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A Reply to Bernardi, et al.
- Kenneth Alonso, Atlanta, Georgia 30310 (15 January 2008)
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Kenneth Alonso, Professor Morehouse School of Medicine, Atlanta, Georgia 30310
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Sirs, Modern ethical concerns prove inhospitable to philosophical solutions as the tradition in which those concerns were lived and understood is now largely lost and dysfunctional in the developed countries of the West. (1) The Humanist viewpoint that values and goals proper to humans can be derived from the examination of human behavior has become [de facto] State policy. Self-satisfaction and autonomous life styles are clothed as social justice. In the absence of a common understanding of what constitutes personhood [existential meaning], there can be no agreed upon fundamental virtues such as fairness, justice, and preservation of human dignity. (2) The fundamental question that no ethics committee or consultation can legislate is what is a person. Is human life a person at conception; or, when the embryo implants in the uterus; or, when the neural streak is formed; at 40 days,120 days, or when the human life can exist outside the uterus without assistance? Is a human clone a person? What constitutes a chimera? Is there a meaning to suffering? Is suicide an act of self-determination? Does the person cease to exist with neocortical death, or must all bodily function cease? Is there an obligation to maintain alive those persons who cannot exist without total assistance? (3) With whom is one to consult: an Orthodox rabbi? an Orthodox priest? a Thomist? a Calvinist? a ulema? the Dali Lama? Richard Dawkins? a medical school faculty whose research is [de facto] directed by pharmaceutical company grants? In the developed countries of the West, ethics focuses on process, not content. (4) For those of us who practice oncology, data derived from well- structured clinical trials [where the process exists guaranteeing protection for decision making to those who voluntarily enter those trials] permit us to frame options for care of patients, fully informing them of likely outcomes. With discussion prior to preparation of advanced directives, it is possible to avoid those cases of conflict that arise when expectations are not supported by evidence. It is not necessarily immoral to refuse therapy nor to voluntarily submit to aggressive therapy with a low probability of success. The physician must remove himself from the care of the patient if the religious views of either the physician or the patient impede effective delivery of care to the patient. No ethics consultation can resolve such an impasse. Evidence based conclusions enable physicians collectively to confront the State [and its corporate allies] to challenge those policies that explicitly or implicitly exclude some from potentially beneficial services. (5) Moral questions, however, remain unresolved. Kenneth Alonso, MD, FACP References 1. MacIntyre, A. After Virtues. Notre Dame University Press. Notre Dame, Indiana. 1981. p6. 2. Englehardt, Jr., H.T., The Foundations of Christian Bioethics. Seits & Zeitlinger. Lisse, Holland. 2000. 3. Alonso, K. Shall We Clone a Man? Genetic Engineering and the Issues of Life. Allegro Press. Atlanta, Georgia. 1999. 4. Hurst, S.A., Hull, S.C., Duval, G, Davis, M., ¨How Physicians Face Ethical Difficulties: A Qualitative Analysis,¨ J. Med. Ethics 31:7-14, 2005. 5. Sulmsay, D.P., ¨Cancer Care, Money, and Value of Life: Whose Justice? Which Rationality?¨ J. Clin. Oncol. 25:217-222, 2007. Conflict of Interest:None declared |
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