Throwback Thursday: Faith, Fatalism, and Apocalypse in America Chapter 8 Discussion

Throwback Thursday, where, essentially I post old writing samples, essays and short stories that I dig up from my pile of hoarded papers and school assignments or from the depths of my computer. So everyone can see how my writing has changed/improved over the years.


Discussion Paper – Wojcik Chapter 8

Apocalyptic beliefs are persistently popular because they offer a coherent narrative structure with which to understand our world, promising an ultimate end to suffering (through rebirth or annihilation at differing points in history), and that harmony on earth with eventually be reached – fulfillment of a cosmic plan. This cosmic plan extends, particularly in the post-cold war era, past the strictly religious and to the extra terrestrial, as Wojcik describes in chapter 8 “Emergent Apocalyptic Beliefs about UFOs and Extraterrestrial Beings.” Despite overt differences, Wojcik establishes fundamental similarities in the arising belief of extraterrestrial apocalypse as a natural extension from belief in the religious apocalypse.

Similar our pre-fall break discussion on whether alien invasion would count as a religious apocalypse, Wojcik establishes extraterrestrial apocalypse as a natural successor to belief in the religious apocalypse sharing “preoccupation with the threat of nuclear annihilation…cultural pessimism…and yearning for worldly transformation by other worldly beings” (Wojcik, 175). For many, this “otherworldly being” is god (or a god, depending on the religion), but for an increasing few, these other worldly beings are of the extraterrestrial kind, which fit into the narrative structures of the religious apocalypse. For some, extraterrestrial is equated with “heavenly” (176). The “UFO phenomenon has become a folk religious movement of global proportions” (177). Similar to how religious apocalypses are popularized by even the non-religious understanding of religious apocalyptic belief through pop culture, extraterrestrial apocalyptic belief is becoming more known, which popularized its fundamental belief.

Our class discussion on aliens counting towards the religious apocalypse focused on whether they could stand as a “replacement” of sorts of god in the apocalyptic narrative. A higher, non-human power which rescues humanity from itself and at the very least a select few humans from the destruction of our planet. Wojcik takes the integration of the extraterrestrial to a higher degree, breaking down each similarity in narrative structure. Most notably, the part of the religious apocalypse which claims humans are powerless to save themselves without otherworldly intervention is echoed in “abductions narratives” which “imply the world is doomed…unless…radical transformation that cannot be accomplished through human effort but only through the guidance of otherworldly…entities” (197).

Extraterrestrial apocalyptic belief shares many similarities to religious counterparts. From narrative structures of abductions (as compared to rapture) to save/take chosen humans, to fully believed sightings (or visions) of those other worldly beings (god, Mary, or aliens), Wojcik characterizes extraterrestrial apocalyptic beliefs as a type of religious apocalyptic belief. While the definition of humans salvation can take different meaning in extraterrestrial apocalyptic beliefs as “not…through worldly cataclysm but…through…genetic and spiritual perfection” (194). Nonetheless, extraterrestrial is equated to a less deterministic religious apocalypse through the “fate of humanity [as] guided by external forces” (208), as a way to explain the world as it is, understand threats to current ways of life, and absolve humans – at least in part – of being wholly responsible to correct it, giving hope of a higher power that will essentially save humanity from itself in same way, shape or form.

Throwback Thursday: “The American Apocalyptic Legacy”

Throwback Thursday, where, essentially I post old writing samples, essays and short stories that I dig up from my pile of hoarded papers and school assignments or from the depths of my computer. So everyone can see how my writing has changed/improved over the years.


“The American Apocalyptic Legacy” Wojcik Chapter 2 Discussion Paper

The End of the World As We Know It: Faith, Fatalism, and the Apocalypse in America​ by Daniel Wojcik examines the role and belief of the apocalypse in American society and culture, with chapter two focusing on the origins of apocalyptic beliefs in America. Starting with America’s founding, in chapter two, “The American Apocalyptic Legacy” starts as defining “the United States…as the new Eden” historically (Wojcik, 21). The concept of America, not only as a hub of apocalyptic belief, but as an originator of modern apocalyptic belief is fascinating.

A central theme of apocalyptic belief, especially traditional, religious apocalyptic belief, is the image of rebirth – a new, better world to come out of the ashes of suffering. Wojcik discusses the prevalence of “apocalyptic ideas…in Puritan belief” (Wojcik, 23) and the imagery of “hellfire and brimstone” (Wojcik, 24) which prevailed religious ideas and sermons. The Puritan apocalyptic beliefs could have found symbolism in the very way America came to exist. As the “new world” of the Americas offered a new beginning and a safe haven for the persecuted Puritans – a physical manifestation of their beliefs, that shows how the world changes to accommodate human beliefs, as humanity shapes the world. Many modern apocalypses have an element of a self-fulfilling prophecy – environmental collapse and nuclear war as fears get worse the more they are debated or ignored. The apocalyptic narrative of America’s beginning could lend credibility to the beliefs of those who lived through it, a confirmation of their faith, and a jumpstart to the perpetuating cycle of continued belief in today’s America, though the specifics of the apocalypse, and the shift away from the religious to the secular have come over time.

Originally, America has its roots in apocalyptic imagery, with its status as “a city on a hill” a shining example, a sort of ideal of god’s plans coming to fruition . Centuries later, even as apocalyptic beliefs has shifted from the religious to the secular, biblical allegory showing America as a central focus in the apocalypse is inescapable. America is considered by many a catalyst of most modern apocalyptic theories of environmental or nuclear disaster – a key component to the beginning of the end. Wojcik traces this continued biblical imagery into the 1980’s (modern for Wojcik, who published this book in 1997) with President Reagan’s views of “Armageddon as the fulfillment of divine prophecy” (Wojcik, 30) citing apocalyptic beliefs in foreign policy and “initiating…a divinely sanctioned nuclear war” (Wojcik, 30) showing how America’s religious apocalyptic beginnings tie inexorably to America’s role in modern secular apocalypses, which are not separate apocalypses at all.

Wojcik examines the way the apocalypse has and hasn’t changed over the years. The core existence of the apocalypse has persisted over centuries, though Wojcik focuses on the distractions of “premillennialist and postmillennialist systems of belief” (Wojcik, 36), showing how belief has shifted from the apocalypse solely being in god’s hands to human beings ability to affect it, from the pessimistic to the optimistic. This shift is centered in American belief and discourse, showing how America has been and continues to be central to the apocalypse, as its inception could be considered a kind of apocalypse itself. This is only one chapter of Wojcik’s book, but America’s apocalyptic origin extends past the genocide of native americans into core ideology of the people who made the new world, and this different apocalyptic view is symbolic of the way, today, the same events can be viewed through different apocalyptic lenses.

Throwback Thursday: A Discussion on “In The Lord’s Hands” by Robert Lifton

Throwback Thursday, where, essentially I post old writing samples, essays and short stories that I dig up from my pile of hoarded papers and school assignments or from the depths of my computer. So everyone can see how my writing has changed/improved over the years.


“In the Lord’s Hands: America’s Apocalyptic Mindset” by Robert Jay Lifton

Most interesting to me is the overarching idea Lifton has that most, if not all, major apocalyptic ideas – no matter how different in details and minutia – boil down to very similar and even formulaic plans, which for those involved are not termed negatively but as a necessary step for the improvement of mankind, a sacrifice made for the overall human good. The end of the world being the end of the world as it is known, with its struggles and evils, ushering in a new world order without these negatives. The apocalypse is a rebirth, inevitable and necessary, for better or worse, past or future, for those who believe in it in any shape or form, secular or religious. When and how is the apocalypse redefined?

Lifton seems to redefine the apocalypse from is usual negative connotation by considering how it is viewed by those who seek it – a rebirth, a revelation (by the greek roots). The apocalypse comes from the search for utopia “apocalyptic violence as…a quest for spiritual utopia” (Lifton, p.59). A utopia looks different to different groups of people, which is why the apocalypse, especially is different religious contexts as Lifton examined, have different looking outcomes, even as the general pattern of the apocalypse is quite similar across times and places. There is a prominence of apocalyptic ideas and ideals around the world and across time periods and persistence of beliefs. Lifton calls it a “sacred mission of murder in order to renew the world” – in other words, it is seen as spiritually necessary, a necessary evil to make the world better. This line of thinking extends into the less global scale secularly, in political coups, new government systems to improve quality of life, and other missions that sought similar goals, such as the Nazi regime which saw themselves as purifying the world for the better of Germany. By this logic, the American Revolution could be seen as a sort of apocalypse. Even secular apocalypses like the Nazis follow a narrative similar to christian armageddon – Lifton’s view of “killing to heal”. The general concept exists in every religion and in secular political doctrines showing the universal human trait of apocalyptic thinking, tracing from ancient times to modern day, from politics, to Islamic tradition. The apocalypse doesn’t so much change as adapt to new times and enemies.

The human nature aspect of apocalyptic thinking is fascinating. Why does the apocalypse draw people of all faiths and cultures as an immutable truth even today when beliefs and knowledge are so vastly different? Is it human nature to search for meaning in suffering, hope in dark times? The apocalypse offers a sense of hope, that violence and suffering become worth it when the ultimate goal of a better world is one day achieved. Lifton mentions the impulse to “force the end”, to speed along this ultimate end goal by making things worse so they can get better. If it can’t be avoided forever, might as well get it over with. Religious scholar John Collins mentions that apocalyptic values of life can transcend death, and there is a tendency to try to make sense of chaos which surrounds human beings, a craving for power or cosmic importance which leads to apocalyptic ways of thinking, that the violence and suffering experienced has an ultimate end and purpose, shifting the blame and responsibility from people to gods or in secular apocalypses, governments. This aspect of human nature closely relates to the french term “l’appel du vide” or “the call of the void” which is a human impulse to think “I could jump from this ledge, this is a way out” which ties into apocalyptic views of forcing the end, to get the worst of it over with, and simply jump, because you can. It isn’t considered a symptom of suicidal ideation, but a comfort of knowing there is always another option, l’appel du vide is a term for the odd and unique human impulse to consider the possibilities for our own downfalls, and in apocalyptic senses, it is martyrdom and sacrifice. The best way to prevent unwanted ends is to force the one we’d prefer, so that it means something better and more important than ourselves. Why do humans have this impulse, and why is it so seemingly universal, to various strengths, and why does it affect some individuals more strongly than others?

America has a power imbalance to affect this cycle of apocalyptic thinking, and more care towards how much destruction or sacrifice is caused or given for an uncertain outcome is needed. Apocalyptic ideals don’t always work as planned, leaving a lot of death or harm, without the rebirth that was sought by the offending group; Lifton gives examples of Timothy McVeigh and Nazi Germany. Ideally betterment can come without destruction beforehand, and reconciliation of what is and isn’t truly a threat in need of an apocalyptic way of thinking and progress needs to be considered between increasingly interconnected groups, with fundamentally similar ways of thinking but see each other as common enemies, with different ideals for how the reborn world should look.

Why does the apocalypse draw people of all faiths and cultures as an immutable truth even today when beliefs and knowledge are so vastly different? The other questions here are how to balance the ideals of a better world among different groups, how can America continue its strive for improvement without perpetuation of the vicious cycles of apocalyptic thought, and how can religious apocalypses can be untangled from the more secular or political counterparts, when the latter is based on the former, and what are the inherent differences in their outcomes sought. The religious apocalypses have clear prophetic paths, all other thoughts or theories on potential world ends are yet to be determined.


References:

Dahl, Melissa. “’Pronoia’ and Other Emotions You Never Knew You Had.” ​CNN​, Cable News Network, 24 June 2016, http://www.cnn.com/2016/06/24/health/words-for-emotions/index.html. Goldfarb, Kara. “Ever Stood On A Ledge And Thought, ‘I Could Jump’? There’s A Phrase For That.” ​All That’s Interesting​, All That’s Interesting, 16 Feb. 2018, allthatsinteresting.com/call-of-the-void.

Lifton, Robert Jay. “‘In the Lord’s Hands.’” ​World Policy Journal​, vol. 20, no. 3, 1 Sept. 2003, pp. 59–69., doi:10.1215/07402775-2003-4002.

Throwback Thursday: Expressing Apocalyptic Belief

Throwback Thursday, where, essentially I post old writing samples, essays and short stories that I dig up from my pile of hoarded papers and school assignments or from the depths of my computer. So everyone can see how my writing has changed/improved over the years.


Belief in the apocalypse is pervasive in human nature, across societies, cultures, and time periods. Why is the belief in the apocalypse still so pervasive today? In what ways is it believed in, and why does it bring hope and fear in turn to different people? This paper will examine these questions through the lens of two articles: “Doomsday Prep for the Super Rich” by Evan Osnos and “‘In the Lord’s Hands’: America’s Apocalyptic Mindset” by Robert Jay Lifton. I will compare where these two authors differ in opinion—whether belief in the apocalypse stems from fear or hope—and how they ultimately agree in many fundamental ways. The fear and hope they argue for are two sides of the same coin, showing the perspectives of different people of the same apocalypse. Why and how people believe in the apocalypse today is constantly changing, and its view as a negative or positive is based on whether the world stands to get better or worse for you. Different individuals will see the same apocalypse with either hope or fear depending on if the world as they know it could improve (as is Lifton’s view) or worsen (as is Osnos’ view). I argue it is the same type of apocalypse they are writing about, viewed from different vantage points of what someone stands to lose or gain.

In “‘In the Lord’s Hands’: America’s Apocalyptic Mindset” Lifton’s focus is that ordinary people can believe in the apocalypse and that apocalyptic thinking can bleed into politics, for example, in situations like political coups, which can change the status quo for the better, or for the worse. A dramatic example of such political upheaval is World War II because “even secular movements like the Nazis have followed a version of the Armageddon script.” (Lifton 64), even political and secular apocalypse-like events follow themes and narratives of the religious apocalypse. Lifton details the historical definition of the apocalypse as “a form of ultimate idealism, a quest for spiritual utopia” (Lifton 59) and traces religious beliefs and their influences on politics. There is a major influence of religious apocalypses in America, clearly seen with the war on terror which was used “as a vehicle for our own salvation” (Lifton 69). This can also be seen as a protection of traditional Christian values and feeling threatened by other belief systems inherent to apocalyptic thinking which Lifton describes as “desolation as a possible means of fulfillment” (Lifton 66). While some may fear this desolation (as Osnos argues), Lifton sees it as a source of hope—a cleansing fire. Lifton thinks people’s motivation for apocalyptic belief is a mixture of hope and fear as “apocalyptic visions…have flourished during times of great suffering…powerful sources of hope” (Lifton 62). The idea is that if the world is going to end, it is for a grander purpose, a comfort for many who feel powerless. In this way, themes of the religious apocalypse feed secular apocalypse as a way of feeling in control of humanities destiny—that the way forward is clear, a set narrative path towards betterment. This can clearly be seen with President Bush “making the war on terrorism a war on evil” (Lifton 67); here, religious ideals were tied to political moves just as religious narratives influence secular apocalypse.

Views of the apocalypse change with the times, and the changing status quo is a potential for things to get better, just as the apocalypse brings a sense of hope through rebirth. As mentioned earlier, Lifton describes “desolation as a possible means of fulfillment” (Lifton 66)—before rebirth and the betterment that comes with it, current suffering must be endeared. Typically, the apocalypse connotes disaster—the world ending before it is reborn, getting worse before it gets better. Things have to get worse before they get better, and for some people, there is nothing left to lose. For these people, the apocalypse is nothing to fear, it is something to anticipate and welcome—the benefits are worth the price. For the majority of people, the apocalypse brings a sense of peace. The apocalypse is seen as “all-consuming violence in a hopelessly corrupt world was, in fact, required for the hopeful and lofty rebirth that was to follow” (Lifton 59), a necessary evil to get what you want, a sacrifice so that things can get better for those in desolate situations, and a promise that their suffering is not in vain.

In Lifton’s view, only the sinners—those who do not deserve nor benefit from rebirth—need fear the apocalypse. This description may very well fit those whom Osnos describes—the elite who stand to lose everything. In “Doomsday Prep for the Super Rich” Osnos interviews multiple prominent survivalists “among technology executives, hedge-fund managers, and others in their economic cohort” (Osnos 2), who typically benefit from the status quo. Those elite who fear this type of apocalypse, which directly affects them, and is more easily believed than a grand religious one. There are two major ideas presented in Osnos’ article: that doomsday prep is no longer a radical position, but as common as insurance for those who can afford it, with “forty percent of Americans [believing] that stocking up on supplies or building a bomb shelter [is] a wiser investment than a 401(k)” (Osnos 5). Second, that it perhaps distasteful that money and resources are sunk into these personal preparations rather than mitigating the causes of apocalyptic fears, such as political discourse, and environmental collapse. Osnos quotes Max Levchin, a founder of Paypal “‘It’s one of the few things about Silicon Valley that I actively dislike—the sense that we are superior giants who move the needle and, even if it’s our own failure, must be spared.’ To Levchin, prepping for survival is a moral miscalculation; he [says]… ‘All the other forms of fear that people bring up are artificial.’…In [Levchin’s] view, this is the time to invest in solutions, not escape” (Osnos 8). The thoughts of the possible apocalypse depicted in Osnos’ article stem from fear, fear which would be greatly assuaged if the causes of that fear, from political to environmental issues, were dealt with head on, rather than only anticipated as a future concern.

Osnos’ article deals overwhelmingly with the fear of the wealthy elite, such as those from Silicon Valley, that America as it is known will collapse. Revolution against the 1%, while not likely, is one of the most likely apocalyptic scenarios America could face. In relation, Osnos writes, quoting Antonio Garcia Martinez, a former Facebook product manager, “when society loses a healthy founding myth, it descends into chaos.” (Osnos 2). The primary founding myth of American culture is that of the “American Dream” the ideal that if one works hard enough, they can attain the life and status they desire. In recent decades, many have lost faith in this ideal, as the wealth gap increases, and further distance is driven between the 1% and the rest of the nation, leading to this aforementioned “chaos” that leads to apocalypse prep. He defines the apocalypse in terms of survivalism and preparation; “less focussed on a specific threat—a quake on the San Andreas, a pandemic, a dirty bomb—than…the aftermath” (Osnos 2). Osnos views the belief in the apocalypse as a manifestation of fear at the changing status quo as well as a coping device—there is ego and self-defense as well as perhaps a sort of guilt at play.

Lifton and Osnos disagree in many ways. Osnos presents the apocalypse as a varied and fearful thing—though even among survivalists there is contention about the specifics, the core belief system holds constant. Lifton shows different religious views that seem very different and are often argued on, even to the point of war and bloodshed, but they essentially boil down to the same narrative structure: some general hope, fear and expectation—that the world will end and be reborn. Those who stand to benefit from a new world order look to the apocalypse with hope (Lifton’s view) and those who stand to lose status or success in this new world order fear it (Osnos’ view), but the apocalypse itself is one and the same. Lifton and Osnos at their core present a very similar argument—that it is fundamental human nature to believe in the apocalypse. The difference in attitude towards the apocalypse does not come from a different belief in what the apocalypse is, but what a person stands to lose of gain from the apocalypse. No matter the ideal of separating the religious and secular—it never works.

More than their differences, Osnos and Lifton don’t seem to disagree too much, in so much as they analyze separate aspects and perspectives of the very same fundamental facet of human nature. While Lifton and Osnos’ thoughts on the apocalypse seem to be separated as religious and secular respectively, with only slight influence from the other type of apocalyptic theory, they are speaking of the same type of apocalypse, split less along secular/non-secular lines and more on socio-economic lines. Lifton’s arguments and beliefs lend more to the common experience of the majority, while Osnos details the experiences of the 1%—while very different thought goes into the why of the fear, the fear and anticipation of the apocalypse is held common. It is the same apocalypse. Reid Hoffman, co-founder of LinkedIn told Osnos in an interview “Human motivation is complex, and I think people can say, ‘now I have a safety blanket for this thing that scares me.’” (Osnos 7). This idea of a safety net is important, because this is how Lifton portrays apocalyptic views in his article; the apocalypse brings a sense of hope that things will one day get better for them. As Lifton says, “Apocalyptic visions…have flourished during times of great suffering.” (Lifton 62). Lifton’s view of the apocalypse offers hope, a safety net of sorts, for those who need it, that things will get better eventually. But the duality of Lifton and Osnos’ arguments is, that for things to improve for the people Lifton is describing, it is generally thought that they have to worsen for the elite Osnos offers insight to, painting a common apocalypse as a sort of zero-sum game.

Fear is the driving belief of the apocalypse, not necessarily fear of the apocalypse, but its cause, coming from an external force. Fear of being unprepared, or the consequences if it isn’t your apocalypse—that if you are not a part of it, you’ll be left behind. For the masses analyzed by Lifton, there is a fear that if the apocalypse, or some apocalyptic-like event does not come to pass, things will never get better. For them, the apocalypse is a source of comfort and hope. For the upper-crust described by Osnos, this very same apocalypse which gives the majority comfort is a source of fear, because they have achieved what they see as their best possible lives, and any change in the status quo may mean the downfall of their money or power. But there is also a comfort to naming this fear; comfort in feeling as if one can prepare for an apocalyptic event rather than a nameless, faceless uneasiness which can stem from an unconscious sense of guilt for leading these better lives. The apocalypse changes with times and places, as the status quo shifts and power changes hands, but the core belief remains the same: a name, a system to believe in, for the fear people have, and the hope they crave.


Works Cited

Lifton, Robert Jay. ““In the Lord’s Hands”.” World Policy Journal 20, no. 3 (September 1, 2003): 59-69. Accessed September 1, 2018. doi:10.1215/07402775-2003-4002.

Osnos, Evan. “Doomsday Prep for The Super-Rich.” The New Yorker. August 10, 2017. Accessed September 01, 2018. https://www.newyorker.com/magazine/2017/01/30/doomsday-prep-for-the-super-rich.

 

Throwback Thursday: On The Use of Unethical Research Data

Throwback Thursday, where, essentially I post old writing samples, essays and short stories that I dig up from my pile of hoarded papers and school assignments or from the depths of my computer. So everyone can see how my writing has changed/improved over the years.


Ethics in medical research can sometimes be a blurry line, with ethical guidelines varying by country, and being far less clear cut than strictly quantitative issues. Such is the case with a study sponsored by the U.S. National Institute for Health, which was conducted in a developing country and is being reviewed for publication by Medical Science Review, a prominent journal that prints cutting edge research on medical issues. The study had stunning results: a simple, short, regimen which promises to cut HIV (Human Immunodeficiency Virus) transmission rates by 80%. While the study was scientifically sound, the morality is questionable, as researchers used a placebo-based control group, rather than either of the other treatments of HIV currently recognized: A long, and a short AZT regimen, which can be an exploitation of the lower economic status of research participants in these countries. The question is whether or not Medical Science Reviewshould publish this study. This paper will explore the ethicality and the moral fraughtness of this experiment, and conclude that, while not identical circumstances, this paper should be published just as other data, such as that obtained during Nazi experimentation, is used. The research should be published, as it is scientifically sound, and the damage done to participants who were ethically mistreated is only worsened by refusing to publish the results of the research. However, a foreword should be published along with it, condemning the unethical research practices.

There are two main ethical concerns which spring from this experiment, given the limited information we have on their research methods. The first being possible exploitation of a developing country and its people as test subjects. The other issue being with the use of a placebo-based control group itself, rather than a previously proven treatment of a long or short AZT regimen.

The first issue is the issue of possible exploitation of populations in developing countries. “The Declaration of Helsinki of the World Health Organization (WHO)…is widely regarded as providing the fundamental guiding principles of research involving human subjects.” (Angell 1) and is a primary source for parsing whether an experiment is ethically treating patients and can help determine if an experiment in a developing country is exploitative. The Declaration of Helsinki states “In research on man [sic], the interest of science and society should never take precedence over considerations related to the wellbeing of the subject,” (Angell 1), which essentially says arguments of an experiment being for a “greater good” or potential benefits to a large number of people does not outweigh a research participants moral rights to care and information. The benefit of the greater good was one way the Tuskegee experiment was justified, that the “study was important (a ‘never-to-be-repeated opportunity,’’ said one physician after penicillin became available)” (Angell 2) and that the results would be “valuable, but it was especially so for people like the subjects” (Angell 2), using an argument of the results leading to a common good to defend the unethical treatment of over 200 poor men of color, many of whom were denied care even after treatment for syphilis (which Tuskegee researched a cure for through deceit of patients) became available.

The Declaration of Helsinki also specifies that “in any medical study, every patient — including those of a control group, if any — should be assured of the best proven diagnostic and therapeutic method” (Angell 1). This part specifically mentions the control group, which in the case of the experiment at hand, was a placebo receiving group. “The Declaration of Helsinki requires control groups to receive the “best” current treatment, not the local one” (Angell 3), the best current treatment globally in this instance what have been a long or short AZT regimen, rather than a placebo for the control group. This is important because “acceptance of this ethical relativism could result in widespread exploitation of vulnerable Third World populations for research programs that could not be carried out in the sponsoring country” (Angell 3). In other words, if we opt for a “local standard of care” model, then researchers will have a scientific and financial interest in maintaining access to populations in which the standard of care is lower than in the United States. Adopting a local standard of care leads to increased possibilities for exploitative practices, allowing for the perpetuation of low-income developing nations and populations without access to quality healthcare, with the defense of researching on them being that a significant number of (significantly wealthier) people will benefit from the medical knowledge, which is the major concern with possible exploitation.

Beyond the issue of exploitation is the inherent moral grey area of using placebo-based control groups, despite being a fairly standard scientifically sound way of researching the effect of a new treatment. Some argue that there is no moral issue with placebo control groups as “some officials and researchers have defended the use of placebo-controlled studies in developing countries by arguing that the subjects are treated at least according to the standard of care in these countries, which consists of unproven regimens or no treatment at all” (Lurie and Wolfe 4). This argument used the local standard of care loophole previously discussed, which has its own issues of exploitative practices which can arise from this viewpoint. However, even though “the citizens of these impoverished countries may indeed have a moral right to a better standard of living…this is almost certainly a claim that will be unredeemed for the foreseeable future” (Crouch and Arras 28). While it can be acknowledged that the local standard of care is not an optimal approach to research in a developing country, in particular instances where the main benefit is to people living in those populations, whatever progress which can be made until inequalities in healthcare can be overcome are better than nothing. Often, the global standard of care is not available to these studied populations, mostly due to economic inequalities. Until those inequalities are overcome “[woman in the] Third World would not receive…treatment anyway, so the investigators are simply observing what would happen…if there were no study” (Angell 2). Finding a new treatment may not be as effective but is better than nothing. As, “a placebo-controlled study is the fastest, most efficient way to obtain unambiguous information that will be of greatest value in the Third World” (Angell 2) and while not the preferred option “the inclusion of placebo controls ‘will result in the most rapid, accurate, and reliable answer to the question of the value of the intervention being studied compared to the local standard of care’” (Angell 2). This is the specific condition in which the research at hand would be considered ethical in its use of a placebo group – when it is used to benefit the population being studied, and not as a cost cutting measure. We are not given the researcher’s motivations however, and so it is unclear if the placebo group was carried out ethically.

However, some researchers take issue with placebo-based control groups for their adoption of the local standard of care in cases such as this and argue that what are termed “equivalency studies” by Lurie and Wolfe be used in their place. Equivalency studies, simply put, use the best-known method of treatment as the control group, rather than a placebo. These researchers “believe that such equivalency studies of alternative antiretroviral regimens will provide even more useful results than placebo-controlled trials, without the deaths of hundreds of newborns that are inevitable if placebo groups are used” (Lurie and Wolfe 3). The issue with equivalency studies is exactly why placebo studies are still a norm in many cases. “This proposed method…would have the undesirable effect of preventing researchers from answering the most meaningful questions that motivated the research in the first place” (Crouch and Arras 29). What is meant here, is that, if the point of the research experiment is to find a treatment which would work and be available in this specific developing country, comparing results to a treatment they have no access to would be pointless, even if placebo trials do wrong by these populations ethically, the economic systems in place have made it impossible to give them the equal healthcare they have a moral right to from the start, so placebo trials are simply working within the confines of the system, even if they are less preferable ethically. A particular condition to ensure placebo trials are not exploitative in nature is that the results will benefit the host country in particular, and that the condition of a placebo group arises from a need to establish a baseline and lack of available treatment, not from attempts to cut costs in developing countries to benefit wealthier populations. Because “even if the organizers were well intentioned, their research may nevertheless violate ethical canons if its positive fruits are not made reasonably available to former research subjects and other inhabitants of the host country” (Crouch and Arras 30).

The argument against the publication of this study rests on the ways it can be viewed as unethical. Without knowing the researcher’s intent to provide care for participants of the study post-experiment, and whether the research is intended to benefit the population the research was conducted in, the question of exploitative practices is highly possible but uncertain, as the motivation and reasoning behind the research methods were not disclosed for this experiment. As examined previously, it is possible to conduct placebo-based research in a developing nation without being explicitly exploitative, as long as the caveats of the Declaration of Helsinki are followed, and the local standard of care is used only to benefit that population itself. If these conditions are not met, the research is unethical, and some may argue should not be published. Arguments against publication might also see allowing the study to be published as showing researcher they can get away with unethical studies which are scientifically sound, because being published is a reward for the bad behavior, a sort of perverse or backwards incentive. Arguments for publication rest on the previously discussed ways these types of experiments can be ethical, or at least, as ethical as possible while operating within the confines of the economic inequalities in place systematically, with one of the goals of research improving healthcare in developing areas to help this gap narrow. Though in this case placebo-based trials are acceptable, a preface explaining why it is reasonable in this instance and precautions taken to limit or prevent exploitative practices should be published with the research, explaining the ultimate goals of helping the developing population at hand, because that it the condition it would take for this experiment to have been ethical or not.

Regardless of whether or not the experiment was exploitative or not, and thus ethical or not, the research should still be published, with a preface detailing all ethical concerns of the experiment. We simply do not know which would apply, as we do not have all the details of how patients were treated or how results are going to be used. There is historical basis for using scientifically sound data with morally questionable background. During World War II, “Nazi scientists performed brutal experiments on Jews and gypsies in the concentration camps” (Wilkerson), and there were “experiments in which the Nazis used hundreds of people to test human reaction to long-term exposure…while they monitored their subjects’ deaths.” (Wilkerson). While these experiments were clearly unethical, the results and data are still used in mainstream science as “it served no purpose to science to ignore data that could help people…The wrongs perpetrated were monstrous; those wrongs are over and done. How could the provenance of the data serve to prohibit their use?” (Wilkerson). This historical basis shows as that, even if the study at hand were proven to be unethical in their choice to use a placebo-based trial, the study should still be published, as the damage which has been done is done, and ignoring the results does not help anyone. The study could still be published, whether or not it was found to be truly unethical.

It is possible to use data that is obtained unethically, because the damage done to people cannot be undone, and using the research does not worsen their suffering. Research methods cannot be ignored, “however hard we might try, we cannot separate the data from the way they were obtained” (Wilkerson), and it is important not to separate the data from its methods, because that allows for complacency and forgetting the past, that is what allows for exploitative practices benefiting a greater good, what leads to looking the other way and allowing another Tuskegee incident, as mentioned earlier in the paper. There is “benign acceptance of Nazi data in modern-day science and the occasional, matter-of-fact reference in contemporary scientific papers. ‘Nazi data…is absorbed without comment into mainstream science,’ Dr. Caplan [director of the Center for Biomedical Ethics at the University of Minnesota] said. ‘That I find disturbing.’” (Wilkerson). It should be disturbing. You should understand where data comes from, and what the cost of it was. “It should be used if the circumstances under which it was conducted are acknowledged” (Wilkerson), meaning that the research at hand could be published, so long as ethical concerns of the study are addressed alongside its publication.

If data obtained from Nazi research can be used ethically, though the research itself was not ethically done, then the same applies in this instance. We do not know the exact conditions of the experiment conducted, and so we cannot know whether the placebo-based control group was used for an ethical or exploitative reason. Whichever is the case, the research should be published by Medical Science Review, as the data is potentially valuable, and the experiment is scientifically sound. However, along with publication, acknowledgement of possible ethical issues of exploitation and the ultimate goals of achieving better local standards of care which justify the use of placebo trials should be published along with the data in the form of a preface or foreword, so that neither ethical issues nor the bigger picture can be forgotten or ignored. Provided the research is proven to have been done ethically, the foreword could detail the conditions under which it is ethical, especially the condition of serving the specific population studied, and working to narrow the healthcare gap between developing and developed countries. If the study is found to be unethical, the study should still be published, but the foreword should describe the ways it was unethical, the conditions which would have made it ethical, and show that the unethicality of the research method is neither ignored nor condoned by the journal.


Works Cited

Angell, Marcia. “The Ethics of Clinical Research in the Third World.” New England Journal of Medicine, vol. 337, no. 12, 1997, pp. 847–849., doi:10.1056/nejm199709183371209.

Crouch, Robert A., and John D. Arras. “AZT Trials and Tribulations.” The Hastings Center Report, vol. 28, no. 6, 1998, p. 26., doi:10.2307/3528266.

Lurie, Peter, and Sidney M. Wolfe. “Unethical Trials of Interventions to Reduce Perinatal Transmission of the Human Immunodeficiency Virus in Developing Countries.” New England Journal of Medicine, vol. 337, no. 12, 1997, pp. 853–856., doi:10.1056/nejm199709183371212.

Wilkerson, Isabel. “Nazi Scientists and Ethics of Today.” The New York Times, The New York Times, 21 May 1989, www.nytimes.com/1989/05/21/us/nazi-scientists-and-ethics-of-today.html.

 

 

Throwback Thursday: Obesity Is Not A Disease

Throwback Thursday, where, essentially I post old writing samples, essays and short stories that I dig up from my pile of hoarded papers and school assignments or from the depths of my computer. So everyone can see how my writing has changed/improved over the years.


Obesity, once merely a risk factor for diseases, has been reclassified as a disease as of 2013, as “the…AMA[1]…endorsed further medicalization… of obesity…Obesity, once considered a risk condition for diseases…has now, itself, been classified as a disease by the AMA” (Reiheld “Aiming at Body Size”). Society understands obesity as being significantly overweight. This is not the exact medical definition, which will be examined shortly, but essentially leads laymen to conclude that being extremely overweight is a disease. However, obesity itself is not necessarily a disease, and should not be considered one. Though for some people it can cause disease, in others obesity mostly causes changes in appearance and Body Mass Index (BMI) but not in overall health. The AMA has classified other not-necessarily-diseases as disease in the past[2]to increase availability of treatment for those who need or seek it. Obesity should be considered a medical risk condition – and treated and monitored as such – but should not be termed a disease.

The definition of obesity may colloquially be the condition of being severely overweight, but the exact definition varies. The Merriam-Webster Dictionary defines obesity as “a condition characterized by the excessive accumulation and storage of fat in the body,” while the CDC defines obesity as “BMI is 30.0 or higher…falls within the obese range”. The Obesity Medicine Association (OMA) defines obesity as “a chronic…disease, wherein an increase in body fat…result[s] in adverse metabolic, biomechanical, and psychosocial health consequences.” Though it is important to note two major distinctions between the CDC and OMA’s definitions: first, the OMA uses BMI, abdominal circumference, and body fat percentage in diagnoses, not only BMI. Second, the OMA paints a far more classical image of disease than the CDC does for obesity, but each boils down to the same medical definition of being overweight by a specific margin or greater. The Merriam-Webster definition does not define obesity as a disease, but a condition of excessive fat on the body, essentially the same definition, in less disguised language.

The language disguises the issue of conforming to western beauty standards, specifically the notion that being skinny is beautiful and the natural state for human beings. These definitions which revolve around body fat reinforce the notion that anyone not conforming has something specifically wrong with them. This is prominent in society in a variety of ways, an example being that “overweight women seen eating apparently unhealthy foods are far more likely than… “ideal”-weight women to be publicly corrected for what they eat” (Reiheld “Women and Responsibility for Health”). This shows how the focus has been shifted from health to body-type when it comes to food and extends to medical diagnoses.

There is a stigma that surrounds overweight bodies, based on a supposed choice to be unattractive. Attractiveness is not something which can be medically addressed, and so weight is used as a proxy to shame individuals, since “we know how to make overweight people miserable, but we have no idea how to make them thin” (Freidenfelds “The Problem”). It is not always about losing weight. For some obese people with other underlying medical causes, as obesity can be a symptom of other diseases such as hypothyroidism, it is about conforming to societal standards. Medical risks are used as an excuse to police fat bodies; whereas when a skinny person is unhealthy, no one’s first thought is their weight.

Though weight can play a role in disease (obesity can for example increase risks of heart disease, high blood pressure, etc.) it is not the sole cause and should not be conflated as such. Considering obesity a disease allows for outside judgement and can cause outside pressure to control factors of health or diet that are not always directly in a person’s control or directly responsible for their obesity. It is also important to note “how damaging the ‘war on obesity’ has been…turning food and bodies from sources of pleasure to sources of dread and shame” (Freidenfelds “The Problem”). The medicalization of obesity only allows for the exacerbation of these problems and shaming. We should not consider obesity a disease in and of itself, it should be considered a risk condition for disease, as “weight and fat distribution have little to do with overall health” (Klein “Body Image”).

For example, smoking increases lung diseases such as Chronic Obstructive Pulmonary Disease (COPD) and lung cancer, but is not itself a disease, despite being considered a poor choice by society. While obesity is not a choice (though part of fat-phobia is the assumption that it is, at least in part) it functions similarly as a risk factor. Obesity, much like smoking, is not an easily changed part of a person and their body. Similar risk factors with this comparison are age, the condition of menopause, and pregnancy all of which are also inalterable, also not a disease. It is also particularly telling that being underweight is not a disease, it is still considered a risk factor. While obesity has been medicalized, being severely underweight has neither been given a name nor medicalization, which shows how “the overwhelming cultural understanding of health in our society emphasizes being slim and muscular” (Klein “Body Image”).

Some might argue that medicalizing obesity can decrease the stigma surrounding it. Medicalization can decrease stigma over some medical conditions, such as autism, but not in every instance. For example, the medicalization of HIV/AIDS has done nothing for the stigma which surrounds it and which “is highly value-laden because of its association with socially unacceptable behaviors” (Reiheld “Patient Complains of…” 83). Similarly, medicalization does not destigmatize obesity because it does not address the root concern of value attached to that condition by society. While medicalization offers acceptability to autism by putting a name to the behavior, HIV and obesity are similarly not granted acceptability because they are still stigmatized as being the result of a poor choice.

Medicalization reifies the thought that obesity is wrong or unnatural and can pin a negative label on individuals who others might not have had the stigma, as obesity visually and physiologically varies by person. This is the very definition of a reification, to make something or equate something as a fact of nature rather than a social construct (Reiheld “Patient Complains of…” 77). Reification allows for the perpetuation of current stigma and societal norms. Medicalization of a reified disease like obesity brings more aspects of our lives under expert control, allowing for the continuation of this reification, in a vicious cycle (Reiheld “Patient Complains of…”). Obesity should be treated as a medical condition, as it can carry health risks, but over-medicalization can have significant inherent risks as well (Freidenfelds “The Problem”).

In order to consider the issues with medicalizing obesity and the reason for its medicalization one must consider the definition of disease before defining obesity as a disease. A disease is defined as “a disorder of structure or function in a human… especially one that produces specific symptoms…and is not simply a direct result of physical injury.” (Oxford Dictionary). Compare this to the definition of a risk factor, “something that increases the chance of developing a disease…examples of risk factors…are age, a family history…use of tobacco products…and certain genetic[s].” (National Cancer Institute). Obesity is not a disorder to the structure or function of a human being – weight can be determined by genetic predisposition or lifestyle, but being overweight, compared to the average weight for a person of a specific gender, height, and age, is not always, or even often, due to a disorder of some kind (such as a thyroid disorder).[3]  It is important to note here, “all adults categorized as overweight and most of those categorized as obese have a lower mortality risk than so-called normal-weight individuals. If the government were to redefine normal weight as one that doesn’t increase the risk of death, then about 130 million of the 165 million American adults currently categorized as overweight and obese would be re-categorized as normal weight instead” (Campos “Our Absurd Fear of Fat”). This demonstrates that the problem being addressed by medicalizing obesity is not health, it’s weight itself.

Obesity more closely aligns with the definition of a risk factor, as it can increase the chance of heart disease, etc. Boorse defines disease as “a type of internal state which impairs health, i.e. reduces one or more functional abilities below typical efficiency” (Boorse 555). Obesity in and of itself does not impede functionality of the human body, so Boorse would not consider it a disease. Only in cases such as those where breathing difficulties or heart disease developed in causation to the obesity would Boorse possibility see obesity as a disease for some individuals and not for others, depending on how functioning was impaired by varying symptoms. Obesity leads to increased risk of certain disease but does not always or even necessarily cause them.

However, one significant benefit to the medicalization of the condition as a disease is increasing access to resources and treatments, such as liposuction, therapy, and support groups. Medicalization increases access to these treatments and preventative measures such as nutrition counselling by increasing insurance coverage and encouraging patients to seek these treatments. There is another side to this though. If medicalization of obesity increases access to treatment, it increases the way treatment may be forced on individuals who may not want or even really need to be treated. In these situations, it is important to know that “baselessly categorizing at least 130 million Americans — and hundreds of millions in the rest of the world — as people in need of “treatment” for their “condition” serves the economic interests of, among others, the multibillion-dollar weight-loss industry and large pharmaceutical companies,” (Campos “Our Absurd Fear of Fat”). Medicalization of obesity may have come about from a standpoint of social stigma and economic value, rather than health concerns, which is not the reason a disease should be labeled as such.

The major issue with these definitions in medicalizing obesity is that they lose the nuances of obesity and distill it as a commonly experienced disease. Obesity does not have a singular cause nor a singular presentation. Obesity can be experienced by a person in name or appearance only, being overweight with a BMI over 30, but with no other symptoms or health issues experienced at all. Obesity can be caused by genetic predisposition and slow metabolic rate, or simply be the result of poor diet and exercise habits, neither of which distinctly must be classified as a disease, let alone grouped together as a singular disease. In fact, “we don’t know whether the small increase in mortality risk observed among very obese people is caused by their weight or by any number of other factors, including lower socioeconomic status, dieting and the weight cycling that accompanies it, social discrimination and stigma, or stress.” (Campos “Our Absurd Fear of Fat”).

Using these definitions of a BMI over 30, some conditions which are not typically seen as obesity would carry the connotation, stigma, or be misdiagnosed as obesity with this as the diagnosis criteria. Examples can include a bodybuilder, who might have a BMI over 30 due to weight in proportion to height, but would not be considered obese by any health professional or layman who happened to see him, despite the BMI being the CDC’s criteria for diagnosis. This is because the definition of obesity as a disease is about standards of beauty and fat shaming, not about technicalities over BMI. Otherwise, obesity would have remained a risk factor, not a disease, or being severely underweight also would have been classified as a disease, whereas it is still considered an unhealthy risk factor.

Another disease which may fall into the categorization of obesity is Cushing’s Disease. Cushing’s Disease, also calledhypercortisolism, is caused by overexposure or overproduction by the body to the hormone cortisol. Cushing’s can cause obesity, and its other major symptoms, high blood pressure and diabetes are easily mistakenly attributed to obesity (Mayo Clinic). To diagnose obesity as a disease in and of itself, it may discourage further investigation or diagnoses, and may lead to the misdiagnosis of diseases which can cause obesity, as solely obesity itself.While Cushing’s falls into the BMI over 30 requirements, it is drastically different than traditional obesity and can cause harm if mistreated or misdiagnosed. There is also a common history of medical professionals ignoring other health concerns because of the appearance of obesity, which can be harmful and stigmatizing to individuals with disease which could be mistaken for obesity.

Obesity should be classified as a medical condition, and deserves treatment for those who want it, but calling obesity a disease does more harm than good, as this ignores the nuances and different forms obesity can take, as well as ignoring the stigma a diagnosis of obesity can carry.


Works Cited

Boorse, Christopher. “Health as a Theoretical Concept.” Philosophy of Science, vol. 44, no. 4, 1977, pp. 542–573., doi:10.1086/288768.

Campos, Paul F. “Opinion | Our Absurd Fear of Fat.” The New York Times, The New York Times, 19 Oct. 2018, mobile.nytimes.com/2013/01/03/opinion/our-imaginary-weight-problem.html.

“Cushing Syndrome.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 6 Mar. 2018, http://www.mayoclinic.org/diseases-conditions/cushing-syndrome/symptoms-causes/syc-20351310.

“Defining Adult Overweight and Obesity.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 16 June 2016, www.cdc.gov/obesity/adult/defining.html.

“Definition of Obesity.” Obesity Medicine Association, 29 Aug. 2017, obesitymedicine.org/definition-of-obesity/.

“Disease | Definition of Disease in English by Oxford Dictionaries.” Oxford Dictionaries | English, Oxford Dictionaries, en.oxforddictionaries.com/definition/disease.

Freidenfelds, Lara. “The Problem with Fat-Talk at the Pediatrician’s Office.” Nursing Clio, 13 July 2016, nursingclio.org/2016/07/13/the-problem-with-fat-talk-at-the-pediatricians-office/.

Klein, Ula. “Body Image, BMI, and the Continuing Problem of the Standards of Beauty.” IJFAB Blog, 15 Apr. 2014, www.ijfab.org/blog/2014/04/body-image-bmi-and-the-continuing-problem-of-the-standards-of-beauty/.

“National Center for Health Statistics.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 3 May 2017, www.cdc.gov/nchs/fastats/obesity-overweight.htm.

“NCI Dictionary of Cancer Terms.” National Cancer Institute, www.cancer.gov/publications/dictionaries/cancer-terms/def/risk-factor.

“Obesity.”Merriam-Webster, Merriam-Webster, http://www.merriam-webster.com/dictionary/obesity.

Reiheld, Alison. “Aiming at Body Size: How Medicalizing Obesity Changes the Very Notion of What It Is to Be Healthy.” IJFAB Blog, The International Journal of Feminist Approaches to Bioethics, 16 June 2014, www.ijfab.org/blog/2014/06/aiming-at-body-size-how-medicalizing-obesity-changes-the-very-notion-of-what-it-is-to-be-healthy/.

Reiheld, Alison. “Patient Complains of . . .: How Medicalization Mediates Power and Justice.” International Journal of Feminist Approaches to Bioethics, vol. 3, no. 1, 2010, pp. 72–98., doi:10.2979/fab.2010.3.1.72.

Reiheld, Alison. “Women and Responsibility for Health: Food, Physical Activity, and Feminism.” International Journal of Feminist Approaches to Bioethics, 8 Oct. 2014, www.ijfab.org/blog/women-and-responsibility-for-health-food-physical- activity-and-feminism/.


[1]American Medical Association (AMA)

     [2]Boorse argues minor ear deformities and the like fall into this category, as his definition of disease boils down to: that which impairs normal function, according to a reference class of the same species, age, and gender (Boorse, 555). Some which considered autism as a different way of living rather than a true disease would also apply autism to this statement.

     [3]It is important to note that, if this idea of a reference class of specific age, gender, and height is being used to classify what the line for overweight is, the percent of adults aged 20 and over with obesity is 39.8% (CDC).

 

Throwback Thursday: PAS Essay

Throwback Thursday, where, essentially I post old writing samples, essays and short stories that I dig up from my pile of hoarded papers and school assignments or from the depths of my computer. So everyone can see how my writing has changed/improved over the years.


The right-to-die, sometimes termed “death with dignity” is fraught with legal and moral issues. Currently in the United States, there are seven states plus the District of Columbia where there is a “right-to-die”, defined as “suicide by a patient facilitated by means or information (as a drug prescription or indication of the lethal dosage) provided by a physician aware of the patient’s intent” (Merriam-Webster Dictionary). This definition is vital to the case of Jane Doe, a woman who wishes to end her life due to chronic illness and pain. Jane Doe has cerebral palsy, is nearly entirely paralyzed (save for her right hand and face), and suffers from degenerative arthritis which causes constant pain that cannot be relieved entirely, even with medication, including morphine. She requires constant care, which her family will not provide. On top of this, she has no job (and no income), no home, and no hope of getting help (except through public assistance). Being forced to continue to live would be physical, and likely emotional, agony. She wants to undergo a sort of physician-assisted-suicide; she asked to be given pain medicine and hygienic care while she slowly commits suicide by starving herself.

Before we can determine whether Jane Doe’s choice to die should be granted to her, we must examine whether she has the right to make this choice at all. In “The Refutation of Medical Paternalism” Goldman states “​paternalistic assumption of authority… is…unjustified…the independent value of self​ determination or freedom of choice” (Goldman, 98) and ​establishes that the value of the choice lies not in the choice itself, but in the very ability to make the choice for oneself. To be denied choices of her own body when she is already limited in what she can and cannot do is cruel, and while Ackerman claims in “Why Doctors Should Intervene” that sickness can impede autonomy, this thought is based in the “​transforming effects of illness…​.autonomous behavior is governed…through deliberation” (Ackerman, 99). Ackerman also specifies that autonomy can be regained; that illness can impede autonomy is a thought that stems from the effects of a recent diagnosis. ​Jane Doe’s is not a recent diagnosis but one she has lived with and deliberated over for years, having done everything at this point that a physician can do to give her back her autonomy. Jane Doe has been declared mentally competent, and is not suffering from anxiety or depression. Thus, Jane Doe’s autonomy is not to be intervened with.

In terms of autonomy directly in cases of assisted-suicide, in “Against the Right to Die” Velleman establishes that patients shouldn’t be offered the choice of physician-assisted suicide or similar means of ending their lives, but should have the ability to request it, legally and morally, and it is up to the physician to grant that request or not. While he establishes autonomy in this case differently he does establish that morally “I strongly believe that a person’s life can sometimes be made worse by being prolonged, and that a swift and painless death can then be a benefit.”(Velleman, 667). Jane Doe is asking for the doctor not to interfere with her choices, a choice established by Robert Misbin that “Proponents of…​physician-assisted suicide​ claim that the principle of respect for autonomy requires that patients be allowed to choose the manner of their death.” (Misbin), a choice established by Velleman as one that, though she may not have the right to demand, she does has an innate right to request, because it is her body, her life, and her choice.

 

Jane Doe has the right to request to die, though not to demand it, which takes us to the physician’s right to refuse to grant physician-assisted suicide. Established by Velleman is that “physicians should have permission to administer voluntary euthanasia, but patients should not have a right to receive it.” (Velleman, 1) establishing the right to refuse, but Ackerman specifies all choices at the physician’s discretion should be made with the patients intentions and interests in mind – not the doctor’s. The physician’s right to stick to their own morals and values stems from the promise of “first do no harm.” (Thomas Sydenham). But is physical or emotional harm worse? What constitutes harm at all? In a similar vein, Goldman states the that the “c​oncept of harm independent of individual differences…when the development of an individual capable of freely and creatively formulating and acting to realize central life projects is blocked, that person is harmed” (Goldman, 94).​ In other words, while the doctor may wish to prolong Jane Doe’s life, morally he is doing her a disservice because it is not where her interest lies. Her interest lies in not being in pain, and in not burdening society because she has no family willing to care for her. She is of sound mind and has not been coerced or pressured into her choice of death by having it offered to her, and by being forced to live against her will, the physician in inflicting more harm on her, physically and emotionally. This directly counteracts the moral claim of “first do no harm” (Thomas Sydenham) because harm in medical contexts should be defined by what the patient considers harm, even if the doctor is the one who took the oath. Moreover, if the physician’s moral concern is being complicit in her death, this is not a usual physician-assisted-suicide case.

There are key differences between her plan and legally termed physician-assisted-suicide, most notably that she did not actively ask the medical practitioner to assist in her death — lethal medication, etc. — she asked to not be interfered with. How does this differ from something like hospice care for a patient with a Do Not Resuscitate Order (DNR)? A DNR is defined medically as “​do ​not​ ​resuscitate​ ​(used​ in ​hospitals​ ​and​ ​other​ ​health-care​ ​facilities​ to ​indicate​ to ​the staff​ ​the decision​ of a ​patient’s​ ​doctors​ ​and​ ​family,​ or of ​the​ ​patient​ by a ​living​ ​will,​ to ​avoid extraordinary means​ of ​prolonging​ ​life).” (​Random House Unabridged Dictionary). In the case of Jane Doe, the physician’s idea of forcing a feeding tube on Jane Doe to prolong her life (so she would not starve) would be considered extraordinary, an interference to the natural state she wishes her body to remain in.

Jane Doe did not request physician-assisted-suicide in the traditional way it is thought of. She did not ask for assistance with the direct act of ending her life, she did not request a lethal dose of medication or information of a lethal dose. She requested palliative and hygienic care while she ended her own life through starvation. She requested pain management while her life came to an end, and for that end to not be interfered with by means such as force feeding. You could argue that this is the same as requesting a DNR. DNRs are very common for patients under hospice care who want to die naturally. A doctor cannot be forced to comply with right-to-die because of their own morals, but they do have to adhere to a DNR. Jane Doe did not ask for help in her death, she simply asked for palliative care, similar to a DNR, a request for death not to be interfered with, not a request that her suicide be assisted (ie. not a request for euthanasia – doctor is not directly complicit in her death). Patients can choose a DNR and can choose not to undergo a treatment even against medical advice. While a patient cannot demand assisted-suicide, a physician cannot force treatment on a patient that is not wanted; patients cannot demand treatment but can object to treatment. In Jane Doe’s case, she is rejecting help eating, likely a feeding tube of sorts. This treatment cannot be forced on her without violating her autonomy. She her request must be granted, as it doesn’t fall exactly under the parameters of assisted-suicide and thus cannot be denied.

If Jane Doe were in a right-to-die state, this case would never end up in front of the ethics board, because of set guidelines in place for dealing with cases where a physician denies a request for physician-assisted-suicide. Among other options another doctor in the hospital would likely grant her request. A request that she legally has a right to, though her doctor could refuse it. So let us assume she is not in a right-to-die state, and that her specific request does not qualify for right-to-die. Physician-assisted-suicide, as defined earlier, is dependent on active involvement on the physician’s part, ranging from lethal dosage of a medication to providing information of what a lethal dosage would be. Jane Doe is asking for even less action – she is requesting an inaction. Jane Doe’s request to be allowed to starve herself is the definition of an inaction on the physician’s part. The physician is asked to do nothing to interfere with her natural death – the very definition of a DNR. Her request should still be granted, because voluntary physician participation is based on the key component of death with dignity that puts the physician directly responsible for the end of the patient’s life – which is not the case for Jane Doe who is not asking for physician assistance and is actively asking for non-interference.

A non-medical example of this can be seen in having someone you care about move to another country. You don’t have to agree, you don’t have to help them move, but you can’t tie someone down and make them stay – they will just find a worse, more dangerous way to do it. If you stop someone from getting on a large airline, they might get on a less legal one if they are very determined. If someone is denied a visa, they may illegally sneak into a country. No matter how bad an idea you think it is, you cannot stop a legal adult from moving to another country, because it is their life, and they feel the benefits outweigh the risks or problems. This can be likened to legally seeking physician-assisted suicide, or in Jane Doe’s case, to starve herself in the hospital with pain management and hygienic care, which if refused, can lead to a person trying to take their lives outside of the controlled setting, leading to worse outcomes like overdoses, failed attempts, longer more painful deaths, and the emotional toll on whoever will find the body.

The case of Jane Doe’s request for assistance in her death is brought before the ethics board of the hospital. We’ve established that she has the right to request assisted suicide, but that in the case of assisted suicide, the physician has the final say in granting said request. While this is true, and a physician cannot be forced to grant a request for assisted suicide even in a right-to-die state. However, Jane Doe’s case is closer to a request for hospice care and a DNR rather than the exacting parameters of physician-assisted-suicide, and as a DNR cannot be denied, the physician is obligated to grant her request, even if he disapproves.

 


Works Cited
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Goldman, Alan. “The Refutation of Medical Paternalism.” In ​Bioethics: Principles, Issues, and Cases,​ edited by Lewis Vaughn, 2nd ed., 93–98. New York: Oxford University Press, 2013.

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“Take Action – States with Assisted Dying Laws.” ​Death With Dignity,​www.deathwithdignity.org/take-action/.

Velleman, J. David. “Against the Right to Die.” ​The Journal of Medicine and Philosophy ​17 (1992): 665– 81.