Jane Haddam’s WordPress weblog

Objectivities–And Happy New Year

with 10 comments

Well, my first thought is this–why, and in what way, are “professional principles” “objective” in a sense that other moral and ethical systems are not?

Most compilations of professional principles I know of are very subjective indeed, and all of them rely on a set of unstated axionatic assumptions–about the nature of the human person, or the definition of justice, or the primacy of the need for the free flow of information–that are nowhere questioned, never mind defended, by the people who sign on to them.

In 1974, the APA went from calling homosexuality a “disease” that could be “cured” to calling it a “sexual orientation” that people should be taught to live with and accept–virtually overnight, and on the basis of no new factual information whatsoever.  The change was not in objective facts but in public and professional attitudes, and “professional principles” thereby did a 180 degree turn in no time flat.

If you were a psychiatrist affirming homosexuals in their homosexuality in 1973, you could have been brought up on ethics charges and booted out of the profession.  A year later, the same could happen to you if you were treating homosexuality as the “disease” it had been “objectively” declared to be just two years earlier.

Nor do I understand the idea of a country full of “religious do-nothings.”  It’s precisely because religion does NOT “do nothing” that this conversation is possible at all. 

And there is no way to leave the Catholic Church out of it, because in the US today, it is the Catholic Church and its practices that is and will be at issue.

Far from doing nothing, Catholics–operating on Catholic principles, including versions o professional codes that were adapted to Catholic moral teaching–built a vast network of hospitals from one end of the country to the other.   Catholic Charities is the single largest dispenser of social services in the nation, and the Catholic parochial school system is the second largest school system in the world. 

Many communities would have had no medical care, no aid to the homeless, no  orphanages, until well into the 20th century, if Catholics hadn’t emptied their pockets and given their time and resources to creating charitable institutions in those areas. 

County and municipal governments could have done those things–but very often, they didn’t.  In fact, very often, they simply weren’t interested.  The do-nothings here do not seem to be those with religious principles.

So let’s get to what started me on all this.

I am not a moral relativist.  I do think it is possible to establish an objective basis for morality.  Aristotle thought so, and so did Thomas Aquinas–who did not rely on “subjective” anything, never mind mere appeal to scripture or Church tradition, to justify the moral code he advocated;  the Summa Theologica contains  page after page of attempts to establish these things on an entirely objective, rational and logical basis.

My problem, at the moment, is that I don’t much like the actual moral codes being thrown up by various secular writers and organizations.  Richard Rorty was truly appalling in his approach to morality, not so much be the specific things he was in favor of or opposed to, as the basis on which he tried to found them.

This is what I call the Peter Singer problem.  Singer is most infamous for declaring that there is no logical reason to say that a third trimester abortion is any different than infanticide, and since that is the case, parents should be allowed to decided, within the first twenty-eight days of life, that their newborn infant will “negatively impact the quality of life” of the rest of the family members, and have it put to death.

Singer’s reason for why this should be considered morally okay is his belief that an infant in those twenty-eight days doesn’t have the characteristics of being human that require us to consider him as a subject and not an object–he has no sense of the future, he doesn’t have real emotions yet, he isn’t cognitively self-aware, etc.

In case you think that this must be a crank on the margins, Singer holds an endowed chair in bioethics at Princetown University, is extensively published by major New York houses, and has a regular column on bioethics in Free Inquiry, the flagship magazine of the Council for Secular Humanism.

And his reasons for thinking it’s okay to kill the baby are not much different from the reasons put forward for some abortions (the child might be born handicapped!) and for a fair amount of the “death with dignity” stuff.  They aren’t really human any more anyway, because they’re not like us in all these ways, and besides, if the family (or the sick person) was being rational, he wouldn’t want to live like that anyway.

I’ve seen two people through terminal cancer, and I’m here to tell you that this attitude–if he was being rational, he’d WANT to die–is endemic, already, throughout the medical system in the US. 

Bill’s last few weeks were like a war, a war against one doctor after another who insisted that it was only Bill’s emotions talking when he said he wanted to be kept alive no matter what, that the pain and debility was worth it as long as he had another day and then another with his children. 

Every time, in every case I deal with, that I refuse to authorize a do not resuscitate order because I was told by the patient himself (or herself) that he wanted to be resusciated, that he wanted to go on fighting as long as possible–every time, I was told I was being “selfish” and that I  didn’t understand that the patient had only said those things because he was afraid.  If he’d been thinking rationally, he’d have done it their way.

I know, too, that the news from Holland is not good–something like one out of every six doctors and nurses say they have quietly “put the patient out of his pain” EVEN WHEN that patient had rejected euthanasia when asked.

It’s against the law, of course, for them to do that, but they do it anyway, and it doesn’t get investigated or prosecuted, because it’s nearly impossible to police. 

So, here’s what I want–at the end of my life, I want to make sure that I can choose to use a hospital that flatly, unequivocably and without exception rejects “assisted suicide,” euthanasia passive or active, or anything like it.

No compromises.  No exceptions.

That is the only real protection I have that some doctor or nurse, acting on “professional principles,” won’t decide to “help” me out by “facilitating” the “rational” choice. 

Sorry, no, I’m not okay with “it will be your choice.”  A hospital that assumes it’s all right to put a patient out of his misery, sort of like a dog, sees human beings differently than one that fights for live at every stage, no matter how hopeless. 

I am not, mind you, asking to be kept alive on “machines.”  I AM asking that I be given food and water without ceasing as long as the rest of my body is functioning.  If my heart is beating and my lungs are working all on their own–as Terry Schiavo’s were–then I do not want my doctors “helping” me by starving me to death.

I’m not happy with the idea of any hospital having the “put them out of their misery” ethic, but I’m willing to compromise to the extent of allowing such a one down the street, as long as I’m not in it and do not have to deal with it.

But it seems to me that “professional principles” in medicine are headed right in the “put them out of their misery” direction.

And if there’s something I need from religious people right now, it’s to fight tooth and nail against the casual assumption that “professional principles” are “objective” where their religious ones are just “private” and “personal” and should not be allowed to effect the practice of medicine or anything else.

Written by janeh

January 1st, 2010 at 11:29 am

Posted in Uncategorized

10 Responses to 'Objectivities–And Happy New Year'

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  1. Jane, as it happens, I was seriously ill a few weeks ago and the Doctors in the ER asked me about my attitude toward “intensive” treatment. I specifically gave the Terry Schiavo case as something I did NOT want.

    Perhaps the only conclusion is that we differ on our attitude toward death.

    I can see the logic of Peter Singer’s position but I reject his premise of trying to define human in terms of attributes. I think it is a very dangerous slippery slope.

    And I agree with everything you said about the Catholic Church and its schools and charities.


    1 Jan 10 at 3:46 pm

  2. Brava!


    1 Jan 10 at 3:49 pm

  3. When my time comes, I want some assurance my desires will be respected, and like Jane, I don’t expect to get it from anyone steeped in the current secular cultural attitudes towards illness, disability, suffering and death.

    I had a brother who was disabled for most of his 44 years; very severely disabled for the last 10 or 15. His death was mercifully quick in the end; but his life was a constant battle for proper care and support, even more so than I am probably aware. He had excellent care, and terrible. Plenty of people thought he was better off dead. He knew disabled people who committed suicide when they were pressured into care options they didn’t want, and followed in the news of aging caregivers with disabled children who choose murder/suicide because they have no other options.

    And like him, I’ve watched the news over the years as the reports of such suicides and murders are presented more and more sympathetically. After one such report I thought ‘If the victim hadn’t been disabled, he’d have been given psychiatric help for suicidal depression. Because he was, his next of kin are exonerated from any blame in helping him kill himself. That’s hardly fair.’

    I don’t want anyone deciding I need helping along to the next world because I’m sick or suffering, physically or mentally. I KNOW from what I’ve seen and heard that if that did happen, my killer would be praised and given, at the most, a slap on the hand by the legal system. I can only imagine what it must be like to struggle for the care and equipment needed to live under the constant reminder to many people my life is worse than worthless, and that I really need someone by my bedside as my advocate for every one of countless hospitalizations. So, yeah, when the Catholics speak up about the sanctity of life, I’m there cheering them on. And I’m not terribly happy when I hear about blockades being put in the way of their social services.

    I wonder sometimes about the position of the Catholics in the US. Ther’re such a big group, and yet I sometimes get the impression that some Americans (well, and to be fair, some others) are still re-fighting the wars of religion. Maybe it’s the influence of American Protestantism, or maybe it’s just because the RCs are the biggest and most obvious objectors to the current orthodoxy in some pretty controversial areas. We’re a combative species, and it comes more naturally to us to attack opponants than to let them do things their way while we do things ours.


    1 Jan 10 at 4:50 pm

  4. What do you all think of the flip side of this? There was a case locally this year involving a 13-year old boy who had Hodgkin’s lymphoma. Because of their religious beliefs, his parents chose not to permit him to have chemo (which has a very high success rate for Hodgkin’s lymphoma) because of their religious beliefs.

    Eventually the state took custody, he got the chemo and has survived the lymphoma. But if his parents had their way, he’d probably be dead, or nearly so.

    And happy New Year to you, too, Jane.


    1 Jan 10 at 5:01 pm

  5. Mary, you present a choice of evils. “The state took custody” sounds too much like 1984 with the child a piece of property owned by the state. On the whole, I’d prefer to follow the parents wishes rather than have a nameless and faceless “state” make decisions.


    1 Jan 10 at 5:21 pm

  6. I know, jd, that’s why I brought it up. But would you really be comfortable allowing a child to die because of his parents’ beliefs?


    1 Jan 10 at 6:34 pm

  7. If someone beats a child nearly to death, the state steps in, and we all call that a righteous intervention. If they “non-treat” him nearly to death, I’m not sure there’s a difference, at least *to the child*. In each case he’s been near death, because of his parents and their actions. You can’t even say that the beating is different because of the intent. The beating could have been meant to follow religious principles of driving out demons or “spare the rod.”

    In neither case is the child property of the state. The state isn’t asserting property rights, they’re acting in lieu of parents where the parents have violated that role (of care and control, as defined by law) by their own choice. You notice that these medical cases are very rare, only where life is at risk. The state doesn’t step in where quite dodgy decisions are made, as long as they’re not life-threatening.

    But there is a great element of slippery-slopeness here. Today we go after parents who risk their children’s lives. We must be very careful that we don’t start asserting state-sponsored parental overview in less dire circumstances. Nobody has yet come up with a guaranteed method to raise a decent, successful child, so the state has no place interfering with parental choice there, no matter how weird. But we *do* agree that letting a child die is not generally in the child’s best interest.

    Well, except Jane seems to know hordes of doctors who keep a keen lookout for possible opportunities to kill their patients. I don’t know where she finds these folks. Most doctors I know fight like crazy to keep people alive.


    1 Jan 10 at 7:00 pm

  8. “Well, except Jane seems to know hordes of doctors who keep a keen lookout for possible opportunities to kill their patients. I don’t know where she finds these folks. Most doctors I know fight like crazy to keep people alive.”

    It doesn’t take hordes. One’s enough. The Australian media simply can’t find enough hours in the day to give sufficient air-time and sympathetic coverage to our own local Kevorkian, Dr Philip Nitschke. Google that name and you’ll find countless references to this man’s single-minded, indeed fanatical, efforts to send people off before their time. The most notorious case was that of a woman who was convinced that she had terminal cancer, a conviction that he did nothing to discourage or even to investigate. After months of legal wrangling he found a way to assist her to commit suicide. At the autopsy, no evidence of any cancer or other life-threatening pathology was found. Did that silence Nitschke? Not a chance.

    It’s all to easy to convince gullible people which, sad to relate, includes a large slice of the chattering classes down here, that life is not worth living when it falls somehow short of some arbitrary, if not exactly the youthful, ideal.


    1 Jan 10 at 7:47 pm

  9. I thought I posted another response, but the Internet seems to have eaten it. Oh, well, it was late and I was tired and maybe I pressed the wrong button.

    No, we don’t like to see a child (or anyone, really, but especially a child) die from the choice to not use what we think would be a successful cure. And since children are humans, too, sometimes to protect them we need to go against the parents’ rights. I’m glad you point out the slippery slope involved. Historically, in Canada, we’ve had children removed from the Doukhabours and the JW because of religious beliefs when there wasn’t any illness involved. I don’t think the recent incident out west involving neo-Nazi parents really counts because I gather there was also drug use and frequent absenteeism involved there as well.

    Age matters too. We recently had a case in which the courts decided in favour of a 16-year-old and her mother, and against her father. The girl refused treatment and died, but at 16, she was old enough to express an opinion. Her father disagreed.

    Most physicians would try to keep their patients alive, or at least follow their patients directives as to when to stop/continue treatment. Not all, and all the ones who don’t aren’t Kevorkians, or criminals in the sense that they end up in prison like that UK doctor who killed all those old ladies. There was at least one recent UK case in which parents went to court to try to force doctors to continue treating their dying child. They thought to do so was to inflict unnecessary suffering on the child. And that’s the big risks. Kevorkian, Nitsche, that Irish doctor whose ‘patients’ included the mentally ill – they’re dangerous because they make euthanasia/assisted suicide seem normal and appropriate. The well-meaning doctor who never hits the headlines who is convinced that his patients need to stop treatment or undergo palliative care (which means the removal of feeding tubes) before they are ready to do so is the real danger.

    I’ve seen the reverse – the doctor who didn’t make himself available to the next of kin very quickly when it had been obvious even during surgery that only the machines were keeping the patient alive and ever would; there was just too much damage and it wasn’t even a case where only food and water were needed, like Schiavo, or where only breathing support was needed, like my brother at one point. But patients like that are merely alive but out of it for a while longer than nature intended. Patients who are pressured to have their feeding tubes removed so they can go to palliative care while they are alert, pain-free and in their right minds – and don’t want to go yet – are essentially killed against their will. And it happens now.

    Really, anyone who is suffering a life-threatening illness needs a like-minded advocate by their side at all times when in hospital, and now, with smaller and more scattered families (plus, of course, the near-certainty that not all family members agree on such issues) mean that fewer have them around. I probably won’t, if I reach a fairly normal life expectancy. This is a really important issue for people like me.


    2 Jan 10 at 7:20 am

  10. With Jane on this one except for the impression –I’m sure not intentional–of public charity as an exclusively Catholic thing. My home town has three hospitals–St Joseph’s (Catholic) Lutheran and Parkview (formerly “Methodist.”) We have three chains of thrift shops–St Vincent de Paul’s (three guesses) Goodwill Industries (founded by an American Methodist) and the Salvation Army (founded by a British Methodist.) All the churches feed into the same net of food banks regardless of denomination, and if I drive a few miles out of town I’ll find Heifer International (Mennonite) shipping good breeding stock to impoverished areas around the world.

    And I don’t mean to be exclusively Christian about this. If I were describing Baghdad or Tehran I would also be describing extensive charitable organizations founded as acts of piety.

    What I can’t seem to find are the secular humanist-founded hospitals, thrift shops and food banks. It leads me to suspect the different attitudes toward life are indeed objective rather than subjective, but based on conclusions nearer the roots of the logic tree. These can make–sorry about this–a radical difference.


    2 Jan 10 at 9:16 am

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