All posts by Hanna Louise Belden

ABC’s “Private Practice” and the Vaccination Debate

Uncategorized

Two different factors brought me to this post: firstly my potentially obsessive fascination with the ethical issues surrounding vaccination, and secondly my unhealthy and frequent tendency to avoid my problems by binge-watching TV shows on Netflix.

I was enjoying one of my aforementioned Netflix binges, pretending that graduation wasn’t looming and that my life was totally on track, when I stumbled upon an interesting representation of the vaccine issue. I was watching a Grey’s Anatomy spinoff entitled Private Practice (try graduating with no life plan before you judge my TV habits). In the episode, a pediatrician named Dr. Freedman is treating a child presenting with symptoms of the common cold. In a stereotypically melodramatic fashion, Dr. Freedman eventually discovers that the kid has the measles. The child has two younger brothers, the older of whom has severe autism that his mother blames on immunization. As such, she is forcefully opposed to vaccination, to the point where she refuses to vaccinate her youngest son for fear of losing him to the same fate as his middle brother.

The oldest brother must be quarantined in a hospital, and his health rapidly deteriorates. Dr. Freedman continues urging the mother to vaccinate her youngest son, who stands to catch the measles from his oldest brother. Dr. Freedman’s genuine and intense concern for the youngest son goes unappreciated as the mother continues to refuse, getting more and more adamant as the episode continues.

Finally, moments after the oldest child has passed away in the quarantine ICU, Dr. Freedman gives the mother a look, turns away, and, in what I like to call “The True Shonda Rhimes Drama Strut”, marches over to the youngest child, vaccine in hand. The mother, initially confused and eventually horrified, runs screaming after Dr. Freedman, begging him to stop. In the pinnacle of dramatic tension, Dr. Freedman pokes the youngest child with the needle, and the camera pans to the mother, whose face falls tragically before she runs to kneel before her child and check him for any potential signs of autism (take a moment to appreciate how ridiculous that looks).

In a very clear lesson in the morality of vaccination administration, this episode shows Dr. Freedman’s overflowing concern for his patients, and his willingness to break CLEARLY DEFINED laws for the sake of his patients’ health.

I found this episode especially interesting because, unlike much of our focus on vaccination in class, Dr. Freedman is not concerned with the pubic health repercussions of leaving the potentially infected child unvaccinated (sidenote: if the child may be infected, administering a vaccine is the BEST way to take care of it. (Sarcasm.)).  He is, instead, solely focused on the well-being of the child. This different perspective marks other vaccination motivations for doctors: preventative medicine on a case-by-case basis and the right of the child to safety from infectious disease.

There also exists here an angle on paternalism. Dr. Freedman overrides the mother’s right to make health decisions on behalf of her child, having clearly stated that there exists no medical connection between vaccination and autism. This overstepping of boundaries, while hugely illegal, is an interesting decision on behalf of the doctor. Dr. Freedman, ignoring all opinions and decisions made by the mother, barges through and vaccinates the child because he knows it is the right thing to do, parental consent be damned.

Overall, I felt this episode raised some very important and difficult questions about vaccination and parental control over a child’s medical decisions. The focus on individuals rather than public health in the debate about vaccination was also a nice shift. The show may be hyper-dramatized to the point of ridiculousness, but they definitely got their point across, loud and clear.

Works Cited:

Childress, James F, Faden, R.R., Gaare, R.D., Gostin, L.O., Kahn, J., Bonnie, R.J., Kass, N.E., Mastroianni, A.C., Moreno, J.D. and Nieburg, P. “Public Health Ethics: Mapping the Terrain.” Arguing About Bioethics. By Stephen Holland. London: Routledge, 2012. 10075-0461. Kindle.

“Contamination.” Private Practice. American Broadcasting Company. Netflix. Web. 8 Jan. 2009.

Isaacs, D., H. A. Kilham, and H. Marshall. “Should Routine Childhood Immunizations Be Compulsory?” Arguing About Bioethics. Ed. Stephen Holland. New York: Routledge, 2012. 398-406. Kindle.

Why is (Respect of) Autonomy Important?: Possible Cultural Preconceptions Surrounding the Argument for Autonomy

Uncategorized, , ,

When discussing biomedical ethics, we frequently favor the right of the patient to decide. This emphasis and respect for autonomy can overrule any number of other considerations. Therefore, I ask the following: Why is (respect of) autonomy important? A typical answer, and likely my own response, would include the importance of the individual’s right to make his/her own decisions. It is an exceedingly important component of any medical decision, and not to be taken lightly. The individual has final say because the body/mind in question is their own.

While reading J. F. Childress’ article “The Place of Autonomy in Bioethics”, I was struck by the potentially confounding factor of socioculturally different views on the importance of autonomy. As a product of American society, I have been raised to believe that the rights and privileges of the individual are paramount. Our culture and, indeed, most of Western thought, is centered on the idea that individuality (and the individual’s conception of that individuality) is to be encouraged. Given the dominance of Western thought in philosophical inquiry, particularly bioethical inquiry, it makes sense that a discussion of bioethics would take into consideration autonomy, the right of the individual to make his/her own decisions.

Free will is another Western presupposition that comes into play when discussing autonomy, the idea that we are the deciders of our own outcomes. Though I do not seek to undermine either of these ideas (free will and the importance of individuality), I think it is important to acknowledge and address the ways in which these ideas shape our dialogue. The reasoning behind the emphasis placed on autonomy is founded in the belief of both free will and individual importance. Should a society, religion, culture, etc. manifest a rejection of either of these principles, autonomy would, in that community, cease to be a worthwhile focus in bioethical conversation.

At the risk of bastardizing, oversimplifying, and/or misrepresenting my argument, I will lay out a general description of what I mean: If we reject the philosophical idea of free will, then our autonomous decisions (whether medical or not) become unimportant – free will is founded in self-determination and without it, predetermination negates the significance of choice. If we reject the sociocultural weight with which we measure individuality, if we cease to believe that the rights of the individual outweigh other considerations, then the value of the individual’s decision is called into question: if the individual is insignificant, why does their opinion and consequent decision matter?

Given that there exist many communities in the world in which one (or both) of these ideas is rejected, I believe reflection on the preconceived significance of free will and individuality under which we discuss autonomy is important to fully understand why our particular society and culture holds autonomy to be important. This type of reflection allows us to transcend our preconceived notions and the potential dangers that arise from not understanding or acknowledging our accepted cultural and philosophical biases.

In short, though I personally believe that a patient’s right to autonomy is exceedingly important, I must acknowledge that a) others- particularly those whose opinions have been shaped by different worldviews – may very well disagree with that opinion,  and b) my reasoning behind that opinion is founded in my own sociocultural and philosophical views on free will and the value of the individual.

Word count: 557

Works Cited:

Childress, James F. “The Place of Autonomy in Bioethics.” Arguing About Bioethics. By Stephen Holland. Hoboken: Taylor and Francis, 2013. Loc 8698-897. Kindle.

The role of equal access in genetic enhancement: A contradiction.

Uncategorized, , ,

In “The Case Against Perfection: What’s Wrong with Designer Children, Bionic Athletes, and Genetic Engineering”, Michael J. Sandel asks us as readers to consider the inherently present repercussions of allowing genetic enhancement to run rampant in our society. While many of his arguments and counterarguments are sound, I found there to be a glaring inconsistency that arose in Sandel’s contemplation of the relevancy of social structure and class in genetic enhancement.

In his section on memory enhancement, Sandel brings up the point that many people worry about the danger of cognitive enhancement leading to two different classes of human beings: those with access to these enhancements, and those without. He even goes so far as to posit that this unfair distribution might, if the cognitive enhancement were to become evolutionary, lead to the division of humanity into two subspecies – enhanced versus natural. This argument is quite an interesting one, as it asks us to picture a futuristic world far removed from our own. Sandel asks “is the scenario troubling because the unenhanced poor would be denied the benefits of bioengineering, or because the enhanced affluent would somehow be dehumanized?” (Holland loc. 2999). He illegitimizes this as a core argument for the immorality of genetic engineering by saying that “the fundamental question is not how to ensure equal access to enhancement but whether we should aspire to it in the first place.” (Holland loc. 2999).

Later in the essay, in his argument on our societal meritocracy, Sandel argues that genetic enhancement would ruin our perception of giftedness as just that – a gift that we are fortunate to have, and would instead encourage the mindset that our new genetically-enhanced abilities are entirely our own, leading us to feel no sense of gratitude for our abilities or sympathy toward those people without our abilities. The contradiction upon which this post is centered stems from Sandel’s claim here that “A lively sense of the contingency of our gifts – a consciousness that none of us is wholly responsible for his or her success – saves a meritocratic society from sliding into the smug assumption that the rich are rich because they are more deserving than the poor.” (Holland loc. 3241). The rather obvious implication here is that genetic engineering would lead to a stratification of society based on the “haves” and the “have-nots”. This dualist idea of “the rich and the poor”, those who can afford genetic enhancement and those who cannot, is strikingly similar to the argument he presented earlier and promptly dismissed.

While both of these arguments speak to the importance of class consideration in the development of an educated opinion about the ethicality of genetic enhancement, I am troubled by Sandel’s dismissal of the first point while taking seriously the second, as the two are very closely related: he uses the same foundation of argument, that genetic enhancement polarizes social structure, to make each point. Why is there a discrepancy in his consideration of these two points? He struck the first point from his core argument because the question on which he was focusing was not “how to ensure equal access” (loc. 2999), but in the second point, which is mentioned near the very end of the article, he points to inequality of access as a serious ethical consideration. It seems to me that, for the sake of consistency, Sandel needs to reconsider his view on the importance of ensuring equal access to genetic enhancement. Is provision of equal access a part of the fundamental question of the morality of genetic enhancement?

 

Sandel, Michael J. “The Case Against Perfection: What’s Wrong with Designer Children, Bionic Athletes, and Genetic Engineering.” Arguing About Bioethics. Ed. Stephen Holland. London: Routledge, 2012. Loc. 2935-3263. Kindle Edition.