Ideas

Life and death ethics

Sidney Katz March 17 1980
Ideas

Life and death ethics

Sidney Katz March 17 1980

Life and death ethics

Ideas

Sidney Katz

In the past two years a Vancouver man has battered his wife, hit a pedestrian with his car, and caused a serious industrial accident. During each incident he was drunk, as he often is. Should a law be passed to compel this man—and other uncontrolled drinkers—to take treatment for alcoholism?

A few months ago a young Montreal man confronted Dr. Jacques Lorrain in his office at the infertility clinic of Sacré-Coeur Hospital. “We want a baby

but my wife is barren. We’re ready to pay a woman to be artificially inseminated with my semen and then turn the baby over to us. Will you arrange it?” Later, Lorrain confessed: “It’s the first time I’ve had such a request. I’m going to need help to figure that one out.”

It is bewilderingly common today for doctors, lawyers, journalists, engineers and businessmen to encounter ethical problems they need help in figuring out. With the decline of the church as the

traditional arbiter of moral issues many professionals, baffled and intimidated, handle moral problems on an ad hoc basis or try to ignore them. But the issues that have reached public attention in recent dramatic cases—the Karen Anne Quinlan euthanasia trial, Watergate, the leaking nuclear reactor at Three Mile Island, the RCMP violations of privacy, the abortion trials of Montreal’s Dr. Henry Morgentaler, the marketing of dangerous consumer products—will not go away. Answers, or at least compromises, have to be found. Yet realistically, says Michael Bayles, director of the University of Western Ontario’s Institute for Ethics and Human Values, “a doctor, say, can’t take six months off to ponder what he should or shouldn’t do when confronted by a moral issue in his daily practice. We’re here to do that job. And we can really help.”

Bayles, a 39-year-old philosopher, is a new kind of late-20th-century specialist: an ethicist. The author of five textbooks and 40 articles dealing with ethical conduct has been director of the London institute since it opened eight months ago. “The ethical institute is an idea whose time has come,” he says, adding that the rush of new ethical dilemmas—such as trying to sort out the good from the evil caused by forced sterilization or nuclear reactors—has caught us unprepared because of rapid advances in medicine, science and technology. In a country with few widely accepted moral guidelines and fewer still wise men to turn to, it is perhaps comforting to find that ethics has become a growth industry: there are now four ethics institutes in Canada, none of them more than four years old, and at least a half-dozen smaller centres in universities across the country.

All of the groups plan to send delegates to a national meeting in Calgary April 14 to 16. “The idea is to make sure we’re not duplicating each other’s work,” says Egmont Lee, director of the Calgary Institute for the Humanities, which is hosting the conference to be followed in May by another one, this time focusing on doctor-patient ethical problems. “In my daily practice I frequently face moral dilemmas and I have nobody to consult about them,” says Dr. Murray Waldman, a Toronto family physician. “There’s a crying need for a resource of this kind.”

Richard Tiberius, a psychologist who lectures on ethical issues to University of Toronto medical faculty, appreciates Waldman’s plight. “When a general practitioner runs into a problem beyond his area of competence—let’s say it’s a heart problem—he can depend on the expertise of a cardiologist. Why shouldn’t that same doctor have an ethics institute available to him when

he runs into a thorny moral issue?” Adds Alan Borovoy, general counsel of the Canadian Civil Liberties Association: “We can’t get enough intelligent inquiry. In our complex society, yesterday’s truths can’t be relied on to resolve today’s and tomorrow’s conflicts.” He also points out that in most modern disputes it’s no longer simply a question of good versus evil. “It’s a question of good versus good. Which one should prevail?”

To make its product—ethical guidelines—the ethical institute follows a step-by-step procedure in exploring all sides of an issue. For example, the London institute—which is funded mostly by private philanthropic grants, as are all the institutes—is currently examining the moral correctness of imposing compulsory treatment on alcoholics and heroin addicts. The process starts with the appointment of a multidisciplinary inquiry group made up of doctors, lawyers, sociologists and ethicists. This core group participates in a series of meetings and workshops, recruiting additional specialists if necessary. Says Bayles: “We think the problem through until, hopefully, we can come up with a statement of what we think is right and wrong.”

Though few practical guidelines have been formulated yet at the young Canadian institutes, the system seems to work, judging from the achievements of

the 10-year-old Hastings Center near New York City. The Hastings definition of death—a detailed, precise judgment which says, basically, that a person is dead when a doctor judges that the brain has ceased both voluntary and involuntary functions—has gained general acceptance by the legal and medical professions. Other Hastings guidelines on prenatal diagnosis, birth control and euthanasia have at least helped clarify the various arguments and bring opinions closer to a consensus. And, gradually, Hastings has gained some recognition as a consultant. When the Karen Anne Quinlan case went to court in 1976, both the prosecution and the defence sought counsel from Hastings.

In Canada, ethicists at Montreal’s Center for Bioethics are also on regular duty at the city’s Children’s Hospital, where they are often called on to act as a sort of ethical liaison between doctors and patients. A typical problem regularly arises when parents of a newborn child with Down’s syndrome are asked to give permission for an operation to relieve an intestinal blockage. Without surgery, the child will die—which is precisely the end distraught parents of a deformed child often desire. But it is the doctor’s job to save life whenever possible. An ethicist, familiar with the complex arguments on both sides of the issue, can serve as a much-needed mediator.

The Montreal centre’s staff has been overwhelmed by invitations to discuss ethical problems with professional and lay groups, says its director, David Roy. Specializing in the fields of health care and scientific research, the centre regularly offers workshops for doctors, nurses, hospital workers, scientists and clergymen. But it is most concerned

with formulating guidelines. It recently submitted a list of recommendations dealing with the sterilization of the mentally retarded to the provincial government, which is planning legislation in that area. As well, the centre hopes to deliver a report in April to the federal task force studying sperm banks.

Looking to the future, London’s Bayles believes ethical issues will continue to proliferate. A major concern will be the allocation of health dollars. “In deciding how to spend a limited health budget,” he says, “we’re literally deciding on who should live and who should die.” For example, is it morally correct to spend billions of dollars on cancer research and very little on preventive medicine when, according to some estimates, 70 per cent of cancers can be prevented by alterations in lifestyle and environment? Business also will face a growing number of ethical problems, Bayles says. “In the past, businessmen tended to ignore the harmful consequences of their activities because they didn’t know how to handle them. Besides, recognition might involve the burden of responsibility.” Then Bayles adds, with perhaps the most meaningful argument for the dominance of good over evil in an age dominated by economics: “Pursuing an ethically wrong course is often, ultimately, much more expensive than pursuing the ethically right one.”