Allowing patients to find meaning where they can

Journal of Clinical Ethics

Volumn 13, Issue 3, 2002, Pages 179-187

  Howe, Edmund G ^a  

^a UNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADAPTIVE BEHAVIOR; ARTIFICIAL INSEMINATION; BIOETHICS; BIOETHICS AND PROFESSIONAL ETHICS; CULTURAL ANTHROPOLOGY; DECISION MAKING; ETHICS; FATHER; FEMALE; FEMALE INFERTILITY; GENETICS AND REPRODUCTION; HUMAN; LITERATURE; MALE; MEDICAL ETHICS; METHODOLOGY; MOTHER; NOTE; OOCYTE DONATION; PROFESSIONAL STANDARD; PSYCHOLOGICAL ASPECT; QUALITY OF LIFE; RUSSIAN FEDERATION; UNITED STATES;

BIOETHICS AND PROFESSIONAL ETHICS; GENETICS AND REPRODUCTION;

ADAPTATION, PSYCHOLOGICAL; ANECDOTES; BIOETHICAL ISSUES; CULTURAL DIVERSITY; DECISION MAKING; ETHICS COMMITTEES, CLINICAL; ETHICS, CLINICAL; FATHERS; FEMALE; HUMANS; INFERTILITY, FEMALE; INSEMINATION, ARTIFICIAL, HETEROLOGOUS; MALE; MOTHERS; OOCYTE DONATION; QUALITY OF LIFE; RUSSIA; UNITED STATES;

EID: 0036770127     PISSN: 10467890     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (42)

1. I suggest that as dreams have been touted as "the royal road to the unconscious," so untoward feelings may be the best clue that an ethical issue is present, but as-yet unearthed.
2. "National identity and patriotism" are "far more important" to Russian spouses [here] than Americans.... Russia remain[s] "the center of the universe." L. Visson Wedded Strangers (New York: Hippocrene Books, 1998), 201.
3. "Russian women ... remain highly dependent on their families of origin...." Ibid., 159.
4. A decision is not necessarily unethical because it is arbitrary. Drawing an arbitrary "line" may be necessary to allow a change from one set of highest-value priorities to another. An example is abortion. Risks to the mother and child can change due to medical advances. Regardless, allowing abortion prior to six months, but precluding it after, even if six months is an arbitrary point in women's pregnancies, accomplishes this end: It changes the highest-value priority from women's bodily privacy to the sanctity of fetuses' lives.
5. "Once the common norm is established," individuals even perceive differently. M. Sherif, The Psychology of Social Norms (New York: Harper and Row, 1963), 111.
6. Mill's major theme in On Liberty is that society should not overly impose its common values on individuals. G. Himmelfarb, "Introduction," in J.S. Mill, On Liberty (Harmondsworth: Penguin Books, 1974), at 27. Mill says, "[In addition to protection from the tyranny of the magistrate, there must be] protection against the tyranny of prevailing opinion and feelings," p. 191.
7. Mill's major theme in On Liberty is that society should not overly impose its common values on individuals. G. Himmelfarb, "Introduction," in J.S. Mill, On Liberty (Harmondsworth: Penguin Books, 1974), at 27. Mill says, "[In addition to protection from the tyranny of the magistrate, there must be] protection against the tyranny of prevailing opinion and feelings," p. 191.
8. For similar efforts to establish such criteria, see M. Lewis, "Kidney Donation by a 7-Year-Old Identical Twin Child," Journal of the American Academy of Child and Adolescent Psychiatry 13 (1974): 221-45, p. 236,
9. and N. Post, "Children as Renal Donors, New England Journal of Medicine 296 (1977): 363-367, p. 366.
10. The Epic of Gilgamesh, trans. N.K. Sandars (Harmondsworth, U.K.: Penguin, 1960), 117-9.
11. This cliché I've found true: I have yet to hear a patient say "I wish I'd spent less time with my family."
12. The desire for genetically related children is universal, as current concerns about exposing non-paternity suggest. "[Biological parents have children] for a wide variety of personal reasons, such as continuing the family line.... a criterion for an acceptable practice of reproduction which casts suspicion on reproduction in the normal biological family is probably too demanding." B.M. Baker, "A Case for Permitting Altruistic Surrogacy," Hypatia 11, no. 2 (Spring 1996): 1-19.
13. T.H. Murray, "What Are Families For?" Hastings Center Report 32, no. 3 (May-June 2002): 41-5, p. 42.
14. Ibid., 44.
15. H.T. Kimmel, "The Case Against Surrogate Parenting," Hastings Center Report 13, no. 5 (1983): 35-9.
16. Murray, see note 11 above, p. 45. For a discussion defending a similar decision that arose a decade ago, see N.S. Jecker, "Conceiving a Child to Save a Child: Reproductive and Filial Ethics," JCE 1, no. 2 (Spring 1990): 99-103.
17. Poem of the Cid, trans. P. Blackburn, ed. G.E. Conomou (Norman, Okla.: University of Oklahoma Press, 1998), 99.
18. Strunk v. Strunk, 445 S.W.2d 145 (Ky Ct App 1969).
19. Lewis, see note 8 above, p. 223. The other twin, Lucy, had severe hemolytic uremic syndrome and was on dialysis. Nancy, the healthy twin, made several comments that are poignant and, even instructive: at one time she feared that if the kidney she donated wouldn't work, they would then take out her other (p. 241). Her fear of what was happening to her sister may, however, have been worse. Nancy said, "Lucy doesn't look like me any more ... she's little ... my hair is longer." At 224.
20. Fost, see note 7 above, p. 363.
21. Lewis, see note 7 above, p. 238. One parent said, " 'The stress of my daughter's illness was way more stressful than the surgery itself.' " C. Jacobs et al., "Kidney Transplants From Living Donors: How Donation Affects Family Dynamics, Advances in Renal Replacement Therapy 5, no. 2 (April 1998): 89-97, at 93.
22. R.M. Eisendrath, R.D. Guttmann, and J.E. Murray, "Psychological Considerations in the Selection of Kidney Transplant Donors." Surgery, Gynecology, and Obstetrics 129 (1969): 243-8, 246; C.H. Fellner and J.R. Marshall, "Kidney Donors: The Myth of Informed Consent," American Journal of Psychiatry 126 (1970): 1245-51. "The fear that genetically unrelated donors is generally motivated by psychopathology has been disproved by studies showing that a desire to help is what motivates these heroic people to give." A. Spital, "Do U.S. Transplant Centers Encourage Emotionally Related Kidney Donation?" Transplantation 61, no. 3 (15 February 1996): 374-7, p. 376.
23. R.M. Eisendrath, R.D. Guttmann, and J.E. Murray, "Psychological Considerations in the Selection of Kidney Transplant Donors." Surgery, Gynecology, and Obstetrics 129 (1969): 243-8, 246; C.H. Fellner and J.R. Marshall, "Kidney Donors: The Myth of Informed Consent," American Journal of Psychiatry 126 (1970): 1245-51. "The fear that genetically unrelated donors is generally motivated by psychopathology has been disproved by studies showing that a desire to help is what motivates these heroic people to give." A. Spital, "Do U.S. Transplant Centers Encourage Emotionally Related Kidney Donation?" Transplantation 61, no. 3 (15 February 1996): 374-7, p. 376.
24. R.M. Eisendrath, R.D. Guttmann, and J.E. Murray, "Psychological Considerations in the Selection of Kidney Transplant Donors." Surgery, Gynecology, and Obstetrics 129 (1969): 243-8, 246; C.H. Fellner and J.R. Marshall, "Kidney Donors: The Myth of Informed Consent," American Journal of Psychiatry 126 (1970): 1245-51. "The fear that genetically unrelated donors is generally motivated by psychopathology has been disproved by studies showing that a desire to help is what motivates these heroic people to give." A. Spital, "Do U.S. Transplant Centers Encourage Emotionally Related Kidney Donation?" Transplantation 61, no. 3 (15 February 1996): 374-7, p. 376.
25. Jacobs et al., see note 21 above, p. 93. Five to nine years later, 95 percent of emotionally related donors reported psychological benefits and greater self-esteem. J. Burley and C.R. Stiller, "Emotionally Related Donors and Renal Transplantation," Transplantation Proceedings 17, no. 6, supp. 3 (December 1985): 123-7, p. 125. Two friends "expressed genuine regret" they could not donate. A wife repeatedly offered her kidney. Ibid., p. 126.
26. Jacobs et al., see note 21 above, p. 93. Five to nine years later, 95 percent of emotionally related donors reported psychological benefits and greater self-esteem. J. Burley and C.R. Stiller, "Emotionally Related Donors and Renal Transplantation," Transplantation Proceedings 17, no. 6, supp. 3 (December 1985): 123-7, p. 125. Two friends "expressed genuine regret" they could not donate. A wife repeatedly offered her kidney. Ibid., p. 126.
27. Jacobs et al., see note 21 above, p. 93. Five to nine years later, 95 percent of emotionally related donors reported psychological benefits and greater self-esteem. J. Burley and C.R. Stiller, "Emotionally Related Donors and Renal Transplantation," Transplantation Proceedings 17, no. 6, supp. 3 (December 1985): 123-7, p. 125. Two friends "expressed genuine regret" they could not donate. A wife repeatedly offered her kidney. Ibid., p. 126.
28. Post, see note 7 above, p. 365. Young children's grief may be partly in response to parents. Careproviders can also contribute: "One cannot help but conclude from these records that the clinicians later involved in these cases too often joined in this preconscious pact not to explore even the simplest details about the death." A.C. Cain, I. Fast, and M.E. Erickson, "Children's Disturbed Reactions to the Death of a Sibling," American Journal of Orthopsychiatry 34 (1964): 741-52, 744.
29. Murray's most important argument that the attempting to weigh infants' being born with problems against their never being born is like "trying to divide by zero . . . [this] cannot yield a meaningful answer." Murray, see note 11 above, 42.
30. A. Kidd, B. Eskenazi, and A.J. Wyrobek, "Effects of Male Age on Semen Quality and Fertility: A Review of the Literature," Fertility and Sterility 75, no. 2 (February 2001): 237-48.
31. W.R. Miller and J. C'de Baca, Quantum Change (New York: Guilford, 2001), p. 85.
32. Careproviders and others have been slow to see healthy kidney donations as altruistic. There has been a "reluctance within the medical profession to submit a healthy individual to surgery ... [due in part to the] . . . suspicion that motivation to donate a kidney was abnormal."
33. Yet the first application to produce embryo clones could be lodged within six months. "Bid to Create Human Embryo Clones," BBC News/ World Edition, 12 October 2002 〈http:// news.bbc.co.uk/2/hi/uk_news/scotland/ 2322489.stm〉.
34. "... under rare circumstances, kidney donation, even by young children, may be ethically acceptable." A. Spital, "Should Children Ever Donate Kidneys?" Transplantation 64, no. 2 (July 1997):232-6,p. 235.
35. G. Annas, "Asking the Courts to Set the Standard of Emergency Care: The Case of Baby K," New England Journal of Medicine 330, no. 21 (26 May 1994): 1542-5.
36. "[T]hese decisions are ultimately ethical or value questions, for which the physician may not be any more expert than the layman." Spital, see note 28 above, p. 236, citing Post, see note 7 above. " 'No longer is the public prepared to accept only the medical profession's judgement on this sort of issue.' " Burley and Stiller, see note 23 above, p. 125, citing J.B. Dossetor, Transplantation Today 1 (1984): 28-30.
37. C. Richardson, "Physician/Hospital Liability for Negligently Reporting Child Abuse," Journal of Legal Medicine 23, no. 1 (March 2002): 131-50.
38. Annas, see note 29 above.
39. Careproviders characteristically underestimate the quality of life that children and adolescents with such problems encounter. S. Saigal et ai., "Differences in Preferences for Neonatal Outcomes among Health Care Professionals, Parents, and Adolescents," Journal of the American Medical Association 281, no. 21 (2 June 1999): 1991-7.
40. It is difficult for most persons and groups to turn down requests to make a decision, although courts do this routinely. When ethics committees should turn down requests is a largely unanswered question. For Irene's request-and others similar to it-to prevail, society would have to accept this unprecedented father-daughter union.
41. S. Fiske, citing Elizabeth Phelps in S. Fiske, "Where Fear Lives," Psychology Today (September/October 2002): 74. There, may be regions in the brain that function like "virtual affective" sites, providing alternate routes of learning to those that "lower animals" possess. What this means is that we, as voting members of society, can learn better and are not as hard-wired and resistant to change as we may think. A.K. Anderson and E.A. Phelps, "Is the Human Amygdala Critical for the Subjective Experience of Emotion? Evidence of Intact Dispositional Affect in Patients with Amygdala Lesions," Journal of Cognitive Neuroscience 14, no. 5 (2002): 709-20, p. 718.
42. S. Fiske, citing Elizabeth Phelps in S. Fiske, "Where Fear Lives," Psychology Today (September/October 2002): 74. There, may be regions in the brain that function like "virtual affective" sites, providing alternate routes of learning to those that "lower animals" possess. What this means is that we, as voting members of society, can learn better and are not as hard-wired and resistant to change as we may think. A.K. Anderson and E.A. Phelps, "Is the Human Amygdala Critical for the Subjective Experience of Emotion? Evidence of Intact Dispositional Affect in Patients with Amygdala Lesions," Journal of Cognitive Neuroscience 14, no. 5 (2002): 709-20, p. 718.