Medical “Ethics”?

I have to share the following true story.

Not too long ago, I attended a talk on medical ethics. The speaker was presenting a number of test cases for discussion. One of the test cases imagined a 32-year-old woman who had an accident that left her with quadriplegia and requiring ventilator assistance. 10 weeks after her injury, she asks her doctor to disconnect the ventilator. The speaker argued that the doctor should respect the patient’s right to self-determination and disconnect the ventilator. There was no subtlety expressed by the speaker about whether 10 weeks was long enough for the person to know what her life could be like after disability. There was no awareness expressed about objections to these sorts of right-to-die cases that have been expressed in the disability literature. There seemed to be no awareness about worries that have been discussed in medical ethics since at least the 1980′s that people who become dependent after such accidents may express a wish to die as a response to concerns about being a “burden,” and to the larger society’s implications that it wishes to be “rid” of such “burdens.” In other words, whose desires are people in such situations who say they wish to die really carrying out: their own “autonomous” desires, or the larger society’s desires to be “rid” of them? Such questions should give us pause as to whether people in such circumstances are really making autonomous decisions and engaging in self-determination when they ask people to help them die.

In a discussion afterword that was somewhat critical of the speaker’s position, someone responded to some of the criticisms by raising the issue of deaf parents who use genetic tests to select for deaf children. Since these cases are rare, one wonders about the motivation behind the fact that they are constantly raised in such discussions. Then the issue of cochlear implants came up, and how morally bad it is (so it was argued) that some deaf parents refuse to allow cochlear implants to be used on their hearing-impaired children. In fairness, the guest speaker argued that the use of cochlear implants should be left up to the parents, but a questioner (another supposed expert in medical ethics) persisted, arguing that refusing to use cochlear implants was immoral because “it costs me money,” by which the questioner meant (as was clarified during further discussion) that refusing to use cochlear implants supposedly costs taxpayers money. A second argument offered by a faculty member was that “deafness is a life or death question, I mean, it’s about whether you are going to get run over by a bus.” To my knowledge, there is no evidence indicating that people with hearing impairments get run over by buses any more often than anybody else. These comments said more about the ethics of the people who uttered them, it seems to me, than they did about ethics in medical contexts, or about disability.

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