Legalizing Medical Marijuana

TUESDAYS WITH ROSEMARY AND MYRA
Virtually everyone is familiar with Mitch Albom’s book, Tuesdays With Morrie. Myra Christopher (Foley Chair at the Center and former Center CEO) and Rosemary Flanigan (Retired Center Program Staff) have decided to regularly contribute to the Center for Practical Bioethics’ blog and call it “Tuesdays with Rosemary and Myra” (even though it won’t necessarily be published on a Tuesday). Read more about Rosemary and Myra at the bottom of this post. 

Note:  Today, Myra and Rosemary are discussing an article about the legalization of marijuana that appeared in National Geographic.


M:  Rosemary, I’m sorry, but I did not get my homework done. So, you are going to have to tell me about the National Geographic article that we agreed to read. Good ethics start with good facts; so, give me the facts, Mam.

R: Okay, basically the article says that marijuana has been found to be helpful in cases of childhood epilepsy and other seizure disorders, and its use in relieving or ameliorating these tremors or whatever the child goes through has led many people to project its use for other medical purposes.  

As you know, across the nation, states are legalizing marijuana for medicinal purposes. However, I believe that the argument for it has got to include further research about its use and side effects. My argument is that we need the research for the justification of its use for purposes other than those for which we have evidence that it works. 

M:  That’s a good argument, but we actually have very little evidence for most of what is done in medicine, and let’s talk about the fact that some states are also legalizing the use of marijuana for “recreational purposes”; so, what’s the distinction? It’s okay to smoke it for fun but not if it helps your back pain? Many people with other illnesses such a migraine claim to benefit from its use.  

Rosemary, a dear friend of yours and mine who died of cancer a few years ago called me shortly before her death and said that her doctor had encouraged her to use marijuana to stimulate her appetite. She asked me if I thought that was ethically OK. I said for, “God’s sake, you are dying of cancer. If it helps you to eat a bite or two, what harm will be done?” And she said, “But it’s illegal!” I think that sometimes we confuse what is legal with what is ethical.

R: So, her doctor wanted her to eat it.

M:  I don’t know if he wanted her to eat it or smoke it. Probably smoke it because I know that when people smoke marijuana they get “the munchies”, and I don’t know what difference it would make if someone smoked it or ate it. Do you think there is a difference?

R:  No, no! I was just asking out of curiosity.

M:  I assume that, like other drugs, marijuana affects different people in different ways. Rosemary, I am assuming that you have NOT smoked or eaten marijuana, but I have. When I was in my late 30s or early 40s, I smoked a marijuana cigarette. 

I had not been part of the “drug culture” in my youth, and I wanted to know what it would be like. Actually, my experience was awful. I felt completely out of control, and anyone who knows me knows how important control is to me. I did not get hungry – just paranoid.

R:   So like Bill Clinton, you didn’t inhale.

M:  Oh no, I inhaled! I can’t imagine why people want to do it, but clearly many, many people like it, and many, many people think it helps them with health problems.
 
I struggle with why we are so twisted up about the use and abuse of marijuana, when our society literally runs on alcohol. I want you to tell me what the difference is in smoking marijuana and having a Manhattan.

R: Society has made alcohol acceptable. It is interesting how often a societal response to something can move the consideration of something from “right” to “wrong.”

M.  Society may think alcohol consumption is morally acceptable, but there are more than 80,000 alcohol related deaths in the United States each year. I don’t want to sound like Carrie Nation, but given what you just said, is the issue about the legalization of marijuana really a moral issue rather than an ethical issue? And if so, why and what is the distinction?

R.   Let me try an analogy. I have always justified the states’ use of capital punishment, but from a global view, capital punishment has come to seen as immoral and, therefore, ethically unjustifiable. Couldn’t the same be said of the use of marijuana, which has been seen as illegal because it is immoral, but with its legalization, has come a shift in the perception of its moral evaluation?

M.  That could be true, but I’m not sure I accept that argument. In bioethics we often use the terms moral and ethical as though they are synonyms, but I want to be able to make a distinction between them because it is important to me that what is “ethical” is not determined by a public opinion poll. Nor do I want something to ethical because it is legal or illegal (slavery was legal). I want that determination made through an analysis of facts, values, motivations, consequences, etc.

R.  True, true, true!  But there are practices in our society that we allow when we do not know whether the effect of something will benefit or harm human nature -- such as the use of marijuana.  hat’s why I’m arguing for further research within a society where it has been made legal. 

M.  So, are you saying that its use is ethical “for now” -- until proven to be harmful?

R. Yes, until we have more evidence.

M.  I sort of hate to agree with you because this has been fun, but I do agree. The value we place on autonomy and personal freedom has to trump (I’ve come not to like using that word in the last few week but…) ambiguity about whether something is right or wrong. I wonder what our readers think. 

About Rosemary and Myra

For several years before her retirement, Rosemary facilitated an online discussion group, primarily for ethics committee members, which had a faithful following. We hope some who participated and others will read our blog posts and respond with their thoughts on whatever subject we are writing about. We would also be grateful if you would provide suggestions for future blog topics. With your help, the two of us are moving into the 21st century, but for Pete’s sake, don’t expect us to tweet!


We have decided to write a regular blog for several reasons. First, there has never been a greater need for ethical reflection than there is today. We both agree about that, but we are very different people, and often disagree on issues. We hope it will be helpful for us to model respectful disagreement. In addition, we just finished writing a history of the Center which took us three years, and we enjoyed doing that so much that we need an excuse to continue writing together on a weekly basis. So, we don’t mind bothering you with our ideas.


I call myself a “philosophical Christian agnostic” and Rosemary is a member of the Sisters of St. Joseph of Carondolet. Rosemary taught high school English and philosophy at Rockhurst University. She is a stickler for the “King’s English” and proper grammar. I grew up in Texas and just like to talk. We are both old; I turned 68 in July; Rosemary is older. We both have had training and education in ethics, but Rosemary has a PhD. We have both worked in bioethics for many years, and we both LOVE to argue. As Rosemary says, “Doing ethics is all about argument.” But ethics is not about mean-spirited disrespectful exchanges that are so prevalent today in a “red-state/blue-state culture.” Through blogging, we hope that our agreements and disagreements will demonstrate that we can argue respectfully and still love and care about one another.

The Sale of Fetal Tissue

TUESDAYS WITH ROSEMARY AND MYRA

Virtually everyone is familiar with Mitch Albom’s book, Tuesdays With Morrie. Myra Christopher (Foley Chair at the Center and former Center CEO) and Rosemary Flanigan (Retired Center Program Staff) have decided to regularly contribute to the Center for Practical Bioethics’ blog and call it “Tuesdays with Rosemary and Myra” (even though it won’t necessarily be published on a Tuesday). Read more about Rosemary and Myra at the bottom of this post.

The Sale of Fetal Tissue

M:  Rosemary, you know all the hub-bub about the video of the executive from Planned Parenthood being caught on tape talking about the sale of fetal tissue to two people posing as employees of a company looking to procure fetal tissue for research purposes. It’s been all over the Internet…

R:  I do know about it. It’s gone viral!

M:  It certainly has, and it has provided fodder for those hoping to be nominated by one of the parties for the 2016 presidential election. The video has been proven to be an example of “hit and run” journalism, but that doesn’t negate the ethical question that underpins it, i.e., “Is it acceptable to sell fetal tissue?” And that’s what I want to talk about.

R:  And I want to ask is there any difference in fetal tissue and other human tissue, all of which gets “sold.”

M:  THAT’S THE QUESTION!

R:  Of course, there is something special about fetal tissue, but does that mean that it can’t be used for research. It’s not the same kind of tissue that comes off your elbow…

M:  Why not? What makes it different?

R:  It is because of the potentiality involved in what it can or could become, but let’s don’t have an argument about that right now. Even though it will certainly come up in our argument later, I’m still going to say that fetal tissue can be used for research purposes.

M:  Okay, but your first claim reminds me of one that Don Marquis, a philosopher at Kansas University, made in an argument against abortion years ago in an article he wrote for the Center. He said the difference between tissue from your elbow and a fetus is that the elbow has a past, i.e., we know something about the arm it hinged, but has no future, whereas a fetus has a future but no past that could reveal anything about its history or values. Is that your argument?

R:  No! It’s not just about tissue’s history; I am trying to skirt intrinsic worth. So, don’t you push me into talking about that, Myra Christopher. I hate objective whatevers!

M:  Whatevers? Sorry, Rosemary, but I want to push you just a little. Most all of us will say that human life is sacred/special, and what I want to talk about may align with your “potentiality” comment, but it may not; I don’t know. But I want to talk to you about the difference between human tissue and a human “being.”

R: I would find it morally reprehensible to use fetal tissue for insignificant research purposes.

M: You‘re still avoiding my issue, but OK….  Insignificant research like what?

R:  I’m trying to get circumstances involved here so that they cast a moral evaluation on their use in one instance and their not being used in another. For example, I would not object to fetal stem cells being used to find cures for cystic fibrosis or sickle cell disease, but I would find it morally reprehensible to use fetal tissue to find a better face cream and make old women look younger.

M:  I agree. I think it is repulsive. It reminds me of the former chair of the President’s Bioethics Commission Leon Kass’s determination based on what he called the “yuck factor”, i.e., if it is just plain old gross, it may be just plain old wrong.

R:  I’ve thought this for a long time, and there is something to be said that should lead us to reflect on why we feel the “yuck”, and maybe in some instances it should cause something to be tagged “unethical”, but in other instances it may simply be a societal “no-no”.

M: I think the point you are getting to is important – not just in this discussion, but in many arguments claimed to be “ethical arguments”. There are important distinctions that should be made between ethics, social norms, etiquette, and the aesthetic.

Last night, I was thinking about us possibly blogging about this topic today, and I remembered being at a women’s rights rally once and a person claiming to be absolutely opposed to abortion was walking around trying to force people to look at an aborted fetus she had in a box. It struck me as the epitomy of irony that a person crusading for the sanctity of life would objectify a fetus for political purposes. 

R:  Poor soul! She was very confused. 

M:  Rosemary, when I was thinking about this last night, I thought about the many, many times I have heard you ask (when teaching ethics committee members), “Is it wrong to torture little children?”

R:  “Needlessly, needlessly torturing little children!” Is what I asked? The point behind that was that, most often, general rules need to have adverbs to make them valid and true.

M:  I agree and add that speaking in “absolute” terms almost always forces you into a corner. But I want to go back to the distinction I need to make between human “tissue” and human “beings” Because it is critical to my position.

For me, “being” implies “personhood” and by that I mean an independent individual whether 1 day old or 100 years old. I would argue that it applies only to fetuses that are sustainable independent of the mother.

R:  You’re not placing the same meaning on potentiality that I am. So, you and I will have a different argument because we differ in the meaning of the potentiality involved in the fetus. That is so simple to me. You want to say that the point of differentiation is when it (the fetus) can live on its own. I say that is not the point; we have to respect it until it gets there; so I am going to call for more heavy arguments for the use of fetal tissue than you would before it is sustainable.

What I'm saying is that justification for use of fetal tissue ought to be weightier the closer the fetus comes to live birth before being aborted. I'm trying to show that potentiality develops and thus the arguments must take that development into account.

M:  I think that’s true. However, I think at a certain point in the development of the fetus our lines cross, and we find ourselves at the same place. However, I want to say that I agree wholeheartedly that fetal tissue, no matter the gestational age of the fetus from which it comes, should always be treated with respect. 

I am reminded of a situation years ago, probably 20 years ago, when a faith-based hospital reached out to the Center for help in deciding what to do with fetal tissue that was not suitable for research. Fertility specialists in their institution were burning such tissue in trash cans in their clinic. That is one extreme. Another was a time when the Center was contacted by a hospital because a group was demanding that the hospital “bury” fetuses with a proper ceremony – no matter its gestational stage.

R:  Why do you call burning tissue in a trash can an extreme?

M:  Good question, because I wouldn’t find it objectionable to burn it in the hospital’s incinerator.  I think the “aesthetics” of the situation were objectionable to me. The whole idea that it was “trash” bothered me and others in the hospital. 

R:  I see it’s not the “burning”; it’s the “trash” that bothers you. So much of these arguments depend on the way we use language and define specific terms.

M: Back to the Planned Parenthood fiasco; I think we agree and disagree about components of this situation. Although we get there along different paths, we agree that when used for significant research that could potentially help people living with disease and injury AND when conducted in done in a way that is respectful of the “donation”, the use of fetal tissue in research can be justified.

However, there are other important factors as well, including “tone”, context, and intent when in discussion about ethically sensitive issues.

About Rosemary and Myra

For several years before her retirement, Rosemary facilitated an online discussion group, primarily for ethics committee members, which had a faithful following. We hope some who participated and others will read our blog posts and respond with their thoughts on whatever subject we are writing about. We would also be grateful if you would provide suggestions for future blog topics. With your help, the two of us are moving into the 21st century, but for Pete’s sake, don’t expect us to tweet!

We have decided to write a regular blog for several reasons. First, there has never been a greater need for ethical reflection than there is today. We both agree about that, but we are very different people, and often disagree on issues. We hope it will be helpful for us to model respectful disagreement. In addition, we just finished writing a history of the Center which took us three years, and we enjoyed doing that so much that we need an excuse to continue writing together on a weekly basis. So, we don’t mind bothering you with our ideas.


I call myself a “philosophical Christian agnostic” and Rosemary is a member of the Sisters of St. Joseph of Carondolet. Rosemary taught high school English and philosophy at Rockhurst University. She is a stickler for the “King’s English” and proper grammar. I grew up in Texas and just like to talk. We are both old; I turned 68 in July; Rosemary is older. We both have had training and education in ethics, but Rosemary has a PhD. We have both worked in bioethics for many years, and we both LOVE to argue. As Rosemary says, “Doing ethics is all about argument.” But ethics is not about mean-spirited disrespectful exchanges that are so prevalent today in a “red-state/blue-state culture.” Through blogging, we hope that our agreements and disagreements will demonstrate that we can argue respectfully and still love and care about one another.

Tuesdays With Rosemary and Myra

Virtually everyone is familiar with Mitch Albom’s book, Tuesdays With Morrie. Myra Christopher and Rosemary Flanigan have decided to regularly contribute to the Center for Practical Bioethics’ blog and call it “Tuesdays with Rosemary and Myra” (even though it won’t necessarily be published on a Tuesday). The words will come from Myra’s pen (actually her computer), but the writing will happen together.

Why We Are Blogging

For several years before her retirement, Rosemary facilitated an online discussion group, primarily for ethics committee members, which had a faithful following. We hope some who participated and others will read our blog posts and respond with their thoughts on whatever subject we are writing about. We would also be grateful if you would provide suggestions for future blog topics. With your help, the two of us are moving into the 21st century, but for Pete’s sake, don’t expect us to tweet!

We have decided to write a regular blog for several reasons. First, there has never been a greater need for ethical reflection than there is today. We both agree about that, but we are very different people, and often disagree on issues. We hope it will be helpful for us to model respectful disagreement. In addition, we just finished writing a history of the Center which took us three years, and we enjoyed doing that so much that we need an excuse to continue writing together on a weekly basis. So, we don’t mind bothering you with our ideas.

I call myself a “philosophical Christian agnostic” and Rosemary is a member of the Sisters of St. Joseph of Carondolet. Rosemary taught high school English and philosophy at Rockhurst University. She is a stickler for the “King’s English” and proper grammar. I grew up in Texas and just like to talk. We are both old; I turned 68 in July; Rosemary is older. We both have had training and education in ethics, but Rosemary has a PhD. We have both worked in bioethics for many years, and we both LOVE to argue. As Rosemary says, “Doing ethics is all about argument.” But ethics is not about mean-spirited disrespectful exchanges that are so prevalent today in a “red-state/blue-state culture.” Through blogging, we hope that our agreements and disagreements will demonstrate that we can argue respectfully and still love and care about one another.

Blowing Smoke vs. Shocking with Electricity

Rosemary and I decided to focus our inaugural blog post on efforts to resuscitate the newly dead because on August 12, the Center will host David Casarett, MD, author of Shocked: Adventures in Reviving the Recently Dead, to deliver the 21st Rosemary Flanigan Lecture which will, as always, be held at the St. Joseph Medical Center. David is a physician/bioethicist at the University of Pennsylvania, and he will talk about his book, which is a history of resuscitation methods, including some that are REALLY weird, such as blowing cigar smoke into the rectum of someone who has died. GEEZ!! Can you imagine? However, we all know that tobacco, i.e., nicotine is a cardiac stimulant. (I still remember the first time I smoked and recall that it was great and took me ten years to stop in part because I loved the rush it gave me.) So, the theory was that “blowing smoke” could possibly revive a dead person, and as distasteful as it might seem, it was worth trying. (Or maybe they were just sickos….)

Is this really any stranger than resuscitating ALL those who die in our hospitals UNLESS the poor soul’s doctor has written a DNR (Do No Resuscitate) order? Is it stranger than policy based on our society’s belief that “anything is better than dying”, including the things we do to those who die in our hospitals today? Stranger than when someone calls a “Code Blue” over the hospital’s PA, people run down the hall with a crash cart? Then someone pounds on the deceased’s chest, inject stimulants directly into his or her heart, and/or shocks them with electricity? The two of us think that, in many instances, the current practice seems just as odd as blowing smoke up a dead person’s rear. We wonder if healthcare professionals have thought about adding a cigar to crash carts ...

August 12 Flanigan Lecture

Please join us on August 12 to hear Dr. Casarett talk about his research and all the weird things he discovered while writing Shocked (you won’t even believe it), and to also discuss this important healthcare policy issue with him. If you are not able to be in KC for the lecture, it will be videotaped and posted on the Center’s website shortly thereafter. Regardless whether you are there or not, we encourage you to tell us what you think about the universal application of CPR for those who die in hospitals by commenting on this blog post.


For more information about the Flanigan Lecture or other Center events, go to the Center’s website at www.practicalbioethics.org.


Myra Christopher is the Kathleen M. Foley Chair for Pain and Palliative Care at the Center for Practical Bioethics. Rosemary Flanigan, PhD, joined the Center’s board in 1986, was its chairwoman in 1991 and, for 17 years following her 1992 retirement from Rockhurst University, served on the Center’s staff.