What is the definition of death? Who decides if research can be conducted on children who cannot voice their opinions? These are the types of questions that were addressed in Friday’s Bioethics Symposium at Yale.
The Yale Bioethics Group hosted a symposium entitled “Paul Ramsey’s Beecher Lectures of 1969: The Structures of an Ethical Revolution and Beyond.” The day-long event traced the evolution of medical ethics over the past three decades.
The afternoon panel discussion in Whitney Humanities Center featured speeches by Nancy Angoff EPH ’81, Associate Dean of Student Affairs at the Yale School of Medicine; Stephen Kellert, professor at the Yale School of Forestry and Environmental Studies; and Maurice Mahoney, professor of genetics and pediatrics.
Angoff’s speech covered the relationship between patients and doctors. She spoke of cases presented to the Bioethics Committee where there was a conflict between the prognosis and the hopes of the loved ones of seriously injured patients. She said that the “strangerhood” between patients and their caretakers is “one of the major challenges to ethical decision-making.”
The relationship must change, she said, and the change “starts with hearing the patient’s story.”
However, there are huge barriers to the formation of this intimacy, she said. The staff at Yale-New Haven Hospital changes every month, and some hospitals have incentive plans where the more patients a doctor visits, the more money he makes.
Angoff said that in a situation of such detachment between doctor and patient she fears that the “patient’s life story may be considered anecdotal.”
“There’s something in us that craves a community, a connection,” Angoff said, adding that disillusionment will take hold of doctors if they lack the intimacy that endows their work with meaning.
Kellert took an environmentalist’s stand on bioethical issues. He spoke of the conflict between what is instrumental to humans and the elements of nature with the intrinsic right to be respected.
Kellert addressed the rights of animals, and how the recognition of human-like qualities in other species motivates our acknowledgement of their rights.
“We have a genetically encoded response to nature,” Kellert said. “Beauty in nature is not just pretty — it’s indispensible.”
Mahoney spoke about the ethics of research on human subjects. Speaking from his experience as a pediatrician, he gave an informed view of children as a population vulnerable to research.
Mahoney said that ethical discourse involves three concepts: autonomy, beneficence, and justice. Autonomy has become the central focus of bioethics today, and Mahoney said he fears that the other two values are compromised by it. It is difficult to apply the concept of autonomy to vulnerable populations, and thus doctors must make guidelines to protect children. These guidelines, however, can make finding cures for childhood illnesses difficult, and Mahoney said that doctors should remember the balance between the three values.