Ethical practice in professional contexts

Ethical Practice

The foundations of biology and medical ethics are historically tied to each other through pioneering scientific research that frequently bordered on the macabre. The manner in which much was learned about the human body, and its various intricacies and functions was learned through direct observation, often direct observation of corpses, and often corpse that were gained through dark deals and shadowy back alley payments. The circumstances of such autopsies are rumored as well as documented and the hint of such activity taking place as far back as 300 BC when one of the worlds first well-known physicians and anatomists (Greek, Herophilus) challenged the moral fiber of his culture by studying human corpses. "Conceivably his most prominent contribution was his pioneering use of human corpses as well as live subjects, to learn anatomy, despite the very vocal disapproval of many who dreaded retribution by some malevolent deity."

Serafini 42-43)

We think of the circumstances of Mary Shelley's Frankenstein: Or, the Modern Prometheus as a modern work of fiction, and yet its defining characteristic, in its context is that it was challenging what Shelley and others saw as the blurred boundaries between science, nature and morality. Shelley, set out to describe a scenario that many could see as the future of science, a goal that though lofty, and usually paved with good intention was seeking to know and see things that many believed, for varying reasons, should remain unknown and unseen. Frankenstein is a social commentary on medical ethics and personal and social fears of such ethics going to far, or in this case not going far enough to stop science from destroying life by discovering secrets that should remain concealed, secrets that could potentially ruin humanity. The lengthy monologue of Dr. Frankenstein about his desire and later ability to reanimate the dead speaks of his separation of self from all things superstitious (meaning faith and fear of the unknown) so he might pursue his goal, of scientific wonder without being hindered by human fear and ignorance.

To examine the causes of life, we must first have recourse to death. I became acquainted with the science of anatomy: but this was not sufficient; I must also observe the natural decay and corruption of the human body. In my education my father had taken the greatest precautions that my mind should be impressed with no supernatural horrors....Darkness had no effect upon my fancy; and a churchyard was to me merely the receptacle of bodies deprived of life, which, from being the seat of beauty and strength, had become food for the worm.

Shelley 44)

Dr. Frankenstein goes on to discuss the fruit of his labor, eluding to the creation of "the monster" which became to him the culmination of his life's work and his pariah, rather than a valuable contribution to the study of science and medicine.

Now I was led to examine the cause and progress of this decay, and forced to spend days and nights in vaults and charnel-houses.... I saw how the fine form of man was degraded and wasted; I beheld the corruption of death succeed to the blooming cheek of life; I saw how the worm inherited the wonders of the eye and brain....until from the midst of this darkness a sudden light broke in upon me -- a light so brilliant and wondrous, yet so simple, that while I became dizzy with the immensity of the prospect which it illustrated,...After days and nights of incredible labour and fatigue, I succeeded in discovering the cause of generation and life; nay, more, I became myself capable of bestowing animation upon lifeless matter.

Shelley 44-45)

There are many examples of scientific and technologic descoveries, not limited to medicine, that have blurred this boundary, like dynamite, an invention intended by its creator, Alfred Nobel to help not hurt, but rather was frequently utilized to destroy and as a tool of war. "He received the tribute of scientists and educators but the ignorant people regarded him with a mixture of awe and fear -- 'he had put the long hammer of Thor to work again among the giants.'" (Marble 6) Nobel is best known for the award named for him the Nobel Peace Prize, a distinction and a foundation said to be founded, by Nobel in the name of Nobel's concern for scientists to create without censure but for peaceful means and the betterment of society. (Marble 4-6) the blurred line between the power of science to do good and to do harm is a universal of literature and life, and was especially important during great periods of human growth, such as the naturalist movement, and the industrial revolution, taking place during the Shelley's lifetime and frequently discussed by the literary and scientific set, "The circumstance on which my story rests was suggested in casual conversation."

Shelley 5) Shelly goes on to discuss a rumor of the ability of Darwin to reanimate a vermicelli, that he had kept under glass, as the source of the literary conversation about the ability of science and humans to discover the spark of life and then reapply it to previously dead beings, including human bodies. Through her apologetic prologue and later in her introduction Shelley speaks of the logical fear of such an occurrence, though recognized as unlikely, as a common place fear among people both in an outside the scientific community.

Shelley 10)

In medicine there are many discoveries and scientific marvels that have been or could be in the future, weapons of war, terrorism and/or contributions of peace, just as explosives have been. One example of just such a medical discovery is the ability to isolate and contain pathogens, that can be used both to study and cure the diseases they cause and also to infect the enemy through biological warfare. The story of Luke Pryor Blackburn, armed with understanding of the disease and its gestational efficacy and ability to kill, was utilized by this confederate doctor and longtime conspirator during the civil war in an attempt to kill Lincoln and infect Washington with yellow fever Blackburn brought the disease to its destination by traveling to Bermuda, where there was a serious outbreak and infecting bed clothing and gentleman's clothing to then be smuggled into Washington. (Singer W18) So, the knowledge that Blackburn gained in a peaceful attempt to treat and potentially cure sick confederates, both civilian and military was then utilized as a potential weapon of war. Hence the concern over medical discovery fueling dangerous disasters, Shelley, likely to have been saying, "I told you so," about the lack of universality of medical ethics would have seen the irony in a doctor, who was supposed to be the ally of the sick, utilizing knowledge to kill because he believed so strongly that the Union deserved to lose the war even at the cost of his and his profession's medical ethics.

Shelley, was of coarse not the first to question the ethical standards of medicine, nor was she or will she be the last to do so. The limits of medicine have been questioned as long as people have been taking apart bodies to study them. "Hippocratic physicians in the fifth through third centuries B.C. were among the first to question the ethical limits of medicine."

Jecker 5) the manner in which anatomists frequently arrived at the ability to perform autopsies on humans was often questioned by the broader society and directly by many, but it was also frequently unspoken and overlooked, based on the demands of science and the fact that technological advances seeking to view internal workings of the body were not advanced enough to offer any insight and the only option for the physician/researcher/instructor was to seek out specimens that would not be missed, occasionally striking deals with institutions to claim the bodies of institutionalized inmates, or paying seedy grave robbers to exhume the recently deceased from their fresh graves. Tactics that frequently challenged moral and religious beliefs, drawing criticism, at the same time that such science was demanded and revered for its insight into the human body. "Christian writer Tertullian spoke for many when he thundered at Herophilus for having cut up corpses in his search for knowledge. (Tertullian also accused Herophilus of having dissected prisoners while they still lived.)"

Adler 17) the tradition of obtaining bodies for medical experiments through what today would be considered unethical means dates back in the modern era tradition to Henry VIII, who made is legal for the United Company of Barber-Surgeons to obtain the bodies of felons to dissect during medical experimentation and teaching. When medical ethics began to catch up to this practice the evidence suggests that the official sanction was removed and anatomists had to rely on seedier sources, in a no questions asked secretive practice, some noted physicians even resorting to grave and gallows robbing to find subjects.

Adler 58) the whole of the system, being allowed and even supported for centuries, surrounded the idea that sacrifices had to be made for science, even if this meant the desecration of human bodies, some of whom had been wanted.

The foundational ideas of the limits of science and medical ethics goes back a very long way and as it has evolved over the centuries, certain laws, rules, regulations and taboos have been put in place to protect the human race from that sometimes blurred line between scientific discovery and human existence. Medical ethics created a system, bound by the ideals of many that came before them to control this blurring and attempt to stand between sciences desire to discover and the public and individual's desire to remain safe and in control of one's own body. A long time medical ethicist discusses the history of medical ethics as one that was founded on the principles of the ancients, but that has now become one where medical ethicists are demanding concrete answers, even laws to guide and demand decisions regarding medical ethics be enforced. "My new colleagues were polite enough, to be sure, and tolerant. But they were telling me of their urgencies and they were asking me to demonstrate how moral principle and moral theory connected realistically to the examining room and the hospital bed."

Radest 4) According to some physicians and ethicists this can equate to a faltering of tradition, where the study of ethics has become a concrete desire for concrete answers and of coarse the answers given are not always in agreement, of all parties.

As the twenty-first century dawns, the Hippocratic tradition is ailing. According to the physician and ethicist Edmund D. Pellegrino of Georgetown University, it remains "the moral backdrop against which most American and British physicians made, and still make, their ethical choices." 56 However, the tradition has been under sustained attack for more than twenty years and is in acute danger of collapse.

Smith 20)

Though this would seem a dire warning of the failing of medical ethics, most individuals would say this is not the case, in fact many would say that the concrete nature of the new science of ethics and bioethical practice. The change in the manner in which researchers see ethics, not as a reflection of what the public/gods will tolerate, in conjunction with the old mantra' "do no harm" has become a systematic exercise attempting to concretely answer questions such as, when does a person really die? The debate surrounding the different definitions of death has become of profound importance in the medical community as technology has reached such a stage that it can now take from one and give to another, to save a life, through the loss of another.

Is brain dead the same as really dead? Of course not!... Brain-death, in my opinion, is simply a futility judgment that has gained widespread acceptance in the medical community.... After all, this brain-dead patient is not a cold stiff corpse but rather a young, warm body with a chest that rises and falls with every artificial breath. 9