Medicine and Ethics: ""The Answers Can't Come From Technology""

              The Times Sun., Feb. 6,1983
UPDATE
A vintage year
for concerts here
Page 2
Andrew Pontz: he's
mild-mannered — maybe
Page 17
By KATHIE COFFEY
The Times
Expanding technology allows today's
physicians to do things yesterday's doc-tors
only dreamed of doing.
Machines can keep heart and lungs pump-ing
after brain function ceases. Analysis of
amniotic fluid can determine the presence of
disease or defects in an unborn child. Human
egg cells can be fertilized in laboratory dis-hes.
But with added possibilities come added
responsibilities to use skills and equipment
ethically.
The decisions aren't easy, and they aren't
taken lightly.
Several local physicians and clergymen
recently discussed in interviews the areas
that cause them greatest concern, and their
thoughts on what the future might bring.
But because the answers to specific ethical
questions can't be looked up in textbooks and
may be arrived at differently by different
people, many were reluctant to talk about
the issue.
One LSU Medical Center professor ter-minated
an interview, and two local
chaplains cancelled interviews, saying the
topic was "too broad" and "too delicate."
However, those who were interviewed said
the majority of ethical problems en-countered
today involve death and dying.
"It's something you never get used to, no
matter how many times you face it," said Dr.
Perry Rigby, dean of LSU Medical School.
One of the ethical problems to be faced in-volves
when to remove equipment that can
keep a patient's heart and lungs going after
brain waves have stopped.
Louisiana statutes define death as an ir-reversible
cessation of spontaneous respir-atory
and circulatory functions, or in the
event of artificial means of support, the ir-reversible
total cessation of brain function.
"You work with those as long as there is
any idea the patient can be helped and
survive," said Dr. Joe Holoubek, co-chair-man
of the Committee of Medicine and Re-ligion
of the Shreveport Medical Society.
But Holoubek said the decision should be
made jointly by the physician, family and the
family's clergyman, according to hospital
regulations.
Dr. Charles Black Sr., co-chairman of the
Committee of Medicine and Religion, said in
most cases he has dealt with in which life sup-ports
have been removed, the patients were
known to be terminal and there was "no ques-tion
with the family or with the doctor.
"There is a quality and a dignity of life,"
Black said. "You need to respect that in a pa-tient."
The immediate family members are gen-erally
more likely to agree to have life sup-ports
removed than the extended family and
friends, according to Donald Heacock, a
clinical social worker and Episcopal
clergyman.
Heacock is one of three area clergymen
who spoke on "Concerns Common to
Clergymen and Physicians" as part of LSU
Medical Center's "Man and Medicine"
course for medical students.
"The most intimate family members are
aware the loved one isn't there," Heacock
said. "The more distant relatives and friends
Times photolllustration/MIKE SILVA
MEDICINE AND ETHICS
"The answers can't come from technology"
are less aware of the loss of personality."
Heacock said fear of criticism often is a
factor when the family is reluctant to re-move
life supports.
When it comes to the question of how long
to prolong the life of a terminally ill pa-tient,
the answers often aren't easy. Among
the factors the physicians mentioned are the
amount of pain a life-prolonging procedure
will cause and whether or not it is to the pa-tient's
benefit or detriment. The patient, or
his family, has the right to refuse further
treatment.
"Most physicians go further to preserve
life than someone else would say reason-able,"
Rigby said.
Many times those with strong religious
convictions will turn to their clergyman for
counsel when faced with decisions about the
health care of a loved one.
According to Monsignor Walter Walsh,
who is a member of the board of directors at
Schumpert Medical Center, the Catholic
Church has definite positions on health care.
These positions can be found in declar-ations
from the Church in Rome, texts writ-ten
on medical and moral practices, and in
Catholic moral theology.
The Catholic tradition on prolonging life is
presented in terms of "ordinary means" and
"extraordinary means."
"Everyone has the obligation to use ordi-nary
means (to prolong life), but is not
necessarily bound to use extraordinary
means," Walsh said.
Extraordinary means offer "no reason-able
hope of recovery and impose excessive
burdens" on the patient and his family, ac-cording
to a 1976 statement by the United
States Catholic Bishops summarizing the
Church's ethical tradition in contemporary
language.
Walsh gave the example of a patient with
a flat brain wave whose heart is still pump-ing
because of life support equipment.
"Does the family have to do this? Morally
speaking, the Catholic Church would say no,"
he said.
Walsh remembered an incident about 30
years ago in which a man in his 60s who had
pneumonia "was in an oxygen tent, which at
that time could have been considered ex-traordinary
means.
Walsh's counsel was asked by the family
whether or not to remove him from the ox-ygen
tent.
After receiving complete assurance from
the doctor that the man wouldn't live, and
taking into consideration the family's econ-omic
situation, Walsh told the family it
would be all right for the oxygen tent to be re-moved,
and it was.
"He lived to be 90 something," Walsh said.
"That makes you skeptical sometimes, but
the principle is valid."
Human sexuality and reproduction is
another area several of the men mentioned
as producing a wide range of ethical ques-tions
today and in the future.
Topics included artificial insemination,
sperm banks, in vitro fertilization, abortion,
amniocentesis, surrogate mothers and
whether or not a minor female should be
given contraceptives without her parents'
knowledge.
"The answers can't come from tech-nology,"
Heacock said. "Technology only
provides the problems. The solution is an
ethical choice."
Heacock said for some the answers are
found in the Bible and for others with the
pope. But for those who have no such
absolutes, the answers will be reached
through discussion and debate.
"Society is moving to giving individuals
and families more personal control over
their destinies and less government controi
and interference," he said.
At present, though, courts have become in-volved
in some cases. One of the most publi-cized
was the Karen Ann Quinlan case in
which parents won the right in court to re-move
their daughter from a respirator.
A more recent example is the Indiana inci-dent
in which parents obtained a court order
barring physicians from feeding or treating
an infant with Down's syndrome.
These court tests have brought ethical is-sues
media attention. While Miss Quinlan did
not immediately die after being removed
from the respirator as had been expected, the
infant died at the age of 1 week.
In the realm of technological advance-ments,
genetic engineering has also come
under scrutiny. Genetic engineering, the ma-nipulation
of the genetic code, has great
potential for benefit and abuse, those inter-viewed
said.
As an example, Rigby pointed out the
potential good that could come from finding
a way to correct the gene sequence that
causes sickle cell anemia.
On the other end are fears of the creation
of "monsters," or that government control of
genetic engineering techniques might result
in attempts to create a "super race."
"Once you start working with human be-ings,
you have to be on real solid ground,"
Holoubek said. "If you treat human life like
animal life, you have another Nazi regime."
Rigby said the road that leads to human ex-perimentation
begins with an individual's
idea. It proceeds through an experimental
stage involving animals or laboratory
procedures that could last for years. Papers
are published on the hypothesis with the idea
of receiving constructive criticism. Fianlly,
the hypothesis is presented to a review coun-cil,
such as LSU Medical Center's Institu-tional
Review Committee on Human Ex-perimentation.
If approved, the experiment
can take place, and later go into testing
levels.
"From our point of view, it's a pretty
straightforward thing," Rigby said.
But, Rigby said, the "loose ends" are that
there are criminals.
"If somebody chooses unethical behavior,
you can't make any rules to stop that," he
said. "Some people won't follow the rules of
society."
Besides those already mentioned, the fu-ture
of health care likely holds many ques-tions
society will have to deal with — organ
transplants, euthanasia and allocation of
scarce medical resources among them.
"No one has all the answers," Walsh said,
"but it's necessary for the disciplines — the
scientific community, theologians and other
related bodies — to come together and try to
understand what we're facing with new tech-nology
and the amazing things that will be
taking place in the next 10 to 15 years,"
Walsh said.
E