Dutch Pediatricians Part Two

Rosemary Flanigan
Distinguished Fellow
Center for Practical Bioethics

Isn’t much of the moral distress suffered by professionals in healthcare today (besides not having enough time to do what you know you ought to do) the conflict of over the “right” thing to do—with patients, families, and fellow professionals.

But consider, as Hilde Lindemann tries to tell us, how we use language. Unless we can get to the level of another’s meaning, we are not helping them, no matter how many words we use.

“Let us remove the feeding tube from Granny” can be heard in so many different ways, and yet we often start our sentences there instead of asking questions of Granny and the family that may lead up to our prescription.

But if I read John Lantos correctly, what the Dutch pediatricians do—and the language they use in doing it—indicates something deeper than language, some reality that deters us from acting in the same way, no matter how we speak of it.

The “something out there” (killing infants if they fall within the Protocol’s limits) is understood or “meant” differently to Dutch and American pediatricians. The Dutchman justifies it; the American can’t. And no amount of “discussion” will lead to consensus.

But that attempt ought to be made, I think, before we agree to disagree—and hand the patient over to another provider.

Links:

Dutch pediatricians and letting babies die, Practical Bioethics, October 2

Autonomy, Beneficence, and Gezelligheid: Lessons in Moral Theory from the Dutch, Hilde Lindemann, The Hastings Center Report

Dutch Pediatricians and Letting Babies Die

Rosemary Flanigan

Distinguished Fellow

Center for Practical Bioethics

October 2, 2009

I have just read through the new Hastings Center Report and I am troubled over Hilde Lindemann's article, Autonomy, Beneficence, and Gezelligheid: Lessons in Moral Theory from the Dutch.

For years now, I've always started off "ethics" workshops by distinguishing between morality and ethics. I see morality as the "stuff" with which ethics deals. Without moral conclusions, I would have nothing with which to "do" my ethical analysis. And the sources of that morality are many-parents, neighborhoods, school, church/temple/meeting hall, etc.

The article deals with Dutch pediatricians who end the lives of babies who 1) have no chance of survival for more than a few days, even on life support; 2) those on life support who might survive after intensive treatment but would always suffer horribly; and 3) those who do not need life support and "whose suffering is severe, sustained, and cannot be alleviated."

Dutch pediatricians make no distinction between direct killing and letting babies die; they need no such distinction. I am still trying to get inside their sense of morality before I can make an intelligent comment.

HELP!!

Teaching Bioethics from Virtue to Kant

Rosemary Flanigan

May 26, 2009

Even though this week will be short, it will be a good one.

How can I tell? Because Terry Rosell is starting a new session with 2nd year medical students who are beginning their bioethics M.A. And he has asked John Lantos, John Carney and me to help him out this week.

John L is addressing “Bioethics and Babies” with the class even as I type; tomorrow John C will address “Aging in Community,” and on Thursday I get to do “Doing Ethics and Avoiding Common Fallacies,” (mixing a little logic in with their Beauchamp and Childress readings on Moral Theories and Method and Moral Justification).

At times like this, I wish I could remember everything I had learned in class—and hope that the students do! But, of course, I don’t and they won’t. But to get them at the beginning, to make them aware of how they think about issues—and how others may think differently—is to share a treasured moment with them.

And we shall close with an analysis of the Baby K case (an anencephalic baby whose mother insisted on ventilator support until the baby died). I want them to see that a utilitarian perspective isn’t the only one possible, and that a Kantian perspective can find us caught up in conflicting obligations—but how does one encourage the development of a virtue ethic without sermonizing!!

No ethical theory guarantees us that we shall be “right,” but arguing civilly with one another might just lead to the development of virtue.

And then a dose of fallacies! I hope all three of us leave some lasting impressions.