Wednesday, May 21, 2008

Some bioethics stories of note...

[Courtesy of Rick Moody]


In the most recent issue of THE NEW REPUBLIC, Steven Pinker has an article on "The Stupidity of Dignity," in which he attacks the uses of the idea of dignity by Leon Kass and other members of the President's Council on Bioethics. Kass is the author of LIFE, LIBERTY AND THE DEFENSE OF DIGNITY: The Challenge for Bioethics. Pinker, it seems, has little respect for the concept of dignity in bioethics. On the contrary, he sides with Ruth Macklin, author of a
2003 article titled "Dignity Is a Useless Concept." Pinker, like
Macklin, believes that "dignity" is a squishy, subjective notion. Above all, Pinker sees dignity as an insidious application of what he terms "theocon bioethics," associated with Kass and his allies.

This is a debate in which I am interested party, since I am co-editor of the book DIGNITY AND OLD AGE, which contains two chapters where I question the hegemony of the ideal of autonomy, so prominent in bioethics today. I do argue that dignity can and should play a critical role in thinking about ethics and the lived experience of old age, precisely because it captures elements of the world not captured by the ideal of self-determination. Pinker, by contrast argues that dignity is relative, fungible, and sometimes harmful, saying that "dignity is a trivial value, well worth trading off for life, health, and safety." Yet even Pinker is compelled to admit that "people generally want to be seen as dignified. Dignity is thus one of the interests of a person, alongside bodily integrity and personal property, that other people are obligated to respect."

Is it really true that dignity "is just another application of the principle of autonomy?" I think not, but the argument is too long for the space of this newsletter. Still, as Kant well understood, there are certain ideas that are impossible to escape. Suffice it to say that, like "freedom" and "happiness," the idea of "dignity" will not soon go away. It is an intrinsically contested concept and one that deserves our attention in all of the stages of life.

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The Report "Achieving Care and Social Justice For People With Dementia" explores the issue of caring for people with dementia. It not only defines what "care" is but goes on to explain what "good care" should be. They authors examine the theory and practice of good care, using the moral categories of: Attentiveness, Responsibility, Competence, Responsiveness and Trust. The key point is that good care requires a continual negotiation between those providing and those receiving care. If caregivers adopt an ethic of care, patients will be assured of fundamental human rights.

For a related upcoming event, note the conference on "Creativity, Communication and Dementia" scheduled for May 30 - 31, 2008 in Vancouver, British Columbia. This event
is sponsored by the Society for the Arts in Dementia Care and the Canadian Institute of Health Research. For details contact: Dr. Dalia Gottlieb-Tanaka at (604) 986-6408 or email at:

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Physician William Osler once described pneumonia as “the old man’s friend:” that is, a relatively convenient way of dying. But what if we deliberately withhold cheap and effective treatment-- say, antibiotics-from older people with dementia? Dr. Gregory Rutecki has pushed this question: "Do [the elderly] die from complications contingent on the antibiotics themselves-- violating primum non nocere? Induction of bacterial resistance as well as
the impact thereof on society is not of primary concern. If the question of resistance is not being asked in other often younger cohorts, it cannot be asked solely with respect to the physically-marginal, demented elderly. They cannot be punished for their so-called biological tenacity."

From "Revisiting an Ethical Conundrum: An Older Person’s Friend
or a Renewed Assault on the Biologically Tenacious?" by Gregory W. Rutecki, MD.

-- H.R. Moody

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