By Dr Ryan Corbin
In today’s society, especially in the political arena, human rights are at the forefront of most discussions, and rightly so. There is a heightened awareness of individuality and, by extension, the expression of this through autonomy, also termed “expressive individuality”.
This principle can be seen now as the founding pillar of not only social reform, but also medical management. We must respect one’s right to self-assertion and this indeed is one of the pillars on which a society must be built upon.
However, in the medical field, is it wise to lean heavily on this as first principle and nothing else?
Medical ethics has traditionally been centred around the respect for and practice of four main principles: autonomy, beneficence, nonmaleficence and justice. ‘Autonomy’ can be defined as self-determination, independence, and freedom to do what one desires, once well-informed. ‘Beneficence’ for a physician is seen as doing what is in the best interest of the patient, and ‘nonmaleficence’ is the commonly known ‘do no harm’. ‘Justice’ involves the equal and fair distribution of health resources.
Therefore, is the patient always right? What determines the best interest of the patient? Has ‘best interest’ been steered to simply meaning complying with patient request? Can we morally ‘protect’ one and harm another in the process?
We must acknowledge that medicine is an ineluctable moral pursuit as it ultimately involves the treatment (for the ‘better’) of persons with innate rights. Subsequently, when faced with any medical decision, the health care practitioner is trained to apply the four pillars mentioned above in an attempt to balance each.
However, autonomy has seemed to dominate this thought process and subsequent action. To understand the origins of this “expressive individuality”, we return to the enlightenment period of history, where State and Church were completely separated. This separation resulted in a void in the objective moral fabric of society, and the philosophers of the time attempted to fill it.
This is exampled by Immanuel Kant who proposed a predominately moral autonomy. He argued, “for an individual to act autonomously, he must deduce the moral law from the first principles of reason, and act in a way in which he would obey a universal rule. To subsequently fail to obey reason in this way is to fail to be autonomous.”
This subjective/personal morality coupled with Rousseau’s morality of contract (anything goes once permitted) eventually laid the foundation for the subjective truth and expressive individuality we witness throughout society today.
Non-interference becomes the cornerstone of morality, but is this form of morality justified?
Am I asking for us to return to the dark ages in medicine of beneficence alone? No. History has shown us that without proper policing, anything can be justified as “for the good of medical advancement”.
Intrinsic value of the human being
I argue however, that without acknowledging we are unique creatures endowed with an intrinsic value, why even attempt so hard to preserve human life? What is so special about you and me?
Remove our intrinsic value and doesn’t life then become absurd and pointless? If this is so, then life at the extremes of age is even more meaningless and therefore why not abortion, test tube embryos and euthanasia?
Putting social norms aside, shouldn’t the medical profession rise above this trend? We who are charged with the dignified role to preserve life? We know the answer sadly is no.
We are seen in today’s modern world as having dual roles, both the angel and the grim reaper. We have lost touch with the original foundation of our moral fabric without an evidently adequate alternative and with this void of moral meaning, our professional morality has become as subjective as society’s.
We will attempt to save a premature, 29-week-old gestation baby in one room, while perform an abortion of same gestation at the mother’s request in the next. We will confirm the error of exploitation in reference to child slavery but also facilitate the creation of ‘sibling saviours’ for the purpose of harvesting tissue from them.
What has the past taught us about humanity? We are not capable of upholding the dignity of the human person. We physicians have attempted to control the gift of life with terrible ambiguity but there is hope. The blueprint is there. We have the founding pillars. Let us return to this as the collective first principle and remember we are not gods but simply instruments of His hand.
With this humble truth, all decisions, no matter how complex, will ultimately lead to peace and happiness for all, not a select few we arbitrarily choose.
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