Sunday, August 5, 2018
Today, I'll take a break from controversy. Let's talk about literature.
In 2003 the President’s Council on Bioethics published an anthology about bioethical dilemmas. It was a surprising contribution by a government committee. Such bodies are better known for generating reports which are dismal, dull, dreary and destined for pulping.
The selections in the anthology ranged from J.M. Barrie’s Peter Pan to Plutarch. Not only were they thought-provoking, but also enjoyable. At the time I thought it was the last word in the literature of bioethics, but since then I have discovered other texts.
One of these, which I highly recommend, is the Japanese novel The Sea and Poison, by Shusaku Endo, who, like Graham Greene, was a perpetual also-ran for the Nobel Prize. Endo is better known in the West as the author of Silence, which Martin Scorsese recently made into a film.
Silence was a 1966 historical novel about the apostasy of a Catholic priest in 17th Century Japan. The Sea and Poison, an earlier work published in 1958, is also about tormented consciences. It is based on an incident which happened shortly before the end of World War II, when Japanese doctors vivisected several American POWs. The focus of the story is not the gory procedure, which is described very briefly at the end of the novel, but the inner lives of the doctors and nurses. How could they have allowed themselves to participate in something which was so clearly evil? It’s extraordinarily insightful – and very relevant at a time when we are debating conscientious objection.
The Sea and Poison is out of print in English, but can easily be obtained second-hand on the internet. It’s well worthwhile for anyone teaching bioethics.
In 2003 the President’s Council on Bioethics published an anthology about bioethical dilemmas. It was a surprising contribution by a government committee. Such bodies are better known for generating reports which are dismal, dull, dreary and destined for pulping.
The selections in the anthology ranged from J.M. Barrie’s Peter Pan to Plutarch. Not only were they thought-provoking, but also enjoyable. At the time I thought it was the last word in the literature of bioethics, but since then I have discovered other texts.
One of these, which I highly recommend, is the Japanese novel The Sea and Poison, by Shusaku Endo, who, like Graham Greene, was a perpetual also-ran for the Nobel Prize. Endo is better known in the West as the author of Silence, which Martin Scorsese recently made into a film.
Silence was a 1966 historical novel about the apostasy of a Catholic priest in 17th Century Japan. The Sea and Poison, an earlier work published in 1958, is also about tormented consciences. It is based on an incident which happened shortly before the end of World War II, when Japanese doctors vivisected several American POWs. The focus of the story is not the gory procedure, which is described very briefly at the end of the novel, but the inner lives of the doctors and nurses. How could they have allowed themselves to participate in something which was so clearly evil? It’s extraordinarily insightful – and very relevant at a time when we are debating conscientious objection.
The Sea and Poison is out of print in English, but can easily be obtained second-hand on the internet. It’s well worthwhile for anyone teaching bioethics.
 Michael Cook Editor BioEdge |  |  |  |
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A difficult and controversial ruling viewed from a lawyer’s perspectiveDoctors’ well-being is suffering because of ‘moral injury’
by Michael Cook | 4 Aug 2018 |
In trying to understand post-traumatic stress disorders amongst soldiers, psychologists have developed the notion of “moral injury”. This is an injury to an individual's moral conscience after a moral transgression which leads to deep shame. In war, this might happen after soldiers have killed civilians or child soldiers.
In a recent article on Stat, two doctors argue that something similar is happening to American doctors. “Failing to consistently meet patients’ needs has a profound impact on physician wellbeing — this is the crux of consequent moral injury.” With the increasing complexity of medical practice, the potential for moral injury is growing.
The authors insist that moral injury is not just burnout – which is certainly a big problem amongst doctors. Its major symptoms are “exhaustion, cynicism, and decreased productivity”. But moral injury arises from the ethical frustration being unable to achieve what most doctors entered the profession to do: to heal their patients.
Navigating an ethical path among such intensely competing drivers is emotionally and morally exhausting. Continually being caught between the Hippocratic oath, a decade of training, and the realities of making a profit from people at their sickest and most vulnerable is an untenable and unreasonable demand.
“Moral injury” is a relatively new insight into doctors’ lives, although it has been studied amongst veterinarians. One paper argues that vets can endure considerable “moral stress” when they are asked to euthanize animals simply for the convenience of their owners. An Australian bioethicist has even contended that it exists amongst doctors who perform euthanasia in Belgium. “There is considerable moral injury occurring among the practitioners as it is opposed to the traditional ends of medicine,” says Dr Megan Best.
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