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EDITOR- Frederick Nenner's moving account (in the issue of the 10th
Feb) of the death of an 84 year old man as a result of premeditated
starvation in a New York hospital and Professor Wade`s accompanying
article on ethical issues relating to the permanent vegetative state
stimulated my reflection on the philosophical and metaphysical basis of
medical ethics.
It is vital to consider universal principles before decisions can be
made on particular issues. The particulars can only be understood within
the context of the universal. Medical ethics can not be divorced from such
basic questions as: Why are we here? and What is the meaning of life? The
consensus answers to these questions determines our universal and as a
consequence our medical ethics. It is not possible for an ethical question
to exist in a philosophical or metaphysical vacuum. The solution of the
particulars always depends on the universal base which is taken. As
doctors, we are generally too busy to consider such concepts or perhaps we
take them for granted.
I would like to mention two universals or philosophical frameworks
which have shaped medical ethics in western civilisation in recent
history. The first is the Judeo-Christian framework of man (of course I
mean both woman and man) having been created in the image of God and as
such acquiring a highly elevated and exalted position. Within this
framework every individual`s life is considered precious and sacred. This
was the consensus framework which existed in western civilisation and
therefore in medicine until fairly recently. Different theories existed
concurrently but nonetheless this remained the consensus until about 40
years ago. Within this philosophical framework the destruction of the life
of the unborn child was considered infanticide. The framework was based on
the absolutes of the Ten Commandments, the existence of a personal God and
the sanctity of human life. A philosophical base existed for the weakest
and most vulnerable of our patients.
The second universal or framework and the one which currently holds
sway within our society and therefore within medicine is the Humanist
framework. The basis of humanistic philosophy is that man himself is his
own frame of reference. There is no absolute and we are all here as a
result of a "fortuitous" series of chemical reactions. As a mere product
of chance, man as man has lost his unique elevated position. Individuals
act on the basis of their personal philosophical presuppositions whether
they are consciously aware of it or not and society acts through the
legislative process and the judiciary on the basis of the philosophical
consensus. The humanistic framework lacks absolutes and therefore a fixed
frame of reference. It has no real basis for morality apart from a
sociological, expedient or pragmatic morality. Indeed in its more advanced
existential forms, the word morality is an absurdity. The morality of
pragmatic Humanism is the relativistic morality of convenience within
which the tyranny of the 51% majority or of the judiciary holds sway over
the vulnerable.
If we hold this world view, then by the process of logic, we are
intellectually and philosophically hypocritical in condemning some of our
colleagues in National Socialist Germany, many of them pillars of the
medical establishment of their day, who ended the lives of their
physically and mentally disabled patients on the basis that these patients
lived lives which were deemed not worth living, who were a burden on state
resources and therefore simply inconvenient. All that was required was the
signature of three doctors on the appropriate form. We have no philosophical
base for our moral outrage but we would not of course be morally
hypocritical in our condemnation. I am convinced that the vast majority of
my colleagues would unreservedly condemn such acts- Thank God-oh sorry !
should I say Thank Chance?
I was deeply touched by the pain suffered by the nurses who tended
the starving patient. Therein lies the dilemma facing medical ethics at
the start of the 21st Century. It is the humanity of man, our own
uniqueness. Our philosophical framework is too small and inadequate to
accommodate our humanity and thereby we are untrue to our own nature. What
a tragedy! For our own wellbeing and for the wellbeing of all our
patients, this dilemma needs to be solved.
Medical ethics--philosophical basis
EDITOR- Frederick Nenner's moving account (in the issue of the 10th
Feb) of the death of an 84 year old man as a result of premeditated
starvation in a New York hospital and Professor Wade`s accompanying
article on ethical issues relating to the permanent vegetative state
stimulated my reflection on the philosophical and metaphysical basis of
medical ethics.
It is vital to consider universal principles before decisions can be
made on particular issues. The particulars can only be understood within
the context of the universal. Medical ethics can not be divorced from such
basic questions as: Why are we here? and What is the meaning of life? The
consensus answers to these questions determines our universal and as a
consequence our medical ethics. It is not possible for an ethical question
to exist in a philosophical or metaphysical vacuum. The solution of the
particulars always depends on the universal base which is taken. As
doctors, we are generally too busy to consider such concepts or perhaps we
take them for granted.
I would like to mention two universals or philosophical frameworks
which have shaped medical ethics in western civilisation in recent
history. The first is the Judeo-Christian framework of man (of course I
mean both woman and man) having been created in the image of God and as
such acquiring a highly elevated and exalted position. Within this
framework every individual`s life is considered precious and sacred. This
was the consensus framework which existed in western civilisation and
therefore in medicine until fairly recently. Different theories existed
concurrently but nonetheless this remained the consensus until about 40
years ago. Within this philosophical framework the destruction of the life
of the unborn child was considered infanticide. The framework was based on
the absolutes of the Ten Commandments, the existence of a personal God and
the sanctity of human life. A philosophical base existed for the weakest
and most vulnerable of our patients.
The second universal or framework and the one which currently holds
sway within our society and therefore within medicine is the Humanist
framework. The basis of humanistic philosophy is that man himself is his
own frame of reference. There is no absolute and we are all here as a
result of a "fortuitous" series of chemical reactions. As a mere product
of chance, man as man has lost his unique elevated position. Individuals
act on the basis of their personal philosophical presuppositions whether
they are consciously aware of it or not and society acts through the
legislative process and the judiciary on the basis of the philosophical
consensus. The humanistic framework lacks absolutes and therefore a fixed
frame of reference. It has no real basis for morality apart from a
sociological, expedient or pragmatic morality. Indeed in its more advanced
existential forms, the word morality is an absurdity. The morality of
pragmatic Humanism is the relativistic morality of convenience within
which the tyranny of the 51% majority or of the judiciary holds sway over
the vulnerable.
If we hold this world view, then by the process of logic, we are
intellectually and philosophically hypocritical in condemning some of our
colleagues in National Socialist Germany, many of them pillars of the
medical establishment of their day, who ended the lives of their
physically and mentally disabled patients on the basis that these patients
lived lives which were deemed not worth living, who were a burden on state
resources and therefore simply inconvenient. All that was required was the
signature of three doctors on the appropriate form. We have no philosophical
base for our moral outrage but we would not of course be morally
hypocritical in our condemnation. I am convinced that the vast majority of
my colleagues would unreservedly condemn such acts- Thank God-oh sorry !
should I say Thank Chance?
I was deeply touched by the pain suffered by the nurses who tended
the starving patient. Therein lies the dilemma facing medical ethics at
the start of the 21st Century. It is the humanity of man, our own
uniqueness. Our philosophical framework is too small and inadequate to
accommodate our humanity and thereby we are untrue to our own nature. What
a tragedy! For our own wellbeing and for the wellbeing of all our
patients, this dilemma needs to be solved.
Yours sincerely
Dr Ryland Jones.
Competing interests: No competing interests