African American Bioethics: Culture, Race, and Identity

Chapter 7. Does an African American Perspective Alter Clinical Ethical Decision Making at the Bedside?

CHAPTER 7 Does an African American Perspective Alter Clinical Ethical Decision Making at the Bedside? Reginald L.Peniston T H E Q U E S T I O N in the title of this chapter is just the type of query for which Friedrich Nietzsche would have had scathing commentary. He might have asked, “Does a German, or Christian, or European perspective alter clinical ethical decision making at the bedside?” He would likely say, “Yes, and in a frightening and self-conscious fashion.” Any perspective tied to group thinking would be an artifice of meaningful ethics. I believe that Nietzsche did engage in a bit of sleight-of-hand when judging motives by outcomes and incentives; however his skepticism and condescension are not traits alien to physicians. My first chief of surgery reportedly said,“You can teach any monkey to operate—surgical judgment is the hard part.” As a surgeon, jealously respectful of philosophers, I regard philosophical re- flection as harder still to teach. Bioethicists, especially those who are physicians or physician extenders, reflect on moral issues complicating all aspects of modern health care. I posit that healing processes and encounters exist prior to the realization of a dilemma or moral conflict. The salutary good of biomedicine precedes the angst of moral doubts. The healing arts become refined as a reaction to and reflection of our injury, our insanity, or our corporal corruption. I refer to biomedicine because science and technology 127 have totally and completely eclipsed the good intentions of those who would heal by magic. This is not to say that when desperate patients resort to faith healers, that if it be for minor complaints or hopeless situations, they will not indeed improve. As I attempt a response—not necessarily an answer—to the question that frames this chapter, let me reveal a guarded opinion, a further bias I have regarding the exercise of such problems. Clinical ethics as commented on by clinicians, professional clinical ethicists, various hospital ethics committees , and professional organizations has not always maintained proximity to academic bioethics and its various commentators and thinkers. Bioethicists , some of whom are in the news, have the uneasy task of wading through and explaining the difficulties of applied ethics, often without the support of that branch of academic philosophy that investigates ethics writ large. Nursing organizations, focus groups, theologians, and other religious representatives and their followers have an even more awkward predicament, because many of them (particularly in the West) make claims to the elements of caring , feeling, compassion, and even healing that biomedicine with all of its scientific and technological tools has made available. Attempts to introduce difficult metaphysical concepts such as spirituality into the curriculum and the research agenda must be the result of their disillusion with medical technologies and physician and research motives. Indeed, promoting improved access to healing technology, whether in public health or tertiary care, represents the single biggest failure of expert panels of bioethicists—partly because such institutions do not give priority to exploring relevant health care policy, something controlled by governments and political machines. From the outset we know that injustices perpetrated against our largest minority group (the poor and near poor) is a national embarrassment. Unbridled American materialism continues to cloak itself in the sanctity of marketplace dynamics as uniquely suited to human fulfillment. Indeed, even nature is portrayed as a divinely ordained lottery or marketplace. It is played out in a hierarchy of genetic or racial endowment. Celebrating diversity is not a real antidote to the happenstance of natural inferiority. Confusion as to the good confronts us in the very nature of biological diversity. There is a spontaneous“bad”or“abnormal”in nature—thus confusion as to man’s purposeful ends. Those beautiful yet frightening Hubble deep space photographs of worlds ending and beginning give us pause as to the evanescence of our existence as a species or as a permanent part of the universe. Does the universe need us to survive? Perhaps our gods need something like Reginald L. Peniston 128 Does an African American Perspective Alter Clinical Ethical Decision Making? us for company or to add meaning to their existence. But back to the question : Is there a distinctive African American bioethics? Most of what has ever been stated on that subject has left me skeptical, including some of Jorge Garcia’s commentary on the matter about a...