Since God gave Moses the 10 Commandments every generation has complained that its successors are falling morally and ethically further in arrears. But Russell McIntyre, who has made a life’s study of society’s ethical behavior, says that in medical ethics particularly, this past generation is marked by a definite upswing.
"In the last 30 years, our entire ethical sensitivity has increased substantially," says McIntyre, "and we’ve shown ourselves willing to take the action to maintain our beliefs." A professor emeritus at UMDNJ Robert Wood Johnson Medical School, McIntyre is giving the 11th in the Stahl lecture series, "Ethics and the Transformation of American Medicine," on Monday, March 31, at 4 p.m. at UMDNJ’s Clinical Academic Building in New Brunswick. For further information on this free lecture call 732-235-6356.
Ted Stahl, physician and UMDNJ professor, endowed the Stahl Lectures in honor of his parents, David Mates and Hinna Stahl. "Ted always felt that this strong sense of ethical belief was one of the greatest gifts he received from his parents," says McIntyre, who chaired the Stahl committee from 1996 to 2006. "It is the goal of these lectures to bring academia and the informed public together."
Few individuals can claim both the breadth and depth of expertise in their field that McIntyre has. The son of a banker, McIntyre grew up in Great Neck, Long Island, and attended Wagner College, earning his bachelor’s in philosophy. He then earned a divinity degree from Philadelphia’s Lutheran Theological Seminary, and two master’s degrees from Wittenberg University in Ohio. While in Ohio, he served as a church pastor prior to earning his doctorate in ethics from the University of Toronto.
McIntyre also holds a doctorate of divinity and completed postdoctoral training in medical ethics as a Kennedy Fellow at Harvard Medical School. He is recently retired after 30 years as a professor at the University of Medicine and Dentistry of New Jersey. He has served as commissioner of the New Jersey State Bioethics Commission. He was also editor in chief of "Trends in Healthcare."
"In the last 35 years, medicine has gone from one of the least to one of the most regulated industries in our society," says McIntyre. Not just a few watchdogs, but our culture as a whole, has become ever-mindful of a whole range of ethical issues. And we have gained a lot less tolerance for acts we deem unethical.
Bad old days. Prior to the l970s physicians held an enormous, unguided power within their practice. "It was considered that doctors are all basically good people who would do the right thing for their patients," says McIntyre. Not only did individuals, but the court system, by in large, defer to the physician’s choice for all aspects of patient care. Then some disturbing discoveries shook the physician’s pedestal.
In l972 news of the Tuskegee Syphilis Study was leaked to the press. Conducted between l932 and l972 by the United States Public Health Service, these syphilis experiments established a control group of 412 poor African-American males, mostly illiterate, from Tuskegee, Alabama. The men were deliberately denied all treatment, were never given penicillin, nor news about penicillin’s curative effects. No informed consent was involved. The public was instantly outraged. In l974 Congress passed the National Research Act which made illegal human experimentation by force or without informed consent.
In l976 the doctor’s deference tradition was legally attacked by the much-publicized Karen Anne Quinlan case. Falling into a persistent vegetative state, Quinlan was being kept alive and comatose via ventilator. Her physicians refused a parental request to cease active care. Contested in court, the case dragged on until Quinlan’s death in l985. Who has the right to decide how much care? What is death? Who has the right to terminate and when? Such were the questions debated in court and the resulting decisions are credited with sparking the right to die movement. Certainly the case’s precedents placed the then-burgeoning bioethics field into major prominence.
These two cases were further amplified by the publication of torturous practices conducted by Japanese and German doctors in World War II. "All of these set us to thinking `not in my country – we Americans must not behave this way,’" says McIntyre.
Ethical enlightenment. "In an odd symbiosis, medicine has revitalized ethics, and ethics has revitalized medicine," says McIntyre. Before l975 ethics was mostly a back-burner elective course taken only to complete one’s philosophy major. Now, with the new advent of medical techniques, and the more prolongable life span, bioethics has blossomed as a study, and courses are packed. Further, medical ethics is a required course at all accredited medical schools.
Conversely ethics has now made medicine everybody’s business. One’s physician is no longer one’s health regent, giving fiats, prescriptions, and making decisions totally on his own. The family is involved. People are appointing hospital buddies to make sure that when they enter a hospital that their care is optimum and their wishes carried out. Alternative medicine aides, ranging from nutritionists to physical trainers, have booming businesses all because we no longer buy into the maxim "just follow the doctor’s orders and you’ll always be healthy."
Arising issues. The right to die, what constitutes "heroic measures," who decides for a patient, and who can refuse care for whom, all remain issues very much debated. Some of these have been addressed by state and federal statute. An adult may refuse a blood transfusion for himself, but according to case precedent, he cannot refuse a transfusion for his underage child or even a family member incapable for choosing for himself.
Informed consent remains a problem that grows with technology. Patients are demanding to not only be told what the intended procedure is, but the short and long term effects, plus alternative treatments. Being told, as stem cell implanters used to do, "we’re just going to give you some cells," is no longer enough.
Definitely the largest issue on the bioethics agenda is the ever-evolving stem cell debate. It evolves with the advancements of the science. It has been known since the l960s that certain cells have the ability to morph and replicate into a variety of specialized cell types. The study of employing these cells to repair damaged human tissue has advanced greatly and almost weekly. None can deny the benefit that such healing would bring. The problem remains, however, that the best source of obtaining such cells is the human embryo – an embryo that must be destroyed during stem cell harvest.
This cuts, literally, to the heart of the question: when does life begin; a primary ethical question of our era. Hope may come from technology itself, McIntyre points out. Cord blood cells (from the mother and child’s umbilical cord) also provide usable stem cells. Many mothers are having their child’s cord blood saved and stored, much the way some surgery patients store their blood to be used during their operation.
But McIntyre is the first to admit that we have not entered an ethical golden age in medicine. Recently, the Bush administration defied the l974 National Research Act by insisting all U.S. military receive, forcibly if necessary, certain vaccinations.
"The beneficial thing one does see," says McIntyre, "is the public’s outrage. People’s sensitivity is raised and they are pressuring their government based on their ethical beliefs." Thus ethics, as always, remains in the hands of the people. It is they who must keep the belief-based debates alive and they whose intolerance of unethical acts will nudge us closer to that golden age.