Medicine’s Modern Crisis
The United States is facing an identity crisis—not about who we are as a country, but about what we are as humans. Medicine by virtue of its inseparable union with the object of its craft, people, reflects this crisis. The abortion debate is a direct symptom of that crisis. By abortion we mean specifically the separation of the mother from the child for the purpose of ending the life of the child. The presupposition behind traditional medicine and ‘medical’ ethics is that individual human life is an end in-and-of itself at any point of maturation from conception to death. If this is the case then changes or differences concerning the belief about when a human life begins and ends should be of singular importance for the medical clinician. The belief on this fundamental point not only held by the physician but by the patient impacts standards of patient care including the limits of what a clinician will or will not do consistent with that belief.
Standards of patient care derive from a balance struck between a consensus of what practicing physicians do and the reasonable expectations of the patients they serve. Those practices are influenced by the clinician’s own beliefs and convictions, beliefs which are informed by the clinician’s culture and enhanced by his medical educational experience. One could argue that the practice of medicine is a lagging indicator of the beliefs or presumptions of the culture out of which it is borne. If that culture is divided regarding its belief about the nature of humanity, divided on its answer to the question “What is man?” then beginning and end of life care—such as abortion and euthanasia—become flash points representing symptoms of that crisis. The deeper issue, the reason why abortion is so controversial for example, is that it represents a fundamental shift in the belief about who and what mankind represents, impacting in turn how we treat one another since a redefinition of humanity impacts who is even called a patient.
Abortion advocates often couch the debate it terms of ‘right to access medical care’ and distributive justice, assuming that the deeper question, “What is man,” has been answered the same way by all of society. The problem with talking strictly about distributive justice in women’s reproductive health is that it masks the deeper issue of what legitimizes medical services in the first place: belief about the nature of humanity. Is man strictly material or is there something deeper that lends gravity to his being higher than that of merely a meaningless collection of complex biochemical reactions? Legislative regulation and judicial decisions regarding access to abortion procedures fail to address these underlying beliefs. Knowing full well that medicine reflects a divided culture perhaps the question we should be asking ourselves in the public debate at this point is not whether women should have access to abortion on demand, but rather under what circumstances could abortion be considered ethical? Just because a patient has access to a medical procedure does not make providing that procedure ethically defensible every time. Medicine is not a stranger to the ethical dilemma. In fact dilemmas are so common that ethical criteria and categories have been established so that the clinician is equipped to handle them consistently without violating his conscience or the patient’s autonomy.
While medicine has always had to negotiate the delicate balance between distributing its scarce resources to a population without sacrificing the primacy of the clinician/patient relationship, it has most recently had to deal with encroaching governmental regulations attempting to legislate that distribution. Certainly the ethical concept of distributive justice is a serious concern, but legislative actions force it to be of paramount concern. While government attempts to manage the details of distributing scarce medical resources through healthcare reform (typically a job reserved for medical professionals) medical professionals are left with the vague notion that the clinician/patient relationship is becoming secondary to the dictates of the State. This refocuses the primacy of the clinician’s concern from the patient to the government’s ‘outcome based’ mandates, and prioritizes the ‘needs of the population’ as interpreted by the State over those of the individual patient. The ultimate outcome of this kind of overemphasis on an ethical category is the reduction of patient autonomy popularly termed ‘choice.’ Such legislative ‘reform’ lands a critical blow to the belief that all individuals are valuable in and of themselves and that it is the physician’s honorable duty to protect the patient’s inviolability. Added to damage caused to a patient’s self-determination, government regulation over the distribution of medical resources could violate a clinician’s own conscience by forcing or denying certain procedures against the will of either the clinician or the patient.
A Reasonable Solution
Given the contentious circumstances surrounding abortion socially and medically—the crisis of belief about the nature of humanity, the lack of continuity of patient care represented in on-demand specialist services, the common coercive elements present in most women’s lives created by an unplanned pregnancy, the political differences, etc.—it would seem the better part of wisdom for the medical community to adopt a standard that would insure increased ethical scrutiny is taken to address more comprehensively and consistently the issues surrounding each patient’s circumstances, and beliefs. It is only then that appropriate treatment options can be discussed. A medical clinician must never assume that the patient holds the same beliefs as the clinician nor that simply electing for the procedure equates to freedom from coercive elements or bonafide informed consent. The ethical dilemma of unplanned pregnancy is present only in the particular patient context. Services therefore cannot be generalized or legislated but rather must be actively addressed by the clinician on a per patient basis. Medicine is allowed to be in crisis. But we at least owe it to our patients to insulate them from that crisis in an effort to avoid violating their true autonomy.
The Commission for Reproductive Health Service Standards has been formed to identify and interpret traditional medical ethics in order to assist and encourage medical clinicians to protect the true autonomous decision-making ability of women facing unplanned pregnancy. While America resolves its crisis of belief about the nature of humanity, women at least deserve to be insulated by the medical community from the manipulation of politically informed agendas or beliefs that reduce the value of a human. The job falls to the ethical physician.