Monday, February 8, 2016

When Medical Ethics Enters the Campaign

Ethical questions in medical care and science will be prevalent throughout the presidential election season. How deeply they are considered will vary greatly. In the past week, two in particular have come to the fore, and how well they were engaged is worth considering.

Asked in Saturday’s Republican debate whether he would consider quarantining Americans returning this summer from the Olympics in Brazil, New Jersey Gov. Chris Christie said, “You bet I would.”

Christie, you will recall, was a vocal supporter of quarantine during the Ebola outbreak, memorably locking up Kaci Hickox in a tent for three days when the nurse returned from caring for Ebola patients in Sierra Leone (though she tested negative for Ebola). So perhaps the certainty of Christie’s reply, now that Zika is the new viral fear, is not surprising.

Rival candidate Ben Carson, a neurosurgeon, countered that “just willy-nilly going out and quarantining people because they’ve been to Brazil, I don’t think that’s going to work.”

In reporting this story, the news service STAT (www.statnews.com) noted that while the World Health Organization has declared a global public health emergency because of Zika, WHO “has not called for quarantining anyone who may have been exposed to the disease. In Zika-affected countries such as Colombia, pregnant women infected with the virus sometimes share rooms in the maternity wards with women who do not have Zika, with only a mosquito net to separate them. There is no evidence the virus can be transmitted through casual contact, or through sneezes or coughs.”

Mortality and care of the dying also became a campaign topic during a town hall sponsored by CNN, when Jim Kirhan, an 81-year-old, terminally ill man, asked Hillary Clinton how she would “advance the respectful conversation that is needed” about physician-assisted dying.

“It's very personal to me and resonates probably with many other people who are elderly dealing with health issues,” Kirhan said. “The question is coming to me as a person who is walking with colon cancer. And I'm walking with colon cancer with the word terminal very much in my vocabulary, comfortably and spiritually.”

The Washington Post said Clinton was “stumped” by the question. So it’s worth considering Clinton’s complete, seemingly impromptu reply.

“I really appreciate your asking the question,” Clinton said. “And I have to tell you, this is the first time I've been asked that question. And I thank you for it, because we need to have a conversation in our country. There are states, as you know, that are moving to open up the opportunity without criminal liability for people to make this decision, in consultation by their families, even, in some cases, with medical professionals. But the issue is whether the medical professionals want to be involved or just be counselors. So it is a crucial issue that people deserve to understand from their own ethical, religious, faith-based perspective. So here's how I think about it.

I want, as president, to try to catalyze that debate because I believe you're right, this is going to become an issue more and more often. We are, on the good side, having many people live longer, but often, then, with very serious illnesses that they can be sustained on, but at some point, don't want to continue with the challenges that poses.

So I don't have any easy or glib answer for you. I think I would want to really immerse myself in the ethical writings, the health writings, the scientific writings, the religious writings. I know some other countries, the Netherlands and others, have a quite open approach. I'd like to know what their experience has been

Because we have to be sure that nobody is coerced, nobody is under duress. And that is a difficult line to draw. So I thank you so much for raising this really important, absolutely critical question that we're all going to have to do some thinking about.”

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