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  • Reverend James Squire

Three Bioethics Decisions For Today

Surgeons have a reputation for being people who go into the field because they don’t want to deal with their feelings about the patient and the fact that their patients may have feelings and perceptions about them. I don’t think this is true, but I may have a biased view as I know and am known by anyone who has operated on me with one exception to the rule that was not my most recent surgery. Because of this exception to the rule, I feel that that knowing your surgeon and your surgeon knowing you is imperative. This human interaction is true for the vast majority of surgeons and is part of their evaluation process. No knowing the patient also, some say, brings about objectivity in dealing with procedures.

When we think of people who have an invasive procedure, we usually think of surgery that involves an incision and entrance into the body with quite a bit of intrusion such as with open heart surgery. The chest is sometimes cracked so once the surgeon enters the body, he or she must carry on with the procedure even if she sees that the surgery will be more involved than she thought it would be. She can’t wake the patient up and say, “What would you want me to do?”

However, there are a growing number of surgeries that require a lot of anesthesia because the procedure is being done on the heart or other vital organ where it is done by going through the arterial system or is done laparoscopically. If the surgeon finds more than expected, then she must make the decision to continue or not, knowing that the procedure could be more that either she or the patient ever expected or, for that matter, what the patient agreed to during the signing of the consent document. She would have to decide if the procedure should move forward or should be stopped and part 2 done later. I have not seen very much on this kind of bioethics decision as it falls under the not many cases are like this kind of case, but it is the rare case that bioethics is also interested in. The doctor can’t appeal to a precedent that usually doesn’t get reported or appeal to the Hippocratic oath that states, “do no harm.”

It is obviously the doctor’s call, but she may ask herself the question, “What would my patient want me to do?” If she knew the patient’s personality then, she would have a better- informed decision.” It is not much to go on, but it is something that could help her with the decision.

Second, I was glad to see that Governor Murphy of New Jersey made a strong statement that the vaccinated, including me, have been waiting for. Namely that it is time to call out those who are not getting the vaccine, those who spread misinformation, and those who seek political points for doing away with mask mandates whether you are vaccinated or not. Currently 90% of the unvaccinated make up those who are in hospitals. Your personal rights stop where my rights begin. Wearing seatbelts, drinking and driving, texting while driving are against the law. That law impinges on our personal freedom because you could hurt others who are innocent victims particularly children under the age of 12 with the potential to get Covid. ICU(s) are crowded and elective surgeries that would make a person’s life better are no longer options in some areas. Governor Murphy has received quite a bit of praise from many quarters with this announcement. We need other voices added to his including President Biden’s voice.

I always instructed my Ethics classes that where you have money, you have ethics. A local firm will pay their employees $1000 to get the vaccine. They have a 90% vaccination rate and will likely reach 100% vaccinated. It is like the joke of the man who asks a prostitute for the price of her services. Man to woman. ‘Would you sleep with me for one million dollars?” Woman’s response is “Sure.” Man questions, “How about for ten dollars?” Woman’s response is “What do you think I am?’ Man’s response is “We have already established what you are. All we’re doing is bargaining about the price.”

Getting sick has driven the unvaccinated to great heights of reversal of attitude regarding getting the value of the vaccine, and pleas to others to get vaccinated, but how much would people have to be paid to get it. We know that everybody has a price. A chance on the lottery or $100 just doesn’t do it, but I wonder what price would.

Third, Pfizer, Moderna, and Johnson and Johnson are pursuing the necessity for booster shots, a third shot, to already fully vaccinated people including people like me. We shouldn’t get a third shot until the rest of the world has access to the vaccine. This is both a moral imperative and a practical one. The Delta Variant did not start in the United States. It spread from other locations to here. We have a moral imperative to make sure the rest of the world including the poorest of nations such as Haiti have access to the vaccine. There is that important ethical question, “Am I my brothers’ or sisters’ keeper?” At the practical level we can no longer see the pandemic or climate change, for that matter, as something that only will affect us. We are citizens of the world and must begin thinking with that global identity. We rise as one or perish as one!

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