Directions Needed
There was a time when faced with ethical or moral dilemma in the course of dealing with his patients that a physician did not have much difficulty which fork of the road he or she had to take. And it was usually a road well traveled by many, given the same set of circumstances, the decision readily made with the conviction that it was the right thing to do. A patient on the throes of dying with no hope of meaningful recovery or life was generally spared the agony of what was seen then and even now as the indignity on intrusion to prolong what is inevitable. DNR was an unknown acronym; advance directive was an unheard of genre in the lexicon of medical language as we know today. A couple unable to have children inevitably resigns either to remaining childless or pursue adoption. Diseases that did not respond to ministrations despite the best efforts and current knowledge were allowed to follow their natural progression.
Over the past two decades of accelerated and continuing evolution of technology and the wonders it brings, and the breathtaking pace of practical and in-vivo applications developed out of scientific research, comes a bioethical minefield what we as physicians have to gingerly negotiate. Add to this the changing societal attitudes and moral values and the economic pressures imposed by the government and others over the allocation of health care resources, the decision process becomes even more complex. Shall we withhold or withdraw any further intervention on someone who is terminally ill so that the scarce resources can be used by someone who has a better prospect of survival? Is it considered an act of charity for a woman to have her uterus be an “incubator” for another couple’s fertilized egg? Does the physician have the obligation to reveal that a patient who has a genetic marker that predisposes him or her to a disease, to an entity who has a legitimate reason to know? And will the anticipated fallout from stem cell research such as cure for Parkinson’s disease, spinal cord paralysis, or diabetes- to name a few- be enough moral justification to create an embryo farm from which we can procure stem cells?
The questions are endless; the answers difficult. There are really no shades of gray between what is right and what is wrong. That is why Bioethics has become an important topic at the SPSA’s annual seminars in surgery.
It is often said that if you do not know where you are going, every road will take you there. Hopefully, after we seriously is immerse ourselves in the study of these complex issues, we will have some guideposts that can help us find the right road to take us there where we need to be.
Edward E. Quiros, M.D., FACS