Lisson, Edwin L.

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The Linacre QuarterlyVolume 43 | Number 4 Article 8November 1976Progress in Medical Ethics: How the Physician CanHelpEdwin L. LissonFollow this and additional works at: http://epublications.marquette.edu/lnqRecommended CitationLisson, Edwin L. (1976) "Progress in Medical Ethics: How the Physician Can Help," The Linacre Quarterly: Vol. 43: No. 4, Article 8.Available at: http://epublications.marquette.edu/lnq/vol43/iss4/8Progress in Medical Ethics: How the Physician Can Help Edwin L Lisson, S.J., S.T.D. Father LisBon, of the Texas In.-stitute of Religion, suggests areas where greater cooperation be-tween physicians alld ethicists will result in mutual awareness and understanding. Looking for a good specialist in medical ethics? With the number of medical-moral questions reach-ing the news media and with in-creasing demands from medical students for medical-moral semi-nars and "Ethical Rounds," many institutions are scrambling to come up with an expert in medi· ca l ethics. But who would this rare crea-ture be? If a physician with the personality and impeccable com-petence of Marcus Welby also held a degree in Moral Theology from the Gregorian in Rome or a degree in Christian Ethics from Harvard, perhaps he would fill the bill. Bu t living, and practic-ing, in the real world where the demands of being merely com-petent in either medicine or eth-ics becomes virtually impossible, the quest for one individual equally competent in both fields may have to be abandoned. Pro-fessor K. Danner Clouser accu-rately and realistically describes this necessary compromise in 264 medical ethics when he asks for a constant and focused inter-change which calls for medical people to become fami liar with the basics of ethical theory, just 3S ethicists specializing in mediA cal-moral questions must become fami lial' with some of the facts of medicine. I The Problems The root of t he problem in finding the ideal medical ethicist lies primarily in the expanding scope of the number and com-plexity of the questions involved together with t he depth or knowl-edge and skills required of either a physician or an et.hicist to re-main basically competent, if not up to date. There is no need here to com-ment on the complexities of the physician's problems. However, the physician may not be aware t.hat the problems facing the ethi-cist a re expanding in not just. one but in two dimensions at the same t.ime. On what might be called a horizontal plane. on the level of concrete practical prob-lems, t.he number and complexity of t.he questions confronting the ethicist are becoming virtually overwhelming. At the same time, the et.hicist confronts another Linacre Quarterly J, • whole dimension of questions in what might be called a vertical dimension. In this vertical dimen-sion of problems, the ethicist faces deeper and ever more fun-damental levels of questions con-cerning data and methodology, fundamental concepts and basic principles. On this level Clouser observes that ... the data force some changes in the theoretical s tructures, and the theoretical frameworks lead to a new under-s tanding of the data.~ In this vertical dimension, philosophical ethks must now re-examine the very meanings of the concepts of life, death , and health together with the humanistic val-ues associated with these funda-mental concepts. Similarly, the moral theologians are forced to te-examine the fundamental mor-al insights and principles con-tained in Scripture and to re-evaluate the bearing of Scripture upon contempora ry concrete mor-a l questions. At the same time they must carefully analyze the content of Catholic tradition in an effort to clarify the funda-mental insights into human na-ture and the Christian vocation pre se rved and comm unicated through magisterial documents. On a level even more fundamental than that of methodology and data, the moralist is being chal-lenged to re-evaluate his role within the Christian community. Thus, for anyone concerned about medical-moral questions, wheth-er he is primarily physician or ethicist, the fundamental prob-lem is the rapid expansion of the November, 1976 questions in terms of numbers and complexity, in breadth and depth. The Dangers One painful lesson presented by the Edelin and Quinlan cases is the real and present danger of issues which are properly medical and moral questions being settled in a court of law. If the nature and function of Illw is to remain that of preserving and protecting the values of society, there must necessarily be some temporal lag between legal decisions and the progress of both medicine and morals. As medicine ga ins in-sights into man's nature and po-tentials for self-preservation, so too, by its own proper data and methods, the science of e thics de-velops its proper insights into man's nature, his possibilities, and his responsibilities. Any re-versal of this temporal sequence will bring irreversible damage to the progress of both medicine and ethics. Such will inevitably occur when the law is asked, or forced by default , to act in advance of medicine and morals and there-by inhibit the progress of both. But even more pernicious to medical eth ics is the threat of ethical apathy. Unlike legal in-vasion which would merely in-hibit growth, e thical apathy could ultimat.ely destroy the medical-moral enterprise through an internal debilitating process of decay. How the Physician Can Help Even though the number and com pie x i t y of med ical-moral questions expands in both verti-265 cal and horizontal dimensions, the physician might take note and take hope from the amount and quality of responsible re-search being carried out at such places as the Hastings Center in New York, the Kennedy Center in Georgetown, the Institute of Religion in Houston, ITEST and the J ohn XXIII Centers in St. Louis, and the Joint Program in Bioethics in San Francisco. From the present lack of clear answers to many complex medical-moral questions, it would be wrong to conclude that practical and help-ful solutions are either impossible or not fo rthcoming. Thus, the first thing that any physician can do to assist the progress of medical ethics is to be patient with the scientists, ethi-cists, and moralists who are spe-cializing in medical ethics. Just as it would be wrong for a physi-cian to stop trying to find a cure for a disease after admitting that he cannot cure an individual pa-tient, so too, it would be wrong to abandon the enterprise of medi-cal ethics, if there are lacking clear answers to medical-moral questions. The medical profession, justi-fiedly or not, has a reputation for being distrustful of outsiders. Moreover, the present state of malpractice consciousness ha s seen an increase in the number of diagnostic tests, a heightened sense of confidentiali ty in record-keeping, and a mollified tone at tissue and pathology confe rences. This climate has provided an even colder environment for the 266 non-medical person with special-ized interest in medical-moral questions making responsible re-search even more difficult. In response, it might be helpful to keep in mind that there is very little likelihood of a responsible working ethicist being interested in malpractice - as little likeli-hood as his being called as an ex-pert wit ness. Moreover, any ethi-cist who has devoted as many years to ea rning his credentials as a physician has his, will be at least as concerned about the un-ethical conduct of attorneys as he is of physicians. Malpractice suits are usually caused by malprac-tice, suit-prone patients, and the testimony of peers. Sometimes they involve actions of unethical attorneys but rarely the opinions of moral theologians. From another poin t of view, Daniel Callahan, Director of the Hastings Center, has observed an ethica l backlash sweeping through scientific quarters . .l This backlash involves a strong sus-picion that t he new concern of ethics represents a latent anti-scientific bias together with a feeling that the personal morali ty of researchers and clinicians is un -der attack. Whether this backlash is justified or not, the conclusions of Charles B. Moore, M.D. , after a year's exposure to Moral The-ology as a Kennedy Fellow in Medical Eth ics, may be as reas-suring to his fellow physicians as it is to ethicists. After noting the inherent linguistic and conceptual difficulties between ethicists and physicians, Moore concludes that Linacre Quarterly I "The obvious link between the two fields is that they both hope to accomplish the same goal -improved medical care for the patient, administered ethically."~ The physician can make an even greater contribution if be-sides merely being not threat-ened, he can develop a positive attitude of openness to the en-terprise of medical ethics. This was also Moore's conclusion: "A more productive way wou ld ap-pear to involve meaningful dia-logue as the two disciplines a t-tempt to approach each other openly) Many of the linguistic and con-ceptual misunderstandings be-tween medicine and eth ics spring from the fact that medical ethics takes place at the interrace of two radically diHerent, but not necessari ly opposed disciplines, each with its own data and meth-ods. This interCace is bridged b y physicians who are specificall y sensitive to, and interested in, the ethical implica lions oC their pro-fession , working in dialogue with ethicists who bring to th is spe-cific area of questions the princi-ples and general norms of their profession. Just as the physician cannot be secu re in his moral judgment without some undeT-s tanding of the moral principles and values operat.ive in his deci-sion, so too the moralist can make little practi cal contribution with-out some understanding of the fact.s and consequences in the medical aspects of the question. At this point, it would also be helpful to keep in mind the fact November, 1976 t.hat the contribution of the mor-alists of t.he past generation such as Mc.Fadden, Healy, Lynch, Ford, and Kelly was largely the work of physicians. In addition to their regular teaching and writing responsibilities, these moralists answered dozens of questions each year from individua l prac-titioners. In preparing practical moral responses to these requests, these moralists rel ied not only upon moral and medical text-books but especially upon the personal opinions of prudent and knowledgeable physicians. As a result, their practical moral opin· ions were not only morally sound but eminentl y practical and use-ful for phys icians.~ Furthermore, when these mor-alists received numbers of ques-tions on the same issue, they felt obliged to publish an article, as much for the benefit of a larger audience as to have their own time. These articles were orten the same in form and content as their responses to individual let-ters. As regards Kelly's work in particular, in the face of continu-ing requests, his articles were compiled into the book which is still used and cited almost a gen-eration later.' Thus t he perduring value and practical usefulness of t he work of this generation of moralists was largely due to the contribu· tion of physicians who brought forth t he questions and provided advice on their solution. There is no reason why the same con-tributions cannot be made in the present generation. In this per-267 spective, any physician can make a valuable contribution, if besides merely being open to the enter-prise of medicine, he assumes positive initiative and active lead-ership in the responsible and re-spectful dialogue which bridges the interrace t.hat is medical ethics. Finally, the most important contribution which any physician can make to the progress of medi-cal ethics is his personal sensi-tivit.y to ethical questions and his personal moral conduct. Always, the first and most fundamenta l ethical decision is whether or not to be ethical. Without continual interest and sensitivity to ethical issues involved in the physician's daily practice, there is no hope whatsoever for progress in medi-cal ethics. Such a continuous ethi-cal sensitivity might prove frus-trating, sometimes even painful , but, one would hope, never de-bilitating or contrary to good medicine. There is then every indication that good specialists in medical ethics are now at work and even more are being trained. But in any academic discipline, the spe-cialist can make his proper con-tribution only in the textbooks and in the classroom - whether he is professor of anatomy, path-ology, histology, or ethics. For the individual medical student moving through his professional 268 training, the real learning is more likely to take place in the clinical situation through the role models he individually respects and se-lects for his individual and pro-fessional conduct. Thus, until Marcus Welby finishes that de-gree in Moral Theology, the real-world teacher of medical e thics will continue to be the individual physician whether he is private pract.itioner or chief of service, through his personal ethical knowledge and moral sensitivity, and most important of all, through his individual example, REFERENCES I. Clouser. K. Danner, Ph.D., "What is Medical Et hi<..'8," A 1I1Io/s of III/ernul M edicille 80 ( 1974) 659. Cf. by the !lame author. "Some Things Medical Ethics Is Not," JAMA 223 ( Feb. 12. 1973) 787·789. 2. Clouser. " What is Medical Eth-ics." I). 660. 3. Cn llflhall , Daniel. "The Eth ics Backlf1sh: ' N os/illps Center Reports. Vol. 5, No.4 (August 1975) I). 19. 4. Moore, Cha rles B .. ~·t.D .. "This is Medil'a1 Ethics." N astings Center Repor/s. Vol. 4. No. 5 (November 1975) p . 1. 5. Ib id . 6. Lisson, Edwin L., S.J. /-l is/orfcuf COlltex/ (II1t1 Sources of A/orul Thc -ology ill lire IVrilillp.~ of Geruftl A. K elly, S .J .. (Rome: Grego riflll Uni -versity. 1975). 7. Kelly, Ge rald A., S.J .. M el/ical· Moral Que8I ioll.~ (St. Louis: Cat holi!' H05pitn1 Association. 1957). Linacrc Quarte rly 

Progress in Medical Ethics: How the Physician Can Help

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Progress in Medical Ethics: How the Physician Can Help

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