CAMDEN, Maine — Should women undergo preventive double-mastectomies if they carry the gene known to increase their risk of breast cancer? Should a young soccer player with a chronic circulatory condition be allowed to opt for an early leg amputation so she can start training with a prosthetic?
“Medical care is becoming more complex in a lot of ways,” said philosophy professor and bioethicist Jessica Miller of Bangor. “For one thing, patients are taking a more active role in directing their care, which is wonderful.” But sometimes, she said, the personal goals of patients or their families may run counter to the clinical expectations of medical staff, or to the doctrines of certain religions, or to the legal obligations of a hospital.
Miller, an associate professor of philosophy at the University of Maine and a clinical ethicist at Eastern Maine Medical Center in Bangor, is one of three philosophers scheduled to speak this weekend at “Thinking about the Good,” a daylong public forum held by the Camden Philosophical Society.
When ethical conflicts arise in a medical setting, the bioethics team at EMMC can help identify and resolve them, she said. For example, Miller said, clinicians may dispute a dying patient’s determination to be resuscitated, until they understand that the patient hopes to live long enough to hold a new infant grandchild. In other cases, she said, a patient’s family may need to hear that their religion, or the law, allows them to reject treatments that do nothing but prolong the dying process.
Especially with children and young adults, she said, the decision to accept inevitable death can be agonizing and can ignite long-standing family discord. So can accepting a competent patient’s desire to be discharged from care to return to an emotionally or physically unhealthy environment.
In all these cases, the voice of philosophy can help bridge differences, she said, and move a stalemated debate over what people should or shouldn’t do to a more productive conversation about “what is the life you can live now that best fulfills your concept of the good?”
New clinical technologies and growing pressure to control health care spending may raise new conflicts, but Miller says there’s nothing new about the interdisciplinary field of bioethics.
“It’s all good people wanting to do what’s right, but with different perspectives on what that means,” she said. The study of ethics, Miller said on Monday, helps shape individual and societal understanding of what is right and wrong in interpersonal conduct and what constitutes “a good life” for human beings. Bioethics helps bring that understanding to the world of health, health care and medical research.
The recognition of conflicts inherent in medical thinking has existed at least as far back as the fifth century when Greek physicians adopted the Hippocratic Oath. More recently, Miller said, hot-button issues such as end-of-life care, the rationing of health services, and the protection of human research subjects have fueled con-temporary interest in bioethics.
Miller said the inability in 1962 of a Seattle children’s hospital to provide lifesaving dialysis treatment to all who needed it prompted the creation of the nation’s first hospital-based bioethics committee. The 1932-1972 Tuskegee syphilis study that withheld treatment from about 400 black sharecroppers, even after penicillin was discovered to be effective in curing the infection, raised public outrage about the lack of ethical oversight in human research projects. And the abortion debate assumed a high profile in the 1960s after the drug thalidomide, prescribed to prevent nausea during pregnancy, was determined to cause devastating birth defects.
More recently, issues such as medical marijuana and end-of-life care continue to challenge bioethicists, she said.
For Miller, disconnects between physicians, nurses, patients and their families, legal and religious experts, and others provides a concrete opportunity to exercise her expertise in a field that can seem distressingly abstract. And unlike the ethical guidelines developed for specific professions like medicine or nursing, and unlike re-ligious doctrine or legal technicalities, “bioethics is a public ethics,” she said. “It’s really for all of us.”
Public concerns about ethical issues often find their way into popular media such as fiction and film, said Miller, who admitted to sharing the popular interest in vampire culture, including the Twilight saga books and films. The stories, in which characters are “born” into immortality yet lose their humanity through the bite of a vampire, reflect the blurred thresholds of life and death created, in part, by advances in clinical medicine, she said. On that note, Miller is slated to deliver a paper this fall at the annual meeting of the American Society for Bioethics and Humanity.
Her timely topic: Bioethics and the Undead.
The fourth annual conference of the Camden Philosophical Society will take place from 9 a.m. to 4 p.m. Saturday, July 24, at St. Thomas Episcopal Church on Chestnut Street in Camden. Other presenters at the event will be professor Ted Cohen of the University of Chicago, who will discuss the risky business of joke-telling as a means of challenging social restrictions, and professor Michael Anker of the College of New Rochelle, who will speak on using the fluid constructs of poetics as a model for developing an ethical way of being in the world.
A donation of $15 is requested and lunch is available. Preregistration is requested by e-mail: email@example.com