[This are my last few proseminar journal entries. I'm done with my classes...one more week in my lab, and then I can finally say that I'm on vacation...]
I think
that I’m finally beginning to understand what Prof. M says when he
asks students to “think like bioethicists”.
Context: I came into this proseminar thinking that a bioethicist
couldn’t possibly process things in the same way that a scientist or a
musician might. (That is, since I
identify as both a scientist and a musician, I will have a very difficult time
learning how to think like a bioethicist.)
However, to
my surprise, I’m learning that there is a similar sort of thought process to
all three of these personalities. All of
them, at their core, involve the proposal of an idea, and then the
substantiation of said idea. Each personality
will take a slightly different approach, of course, but my point is that if I
can think like a scientist and like a musician, there’s no reason why I can’t
learn to think like a bioethicist. (In
other words, it may not be as far out of my reach as I thought.) After all, I already like to think
systematically; that’s the way I’m wired.
And a bioethicist, according to Prof. M, survives by a) clearly
defining the concepts and terms he wants to use, b) using those concepts and
terms with stringent consistency, and lastly, c) using them to advance the proposed
argument – that is to say, “thinking hard with them”.
One topic
covered today that I found especially interesting was the question of how
bioethics attempts to handle the physician’s apparent duty not to kill. My knee-jerk reaction to this issue is firmly
rooted in my faith, which takes a clear stance on it in Exodus 2013:
“You shall not murder.” Therefore, if I
were to assume a position strictly based on my religion, I would be the
physician who, without exception, refuses to perform any kind of
abortion and rejects physician-assisted suicide (or euthanasia, or whatever
they’re calling it these days. That’s
all very confusing, especially with the connotations of terms like “euthanasia”.) But here’s my problem – deference to a
religious position, however clear, seems like an almost laughably easy route. In fact, it’s too easy. Why?
Because of cases like Dax Cowart.
I’m finding
that it’s one thing to talk about issues like abortion and active
intentional killing in theory. Yes, it’s
one thing to tackle these issues systematically, to delineate the categories
and arguments, to make all of the charts and tables. I rarely have a problem when it comes to
examining difficult issues with a cool, analytical approach. But it’s another thing entirely to see
such issues. As a student, it’s a
completely different experience to be presented with real cases…real
people…real lives. This is not
theory anymore! How can I possibly
decide that active intentional killing is universally wrong when Dax Cowart
went through such agony and mistreatment from the very professionals who were
supposed to be helping him?
This brings
me to some thoughts on the two types of “active killing”. As I understand it now, the difference
between homicide and assisted suicide lies in who takes the “last step” before
the individual dies. At this point (i.e.
the caveat being that I’m not a physician yet), I can’t see myself ever agreeing
to commit homicide, even at the request of a patient. Even the sight of those words makes me
shudder. However – if it would fall
in the realm of quality medical care, I might, after a lot of
consideration and conversation, assist a suicide. (That said, I really hope I never run into
this kind of situation; even thinking about it is making me nervous.)
At the end of
the day, do I believe that there is something intrinsically wrong with killing
another person? Yes. Killing in the sense that I believe God meant
it in the Decalogue (that is, murder) clearly violates respect for the
individual and the sanctity of life. I
think that murder (in this case, homicide) unjustly interferes with a choice
that is no one’s to make but God’s. But then
again…I don’t believe that God sanctions unnecessary suffering.
***
This could be a little nitpicky, but I
really liked that Dr. S asked us those basic questions: why medicine,
and why LIM. I was a bit caught
off-guard since I sat near the front and had to go first, but I’m realizing now
that those answers are really important ones to have at my fingertips. They’re basic interview questions, after
all…and having comprehensive, elevator-ride answers to them will only serve me
well as I progress through my education (i.e. residency interviews). And I haven’t even mentioned that it will
help me to have those answers clear and accessible whenever I’m doubting my
abilities or my call to this profession (which happens way too often. But then, I guess I would be a lesser steward
of my own growth if I didn’t look at my choices with a critical eye once in a
while…)
Oh, one other thing: I’m not sure that
this was her intention or not (or whether it’s just my projection), but I felt
like Dr. S did a good job of subtly saying that the MBA is a better
choice for LIM students than is the MS.
I understand that she’s speaking from life experience, and that she’s
seen MBAs go “farther” in the job arena…but as an MS student, hearing that is a
bit harsh. I do wish that she had given
a more balanced picture of what these graduate degrees – both of them – could
do for us, instead of just implying that the MS students are destined to be
disadvantaged if/when we ever decide to step away from clinical work. For now, it feels like just because I’m not
expressly interested in management, finance, accounting, informatics, etc., I’m
losing out and settling for the consolation degree…
***
I was thoroughly
unimpressed by today’s lectures. Prof.
L speaks well for sure, but as a LIM student, I felt somewhat excluded
after the relevance of the talks given by Profs. M and V to my
future. Eugenics, Sims, and more
on the history of bioethics? Perhaps I’m
just tired, and a little burned-out (which would be a reasonable assumption,
given the pace which I’ve maintained since the end of spring term), but I
really don’t want to hear any more history.
That’s not going to help me, practically speaking, over the next few
years. What will help me is more
examples of how to systematically work through difficult cases, and clinical
situations where the ethics are murkier than anyone would like. I much prefer the lectures in which I get to
learn about the ethical principles involved and then apply them to real
scenarios. And I don’t know about my
peers, but I do not see myself ever getting involved in animal research – my
summer research fellowship (in a Drosophila
lab) is teaching me that and more. I
certainly don’t support the practice of hurting animals for scientific gain,
even if they cannot feel pain, but yesterday’s lecture by Dr. S gave
me all the clarity I need about how the next few years of my life are going to
play out. So all of this talk about animal
experimentation, for example, is leaving me rather bored and disenchanted with
this proseminar for today.
That said, I forgot to mention yesterday
that Dr. S did leave me thinking about something positive. (I was a bit harsh on her, I think…) She did spend quite some time talking
about academic medicine, albeit in the context of how much money different
professors at varying “levels” (i.e. full, associate, visiting) can earn. Perhaps at some point way in the future, when
I no longer have the same energy for my private practice that I started with, I
could be a clinical professor! I already
know that I enjoy teaching – how much more enjoyable could it be to teach
future physicians about the profession I love (and only expect to love more as
time passes)? And then, on the practical
side, this could give me the more structured schedule that I may need as I
settle down and raise children. This
definitely deserves some more thought on my part, since it would probably
affect where I choose to pursue residency positions – I would need to look more
seriously at university hospitals and other teaching facilities…
I was really thrown off by Dr. P's lecturing style. Perhaps the issue is a
simple incompatibility with my learning style.
In any case, it took me a
significant amount of time to get used to the way she was handling her lecture
time. I wish that it had been more
structured – that is, less of a “casual discussion”, less haphazard, less
jumpy. I’d like to give her the benefit
of the doubt, as I have been learning in a decidedly “undergraduate”
environment for the past three years.
It’s strange, how quickly I judged (i.e. within the first fifteen
minutes) that she was an ineffective lecturer, just because she didn’t really
give much background or introduction to any of the myriad topics she
covered. I guess it goes to show that no
matter how much you’ve learned at a university as prestigious as UC Berkeley, a
degree from there doesn’t automatically make you a good teacher of
everything you’ve absorbed. The lesson
for me, perhaps, is that no brand-name medical school or residency position, in
itself, will make me a good physician.
But enough of my editorializing. I did learn a bit from her. For example, before today, I had
no idea what “23 and Me” is, much less the ethical issues that surround
it. But now that I’ve done a little bit
of Googling on it, I am amazed that for just a few hundred dollars, I could
send in a biological sample and receive my entire genome in return. And then, there’s the whole issue of genetic
testing not just being available to all, but actually being recommended (for
certain pregnant women). Do people
really need to know the intricacies of their genetic programming? Are we just opening new doors to increasing
the cost of healthcare – for procedures and scans done largely out of
paranoia? All of this makes me wonder if
we’re getting to the point of doing science just for science’s sake…
***
What a
wonderful end to the seminar. I never
thought that I would ever be interested in writing, publishing, and all of
that…much less in the field of research ethics!
I mean, I’m obviously settled on pursuing a career in medicine, but today
corrected my previously-held notion that as a physician, I would have neither
the time nor the capacity to write.
For example, I was intrigued when Prof. P mentioned
that a medical student occasionally wrote for a column in the “New York Times”. After spending some time on Google, I didn’t
find this student, but I did find a Dr. Perri Klass, professor of journalism
and pediatrics (what a relevant combination!) at NYU, who has written quite a
bit for the “Times”.
Here is one article
of hers which takes on the issue of patient confidentiality…with
middle-school-age children. This
fascinated me partly because patient age was rarely incorporated into
discussions on confidentiality, either in this proseminar or in class last
term. However, I think it’s going to be
an important part of my education, especially when I begin to see patients.
I’ve never really thought of myself who might go into
research, even clinical research; I guess I don’t really have a burning desire
to explore that side of medicine. But it’s
nice to know that you don’t have be a “researcher” to write for peer-reviewed
journals (as well as other forms of media).
I’m thinking about people like Dr. Sanjay Gupta, for example, who’s made
a name for himself both as a clinician and as an educator…he affects so many
lives, just because he makes the occasional television appearance. I wonder if I could be like him, and dare to
reach outside the confines (albeit safe confines) of a private practice. That would mean venturing outside my comfort
zone for sure, but I do like to write.
Perhaps I ought to make sure that I don’t forget to write, even as
medical school threatens to take over all of my time. After all, as Prof. P pointed out, the
scholar Janet Emig said, “writing makes our thoughts visible and concrete and
allows us to modify them. Writing down a
word, a sentence, a paragraph, suggests more words, sentences, paragraphs. Writing progresses as an act of discovery.” I’d like to distinguish myself somehow while
I’m in medical school; perhaps writing, in some way, will help me to achieve this
goal.
Speaking of Prof. P, I must say that I am extremely
impressed with both his lecturing style and his attention to detail as a teacher. The way that he takes seemingly-insurmountable
tasks (i.e. explaining how to write and publish in a journal) and breaks them
down into manageable chunks is a really helpful thing for me, as a student who
knows next to nothing about that process.
His starting with the basics (i.e. why publish at all, techniques for
coming up with ideas) is making the world of publishing seem far less
inaccessible. His business acumen, with
regard to everything from HIV research to genomics to IRBs to research ethics and
publishing, has me in awe! I will
certainly be consulting him for advice on how to move forward with my
healthcare management project. (I think
that I’d like to do something with regard to improving treatment and management
of patients with eating disorders, but am aware that any research on mental
health will require me to get all kinds of permission from the Albany Med IRB. Time shall tell…)
