On Thursday, May 3, HSGP hosted a potluck and presentation by Serah Blain, Executive Director of Secular Coalition of Arizona. The National Day of Reason was billed as an opportunity to get behind something we can all believe in: Reason.

Following daytime events in downtown Phoenix, a good crowd enjoyed the potluck and the presentation.

by Linda Wendler

Ethical Dilemmas in Medicine: a non-sectarian approach to decision making

Technological advances have provided new options in medical care. With the new options come new ethical dilemmas. The April 22 speaker, Dr. Thomas R. McCormick, provided an overview of ethical systems developed to make medical decisions, and then gave examples of how those ethical principles may be applied in contemporary medical decision-making.

Dr. McCormick started with the age-old theocentric model of ethics, one that attempts to interpret God's will and apply that interpretation to how humans should behave. In this model, humans are driven by fear of divine disapproval and punishment for "bad" behavior.

More contemporary thinkers, realizing that we live in a pluralistic society with competing notions of "God" and "Good", strive for an ethical model that can be applied without resort to religion. Some ethical systems are based on self-approval or the approval of others, yielding the so-called "newspaper test" which asks how an individual would view their own action if it were published on the front page of the newspaper.

Kant, for example, developed a non-religious ethical framework based on reason. He reasoned that the only good thing is "good will" and the willingness to perform one's "duty". In this case, the individual may have to act against social norms. Kant's categorical imperative can be paraphrased as "don't do anything that you wouldn't want everyone else to do and always act so as to treat other individuals as an end rather than as a means to satisfy your own ends."

Utilitarians Mill and Bentham felt that the goal for medical decisions is to procure the greatest good for the greatest number of people. They also asserted that actions have to be judged in context. If the truth may hurt, consider that truthfulness doesn't serve itself, but must serve the human community. The take-home message is that it may be better to consider the time and manner of delivery of certain "truths" than to commit to telling the whole truth all of the time.

Dr. McCormick briefly mentioned other ethical philosophies including Natural Law ethics, Feminist ethics, and the works of W. D. Ross who listed seven prima facie duties as guides for ethical living. These duties are fidelity, reparation, gratitude, justice, beneficence, self-improvement and non-malfeasance.

The goal of an ethical theory is to provide consistency and continuity in resolving ethical questions. In health care, advances in technology have challenged medical ethicists to develop principles to guide decisions on patient care. Some of the principles date back to Hippocrates, such as "do no harm" and the concept that a treatment should provide a benefit to the patient. The autonomy of the patient is a newer concept, a departure from the paternalist model of medicine in which the physician always made the decisions. This model persists in some countries, but it is in decline in the US.

A particularly vexing ethical question is posed when a patient loses consciousness of self and of others, as in advanced dementia or with a persistent vegetative state. Modern medicine can keep this kind of patient alive so the question becomes "is this a good thing"?

Dr. McCormick presented a methodology that is commonly used to help resolve medical ethics cases when a specific treatment is being considered. First, there are questions of the medical need for intervention and the likelihood of success should the treatment be applied. Secondly, the preferences of the patient must be considered. This assumes, however, that the patient is capable of expressing informed preferences, which is an issue in cases of dementia or for minors. Dr. McCormick pointed out the value of a living will or other advance directive for increasing the likelihood that the patient's desires are honored. Quality of life with or without the treatment is the third question, and contextual issues such as legality, availability of resources (such as organs for transplantation), financial constraints and cultural issues are the final consideration.

Throughout his presentation, Dr. McCormick brought his topic to life with the use of anecdotes and real life cases involving ethical issues. For example, the case of an infant born in 1971 with both Down's syndrome and a digestive system malformation that was repairable. The parents declined intervention and the baby died, but he pointed out that in today's environment, Child Protective Services would probably become involved with a different outcome. Another scenario he described involves the practice of so-called "Family Balancing" which uses technology developed for selecting against embryos with sex-linked hereditary diseases to select an embryo of the gender a family wants. Is this ethical?

A particularly poignant example was that of an elderly widow who had been on dialysis for ten years before she developed Alzheimer's. She had earlier expressed a desire not to stay on dialysis should she develop dementia but she did not prepare an advance directive and her children insisted that she continue to be kept alive long after she ceased to recognize them. This case brings up the question of what is valuable? Is it life itself or is it consciousness, awareness, the ability to participate in the human community? Which values count most, her family's values or the greatest good? Since dialysis is paid for by the federal government, this is an issue that strikes us all in the pocketbooks as well as the heart. Dr. McCormick described some potential courses of action to prevent this situation from happening, ranging from requiring advance directives of dialysis patients to lobbying for legislation that limits dialysis.

Opening the topic for discussion, Dr. McCormick emphasized that his intent was to make his audience think seriously about troubling questions. His questioners touched on topics such as rationing of medical care, requiring patients to pay if they want certain treatments, and ethical questions regarding assisted suicide and death with dignity.

HSGP Chapter Profile

In early 2011, Eric Nguyen of the American Humanist Association interviewed Shelley Newman, HSGP's president at that time. The interview serves as a profile of the Humanist Society of Greater Phoenix, including a brief history of the organization.

Read the interview on the American Humanist Association Website.

To encourage prospective members to join us and HSGP members to keep their membership current, an anonymous donor has agreed to buy breakfast for all current HSGP members at our regular meetings through August of 2012. HSGP's board of directors is very grateful for this generous gift, and is confident that this added benefit will increase our membership.

Breakfast is still offered to guests and can be purchased at the welcome desk by the entrance door. Of course, donations are always gratefully accepted even if your breakfast is free.

To claim your free breakfast, just pick up and wear your pre-printed member nametag at the welcome desk, and let us know if you plan to eat breakfast.

Also, please remember to drop off your nametag when you leave, at the welcome desk or in one of the boxes just inside the doors.

For your convenience, the membership desk is immediately inside the door at each Sunday lecture. Stop by to join or renew your membership in HSGP, or to update your records such as your email address.