Panama City News-Herald from Panama City, Florida on September 9, 1973 · Page 58
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Panama City News-Herald from Panama City, Florida · Page 58

Panama City, Florida
Issue Date:
Sunday, September 9, 1973
Page 58
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DoetorsT Ethics in Uplietival: Tou^ Questions bom the Brave ]Vew World of Medieine By Bruce HUton "When the doctor came back, he saw to his relief that the baby was no longer breathing. The next morning he called the Hastings Center to asic, 'What do you think i should have done?'" Ten years ago, life was simpler. So was the medical profession. The lines between life and death, right and wrong, were relatively clear and unquestioned. This is no longer the case. For two years I was a senior staff member of the Hastings Center, based in Hastings-on-Hudson, N.Y. The Center brings together scientists and physicians with lawyers, philosophers and others to examine the ethical dilemmas arising from the "biomedical revolution." Below are just a few of the hundreds of knotty problems the Center has studied, and which doctors are encountering every day (names and details have been changed to protect anonymity). Most of these cases would not have come up ten years ago. None of them has an easy answer, but each demands an answer. Judge for yourself. You're the doctor. What would your answers be? THE FETUS THAT WAS A BABY Mrs. L., a mother with five children, had come to a major big-city hospital for a therapeutic abortion. The child, she said, had been unplanned and was unwanted. The operation was normal right up to the time Dr. B., the young physician on duty, realized that he was holding not an inert fetus, but a living, breathing premature baby. What should he do? Placed quickly in an incubator, the baby would undoubtedly survive. Left alone, it would die. And there was no senior physician on duty to ask. Lx>oking much more calm than he The author, Bruce Hilton, is now director of the National Center for Bio-Ethics a nonprofit organization whose role is to foster public awareness of ethical and social problems arising out of the "new biology." "SiM MM nothing aftor the firat experianco of being strapped to the table, given a swiatiM, and Jolted into a convulsion by the ahock. But two daya later she rebolted. 'That waa torturai' she acraamad. 'I won't let you touch me again!'" really was. Dr. B. saw to the mother's needs, had the baby placed in a bassinet, and went to the cafeteria "for a smoke and time to think it over." When he came back, he saw to his relief that the baby was no longer breathing. The next morning he called the Hastings Center to ask, "What do you think I should have done?" While the Center doesn't function as a counseling group, the staff did come up with these questions that might be part of the decision: How much importance should be given to the mother's intent? To her ability to raise the child? To the rights of the child to life? To the rights of the brothers and sisters? What about the possibility that the saline solution used to start the abortion could have caused brain damage in the baby? And who should have made the decision anyway? Should the mother have been consulted? t The discussion produced no easy answer. But the staff, now at least, had some of the questions that would help them make such decisions in the future. FORCIBLE SHOCK THERAPY Mrs. F. had become deeply despondent and quarrelsome after her husband's death, and wasn't being helped by her psychiatrist. She signed herself into the psychiatric ward of a private hospital for shock therapy. She had to sign a consent form before submitting to the treatment. She said nothing after the first experience of being strapped to the table, given a sedative, and jolted into a convulsion by the shock. But two days later she rebelled. "That was torture!" she screamed. "I won't let you touch me again!" The psychiatrist used every means to get her to continue. But she remained firm in her refusal, and only the locked door kept her from running away. The staff met, and the majority decided to continue treatment. Kicking and screaming, Mrs. F. was carried back into the treatment room. Later, in Center discussions, a psychiatric nurse argued that the full course of treatment was necessary for success, and that to stop before it was over could leave the patient in worse condition than before. Once Mrs. F. signed the agreement, it was argued, she became the responsibility of the hospital staff, who had to do what was best for her own good. She could not whhdraw consent-especially since her change of mind might be a symptom of her disease. On the other hand, a physician-attorney argued, forcible treatment should • be used only for a patient judged by a court to be unable to choose for himself —that is, one who's been legally committed. To force a voluntary patient like Mrs. F. to undergo treatment she doesn't want is clearly a violation of her rights, he said. BUYING "DISCOUNT" BLOOD With the growing need for blood in this country, a commercial firm found a profitable business: importing 10,000 liters of blood plasma each month from Haiti. Poorer citizens there could make as much as $182 a year selling blood. Is such commerce ethical? Those who defended the practice pointed out that the money was helping the local economy to the tune of some half-million dollars a year, and putting food on the tables of many who might have gone hungry. It also brought badly needed plasma to the U.S. Critics argued that the practice demeaned the donors and threatened their health, and that it eased the pressure to develop a better blood exchange system within the U.S. The extraordinary poverty of the Haitians meant they did not have the freedom to say no; any offer was one they couldn't refuse. Finally, critics suggested, making blood a salable and importable commodity opened the door for an international commercial traffic in kidneys and hearts. The question became moot when the man who arranged the deal fell out of favor with the Haitian regime, and the company lost its contract. But it-or a similar venture-will surely pop up elsewhere. 4 • FAMILY WEEKLY, SeptomlMr 9,1973

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