be incredibly complex, and the precedent this would set would have to be unbelivably nuanecd, or else this would open all sorts of issues up. Ideally, if the doctor weren’t unscrupulous, this would never have happened, but conceivably, something like this could merely be a result of a mistake, and not any sort of fraudulent or disingenuous intentions.

Sheesh. Wow.

Tonight, my old roommate and his wife invited me to go with them to their Sunday School class’s monthly dinner, where a doctor from church (and faculty at the med school) was going to tell us about his recent trip to India. It was a night well-spent. It reminded me of the joy and the fun that is missions, it reminded me of how I am not a Christian just in the US, but I am a member of the Body of Christ that spans time and space, and that I am inextricably intertwined with my brothers and sisters in Germany, Bulgaria, Qatar, Uzbekistan, Myanmar, Sri Lanka, South Korea, Indonesia, Uraguay, and in the rest of the world.

It reminded me of the great need for people who will go to the unloved, the untouchables, the ostracized and outcast of societies. It reminded me of how much going can and does change you, and the way you see and perceive the world. It reminded me of how little I have been thinking about it in recent months, with all my thoughts about graduate school and rotations.

Reading: Let the Nations be Glad! by John Piper

CNN.com – Patients pay price for public hospital care – Sep 6, 2004

The thing they fail to tell you is that Zale-Lipshy Hospital is not just right down the road – it’s next door. It’s one of the hospitals in the medical center that serves predominantly private patients. His surgeon probably performs surgeries over there, too.

Anyway, I think it’s a great hospital. It has it’s problems, but I think they do some of the best work in the state, if not in the nation, in terms of being a truly patient-oriented institution. The problem comes with other social factors, such as problems with patience, compliance, patient education, and just the generally pervasive problem of little to no continuing primary care for much of the population that Parkland serves. Public hospitals have been, and will continue to be, one of the last places for the indigent/less insured in our nation to get care, and in Parkland’s case, particularly high-quality care. There will come a time, though, when funding and resources will have to be allocated such that Parkland will have to decide to either treat fewer people, or provide less health care.

Much like John Peter Smith has already decided to do for undocumented residents. Tarrant County’s public hospital is no longer providing non-emergent care to illegal immigrants/undocumented residents/whatever else you want to call them. They had to make a hard decision, and they made it. Parkland, and other public hospitals, have been making that decision in one way or another, and they will have to continue to make it unless something changes, and the burden does not fall solely on the public hospitals.

That means either someone else has to be willing to take those uninsured/unable to pay patients, or more funding goes to the hospitals so it’s possible to care for them, or something else.

So who’s going to step up?

I was completely unaware of this debate until just recently, and here are some thoughts I posted to a message board I frequent. I will cut out the massive quotes, but I will leave in some important stuff. If you want to read the original message, it’s here.

Gene Rudd. Is Vaccination Complicit with Abortion? The Annals of Pharmacotherapy: Vol. 37, No. 9, pp. 1340-1341.

Is it reasonable to conclude that accepting a vaccine manufactured using cells cultured from embryonic tissue obtained from an abortion done many years ago makes you complicit with that abortion � or any abortion?

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Medicine’s history in perspective � Sadly, the history of medicine has its dark past. Today we benefit from knowledge and technologies that we advanced via experimentation that should shame a civilized society (e.g., use of information gained from human experimentation by Nazi physicians during WWII). Would we ever condone such behavior again so that useful knowledge might be gained? Of course not! Yet, can we disentangle that knowledge from what is known and applied today? I think not. Opposing vaccination because of its sordid past suggests a standard that would be impossible to apply throughout healthcare.

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When we compare our clear moral duty to care for our children with a much less certain moral duty to reject a vaccine because of potential complicity with abortion, the choice seems clear.

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In determining complicity, some ethicists distinguish between “immediate and mediate” and “proximate and remote” cooperation with the immoral act. While at times confusing, these distinctions describe the degree of separation between 2 events that also separate their moral complicity. These arguments are supportive of the opinion that someone can remain opposed to abortion without having to refuse vaccinations. While time does not change the face of evil, it can separate us from being an accomplice.

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Since this debate seems focused mostly among those with religious convictions, adding a comment about redemption seems appropriate. While never condoning evil acts so that good may result, the Judeo-Christian tradition teaches of a loving God who seeks to make good out of evil. A Christian does not reject the resurrection (good) because of its linkage to crucifixion (evil). Though linked, participation in the good does not endorse the evil. Neither does one need to reject the benefits of vaccination (good) solely because of its past linkage with abortion (evil).

Furton EJ. Vaccines originating in abortion. Ethics Medics 1999;24(Mar):3-4.

As for receiving benefits from past immoralities, that is a common feature of our fallen world. Human history is filled with injustice. Acts of wrongdoing in the past regularly redound to the benefit of descendants who had no hand in the original crimes. It would be a high standard indeed if we were to require all benefits that we receive in the present to be completely free of every immorality of the past.

Maher DP. Vaccines, abortion, and moral coherence. Nat Cathol Bioeth Q 2002;2(Spring):51-67.

Now, in the present case, the only opportunity for cooperation in abortion occurs in connection with the initial transfer of tissue. Today, when a person receives a vaccine injection, there simply is no cooperative action with whoever performed the abortions.35 The vaccine user provides no material assistance in the abortion nor acts in such a way as to will that the abortions take place. It is true as a matter of fact that the cell lines used to produce vaccines come from abortions, but abortion is not essentially necessary as a means to this end. This does not mean that the use of the vaccine is totally unrelated to abortion, but only that the distinctions that help to assess cooperation in evil do not provide a coherent moral analysis. Considering the independence�not only in time and place, but also morally�of vaccination from abortion, one comes to see that one achieves a morally coherent understanding of vaccination without essential relation to one�s moral condemnation (or for that matter, approval) of abortion.

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After all of this has been said, if one judges that the use of these vaccines is indeed morally coherent for those who condemn abortion, even if it is not unqualifiedly desirable, one must be prepared for a further challenge. If the use of these vaccines despite their connection with abortion were to become customary, and if people cease to be uncomfortable with the regrettable origins of these vaccines, it will probably become more difficult to maintain the distinction between the use of existing fetal cell lines for vaccines and the use of fetal tissue for research and transplantation, not to mention the various experimental uses of frozen human embryos. The distinction articulated above�between a noncomplicit, accidental relationship and an association that is incoherent with principled opposition to abortion�will probably become more difficult to defend in public. As the practice of fetal tissue research and transplantation spreads, the sorts of arguments presented above are likely to be recast and used in support of this sort of research and transplantation.