Life as an Extreme Sport

Nazis & Structure: The Inherent Conflict-of-Interest in Bioethics?

Bioethics

This month’s free article from the Journal of Medical Ethics is a doozy: a medical student looks at Nazi physicians, moral luck, and the circumstances that conspire to create the situation where doctors feel that their participation in something as hindsight-reprehensible as the T4 euthanasia program is not only acceptable but morally sanctioned. It’s worth a read.

The interesting thing that stands out to me – aside from Colaianni’s excellent description of medical training that brings up impressions of systematic brainwashing (which may not be intentional but is there nonetheless) – is that it really impresses the need for watchdogs outside the system.

It’s perhaps fitting that I stumbled across this free access article when I was trying to get the feel for another debate raging across articles and commentaries: whether or not physicians needed to advocate for removal of end-of-life care in medically futile cases to the degree that they advocate for care in cases where the religious beliefs of parents conflict with best-accepted medical care. The argument, at least what I was able to glean from the abstracts available to folks without university affiliation or the ability to pay for a yearly subscription, seems to be that because of 11 cases (only five of which remain unresolved) of parents believing life support must be maintained until a miracle occurs, out of 203 total cases, physicians should advocate more strongly for legal recourse to end care. Why is it fitting? Because at least in my mind, that debate over religion and standards of care already started me thinking of the role of bio/medical ethicists in a hospital situation, and the concept I’ve been kicking around for a while: that by being situated within hospitals, embedded with physicians (if not physicians themselves), the ability of a bio/medical ethicist to do their job is compromised.

Colaianni writes that about hierarchy in medicine, and how the medical student reports to the intern reports to the resident reports to the chief resident and all the way up, Old MacDonald’s Farm style. Much like military structure, you’re taught to listen to those in charge and follow command structure; placing the ethicist within this doesn’t necessarily create an escape-valve, because the pressures that are on the physicians – loyalty to people, the institute, etc – aren’t alleviated by simply having another (different) title.

In particular, this quote stood out:

…three junior physicians marked brief questionnaires about mentally handicapped individuals with a red ‘+’ (for death) or a blue ‘—’ (for life). In this way murder was systematised, sanitised, ‘medicalised’ and sanctioned.

Ethicists are expected to function within the system, where things are systematized, sanitized, medicalized, and sanctioned. As any whistleblower knows, stepping outside of the institution that you function within is extremely hard – and can carry heavy penalties. Is it any wonder, then, that we hear of repeated scandals regarding ethics boards, hospitals, or even the public sector? In each case, the people who are expected to stand up and say “no, wait, hang on” are presented immediately with an extreme conflict-of-interest: standing up and speaking out against colleagues; friends; the system that supports their work and signs their paycheck.

What, then, is the solution? The obvious pie-in-the-sky one isn’t at all pragmatic: independent and transparent ethics committees. But money is the immediate issue there, so what if instead of trying to overhaul the entire system, we overhauled just one part of it? Instead of, say, the University of Minnesota bioethicists policing in-house research and medical practice, what if they policed Duke’s research and medicine? Duke’s bioethicists could then police UNC (as we wouldn’t want to create a system of reciprocity where UMinn would ignore Duke’s violations in exchange for Duke ignoring theirs). UNC could police Stanford who could police the University of Washington who could… and so on. While this would not remove issues (and in fact would create new ones), it would at least alleviate the immediate conflicts-of-multiple-interests issue. It is, in the very least, worth a consideration.

A Teacher Wouldn’t Be Fired for Being a Companion

...and everything else, Pop Culture

Sex work, I have written, defines the people who do it like no other occupation. Associated with deviance, drug use, mental illness and disease, to be labelled a “prostitute” is to be cast as the lowest of the low. No matter the realities of our experiences, we are thought of as victims and as inherently damaged, either before or as a result of our profession. Worst of all, once a sex worker, always a whore.
-Melissa Petro, Jezebel

And that, right there, in a few simple sentences, sums up the point and power of Inara in the Firefly ‘verse. For all you may disagree with aspects of sex work represented, this comment (and the entire article) highlight just what it was Inara was supposed to flip around. Rather than be the lowest of the low – an attitude still embraced in some parts of the ‘verse and clearly exemplified in Mal – as a whole, Companions were on the top of the social class system a pyramid. (And, in fact, with Nandi, you get to see how Companions themselves maintain social and class structure.)

Inara was not a victim. She didn’t need rescuing, from her choices or her career. There was no societal stigma to her profession, and she certainly would not have been fired from a teaching position for having previously been a Companion.

When Programs Implode — Penn State & Personal Experience

...and everything else

The NCAA announced numerous sanctions against Penn State this morning; a large fine, the vacating of wins, a reduction in scholarships, removal from Bowl games. The Big Ten quickly followed with matching sanctions (since Penn State will be ineligible to compete in post-season games they will not receive championship revenues), and of course, everyone is still waiting to see what the Department of Justice and the Department of Education is going to do (but it’s safe to say that Penn State is looking at further sanctions).

The thing that impressed me about the NCAA decision is how it was designed to affect the university and the utterly broken, sports-focused culture that allowed the Sandusky abuse to continue for so long; the culture that said it was better to cover-up, for the school’s sake, than to actually report a child predator. Yes, these sanctions will affect the student athletes — but minimally. The NCAA clearly forbids Penn State from taking money from other athletics programs, so a smaller team like women’s field hockey shouldn’t be affected by the sanctions. Likewise, anyone directly affected by the football-focused punishments have several options. All the football players are being allowed to transfer to other schools, if they wish, without losing eligibility to play this year. Yes, the timing sucks and school starts soon — but the option is there, and already, players who signed intent letters have dropped them and are clearly going elsewhere. And the option exists for all football players, not just incoming students. Likewise, football players are allowed to keep their athletic scholarships even if they choose to no longer play.

The NCAA went out of their way to make sure that sanctions didn’t include something that would directly and negatively impact individual players, like the death penalty would have. Yes, the NCAA did adopt a scorched earth, nuke from orbit policy — but it’s aimed directly at the malignant football-as-god culture of Penn State, and that’s specifically what they aim to dismantle.

I am sympathetic to the students who are caught up in this. They chose Penn State based on reputation, on the idea that they would be going to a school where they’d be working with the best in their field, and they’d be learning from the best, with opportunities that they couldn’t have anywhere else. Anyone who has read my blog for a while, or who otherwise knows me, knows just how much I understand this motivation — it’s precisely how I made my graduate school decision back in 2006. But unlike the Penn State players, I didn’t have a governing body going out of its way to protect me in 2008; it doesn’t take a degree in rocket science to poke around and see what happened to me (or the long-term fallout). So yes, I understand — I probably understand what those Penn State students are going through more than anyone who hasn’t been on a team slapped with NCAA sanctions.

But because I understand, I see, clearly, just how far Emmert and the NCAA executive committee went to do their best to protect any student affected by the sanctions, with the understanding that the students are not to be faulted for making a school choice based on the information they had at the time. Yes, it sucks — there’s no other word for it — that students are going to be affected by the sanctions that the NCAA and Big Ten are levying against Penn State. But there is also no way to directly enforce sanctions, especially sanctions designed to function as a corrective to an out-of-control problem, without having some affect on the students.

It could be so much worse. They could be out of scholarships, out of school, told with almost no time left before the academic year begins that they are on their own and there’s no help out there for them. They’re not. Yes, it’s going to be an uncomfortable couple of weeks as players make their decisions, and it will be hard for anyone who chooses to stay — but this is one of those life lesson moments. People above you fuck up. People in organizations make mistakes, and unfortunately it does trickle down and affect everyone in an organization. It happens in business all the time — see Enron, see the multiple bank scandals of the last few years, see Wall Street. And when you’re a low level peon in an organization where the folks up top fuck up, whether or not you’re a graduate student or a football player or a secretary or even security guard, you’re going to see the effect in your own life and you’re going to have to figure out how to roll with the punches.

It’s life, and it’s living, and it’s a horrible lesson to have to learn when you think you’re in a protected sphere. But there’s a net for the Penn State players, and they’ll have a chance to at least land on their feet, thanks to the consideration of Emmert and the NCAA. A lot of people, myself included, weren’t given such a luxury.