Last month, I wrote about the role of the hospital Ethics
Committee and commented that open and honest communication between healthcare
professionals, patients and family solves most ethical dilemmas. That assumes
we are speaking the same ethical language and have a common ethical foundation,
both in medicine and in society at large. In our increasingly pluralistic
society, that is no longer a safe assumption. The recent Orlando attack on a
gay nightclub showed us that people can do terrible things when ostensibly motivated
by a perverse ethic or belief system.
Ethics, at its core, is simply a set of moral principles or
values which guide an individual’s – or a religion’s or a government’s –
actions. In the United States, that governing set of principles has been rooted,
sometimes more and, regretfully, sometimes less, in a Judeo-Christian ethic
based on the inherent (and, according to the Declaration of Independence,
Creator-endowed) equal value of every individual. In medical ethics, the two related
guiding principles date much further back, to Hippocrates around 400 BC: the
sanctity of human life and the concept of “first do no harm”.
Modern medical ethics rests on four major pillars: Autonomy
(the patient decides), Beneficence (does it help), Non-maleficence (don’t harm),
and Justice (is it fair or impartial). In other words, do our medical
recommendations and interventions respect the rights of the individual patient,
are they helpful, do they not do harm, and are they fairly and equally available.
It is a tall order to keep these broad principles in mind, especially when
trying to balance competing interests with limited resources.
American history in general – and medicine in particular –
has tended to elevate Autonomy over and above her sister principles. We are a
pioneering, individualistic “I did it my way” society. The winds appear to be
changing, both in healthcare (with the move toward universal healthcare) and in
political discourse. The traditional emphasis on the individual’s responsibility
in his or her own pursuit of happiness is taking a back seat to the notion that
it is the government’s role somehow to guarantee equal outcomes, seemingly
regardless of effort, for all. For example, we just completed a groundbreaking
primary season where an avowed socialist garnered significant support on a
platform of income redistribution.
Amidst this sea change of process, of roles and
responsibilities, can we agree on a common ethic to guide us?
I firmly believe that regardless of who we elect and within
whatever system of healthcare delivery we end up with, a Judeo-Christian emphasis
on the inherent, God-given value of each and every individual (whether black or
white, gay or straight, handicapped or not, born or unborn) is uniquely
protective of both the individual and society as a whole. Mass shootings and
terrorist acts demonstrate that our moral ethic (or lack thereof) determines our
behavior. To paraphrase a Dostoevsky character in The Brothers Karamazov: If
God does not exist, all things are permissible. A disturbing corollary appears
to be: If my moral ethic condones and encourages killing lots of people, why
not do it?
Motivational speaker Zig Ziglar once said, “Since belief
determines behavior, doesn't it make sense that we should be teaching ethical,
moral values in every home and in every school in America?” Whose values? All
belief systems are not equal. Governments and terrorist organizations which do
not value the individual, inherent worth and equality of “all Men” – to again
reference the Declaration of Independence – are not going to treat their (or
our!) citizens equally. In fact, they may kill them (and us).
If I had to choose one word to describe the ethical
principle I pursue in life and in healthcare, it is love. Not hate, not
selfishness. Not religious dogmatism. And not a “love” of government, cult or
fanaticism that discriminates or (God forbid!) kills others in the name of some
god or political whim. It is the pure Christian commandment to “Love your
neighbor as yourself.”
Is this idealistic? Absolutely. Is it achievable? No, to be
honest. But that doesn’t mean I stop working tirelessly, incessantly toward
that goal. Our country should do the same.
