Saturday, May 26, 2007

A modest proposal regarding 'bioethicist'

At some point, someone made up the term 'bioethicist' to refer to a person who does bioethics. I am not sure anyone (even Albert Jonsen) knows who created the term or when. But with all those harsh 'c' and 's' sounds, I do know it is a horrible thing to pronounce. Any discipline whose practitioners cannot be referred to without spitting is hard to take seriously. The situation would not be improved by adding some other suffix: if anything, 'bioethician' is worse than 'bioethicist.' Bioethician looks good on paper (close to 'physician'), but just try saying it. You can't.

So let's drop 'bioethicist' altogether. Replace it with 'bioethics worker.' The same goes for 'ethicist': ethics worker. For one thing, the change in terminology shows solidarity with sex workers, and it suggests (correctly) that we are all prostitutes in one way or another, doing undesired things in order to pay the rent. 'Bioethicist' gives the false impression of a (well-paid) expert in the realm of values, somehow elevated above the common folk, making pronouncements; whereas a 'bioethics worker' lives with those affected by the issues he or she studies, gets his or her hands dirty, faces the risk of occupational hazards and injuries. 'Bioethics worker' is a better description of the activity, and at least you can say it.

Just eat it?

In regard to food, consumers in capitalist economies are both powerful and increasingly vulnerable. On the one hand, the varieties of relatively affordable foods available are astounding. Supermarkets are local exhibitions of globalization, with fruits from Jamaica and vegetables from Japan and seafood from Thailand in stock 24/7. But consumers often have little time to cook for themselves -- home cooking seems to be on the decline -- much less carefully check the ingredients of every little thing that they are putting into themselves. The obesity epidemic in developed countries indicates that much of 'processed' and 'prepared' food is just plain bad for you. But there are also signs that some foods circulating in the global economy may be downright hazardous.

China has been in the spotlight lately. There was the recent scandal involving the deaths of domestic pets in the US caused by the presence of an industrial chemical (melamine) in a Chinese pet food company product. But if it can happen with pet food, it can happen with food destined for human consumption, because the problems have a common and familar root: the desire for as big a profit margin as possible by producing goods using the cheapest means (including labor) under the least amount of regulatory oversight. National Public Radio has a piece on China and the increasing US dependence on its cheap exports, including food and food ingredients, that makes for chilling reading. Toothpaste from China is currently being tested by the FDA for diethylene glycol (a chemical used in antifreeze); when it turned up in cough syrup in Panama last year, it was responsible for 51 deaths. There is an anecdote about companies speeding up the drying process of herbal tea by laying the leaves out in large quantities and driving trucks over them, using the exhaust of the trucks as 'dryer'. Unfortunately, Chinese trucks use leaded gasoline. Another shocker is the presence of antibiotics in Chinese fish and seafood, which is apparently meant to counteract the effects of the polluted waters they were raised in. Bon appetit.

Should bioethicists bioethics workers weigh in on such issues? Or should they stick to the standard repetoire of bioethics issues: abortion, euthanasia, informed consent, reproductive health, genetic research and access to health care? Taking the 'bio' in bioethics seriously means being prepared to understand and discuss any ethical issues raised by developments that seriously impact on human health and well-being. This means, as David Resnik argues in a recent Bioethics Forum, analyzing the ethical issues raised by the myriad interactions between humanity and the natural environment. It also means discussing the dependence and vulnerability of food consumers, food safety, the politics of global markets, and the role of national and international regulatory bodies. Eating always requires a certain amount of trust, but it shouldn't involve a leap of faith.

Thursday, May 17, 2007

Ethical limits of physician's care for patients?

What sacrifices should health care workers be prepared to make in order to provide care to their patients? In affluent societies, this question is usually raised hypothetically in regard to patient care during epidemics of highly infectious and deadly diseases. Should doctors treat patients when doing so poses grave risks to themselves?
In Zimbabwe, a similar question is raised by routine medical care in a context of political, economic and social disintegration. And the medical corps in the state hospitals answered it, in a sense, by going on strike for the last months, and paralysing the nation's health care system. These things happen when your country's inflation rate hits a mind-blowing 3731%: doctors cannot make a living wage, and patients cannot hope to pay their hospital bills.
Are striking doctors in such a case going against the Hippocratic tradition? Are doctors to shoulder the blame for a government that has abandoned the majority of its people? Is soldiering on, working for poverty-line wages with diminishing resources, what should be expected from Zimbabwean doctors from an ethical point of view? Are outside observers correct in condemning them if they 'drop their tools' and protest their conditions?

Tuesday, May 01, 2007

New and exciting forms of abstinence

Tobias Randall, head of the $15 billion President's Emergency Plan for AIDS Relief (PEPFAR) and administrator of the US Agency of International Development (USAID), resigned last week after he admitted having used a Washington escort service for massage. Randall stated firmly that he did not pay for, or receive, sexual favors. His plea of innocence -- made while handing in his resignation -- will help the cause of Deborah Jeanne Palfrey, the boss of the escort service, who claims that her business is legal because it involves only the use of costumes, massages, lascivious conversation, and (for example) young women playing Monopoly in the nude.

The irony, of course, is that Mr. Randall was a strong proponent of 'abstinence only' programs to prevent HIV transmission worldwide, and was also the chief enforcer of the 'Anti-Prostitution pledge', which requires USAID grantees to state their opposition to prostitution in writing and strongly discourages programs that distribute condoms to sex workers. In other words, Randall seems to have very much enjoyed the company of women who, in his professional role, he didn't mind exposing to risks of HIV infection worldwide. And if things were not bad enough, Mr. Randall is quoted in his ABC interview as saying that he 'invited gals to come over to the condo' to give him a massage, stating a special preference for 'Central American gals.' Did he really say 'gals'? Mr. Randall is one step away from being the Don Inus of global health.

On the other hand, according to his own account, Mr. Randall did abstain after all. You might even say that the former 'AIDS Czar' was taking abstinence to a new erotic level, showing the rest of us that abstinence could be very very sexy, albeit without the sex, a way of having your cake and not eating it too. Perhaps it was an exercise in policy experimentation, a bold personal journey beyond the ABC approach to a place where you are not really faithful, not really abstinent, not really using a condom, not really at risk for HIV and not really having sex. (Such behavior may not be for everyone, so he wanted to try it out first.) Then again, maybe it was simply a case of an repressed hypocrite, who was riding his moral high horse last week, and whose name does not even register on the USAID or US Department of State websites this week.

What lessons are to be drawn from this? One possibility is to acknowledge, rather than deny, the pervasive sway that sexuality has over humanity, and try to translate that acknowledgement into science-based and psychologically realistic policies dealing with sexually transmitted diseases around the world. Given the number of lives in the balance in the fight again HIV/AIDS, winning that acknowledgement is far more important than explaining Mr. Randall's puzzling failure to find a registered massage therapist in the nation's capital.