the glory and the horror

There was an ethics discussion/talk today at the hospital where I’m doing my rotation, and it was about the decision to resuscitate (or not) neonates, just as they’re delivered. This is the sort of situation that I think most people who say medicine isn’t a moral endeavor conveniently overlook or forget about.

When people speak of choosing not to resuscitate, presumably they are doing so at least partly because they don’t want to put the child and family through “unnecessary” suffering. This also presumes that there is a level of suffering that is “necessary” if there is also a level that reaches “unnecessary.” If that is the fact, then that also means that someone is making the decision about what that level is, and what is an appropriate amount of suffering for people.

What this line of thinking fails to take into account is that suffering is often the means by which we, as humans, are forced to deal with our failings and frailties, and come to grips with the fact that there are things that cause our suffering. In our dealing with that reality, we are changed, and are different people after the experience. Some would say they are changed for the better, and some might say they came out worse on the other side. However, to simply say that all suffering past this level is bad, and should be prevented… well, that seems to be quite a moral statement.

And we do this all the time in medicine, but I think that we’re too scared to admit it, or we just like to hide behind societal norms, without thinking too hard about how we actually set trends in the ways we talk and deal with various situations with suffering in medical care and treatment. Quality of life discussions automatically make judgments as to how much and what types of suffering are “acceptable,” and I don’t think that’s something medicine is prepared to admit and face the implications of those sorts of judgments.