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.

Some Quick Thoughts on Ethics

Over the past years I have developed into a kind of ethics "consultant", workshop leader, and a champion of ethical behavior. While mine has been in the health care field ever since I was in grad school in the early 90s, I am very aware of the wide-branching of ethics - and its lack in our society. A friend of mine has commented that many of the big problems we have faced over the past couple decades (or more) are due to the fact that we don't teach or talk about ethics.

Actually, I am not sure we ever have. Or at least we have never connected ethical behavior with day to day life. We allow ethics to kind of hang out in the cosmos with no clear application. Instead we take the position that the "ends justify the means." (Actually that is an official ethical principle, albeit one that I generally find hard to justify.) In any case, we have certainly heard a great deal about "ethics" in recent weeks with the election of Mr. Trump. Those who held Mr. Obama to high ethical standards are now ignoring the low ethical standards of Mr. Trump. 

His seeming unwillingness to follow certain legal issues- or spinning them into irrelevance (son-in-law as Sr. Advisor; not divesting things that could be conflict of interest) or just moving past them as if they didn't exist (I got elected. Now I don't have to show my tax returns.)

Ethics is a tough field to explain, expand on, and get people to understand. "So what," some might say, "if he's honest we don't have to worry. If everything comes out all right, well, ethics be damned." Until of course it's someone you disagree with. Round and round and round it goes.

Instead we get into heated arguments about celebrities making statements while ethics is set aside. Or we get the President-elect raising other issues instead of his personal ethics. (CNN is "fake news" so I don't have to answer their reporter's question.)

I will end this brief discussion quite simply:

• If we ignore ethics, we are doomed to be taken advantage of; if not by Trump, then by the next one who will follow the precedent.
• If we ignore ethics, or follow the "ends justify the means" thinking, we leave ourselves open to follow the whims and ideologies of whoever happens to think they are in charge this time.
• If we ignore ethics, we are ultimately ignoring the role of oversight of our elected officials, something the Founders would shudder at.

Just some quick thoughts, as I sit and watch in uncertainty and disbelief that this is really happening right here. Under our noses.

And we are letting it happen. 

Hence I continue to wrestle with my dark night.

I Get Angry - Very Angry

If this law is enacted in Michigan, it will be another step backwards in the fight against discrimination. It would allow doctors and EMTs to refuse care, repeat REFUSE CARE to people whose lifestyles they disagree with.

If it wasn't from a local CBS newsfeed in Detroit I would have thought it was a headline from The Onion.

It says something very unhealthy about American politics when a bill like this is even considered as a possibility. It goes against every ethical standard of every health care license issued. It contradicts every basic human value and every bit of Christian faith. It is a perfect opportunity to dig into a) The Parable of the Good Samaritan and b) The story of the woman caught in adultery - let those without sin cast the first stone.

What kind of nation are we becoming when we justify torture because someone else attacked us so we can respond with revenge and anger? What kind of human and humane value systems are we discarding in the name of an abusive understanding of religion? It is a good thing these politicians were not in charge in the civil rights era.

Oh, wait a minute, they were. And they were proven to be on the wrong side of history, faith, and ethics.

If we allow that kind of thing it is no different from the radical Islamist sects who want to impose sharia law. It lowers us to a least, and pretty damn low common denominator.

Just Thinking

When working on some of genealogical research the other week I had one of those moments when the world made a little bit of a shift. It comes with just a simple questions:

Why do almost exclusively self-identify with the "family" of our birth surname?

I was looking at my family tree and realized that just three generations back (my great-grandparents) I can potentially find as many as eight surnames and the one more generation (great-great grandparents) there would be sixteen. Does that mean I am as much a Klein and a Keller and a Freighley and a Ritchie as a Lehman? Then, by marriage I am also related to another whole set of family names on my wife's side. But without confusing it too much, just sticking with my direct ancestors, who am I?

This made me think back to a part of the Race exhibit that was here in Rochester a few years ago that was originally developed by the Science Museum of Minnesota. The basic point of it was that, at the very heart of who we are, we really are mutts. We are a mixture of ethnic, national, religious and probably racial parts. Genetic research is showing this truth at an even deeper level.

Another piece of the reality also goes to what portion of who I am is what national background. I know there are Ukrainians and Germans, Scottish and English back there. Because of ghettos in the Ukraine before 1900, that may be the greatest part of my heritage. Yet all these years I identified as of German background. And, since the Germans arrived here at least 80 years before the Ukrainians, that also makes me American, since here is where I was born. As were members of my family back at least five generations.

Maybe, then, for me it's time to even drop the hyphenated ethnicity and just be American.

See what I mean when I say it caused a slight seismic shift of self-identity.

Which brought me back to a discussion some of us were having on an ethics meeting about diversity. We finally got to the idea of self-identity. Different people talked about different ways of doing that. It struck me at that moment that my cultural identity is as much 60s Hippie Radical as it is a German-American or whatever. In fact, maybe even more so. A great deal of that ethnic identity has broken down in my life.

That wasn't true of my family. But perhaps being part of a religiously mixed marriage of the 40s and 50s helped move me the way I have.

So that's where it has taken me today. I look forward to the day when these issues are resolved in favor of being part of the one and only human race and where nationality is truly as a citizen of the world trying to keep our world from falling apart.

I think know that's what John Lennon was singing about.

Crumbs of Grace

Sunday's Gospel text was the story of the Phoenician woman who pleaded with Jesus for his healing. He refused with a somewhat snide remark.

It is not fair to take the children’s food and throw it to the dogs.

But she was quick with a comeback:

Yes, Lord, yet even the dogs eat the crumbs that fall from their masters’ table.

Which led me to think the title of today's post. All any of us get in our day to day lives is truly nothing more than a few crumbs of grace falling, I believe, from the bounty of God. Crumbs of grace.

Yet it is enough. It is always enough. Grace is never deficient.

I have never thought,

Gee, if only I had a little more grace today. Things would go so much better.

Nor have I thought, (out loud, anyway!)

I deserve more grace. Look at all I have done. Look at how wonderful I can be. Surely there's more grace set aside for me.

I know that when I write that it sounds downright silly, if not idiotic. We all know (intellectually) that grace is unearnable. It's free, a gift, far beyond anything we deserve -or would get if justice were based on our human standards. Yet I have heard many people over the years make statements, in coded language of course, but the message is clear:

Look at me, I deserve more grace.

Sunday evening then I was doing some research for a presentation this fall that includes a look at "feminist ethics." As I was reading the description and insights of feminist ethics, it struck me that in the scene from the Gospel on Sunday, we were seeing an example of the "ethics of care" that the woman was presenting.

The "old ethics" was that this woman was below any attention. She doesn't even deserve grace. (I know, that's an oxymoronic statement!) But her ethic is far stronger. Her ethic is based on relationships and healing, not strength and force. Her ethic is based on caring for her daughter. So, in essence she says to Jesus and the disciples:

I don't care what your ethic is, mine is to take care of my daughter. It is as good as your ethic. Maybe better? Even the dogs get to eat the scraps, and Jesus, you are a man of grace and have a lot to share.

I then came across a quote in my reading that, for me, summed up the difference between her ethic and the ethic of force and wielding power:

grace is a healing power rather than a saving force.

What a statement. Healing vs. saving. Force, or a gift. Perhaps if we were more attuned to the Canaanite woman's ethic, we would be more open to caring for those around us in a more helpful way.

The Saddest of Truth

In the absence of ethics, rules rush in to fill the void.
--Rushworth Kidder

In Memoriam:Joe Paterno

It all happened so quickly this fall and winter. He was still riding high, the greatest, winningest, high-quality college football coach. Then it all fell apart.

Jerry Sandusky and the sex-abuse scandal.

JoePa fired.

Now he's gone.

Hopefully, in looking back from the point of football history, he will be remembered for what he did...

And as a cautionary tale, for what he didn't do. May we never forget that to take the extra step when protecting others is essential. Power, ethical and moral as well as all other kinds, demands our vigilance and self-awareness.

Over the many years Joe Paterno had that. He lost it and paid the price.

May he now rest in peace.

Penn State Refelctions (3)- The Dilemma of Ethics

Thursday I said the following in a post on the scandal at Penn State:

But the cautionary tale in all this is far deeper than the pain of watching Paterno in pain, losing his dream to a sick, VERY SICK man who was more interested in satisfying his own sick drives. It is far deeper than seeing a grand and prestigious university be undermined by authorities who felt it better to hide the truth than care about the safety of children.

The message is far more than football or universities or even the law. It is far more important than even a legendary individual like Paterno.

Very simply the message is about our humanity and our willingness to be more humane than we tend to be. The message is about taking care of our children and ourselves with dignity and respect. The message is that the letter of the law is not enough.

A couple days ago I was leading an in-service on an ethics presentation I have done. I commented to my colleagues that for me the theme of ethics isn't about what is legal or legal. It is often more about what "should" be done. In my field of counseling when we get into questions of ethics it often revolves around the legal stuff- the relationships we are not to have with clients, not taking advantage of power positions to take advantage of others.

Those are essential topics of ethics, of course, and I will certainly emphasize those in the courses I lead or teach on ethics. We must not avoid them. But neither can we avoid the more important issues of protection of the vulnerable or even going the extra mile, beyond the letter of the law, to do the next right thing.

As I was talking I ad libbed into the Penn State situation. I realized that under the legal issues and incredible sickness of the perpetrator, this is what makes it even more devastating.

Sadly this is where I fear Joe Paterno got lost 10 years ago. He admitted so in his retirement statement on Wednesday.

This is a tragedy. It is one of the great sorrows of my life. With the benefit of hindsight, I wish I had done more.

It is that "more" to have done where ethics can take over. An ethical standard short-circuited by following the letter of the law is unethical. Not illegal, but morally questionable. Paterno, as a man of integrity, knows that today. If he didn't learn it before Wednesday, he learned it when the Trustees of the university stood up with their own integrity. It was seen again last evening at the candlelight vigil and today by both teams on the field.

The leaders of the university who didn't even go as far as Paterno are even more morally questionable. The parallels between this situation and the scandals of the Catholic Church over the past decades are unmistakeable. It is in that leadership position that we have all been let down, blind-sided, taken advantage of by people who should have been better than that. They knew better, but were afraid to do what  might hurt them or their image or their institution. They believed on some level that their security, their position, their institution, was above the law. Or worse, that they were in the position to say what the law should or shouldn't do.

They and their institution and their "brand" and their security and safety was worth more than the safety and security of some young men, boys, unable to defend themselves and left even more defenseless by the actions of these self-important men.

What happened to these boys by Coach Sandusky was reprehensible, hateful, shameful and sinful.

What happened to these boys by the leadership of Penn State is just as reprehensible as they had the chance to do something and didn't.

I am aware as I write this of the anger in the depths of my soul for what has happened. I too- we all- have been abandoned by these non-leaders. We have been robbed of hope and dignity and trust in our public institutions. Again. Over and over it has happened- and will happen. I cannot help but think of two of my personal heroes from World War II who faced an evil greater than this.

First was Dietrich Bonhoeffer, outstanding theologian and courageous human being who participated in a plot to kill Hitler. He wanted to stop the insanity and destruction the Nazi regime was bringing on the world.  He lost his life in a Nazi concentration camp for it.

Second was Pastor Martin Niemoller, a Lutheran pastor who stood up to the Nazi aggression. He didn't lose his life, thankfully, but stood up for what was right.

In situations far more dangerous, personally dangerous, than Penn State football, these two men did what was right. Against great odds they did the next right thing.

Some non-leaders at Penn State felt they had more to lose by doing what was right- so they didn't. The results, when finally found out, had far more destruction to far more people than would have happened ten years ago. And the original victims continue to be victimized.

I am sure that the story, as it continues to unfold, will continue to contain revelations we don't like to hear. There will be attempts to spin the story. There will be stuff that makes us repel in disgust and anger. Somewhere, I hope, we will find some of the ethically courageous who finally thought the time was long past when something right was to be done. Even if we never know their names, we can be grateful that they decided to honor the victims and not the victimizers.

May we all learn that lesson. Again.

More Reflections on Penn State

It keeps going around in my head. It's like a friend has died, or perhaps worse than that- a friend has committed suicide or a combination suicide-homicide. The old friend is Penn State. And Joe Paterno has been Penn State since I was a freshman in college.

As I said the other day I grew up just about 50 miles from Penn State. I applied there for college and was accepted but chose a small college in the southeastern part of the state. But the Nittany Lion has strong history and gets into your blood.

Over the years since I lived in Pennsylvania the "brand" Penn State has grown and increased in stature and quality. Sitting in the "wilds" of central Pennsylvania, far from big cities, it was its own world, but one that produced great academics and great football. When one said that it always came back to Paterno, JoePa. He pushed academics and integrity and honesty. Perhaps, though, in the final analysis Penn State's central PA isolation and the legendary stature of Joe Pa was what finally led to his and the U's undoing.

In the end Penn State and its "brand" image and the power and money of Football proved greater than JoePa. He was run over by the effects of the juggernaut he helped attain that stature. Hide things, hush them up, circle the wagons, protect!

Paterno's statement yesterday which I posted here was one of the most painfully sad and desperately painful statements a public person like Paterno has ever written. The cynics may say that it was a way of saving face or of short-circuiting the inevitable or that he had a good speech writer. But that statement was Joe Paterno. It was the kind of statement a man of his integrity and spirit would want people to read and say "Yes! That's Joe Pa."

But it was also Joe the Powerful. He was a man who could refuse the suggestion of his bosses that it was time to retire. It was also Joe the Powerful who wanted to go out his own way and take the power and control from the hands of the Trustees. Perhaps for the first time in a very, very long time, they stood up and took their place and not bow to Paterno.

But the cautionary tale in all this is far deeper than the pain of watching Paterno in pain, losing his dream to a sick, VERY SICK man who was more interested in satisfying his own sick drives. It is far deeper than seeing a grand and prestigious university be undermined by authorities who felt it better to hide the truth than care about the safety of children.

The message is far more than football or universities or even the law. It is far more important than even a legendary individual like Paterno.

But that's for Saturday's post.

For today I mourn and try to wrap my head around a world spinning off its axis. Not for me, but for the victims and their families. Not for the disgraced coach or athletic director but for the hope, now shattered for so many. I mourn because there was this unthinking riot that followed Paterno's firing but no one, NO ONE, stood up in anger for the victims.

Oh how the mighty have fallen.

Let us lift the children harmed by the mighty.

When a child's spirit's broken
And feels all hope is gone
God help them find the strength to carry on

But with hope and faith
Yeah, we can understand
All God's children need is love
And us to hold their little hands

Hallelujah, hallelujah, let us all love one another
Hallelujah, hallelujah, make all our hearts blind to color
Hallelujah, hallelujah, God bless the child who suffers
--Shania Twain

Science Ethics

It has often been a subject of ethical debate: Should scientists work on projects which may end up being used in unethical ways. The most common of these, of course, surrounded the development of the atomic bomb during WW II. Some looked back on their involvement with regret. Others didn't. Should they or shouldn't they?

Well, in the news today was David Nichols, a synthetic chemist and chairman of the Purdue University pharmacology department. He wrote in the journal Nature how he is bothered by the fact that there are those who use his published research in ways that could harm people. His article begins:

This is the start of the international year of chemistry, intended to celebrate the contribution of my field to mankind's well-being. Yet, during the previous year it has become disturbingly clear to me that some of my scientific contributions may not be aiding people's well-being at all. In fact, they could be causing real harm.

A few weeks ago, a colleague sent me a link to an article in the Wall Street Journal. It described a "laboratory-adept European entrepreneur" and his chief chemist, who were mining the scientific literature to find ideas for new designer drugs — dubbed legal highs. I was particularly disturbed to see my name in the article, and that I had "been especially valuable" to their cause. I subsequently received e-mails saying I should stop my research, and that I was an embarrassment to my university.

His study of MMDA (street name: Ecstasy) was being followed by these "entrepreneurs" to make better designer drugs. Nichols purpose was to help in psychotherapy and other possible uses in neurochemistry. He writes:

I was stunned by this revelation, and it left me with a hollow and depressed feeling for some time. By 2002, six deaths had been associated with the use of MTA. It did not help that I knew some of these fatalities were associated with the use of multiple drugs, or had involved very large doses of MTA. I had published information that ultimately led to human death.

None of the chemicals, he says, in and of themselves are fatal, but in a toxic mix, as is often the case in club situations, they can be lethal. This has caused Nichols some personal pain. He ends with:

[I]t really disturbs me that 'laboratory-adept European entrepreneurs' and their ilk appear to have so little regard for human safety and human life that the scant information we publish is used by them to push ahead and market a product designed for human consumption. Although the testing procedure for 'safety' that these people use apparently determines only whether the substance will immediately kill them, there are many different types of toxicity, not all of which are readily detectable. For example, what if a substance that seems innocuous is marketed and becomes wildly popular on the dance scene, but then millions of users develop an unusual type of kidney damage that proves irreversible and difficult to treat, or even life-threatening or fatal? That would be a disaster of immense proportions. This question, which was never part of my research focus, now haunts me.

Sadly, given the opportunity to make a buck (or millions of bucks) some people lose any ethical understanding. They lose perspective of what they are doing. No, not Nichols. He is speaking out and is now bringing into the public eye once again the questions surrounding scientific ethics. My guess is that some will criticize him for having spoken out while others will criticize him for his work. He will not be praised as much as he will be criticized.

Which is sad. This is an issue that needs to be widely discussed. Not just about designer drugs, but about those prescription drugs that get pulled off the market years after they were introduced because "all-of-a-sudden" people discover they are causing problems- like heart attacks or birth defects. Sometimes the drug companies and the scientists knew of these risks; sometimes they didn't.

Modern chemistry has brought us miracles. But it has also brought us disasters- just like most human endeavors, including organized religions. These discussions on ethics are an essential part of research- and the public sphere.

From F1 to Football to Good News

First, Formula 1 Racing:

SPA-FRANCORCHAMPS, Belgium, Sept. 13 — McLaren Mercedes, the leading auto-racing team in the Formula One world championship, was fined $100 million today and excluded from the constructors championship this season, after the International Automobile Federation found the team guilty of cheating by using data obtained from Ferrari, its main rival, to improve its own car.
--NYT

Then on to football:

Belichick Won't Discuss Alleged Spying
FOXBOROUGH, Mass. (AP) -- .... New England beat the New York Jets in last Sunday's season opener in which an on-field video camera allegedly focusing on Jets coaches was confiscated from a Patriots employee.

The New England coach was fined the NFL maximum of $500,000 Thursday and the Patriots were ordered to pay $250,000 for stealing an opponent's defensive signals.

Commissioner Roger Goodell also ordered the team to give up next year's first-round draft choice if it reaches the playoffs and second- and third-round picks if it doesn't.
--Associated Press

When winning becomes the only thing- any way to win becomes fair game. What a commentary! There's lots and lots of money in winning, too, which just adds to the pressures- both internal and external. Somehow we lose perspective. These are only games.

But at least someone is working on the important things in life- the things that really get you upset and ready to even say bad words. So with all the news of spying on games, here's some good news of a truly important move forward.

Stepping in gum on the sidewalk won't be such a sticky situation anymore—scientists have invented nonstick gum.

Clean Gum, as it is called, supposedly can be easily removed from shoes and pavement (as well as from hair, skin, and clothes). So walk down the street without fear of ruining your favorite shoes.
--LiveScience

Here's One To Think About
Scott Adams of Dilbert fame has a uniquely interesting blog, The Dilbert Blog. Last week he posted an interesting "ethical" dilemma that brought a lot of comments. I found it interesting so I thought I would steal post it here for your enjoyment and thought.

The Butler’s Dilemma

Let’s say you’re the butler to a billionaire who lives alone. The billionaire dies in his sleep. You know he owns a large piece of jewelry that no one else has seen, and you have access to it.

If you steal the piece of jewelry, sell it, and give the money to an African charity, you can feed an entire village for a year. The village would otherwise starve. If you don’t steal the jewelry, it will go to his surviving family who has so much money they won’t care about it.

Obviously it is illegal to steal the jewelry and feed the starving village in Africa. But do you have a moral obligation to commit the crime for the greater good?

And if so, do you likewise have a moral obligation to steal anything else you can get your hands, from dead billionaires or living neighbors, if you can use the stolen property for the greater good?
--Link

I am a big student of ethics. The twists and turns and insights that ethics can bring to light are truly challenging. While this one may sound fairly straight-forward, think awhile on the nuances and variations that you can spin this with. It can make your head spin as well.