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Printer-Friendly ModeLecture discusses science, medicine ethical dilemmas
April 25, 2005 —
Thursday, April 7 marked the 2005 Albert J. Beutler Forums on Ethics and Practice. The lecture focused on the topic of Ethical Interaction and Structure of Science and the Art of Medicine, presented by David C. Parish, M.D., M.P.H, and F.A.C.P. from Mercer University School of Medicine and Medical Center of Central Georgia.
The Forums were established as a tribute to ordained minister Albert J. Beutler and examine current emerging ethical behavior.
Parish outlined his lecture in three parts. First, he focused on definitions, stating that he believes difficulties in understanding stances on ethical issues are largely due to confusion in definitions.
The first definition that Parish discussed was interaction in science. He explained that there are two types of interaction: physician-patient interaction and physician-structure interaction. Parish said physician-patient interaction focuses on care of the patient, and is the most rewarding. Physician-structure interaction involves structures such as hospitals, insurance companies, and societies, all of which are very complex.
Parish pointed out that the concept of ethics is diverse because physicians live in different societies, all of which have their own set of ethics. As an example Parish said America views healthcare as a commodity whereas a third world country views healthcare very differently.
Next, Parish looked at sources of the conflict that occurs between people. The first source of conflict is found in people's principles and beliefs, since that is where one bases everything. To illustrate, Parish used an example of a pro-life person debating a pro-abortion person. The conflict is not who is right, according to Parish, because both are right within their own context. Rather, the conflict is in a very different understanding. This type of conflict, says Parish, can lead to violent conflicts. The next source of conflict is what is known, which, Parish says, gets more complex with strong ethical implications. The last source of conflict that he mentioned was resources, which cause struggles that are present in every society.
Next, Parish explained the division between science and medicine, showing how science is divided into disciplines, while medicine is an art formed by science. He explained that science is based on the assumptions that reality is explainable and understandable, and that this understanding can be gained from specific questions, as in the scientific method. Such understanding then leads to principles, which are the basis of ethics. The problem with this is that rejecting one hypothesis does not mean another is true.
After this, Parish focused on medicine. Parish defined medicine as the art of maintaining and restoring health. Furthermore, he said that health must be thought of as optimal well-being, not merely the absence of disease. Parish explained that while science has either physician-patient or physician-structure interaction, medicine has human-human interaction. He then explained how doctors diagnose and treat patients.
Parish illustrated the ethical dilemmas that occur in medicine by citing specific examples from his work. His first example was a teenager who had developed kidney disease from the damages of sickle cell anemia. In order to treat the disease, the boy required a kidney biopsy, which would require a blood transfusion. But, because the boy was a Jehovah Witness, he refused a blood transfusion, as it was against his religion. "Now," Parish asked, "what do you do?"
He explained that ethical problems exist for the physician, who does not want to do the biopsy without the blood transfusion because it would kill the boy, as well as ethical problems for the family, who do not want to compromise their religion.
Parish said simply, you cannot sustain someone else's idea of who they are in the world. This example also illustrated how specific ethics is to society because this example situation could not even happen in a third-world country because they would not even be able to diagnose the kidney disease. Science is not the question here, Parish said, it's humanity that is problematic.
In his next example, Parish spoke of the risks involved with medicine. In treating disease, we think there is an answer, so we are reluctant to see the dark side and see that we may actually make it worse. Often, medicine yields a good thing, but only after numerous static and worse results.
Next, Parish drew back to his introduction on the ethical dilemmas of resources. Sometimes the medicine is available, but does using drugs solve the problem?
To illustrate this ethical dilemma, Parish used an example of the medicines used to treat pregnant mothers with AIDS.
The drugs greatly decrease the baby's chance of developing the disease, but then the mother dies and the baby is alive with no one to care for it. The ethical dilemma does not revolve around the drug, Parish said - the dilemma is on how to put all the resources together.
In summary, Parish said that the ethical dilemmas that exist in science and medicine have complex sources and can cause conflicts, but people argue instead of trying to find the best solutions. He said there is not always a right answer, but that inner actions and regard for each other should not change.
The only way forward, Parish concluded, is realizing that there are real situations that require decisions. Decisions can be made in different ways, Parish said, and they need to be made.