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Blog Posts (87)

May 27, 2016

Why America Needs Bioethics Right Now

by Craig Klugman, Ph.D.

From the title, you probably assumed I’m going to talk about the fast changing pace of medical technology, whether we should be working on human embryos, claims that scientists will be able to do head transplants within 2 years, or even whether the Olympics should be postponed because of Zika.…

May 27, 2016

Rio Olympics Later:­ For the Good of Both Public Health and Sport

by Arthur Caplan, Ph.D.

It is imperative that an open, transparent discussion of the risks of holding the Olympics as planned in Brazil occur as soon as possible.  

May 23, 2016

The Politics of Fetal Pain

Earlier this year, Utah passed a fetal pain bill that requires the use of general anesthesia on women seeking abortions at 20 weeks gestation or later.  This bill, which relies on a controversial claim that fetuses may feel pain as early as 20 weeks, has been heavily criticized as an attempt to abrogate abortion rights rather than serving a legitimate protective purpose. 

The issue of fetal pain has long been a source of contention in the scientific community, and the dispute has led to several states restricting or prohibiting abortions 20 weeks or later on the basis of potential fetal pain.  While many argue that this law is just one of many across the country aimed not at protecting health, but at restricting or eliminating abortion rights, this law, in fact, seems to be justified in its goal of minimizing the possible experience of suffering by the fetus. 

While studies have not proven that a fetus can feel pain prior to the third trimester, reasonable doubt about the possibility of fetal experience of pain exists.  As E. Christian Brugger argues in his article entitled “The Problem of Fetal Pain and Abortion: Toward an Ethical Consensus for Appropriate Behavior,” there is no moral certitude that fetuses do not feel pain after 20 weeks, and “a preponderance of evidence supports the conclusion that fetal-pain experience beginning in the second trimester of pregnancy is a real possibility.”  Brugger makes the argument, drawing from several researchers of fetal neuroanatomy that all the neural structures for both pain perception and consciousness are in place by 18-20 weeks.  Furthermore, he argues that those who deny fetal consciousness until much later in pregnancy may be relying on outdated assumptions which place the seat of consciousness in the cerebral cortex, despite growing evidence that the upper brainstem and subcortical tissues may actually play a greater role.

If it is reasonable to believe that the fetal experience of pain is possible after 20 weeks, it seems equally reasonable to consider requiring anesthetic or analgesia for such fetuses to prevent unnecessary suffering.  Despite statements from ACOG and others supporting the assertion that fetal pain is not likely before the third trimester, even the possibility that the fetus may experience significant pain and distress supports the notion that, in the face of uncertainty, we should err on the side of preventing such pain.

Opponents of such requirements argue that anesthesia can pose significant and disproportionate risks to the woman with no corresponding benefit, and that the use of anesthesia will increase the cost of abortion significantly, potentially limiting access to the procedure for many women for financial reasons.  While mandating anesthesia or analgesia is not without risks, these risks are not disproportionate if the benefit is eliminating possible pain experienced by the fetus. 

Whether or not the primary purpose of this law is to curtail abortion rights, its effect is, in fact humane; that is, it is an attempt, in light of scientific and moral uncertainty, to prevent unnecessary fetal pain if, in fact, the fetus can and does experience it.  This compassionate approach seems eminently reasonable, and should be supported.

 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

April 28, 2016

Expanding The Moral Community: Why is it so hard?

Much of American history can be described as the struggle to expand the moral community in which an increasing number of human beings are seen as having basic rights under the constitution. We forget sometimes that though the inclusion of all people was perhaps implied in our early documents, as in “We hold these truths to be self-evident, that all men are created equal…” from the Declaration of Independence, it has taken historical time and struggle to come closer to realizing that ideal. This struggle has been the quest for recognition of more and more individuals not assumed initially to have the right to vote and exercise control over their lives, which included African Americans, women, minorities, and more recently the LGBT community. The growing recognition of more and more individuals as being full fledged citizens has been a slow, often painful, birthing process of freedom, in the sense of unleashing human potential and possibilities, within the democratic process.

 

The recent uproar over the Anti-LGBT law passed in North Carolina is a reminder of how difficult it is for many states and communities to accept and accommodate historically marginalized people into the mainstream of society. This law was a quick reaction by the right wing North Carolina legislature and governor to an ordinance passed in Charlotte, similar to what other cities around the country are doing, allowing transgender people to use restrooms according to their gender identity. Perhaps this law also should be seen as a reaction to the Supreme Court ruling in 2015 legalizing same-sex marriage, which has been propelling society toward greater openness and acceptance of LGBT life styles, integrating them into the mainstream. Many who favor the Anti-LGBT law claim that individuals born as male, but are now identifying as female, could pose a risk to women and girls in public bathrooms, though there seems to be no substantial evidence whatsoever of such a risk. My sense is that the individuals who support this law in fact are using risk as a smokescreen in attempting to preserve what they perceive as waning values and norms in society: In the name of conservatism they hang on to an exclusionary vision of society that no longer fits the conditions of expanding freedom and opportunity.

 

So what some see as waning values and norms, others see as moral progress toward more robust democratic ideals and values. This inherent, historical struggle of opposing social and political forces has resulted with unexpected rapidity in the social and legal acceptance of gays and lesbians in the past 20 years in the United States. Most young people today especially those living in metropolitan areas, like Charlotte, where cultural diversity is a daily reality, readily accept that people naturally have different sexual orientations and gender identities, which people should be free to express in their lives. This liberal openness to diversity likely stems from the fact that they live in the midst of, and have normal interactions and friendships with, people of diverse sexual orientations and gender identities, which prompts them to look upon them as neighbors and as normal people. On the other hand, my guess is that many of the advocates of the Anti-LGBT Bill in North Carolina have little or no contact (of which they are aware) and no or limited relationships with LGBT individuals. Also, part of the resistance to greater inclusion of the LGBT community could be stem from the anxiety of having to recognize one’s own uncomfortable feelings and inclinations about sexuality and gender.

 

An additional factor to explain the reluctance of many self-identified conservatives to accept alternative sexual and gender orientations may be related to religion. Particularly, in the “bible belt” regions, regardless of whether or not they are followed by church leaders and members, clear notions of basic moral norms of right and wrong are assumed. Sadly, religious morality has been historically integrated with and used to justify a range of regional cultural values and norms—even heinous ones such as the use of Christianity to justify the institution of slavery. But in fairness even many Christians outside the bible belt follow Catholic natural law theory based on certain features about human nature from which basic norms are predicated about what is “normal” as well as “right” and “wrong” in a content rich, objective sense. In short, the point is if one believes that members of the LGBT community are engaging in a personal life style that is assumed to be inherently immoral, a barrier to inclusion is created.

 

So we in America today are in the midst of a culture war between conservative communities in rural and smaller towns on the one side espousing religious assumptions about human nature (which affects how they perceive risks) and liberals celebrated diversity in more progressive, metropolitan areas on the other. Advocates on either side of this divide bring to bear ideas and theories in an effort to convince others of their position. However, my sense is that articulating arguments to defend the root moral assumptions of either side is unlikely to change the minds of individuals on the other side. The result seems to be communities of individuals living in parallel universes with alternate moral vocabularies who “talk at” each other. Though I am for a liberal, moral vocabulary to account for moral progress within the democratic process, the real change that many of us liberals seek really is at the emotional, and even spiritual, level relating to how human beings are able to show empathy and respect for their fellow human beings in their communities.

 

We know human identity is based largely on social identity within a particular group or groups related to broad social categories such as religion, race, ethnicity, social class, etc. and to more specific ones such as professions, sports teams, political parties, etc. One of the inherent features of social identity is that individuals have a sense of self-identity by virtue of their group affiliations, which is also defined in terms of groups with which they are not affiliated and to which they stand in opposition. When group identities become rigid, to the point of engendering animus toward other groups, barriers are created which can marginalize the rights of individuals in those groups. But through exposure to, and openness to personal relationships with, individuals outside one’s own group, group identity becomes more flexible and open to change—this is an inner change of heart and disposition toward others.

 

Perhaps many of those who self-identify as conservatives in North Carolina who favor the Anti-LGBT law, and who also are predominantly Christian, should remember the ministry of the central character of their faith tradition. The thrust of Jesus’ ministry as defined by scholars like John Dominic Crossan is one of radical inclusion and hospitality. Jesus spent his time interacting with, eating with, and drinking wine with those on the margins of society who were outcasts and viewed as unclean and dangerous according the prevailing hygiene laws. His message to these people was that they too can be included in the moral community and be loved like all others. This is a robust message of compassion and love.

 

Ultimately, struggle for expanding inclusion can only succeed when opponents of bills like the Anti-LGBT Bill are able to show members of the LGBT community the kind of compassion and love Jesus showed to those on the margins of society in his day. The struggle of inclusion really is the struggle to expand what one thinks of as the moral community, or more simply, the neighborhood.

 

 

 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

April 6, 2016

Paternalists at the Gate: Those With Privilege Fight to Keep It

by Craig Klugman, Ph.D.

One of the main concepts that most medical ethics instructors teach to their students is that of autonomy—self governance.…

February 24, 2016

Amusing Ourselves to Death? The Tension between Entertainment Values and Civic Virtues

Kayhan Parsi, JD, PhD

“In Huxley’s vision, no Big Brother is required to deprive people of their autonomy, maturity and history.…

February 23, 2016

Zika: Time for the next wave of sensationalized worry

by Craig Klugman, Ph.D.

On the season (series?) finale of the X-Files (Season 10, episode 6) this week, all of humanity is being attacked by the Spartan virus, a disease that seems to turn off the human immune system and permits other diseases to kill us.…

January 12, 2016

Powerball Fever Is Born of Epic Inequality

by Craig Klugman, Ph.D.

Like many Americans and Canadians, I hold in my hand a ticket for a chance to win to the record $1.5 billion lottery.…

January 7, 2016

Base Gun Policy on Science, Not Rhetoric

by Craig Klugman, Ph.D.

This year, my university required all instructors to talk about “live shooter” plans in our classes. Although this institution does not permit guns anywhere on campus, we are supposed to be prepared because we live in a world where mass shootings occur in schools and where in more places people carry firearms.…

December 4, 2015

The Bell Tolls for Death by Neurologic Criteria: Aden Hailu

by Craig Klugman, Ph.D.

A judge in Reno, Nevada this week denied a request by St. Mary’s Regional Hospital to conduct an evidentiary hearing to determine that a patient is dead.…