Can a Law be Unethical?

Traditionally there are four basic principles of medical ethics:

• Autonomy
• The right of the individual to self-determination.
• Informed consent is basic to health care.
• Do no harm. (Non-maleficence)
• Actions should not be the cause of harm.
• In practice, don't be hasty and do thorough evaluation.
• Do good. (Beneficence)
• Actions that promote the well-being of others.
• Needs of the patient come first.
• Justice and Respect for Human Rights
• Fair and equitable distribution of scarce resources
• Respect for the rights of each as a person.

There can, of course, be conflicts between different of these principles. Ethicists have been discussing and arguing about them for years. Principles of ethics which underlie the discussions can take different approaches and end up with different results. In my work for the past 25+ years I have studied and specialized in ethical issues and concerns, chairing committees, making presentations, being open to discussions. As a result I tend to think in terms of ethics and the riddles and difficulties we can face.

Yes, a law can be unethical. Unethical does not mean illegal. We do not need to go to extremist countries to find laws that were unethical- at best- and inhumane at worst. Laws of segregation in the post-reconstruction South in the United States were not illegal. They were the law. But we know they were certainly unethical in spite of the ways they were justified. Eventually they were seen as "unconstitutional" which made them "illegal." But it took legal interpretations and arguments to get to that point.

I hope someone will take a hard ethical look at the proposed health care reform law in the Senate. Yes, there are conflicting needs and wants. There are questions, for example, about equitable distribution of resources.

• But will the new law cause harm? 
• Will it be just and respectful of the life and dignity of individuals? 
• Will it promote doing what supports the well being of others? 
• Will it support the autonomy of all patients and their right to medical care?

I could go on, but I fear that the new law will make a difficult arena- medical care- even more difficult and less able to meet the care of the patients- which in the end is always the first and foremost need there is.

Calendar of Saints: Mayo and Meninger Families

Periodically I post a quote from a saint from the Episcopal Calendar of Saints that week. I connect it with a picture that I have taken as a kind of poster. These are meant to be meditative and mindful, playful and thought inducing. I hope they are helpful in your spiritual journeys.

Mayo and Meninger Families
Pioneers in Medicine
March 6

William Worrall Mayo (May 31, 1819 – March 6, 1911) was an English born medical doctor and chemist, best known for establishing the private medical practice that later evolved into the Mayo Clinic. His sons, William James Mayo and Charles Horace Mayo, joined the private practice in Rochester, Minnesota in the 1880s.

William James Mayo (June 29, 1861 – July 28, 1939) was a physician in the United States and one of the seven founders of the Mayo Clinic. He and his brother, Charles Horace Mayo, both joined their father's private medical practice in Rochester, Minnesota, USA, after graduating from medical school at the Univ. of Michigan in 1883. In 1919, this private medical practice became the not-for-profit Mayo Clinic.

Charles Horace Mayo (July 19, 1865 – May 26, 1939) was an American medical practitioner and was one of the founders of the Mayo Clinic along with his brother, William James Mayo, and others. He graduated from the medical school of Northwestern University (now called the Feinberg School of Medicine) in 1888 and joined his father, William Worrall Mayo, and older brother, William James Mayo, in their private medical practice in Rochester.

The Mayo Clinic came to be regarded as one of the foremost medical treatment and research institutions in the world. Within Mayo's lifetime it registered one million patients. The idea of medical specialization was developed by this group of medical pioneers.

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Charles F. Menninger (July 11, 1862 - Nov. 28, 1953), with his two sons, founded the Menninger Clinic in 1925 in Topeka, Kansas. This was one of the first places which sought to treat psychiatric maladies as illnesses which could be cured, rather than simply providing custodial care. ... He sought collaboration with local Topeka doctors, who tended to reject him due to his homeopathic background. As a consequence, he became enamored of collaborative group practice, such as he saw at the Mayo Clinic. This would later strongly influence his own clinic.

Karl Augustus Menninger (July 22, 1893 - July 18, 1990), born in Topeka, Kansas, was an American psychiatrist and a member of the famous Menninger family of psychiatrists who founded the Menninger Foundation and the Menninger Clinic in Topeka, Kansas.

William Claire Menninger (Oct. 15, 1899 - Sept. 6, 1966) was a co-founder with his brother Karl and his father of The Menninger Foundation in Topeka, Kansas.

Personal note: I am humbled to be employed by the Mayo Clinic with its rich history of health care innovation. The spirit of the Mayo Family continues to be felt strongly throughout the clinic's work. I also remember Karl Menninger and his influence on many of us entering ministry in the 1970s thanks to his amazing book, Whatever Became of Sin?, published in 1973. Google Books says:

Menninger's renowned book questions what is wrong with our ethics, values and morality and asserts that the answers lie within ourselves

Perhaps it is time to re-read that and see if it holds up to 43 years.