Listening to the Whispers: Re-thinking Ethics in Healthcare

4. Teleology, the Modern Moral Dichotomy, and Postmodern Bioethics in the 21st Century

4 Teleology, the Modern Moral Dichotomy, and Postmodern Bioethics in the 21st Century john paul slosar It could be suggested that the turn of the 21st century, the beginning of the new millennium, would have been a fitting occasion by which to mark the beginning of the postmodern era of bioethics. In its current form, bioethics began as a critique of traditional medical ethics conceived as the customary practices of physicians rooted in the Hippocratic tradition. Medical ethics in this previous form survived for more than two millennia until only a few decades ago, when intellectuals and academics outside of medicine began to critique some of its central moral tenets. The majority of these thinkers were philosophers and theologians who critically examined the moral character of the medical profession as manifested in the creeds recited at medical school graduations and adhered to by physicians dogmatically, if not unconsciously, in their noble efforts (Jonsen, 1998, pp. 23–24). These critiques reflected diverse moral perspectives that previously had been considered as having little relevance to the practice of medicine. These moral perspectives, which have begun to reshape the moral character of medicine, are largely influenced by modern moral theory. The way in which modern moral theory has begun to reshape the moral character of medicine can be illustrated by considering a case and the commentaries of two bioethicists: At age seventy, Mrs. R. had become severely disabled by cardiac failure due to a damaged mitral valve. In an attempt to restore her quality of life to what it was 138 prior to the cardiac failure, she underwent valve replacement surgery. Twelve hours after the surgery, however, her cardiac output began to drop and became insufficient. Despite attempts employing a variety of means, treatment in the ICU did not restore her cardiac output to a sustainable level. With appropriate informed consent, Mrs. R. had an experimental cardiac assist device implanted in her chest. A few hours after this surgery, her cardiac output began to fall again. Though she was on a respirator and receiving fluids, everyone involved in her treatment agreed that Mrs. R. would not survive through the night. Since Mrs. R. was conscious and vaguely alert, her physician treated her for pain with morphine (with consent again). After turning off the respirator and cardiac assist device , her physician gave her another dose of morphine. When Mrs. R. continued to show signs of pain and discomfort, jerking at intervals and furrowing her brow, her physician had the nurse draw up 10 cc of potassium chloride and, with the consent of the family, injected it into her intravenous line. Within minutes, Mrs. R. lay still and the cardiac monitor showed no heartbeat. (Adapted from Levine, 1989, pp. 144–145) In providing moral analysis of this case, two bioethicists arrive at conflicting conclusions. One morally vindicates the physician’s actions, while the other condemns them. According to the former, “My opinion is that [the doctor] did nothing morally wrong. . . . Upon determining . . . that further interventions were turning futile and useless, [the doctor] did the humane thing. He provided a quick, painless death, a good death.” (Levine, 1989, p. 145). According to the other commentator, the physician’s actions cannot be justified because the physician acted to end the patient’s life despite the medical profession’s code of ethics, civil law, and the duty to “cherish” life (p. 145). The commentator who vindicates the physician saw nothing morally wrong with the physician’s actions because, in this case, that commentator places the emphasis of moral evaluation on pragmatic results. From this perspective, the moral value of an action is determined by its resulting state of affairs, and the physician’s action was perceived to have a good outcome, namely, a quick and painless death, “a good death.” On the other hand, the commentator who condemns the action of the physician places the primary emphasis of moral evaluation on principles of moral obligation as rooted in the customs of the profession, the laws of society, and any intrinsic value of human life. From this perspective, adherence to these constraints on human action takes priority over the outcome or result of the act as the basis for moral evaluation. These moral Teleology, Moral Dichotomy, and Postmodern Bioethics 139 views constitute a common polarity found in the acculturated moral reasoning of contemporary society. On one hand, people seem to act based...