Dr. Joseph S. Drage is chief of the developmental Neurology Branch within the National Institute of Health. A specialist in the developmental disorders of children, he helps decide what research projects will be approved and funded by NIII. Joseph Drage is one of a handful of individuals to whom we turn for direction in the area of health care in this country.
Last week Drage and 48 other physicians and nurses with similar positions left those positions and responsibilities to study ethics, and the application of ethics to medical problems, at Georgetown University.
Through the invitational Intensive Course in Bioethics presented by the Rose and Joseph P. Kennedy Institute for the Study of Human Reproduction and Bioethics, many for the first time had a chance to examine the formal discipline of ethics, which provides us with formalized systems for judging right and wrong, good and evil.
"This has broadened the horizon," said Drage, on his way to the last sessions of the course - the panel discussion on treatment of handicapped newborns and the lecture on perspectives in law and ethics.
"This improves your ability to look at things in a broader perspective," he said. "These are some of the issues I have to deal with in my work at NIH, and this gave me a chance to examine the philosophy" behind them. The course provided the participants with "lines of thinking of what's ethical and what isn't."
Until very recently the belief prevailed that major societal problems should be solved by those members of society with expertise in the problem being discussed.
Economists and actuaries were charged with working out the details of national health insurance, physicians with deciding who should or or should not be kept alive with various medical technologies, and penologiests with deciding whether prisoners should be used in medical experimentation.
Within the past 10, and particularly the past five years, there has come a growing awareness that each of these, and a myriad of other basic questions that face society, are ethical, rather than technical, in nature.
"The purpose (of the Kennedy Institute course) is to create a number of people in positions of leadership who will become acquainted with the forms of ethical arguments," said Dr. Andre Hellegers, a physician/ethicist who heads the Institute.
"We want to acquaint people with the forms of ethical argument," he continued, "otherwise they will not understand the nature of the kinds of questions being asked by the public. For instance, by what means are the allocation of medical resources being done? Should it be ends oriented or means oriented? By what methods would you judge - the number of lives saved?"
"You must first understand the methods and then decide whether one method would be more ethical than another method," said Hellegers.
The six days of formal lectures and informal discussion groups, paid for by the Joseph P. Kennedy Jr. Foundation at a cost of about $18,000, included such topics as:
Utilitarianism, the school of ethical thought that is most commonly held to espouse that which is useful is right, or, even more simplistically put, that the ends justify the means.
Deontological theories, which hold that some acts are right in and of themselves, regardless of their consequences.
Concepts of health and disease, an examination of the ways in which society has viewed disease at different points in history, and the fact that the ways society has viewed particular diseases has effected their treatments.
The rights of patients and professionals, an examination of the ways patients' rights and health professionals' rights come into conflict and how those conflicts might be resolved.
Ethical issues in the care of the mentally retarded, which included a discussion of the question of whether, if all the "retarded" individuals in society were eliminated, society would pick a new group to call "retarded."
One of the main purposes of the course, said Hellegers, was to teach the participants that "there is such a thing as a professional ethicist."
When faced with a major problem in their home institution, such as whether it is right to carry on a particular research program, Hellegers hopes those who took the course will "know that when there's a discussion to be led they'd better get a professional ethicist."
"I would hope that someone comes out of this course and, if there's a problem where he's faced by a tricky feeling in the gut, that he picks up the phone," not to be told what to do, said Hellegers, but to be helped to see "what the options are."