The Limits of Principle: Deciding Who Lives and What Dies

The Limits of Principle: Deciding Who Lives and What Dies

The Limits of Principle: Deciding Who Lives and What Dies

The Limits of Principle: Deciding Who Lives and What Dies

Synopsis

A twenty-first century science will not easily answer to an eighteenth century philosophy. Abortion, euthanasia, genetic engineering, and organ transplantation all raise seemingly irresolvable issues. Koch offers new approaches--public and inclusive--that may resolve them. After explaining the limits of principled ethics, he offers new approaches and then uses them to examine two critical issues: how do we decide who will receive organ transplants and "the problem of Baby K," the care or non-care of "brain stem babies." This is a unique, innovative argument that challenges traditional bioethics' approach to complex problems.

Excerpt

In the early 1950s, a violent epidemic of bulbar poliomyelitis swept the industrialized world. Tens of thousands of persons, mostly children, were infected with a virus whose disease course ended, for most, in death from respiratory paralysis. The fortunate few who survived the illness often did so with long-term disabilities. When it was reported that positive pressure ventilation could save many patients, hospitals in Canada, North America, and Europe strained their resources to provide treatment. First-year medical students were pressed into service at many hospitals. They were taught to manually maintain those patients whose respiratory muscles had been permanently damaged by the illness. Eight hours on and eight hours off, they physically kept alive those who otherwise would have died from the disease.

The salvation of a population of thousands of persons whose lives would be spent encased from chin to feet in an "iron lung" requiring long-term supervision and physical assistance was viewed with pride by both the medical profession and by society at large. Saving poliomyelitis patients was saving human life, the physician's first goal. A physically restricted life spent in a breathing apparatus was perceived by all as far better than no life at all. For the medical community it was an at least partial victory over a disease that had been inexorable. For the public at large, it was a triumph of modern medicine celebrated popularly in newspapers and magazines. During the 1960s, Reader's Digest would report on patients in the iron lung who became bridge masters, received ac-

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