Revisiting Physician-Assisted Suicide: Reaffirming the Christian Hippocratic Legacy

Support for physician-assisted suicide is growing as a result of ever-expanding cultural pressure. Healthcare professionals should oppose this trend and recognize that physician-assisted suicide is a misguided answer to human suffering. For 25 centuries, the Hippocratic Oath has served as the ultimate credo of the medical professional, and serves as a more trustworthy guide for professional ethics than contemporary culture. In this essay, I reflect on the Hippocratic Oath from a Christian perspective and reaffirm that physician-assisted suicide, despite growing in cultural acceptance, remains a misled answer to human suffering and as such is dangerous for the profession of medicine. Physician-assisted suicide corrupts the medical profession, relies on a distorted view of autonomy, and subverts true compassion. The way forward for the medical professional, in contrast, is an ethic of a “good death” comprised of healing, palliative care, and true compassion.

First Principles for Medical Artificial Intelligence

Medical artificial intelligence (AI) technologies, by their capacity to decipher enormous data sets, identify meaningful patterns beyond what human intelligence can recognize, and in some cases render decisions without human assistance, are poised to transform healthcare. As with any powerful technology, careful ethical analysis is needed if we are to realize the benefits of AI while avoiding its perils. Four available perspectives are recognized. One perspective is technological sentimentalism, which resists novel technologies that seem to displace a more natural way of inhabiting the world. A second perspective is technological messianism, which uncritically welcomes novel technology as intrinsically good and the answer to all human problems. A third perspective, common today, is technological pragmatism, which weighs benefits and risks in a utilitarian framework that emphasizes empirical facts but disregards moral values, considering them to be opinions without consequence or validity. A fourth and preferred perspective is technological responsibilism, which considers not only outcomes but also the moral values laden in the design and implementation of technology. Technological responsibilism respects the deeply human attributes of voluntary responsibility, moral agency, and character. Morally responsible use of AI is needed if healthcare professionals are to sustain their focus, not on technology, but on patients.

Ethics of the Extreme

Extremism, which is variously regarded as the adversary of peaceful moderation or the vanguard of righteous dissent, often is immediately recognizable, but sometimes it may be ambiguous, insidious, or undefined. Growing apprehensions about mainstream extremism reflect a linguistic contraindication that may be a symptom of cultural disorientation. Insights from neuroscience suggest that some forms of extremism may arise from an imbalance of brain pathways involved in moral reasoning, such that those signaling sacred valuations and rule processing attain dominance over those representing empathy and deliberative reasoning. If the brain be compared to an orchestra, extremism would be analogous to the unpitched percussion section taking over, the bass drum and clash cymbals intruding into orchestral harmony and drowning out the string and brass sections with harsh, metronomic, auditory hyperintensity. And yet there is a proper role for these instruments. The ideal balance, whether of neural signals or orchestral voices, requires discernment of value beyond factual information. A number of ethical approaches supply moral clarity to assist with making ethical distinctions when convictions reach into the extreme, and while helpful, these leave unanswered deeper questions of ultimate meaning.

A Forgotten Crown of Glory: The Elderly and COVID-19

The nursing home where I worked this past summer was fortunate. The long-term care facility shielded its residents from the chaos of the pandemic unfolding outside and managed to avoid any positive COVID-19 cases among its residents and staff for the summer. Of course, this came at a cost. Visitors were barred, activities were canceled, and residents were largely made to stay in their rooms. Even though residents received the same medical care as before—physicians still inspected wounds and nurses continued to pass medications—their mental health and overall wellbeing noticeably diminished. No longer able to enjoy bingo or attend religious services, they sat in their rooms watching TV, becoming more confused by the day.

Other nursing homes have encountered greater medically-related difficulties. By October of 2020, nearly 50% of COVID-19 deaths occur in nursing homes, with Britain losing approximately 5% of its nursing home population to the virus. During those early months of the pandemic in the US, residents and employees of nursing homes accounted for 35% of COVID deaths in the country.  The elderly in general were afflicted by the disease at a disproportionate rate, and this knowledge caused many to shelter in their homes uncertain about when they might be able to leave.

Medicine Masked: Ethical Implications of Half-Hidden Faces During a Pandemic

During the COVID-19 global pandemic, in combination with handwashing and eye protection, face masks have become necessary apparel for healthcare professionals to prevent transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[2] As the mouth both breathes and speaks, a barrier to potentially infectious respiratory droplets can also be a barrier to communication. This is obvious to the hearing-impaired, who rely on reading lips to interpret words they cannot clearly hear. Masks also modify communication in subtle ways in which the wearer may be unaware. The masking of facial expressions can alter how the wearer is perceived.

The Ethics of Naming Epidemics

Epidemics and pandemics have profoundly shaped the course of human history. Naming them has ethical consequences because of the value laden in words. Nuances of language can themselves be contagious, influencing attitudes toward people, nations, and other qualities that may be incidental to the initiation or propagation of an infectious disease. A poorly chosen name for an infectious outbreak can divide communities at a time when people should be coming together and collaborating for the sake of the common good. Striving for objectivity in language is helpful, but it is also insufficient, for it omits the ethical framework needed to respond to a pandemic and does not adequately address the meaning of suffering.

The Dignity of Human Life: Sketching Out an “Equal Worth” Approach

The term “value of life” can refer to life’s intrinsic dignity: something non-incremental and time-unaffected in contrast to the fluctuating, incremental “value” of our lives, as they are longer or shorter and more or less flourishing. Human beings are equal in their basic moral importance: the moral indignities we condemn in the treatment of e.g. those with dementia reflect the ongoing human dignity that is being violated. Indignities licensed by the person in advance remain indignities, as when people might volunteer their living, unconscious bodies for surrogacy or training in amputation techniques. Respect for someone’s dignity is significantly impacted by a failure to value that person’s very existence, whatever genuine respect and good will is shown by wanting the person’s life to go well. Valuing and respecting life is not, however, vitalism: there can be good and compelling reasons for eschewing some means of prolonging life.

A Legal Comment

O.R. Johnston’s article canvasses many of the varied issues, ethical, medical and legal arising from the decision in Gillick V. West Norfolk and Wisbech Area Health Authority. This comment will focus more specifically on some of the legal issues involved.

A General Practitioner’s Response

As the author of the editorial in the Christian Medical Fellowship Journal to which Mr Johnston refers, it is perhaps not surprising that I am very substantially in agreement with the points that he makes, although we have never communicated personally about this matter. I will seek nevertheless to amplify some of them slightly from a medical view-point.

Reflections on the Doctor in Society

As we struggle with the implications of in vitro fertilisation (IVF), the question of abortion and the ethics of health care it is essential that we understand the nature of the conflict between good and evil, and are clear as to the basis of our own stand. If there is to be a clear Christian witness in the medical field it can only come from those with an underlying commitment to obey God.