BIOETHICS: Medical ethics education has moved from etiquette lectures to weightier issues

By Tammi Reed Ledbetter
May 22, 2005
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DALLAS?When Robert Orr was in medical school in the 1960s, the training he received in medical ethics amounted to an hour-long presentation on etiquette. Only three students showed up for the Saturday morning lecture.

“It had nothing to do with what we think of now as medical ethics,” Orr said during the opening session of “Cutting-Edge Bioethics: Human Life on the Line,” held May 6-7 at Criswell College.

The two-day conference on “end-of-life issues, reproductive technologies, stem cell research and beyond” was jointly sponsored by The Center for Bioethics and Human Dignity, Christian Medical & Dental Associations, Trinity International University, The American Academy of Medical Ethics together with Criswell College and Baylor Health Care System of Dallas.

After a lifetime of practicing medicine for which he was named Vermont’s Family Doctor of the year in 1995, Orr now serves as an ethics consultant. In the more than 1,400 cases for which he’s offered advice, questions often center less on what can be done than what should be done.

“The first people who started asking questions about what should be done [in terms of medical care] were the theologians,” he said, alluding to moral issues such as abortion that moved medical ethics to the forefront. “Sadly, over time, the voice of the theologian has gotten weaker and weaker and less listened to as the baton was handed over?first to philosophers,” Orr said. “Then clinicians?the physicians, nurses and social workers who deal with patients daily?became involved and engaged.” Next came the attorneys and judges, he said, and more recently people with a business background analyzing the cost of care.

Ethics committees were formed in the 1980s in response to cases such as that of brain-damaged Karen Ann Quinlan whose family fought for the right to remove the respirator when she was in a comatose state. Nowadays, teams of 12 to 20 consultants deal with educating patients, evaluating policy regarding ‘do not resuscitate’ instructions and informed consent, as well as offering help with decision-making for those receiving the care.

The ethical questions raised in the medical community have changed in response to technological advances. “When I was in medical school in the 1960s the question was, ‘Should we tell the patient he or she is dying?’ Ninety percent of the time patients were not told,” Orr said of his early experience. “Now there’s been a sea change to 98 percent of the time we do [tell them].”

Orr said breakthroughs in medical treatment have led to:

?involvement of medical personnel in executing prisoners through lethal injections;

?protecting patient confidentiality as records are stored electronically;

?access to healthcare among patients who are uninsured or underinsured and the rising cost of care;

?xenotransplantation utilizing organs from animals to replace diseased human organs;

?reproductive technology that provides “babies without sex;”

?so-called “gene enhancement” to remove unwanted traits that threaten a patient’s health; and

?artificial intelligence and artificial life, which raise the question of what it means to be human.

“What is normal?” Orr asked. “Should we eliminate those who are not normal? Once we start being able to change genes we’ll be asking the same question of who should live and with what characteristics.”

Orr said: “Technology raises questions of can-do versus should-do. When you have a man dying of lung cancer with difficulty breathing, can we put him on a ventilator to postpone dying a few days or weeks? We can, but should we?”

Raising the issue of “marginal benefit,” Orr said decisions must be made between differing plans such as one tr