Erich H. Loewy

Of Healthcare Professionals, Ethics, and Strikes

The question of whether physicians or other “essential” healthcare workers are ethically entitled to strike is troubling in that it entails a conflict in obligations. This question of a conflict of obligations (and the answer to it) has wider implications for many other workers.

Curiosity, imagination, compassion, science and ethics: do curiosity and imagination serve a central function?

Curiosity and imagination have been neglected in epistemology. This paper argues that the role of curiosity and imagination is central to the way we think, regardless of whether it is thinking about problems of ethics or problems of science. In our ever more materialistic society, curiosity and reason are either discouraged or narrowly channeled. I shall argue that the role of curiosity and imagination for both science and ethics is so important that nurturing them can be seen as an ethical obligation and suppressing them as ethically problematic.

Of community, organs and obligations: routine salvage with a twist.

This paper makes the assumption that organ transplantation is, under some conditions at least, a proper use of communal medical resources. Proceeding from this assumption, the author: (1) sketches the history of the problem; (2) briefly examines the prevalent models of communal structure and offers an alternate version; (3) discusses notions of justice and obligation derived from these different models; (4) applies these to the practice of harvesting organs for transplantation; and then (5) offers a different process for harvesting organs from the newly dead.If community is viewed as united by a set of shred goals and common values among which the value of community itself is important, then certain reciprocal obligations among members obtain. I suggest that routine salvage of organs from the newly dead be instituted but that it be routine salvage “with a twist”: rather early in life all members of the community are given the opportunity to refuse but their refusal carries the reciprocal condition that they cannot later become the recipients of that which they refuse to others.

Education, Practice and Bioethics: Growing Barriers to Ethical Practice

While Bioethics is now taught at all medical colleges in the United States as well as in other nations, and while discussions about Bioethics have become frequent in most medical journals there are increasing barriers to teaching and incorporating what has been taught into daily practice. I shall discuss some of these barriers and suggest that integrating the teaching of Bioethics throughout the curriculum after presenting some of the basic theory and methodology is the most effective way of teaching this vital subject. Furthermore, courses in health care ethics are often taught as something distinct and distinguishable from ones medical practice. I shall emphasize what I consider to be the failure of Bioethics to participate effectively in creating a context whereby what has been taught can be put into praxis. In this brief article I will discuss such barriers and suggest several approaches and remedies.

Bioethics at the Crossroad

Bioethics and its offspring Health-care Ethics have a variety ofuses and obligations among which and perhaps most importantly istheir social obligation. This paper raises questions as toBioethics fulfilling the necessary criteria for a profession,suggests that it can serve as a link between individual andcommunal problems, discusses the task of health-care ethics as well as ways of teaching it, lists some of the obligationsof health-care ethics professionals and discusses the dangers to and failings of these health-care professionals today. Itconcludes that we are at a crossroads in which we must choosebetween our own personal security and comfort and fulfilling our social role.

Justice and health care systems: what would an ideal health care system look like?

An ‘ideal’ health care system would be unencumbered by economic considerations and provide an ample supply of well-paid health care professionals who would supply culturally appropriate optimal health care to the level desired by patients. An ‘ideal’ health care system presupposes an ‘ideal’ society in which resources for all social goods are unlimited. Changes within health care systems occur both because of changes within the system and because of changes or demands in and by the ‘exterior environment’. Social systems must be in a homeostatic balance. If one component fails to accommodate itself to other forces, needs and interests within the system, the system is imperiled. It is difficult to create a just health care system in an unjust society, just as it is difficult to practise truly ethical medicine in an ethically corrupt system.

Use and abuse of bioethics: integrity and professional standing.

This paper sets out to examine the integrity and professional standing of “Bioethics.” It argues that professions have certain responsibilities that start with setting criteria for and credentialing those that have met the criteria and goes on to ultimately have social responsibilities to the community. As it now stands we claim that Bioethics—while it certainly has achieved some progress in the way medicine has developed—has failed to become a profession and has to a large extent failed in its social responsibility. We feel that Bioethics has to define itself, set criteria for membership in the profession, police itself and—above all—meet its social responsibility to become a profession meriting that name.

Age Discrimination at its Best: Should Chronological Age be a Prime Factour in Medical Decision Making?

This paper briefly reviews the papers in this special section of HCA and makes the point—a point which should be obvious—that statistics are useful only as guidelines but tell one nothing about the individual patient in front of you. Chronological age merely shows what is true of most but decidedly not of all patients in a particular age group. To ration on the basis of age alone is unfair to the individual denied treatment and damaging to the community because it disturbs the solidarity which comes about because most members of the community feel that the community has obligations beyond those of not directly harming them; indeed, what produces solidarity is the feeling that members of a community will do their best to come to each others help. Rationing on the basis of age alone denies people of equal treatment under the law and—when it comes to the elderly—is a type of age discrimination. It is pointed out that what matters is a patient’s disease and not his/her age. A permanently vegetative person 8 years of age is a much sadder occurrence than it would be at age 90—but the critical fact is that both are permanently vegetative. Age cuts both ways—it is irrational to spend hundreds of thousands of dollars, untold amounts of time, energy and devotion to the 520 gm infant with a gr IV diffuse haemorrhage whose chance of leading a sentient life is close to zero and to hesitate before using a diagnostic MRI on a patient who is 90 but fully alert and enjoying life. It is concluded that age as an independent variable in the allocation of resources is ethically highly problematic.

A Dialogue on Species-Specific Rights: Humans and Animals in Bioethics

At the end of the most violent century in human history, it is good to take stock of our commitments to human and other life forms, as well as to examine the rights and the duties that might flow from their biological makeup. Professor Thomasma and Professor Loewy have held a long-standing dialogue on whether there are moral differences between animals and humans. This dialogue was occasioned by a presentation Thomasma made some years ago at Loewys invitation at the University of Illinois, Peoria, Medical Center. During that presentation, Thomasma argued that human beings are sufficiently distinct from other animals genetically and otherwise to justify a moral difference in rights and obligations. In effect, he argued that there are species-specific rights. This essay will pick up the threads of that dialogue.

What would a socialist health care system look like? A sketch

In this paper I argue that, since institutions must reflect the societies in which they are placed, a socialist health-care system cannot be understood unless democratic socialism—which would assure all of basic necessities of existence, full education and health-care to all members of the community—is not incompatible with a flourishing market for other products. In contrasting single with multiple tiered health care systems, I suggest that a single tiered system in which all have equal access to health care and none can buy more, is most consistent with the ideals of democratic socialism.