Why doctors mustn’t lie to their patients

Honestly, I would have thought that a post about why doctors lying to patients is verboten would be wholly unnecessary.  Just like “doctors mustn’t operate on their patients while intoxicated” or “doctors mustn’t rifle through their patients’ belongings while they’re under anesthesia,” “doctors mustn’t lie to their patients” seems so obvious as to be beyond stating.  But it seems I was wrong in thinking this way, as some of the comments about one of Rose’s recent posts seem to indicate.  Further, there is an implication that this prohibition against lying stems from “professional ethics” understood to be some kind of collective handshake we all shared between rounds of golf at a conference one day, rather than a well-thought-out system of professional probity built on the rubble of some rather horrible historical mistakes.  Which is, of course, what it really is.

Let us begin with the rather easy slippery slope argument, which in this case is more like a well-greased fireman’s pole.  If doctors are legally permitted to lie to their patients to prevent abortions (a discussion of which started this whole conversation, and which I do not think is actually permitted by certain recent legislation), what other things are we allowed to lie about in service to our own moral reasoning?  Am I allowed to lie about the prognosis of a terminal cancer because I fear the patient may commit suicide?  Conversely (in an example suggested by BSK in that same comment thread linked above), am I allowed to lie about the possibility of recovery for an injured patient because I know his kidneys and liver might help patients awaiting transplant?  Am I allowed to tell a woman I’m treating her for a yeast infection, rather than the chlamydia she got from her philandering husband, because I disapprove of divorce?  Am I allowed to withhold from patients that they are infected with syphilis because I believe the greater good will be served by learning from how it ravages their bodies?

I sincerely hope that the answer to all of these questions is a resounding “no” from everyone.

The physician-patient relationship exists within a great differential of information, privilege and power.  Physicians know how to interpret signs and results about patients’ own bodies that they themselves cannot.  They are given the privilege of prescribing medications, including those that are dangerous and/or addictive.  They can give patients access to special services, and excuse them from work or school or civic duties.  They can perform risky and invasive procedures.  And since patients often want or need these things, physicians have greater power in the relationship.  Medical ethics are a means by which the ill effects of that power differential are mitigated.

Giving patients accurate and comprehensive information about their health and allowing them to make their own best decisions is a foundational part of medical ethics.  It is obvious reason for informed consent laws.  It is the reason that any research hospital has a institutional review board to ensure that those enrolled in medical studies have been given all the information they need about risks and benefits to make their own choices, and are not being pressured or coerced.  It cannot be dispensed with.

Withholding or tampering with information in order to manipulate a patient into a choice we think she should make is exploiting rather than obviating the power differential in the physician-patient relationship.  If the choice is a moral one, we are robbing her of her moral agency and substituting our own.  I am  confounded in the extreme that anyone would argue otherwise.  Arguing further that this evil is necessary to prevent another evil (such as abortion) makes us magistrates rather than healers, and invests us with powers that are not rightly ours.  We are  charged with caring for our patients’ health, not dictating their moral choices.

My esteemed interlocutor and fellow Ordinary made reference to the Nazi regime in his comments, and so perhaps I may be forgiven for doing so myself.  In medical school, when I was taught about medical ethics I was reminded that one of history’s greatest monsters was a doctor.  Were I one who believed in hell, I would reserve a place of special darkness for him.  He was not discussed as some kind of rhetorical figure, meant to score a point in an argument about right or wrong.  He was discussed as a reminder to all of us that we are given a role in society that comes with a solemn responsibility to never, ever allow such hideous perversions of our work as physicians to come to pass again.  We must never abuse the privileges and prerogatives of our profession.

I neither want nor should be granted the power to subvert my patients’ moral agency, and there must never come a time when I or any of my colleagues are given the legal capacity to do so.

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.


    • To be clear, it’s about lying in general, not medical ethics.

  1. Now that doctors “ethicially” kill, Dr. Saunders, you’re still not engaging the dilemma as it exists.

    Abortion for gender? This is already happening often in India and China. The doctor is just the doorman at the slaughterhouse?

    If the choice is a moral one, we are robbing her of her moral agency and substituting our own.

    That Pontius Pilate is becoming a moral exemplar is the modern problem, that such a thing is even thinkable. The problem is that medical ethics already permit the unethical, the immoral: you build on sand here.

    Nothing personal in all this of course, sir. But again, the doctor cannot wash his hands of his own moral agency by claiming a “professional” ethics. “Just following orders” [the patient’s] will not do. And neither can there be anything more than a legalistic answer to the problem that the fetus becomes the doctor’s patient too. The fetus cannot call for an appointment.

    • “He’s a very moral obstetrician. All his patients are expecting perfectly healthy boys.”

      • Astonishing, Mr. Schilling. It’s all there:

        “He’s a very moral obstetrician. All his patients are expecting perfectly healthy boys.”

        • I omitted the consequence, since it’s obvious:

          “He’s completely full of shit.”

    • We are at an impasse, Tom. You think the moral argument against abortion is of such weight that it allows for doctors to decide for patients what they are to do. I do not. You consider the question of abortion to be settled, and that the answer is “murder.” I do not. You argue that those who merely allow women to make their own decisions are accomplices in murder, and that the mere possibility that they may abort is sufficient justification to deceive. I dissent.

      I cannot speak to medical ethics in other countries, Tom. What is done in India and China is a topic someone else can take up. I speak from within my own experience in this country, nothing more.

      I find it fascinating that you situate your arguments behind a tissue of conviviality and then put scare quotes around “professional.” I also find it interesting that you conflate the doctor who provides his patients with honest information about her pregnancy and the abortionist, as though they are both “just following orders” to the same extent. I find it ironic that you do so immediately after telling me that I build on sand.

      I have shared my thoughts about why giving physicians legal sanction to lie to their patients because they feel morally fit to do so is perilous and impermissible. If what I have said is insufficient to persuade you that there must be some other remedy for the evil of abortion than deceit, then there is little I believe myself able to add at this point.

      • As a doctor, you could say naught else, Dr. Saunders. Indeed, you are obliged to continually fall back to what is “legal,” for to consider what is moral—or immoral—is frightening. However, abortion for gender selection may give you pause. It should give you pause. It is legal, and you would indeed be the doorkeeper to the slaughterhouse.

        And if I use such a strong image occasionally, well, I’ve decided not to be bloodless about it. Certainly the other side of the question is unashamed at its own passion for their position.

        As for “convivality,” etc., in our previous correspondences, I did include the proviso that if you don’t believe the fetus has human rights—and I do not call that position invalid—none of this applies to you personally.

        Neither do I personally necessarily call abortion “murder.” English common law [and other traditions] put it more as manslaughter, a quasi-homicide. One can consider the [im]morality of abortion without going full nuclear with “murder.”

        • You are conflating things falsely.

          A doctor can (and ought to) refuse to engage in a procedure he considers immoral. He ought not to (and probably can’t) interfere with a patient seeking that treatment elsewhere, which is what lying would amount to. If the doctor disagrees with abortion, or disagrees with abortion to select gender, he need not perform the procedure. But that does not make it acceptable for him to lie to the patient just as it would be unacceptable for him to padlock the door to the room the abortions are done in.

          And while I understand the distinction between a lie of omission and the other type (is it commission?), would you only consider the former tolerable or both? It seems as if you think it acceptable for a doctor to decline to inform a patient of something. But suppose the patient asks. “Does my baby have X?” Would it be okay for the doctor to say “No” when the answer is “Yes”?

          • Actually, I was wondering more about how this applies to cosmetic surgery.
            I want to see if this is a general trend or a specific trend.
            I was about to go into a long and arcane example of general and specific trends, but I decided to spare you at the last moment.
            I take aspirin for my heart, but the results are unclear as to whether my heart has become more or less merciful because of it.

            But really, I think that, in an honest assessment, we might well be more toward enforced abortions by the end of this century.
            We need to be careful about what we do in this time.

        • Indeed, you are obliged to continually fall back to what is “legal,” for to consider what is moral—or immoral—is frightening.

          I find the condescension that drips from that statement impossibly wearying, Tom. Please do not presume to tell me of what I am frightened.

          Your position requires a blurring between the doctor who provides information to a patient and the doctor who performs the abortion. You color them both with the same brush. They are not the same, and an argument against the latter does not pertain to the actions of the former. Your opposition to abortion is a separate issue from the obligations of a doctor to his patient.

          Information is morally neutral. “You’re pregnant.” “You’re having a girl.” “Your baby has Down syndrome.” “Your baby is anencephalic.” All of these are morally neutral statements. All of them could lead to an abortion. None of them must lead to an abortion. The doctor is not entitled to determine which pieces of information to withhold because of the possibility, because the person who transforms that piece of information from the possible cause of the abortion to the actual cause is not and never will be him. It will always be the pregnant woman, and the doctor may not seize for himself the right to determine by his own guesswork where her line might be.

          But even if we allow that he could somehow determine with perfect accuracy which piece of information might cause her to abort the baby, it would still not be his prerogative to withhold it. You seem to think that the argument “abortion is really bad” is sufficient justification for a doctor arrogating unto himself the moral decision-making of his patient. In which case, I wonder what other evils are sufficient for the doctor to be similarly manipulative, and who then is tasked with drawing those lines.

    • If you are a doctor who feels that euthenasia is immoral, and know that your patient is a strong proponent of legalizing euthenasia, would you be morally justified, in fact morally obligated, not to tell him or her that he or she was terminally ill (once upon a time, there was actually a huge debate among physicians about whether to tell patients of terminal diagnoses, I know, but I think that debate has long been decided in the general case, making this specific one viable).

      • As I indicated in reference to a similar question in the original post, withholding accurate information about a patient’s condition to prevent them from ending their own life is immoral and unethical.

        • To say more, I think Tom is laying out a fairly consistent and comprehensible position that is in contrast to your own. I want to see how far he would take it. Eventually, he’s going to run into problems of probability. There is no way that the doctor can know that a woman is going to seek abortion, or that a person might off him or herself if he or she learns of a cancer diagnosis, so how much uncertainty is allowable? And for what potentially immoral acts? If an optometrist thinks that a person will drive recklessly, is he or she obligated to lie and say that person’s vision falls below the threshold for obtaining a driver’s license? I’d like to see Tom flesh out the principle: lying to prevent an immoral act by another is permissable if and only if the set of conditions X holds, where X includes a level of certainty, types of infractions (or at least a straightforward way of determining whether an infraction may justify lying), etc. If we assume that lying itself is a potential moral infraction, and that lying to patients by doctors is much more serious than ordinary lying (“I thought it was a lovely story, and you tell it so well!”), then a very clear sense of what conditions make it an obligation is very important.

          • I don’t have an answer or a speech to give. I am, however, unsatisfied with the attempt to moot the question, because it’s not moot, and advances in medical science are bringing the question closer to reality than abstraction.

            It is legal—and not professionally unethical—to abort for gender selection, or eye color for that matter. Clearly professional ethics are not the end of the question. I mean, for a doctor with a belief system like my friend Saunders’ here they are, and he’s off the hook personally as far as following his moral conscience.

            But the prevailing ethics of the medical profession in 2012 are the result of mere politics, conventional, a vote: a half century ago, aborting for gender [or performing late term abortions] would have made one a pariah in his profession, if not an inmate.

            I appreciate Saunders’ distinction between making the diagnosis and performing the abortion, but I’m not sure it holds all the way through, any more than Pilate could wash his hands of his own moral agency.

            Again, none of this holds if the doctor is comfortable with the fetus having no right to life. And I don’t want to go Godwin, but only grave issues have the sufficient gravity to be effective analogies—I think of the Underground Railroad, the refusal to obey the Fugitive Slave Act, and return slaves to their rightful [legal, constitutional] owners. you do what’s right or you do what’s legal. in the case of prevailing medical ethics, it’s about what’s legal, that is, what is voted or decreed by the Powers That Be in the medical profession. But what is legal is not necessarily what is moral, what is right.

            The latter assertion should be fairly uncontroversial.

            Dr. Saunders states we are at an impasse, and since he has resolved the moral conundrum to his own satisfaction, “we” are. However, I am not. I didn’t have a position when I read Rose’s first post along these lines, and I still don’t. However, I have far more reservations about the medical profession and how its ethics have “evolved.” Leaving out the abortion question, the original Hippocratic Oath forbade euthanasia; I see the modern version contemplates it.


            The question of ethics never closes; in 100 years, they may be appalled that physicians ever aborted fetuses. Or the ethics of medicine may be indistinguishable from those of auto mechanics: Whoever’s paying the bill calls the shots.

          • If this were an issue only doing what’s legal v. doing what’s moral, you’d be right. But this is not necessarily an issue of legality v. morality. This is a moral dilemma for the pro-life doctor. It’s about two different moral obligations – to save the fetus, and to practice with autonomy for patients. And there are indeed moral (not just legal) arguments for the autonomy as the cornerstone of medical ethics.

            The question, as in any moral dilemma, is which obligation should trump.

          • Rose, right, which is all I’m asking Tom to answer I do think the doctor has a moral obligation to tell the truth to his or her patients above and beyond telling the truth in other circumstances, because of the nature of the relationship (one of power and unique knowledge, of trust, and of important and often deeply life-affecting decisions). I don’t think this is merely a matter of professional ethics, but of ethics generally (other, analogous relationships would demand the same, even if there is no recognize code of professional ethics in those relationships). I understand Tom’s position: that the moral obligation to keep the fetus alive is weightier than the obligation to tell the patient the truth. What I want to know is how far that extends, both in terms of uncertainty and the other situations in which this might apply (like the euthanasia situation).

            Tom, I’m not asking for a speech. I’m asking for a more thorough explanation of your position, so that I can evaluate it. I take it seriously, but I can’t evaluate it without more information.

          • I don’t have a position. I’m discussing. Until Rose’s post, I didn’t realize the true nature of the problem, that medical ethics can permit—indeed facilitate—the immoral, such as [we Westerners might agree, anyway] abortion for gender selection.

            And the problem that since all morality is on the practical level conventional, the product of consensus, that we as a people, a civilization, have largely ceded the great moral questions to the doctors and the lawyers. I wouldn’t be surprised that the Roe decision moderated many doctors’ ethical stands on abortion, but the legal/constitutional should have zero to do with what is moral or immoral, right or wrong.

            And what makes the doctor’s [or lawyer’s] moral judgment any better than the rest of ours? It could indeed be worse. [“Whenever I discuss politics with a surgeon, I wonder how he doesn’t kill all his patients.”—Andy Rooney] There’s no reason to defer to their moral reasoning. It could merely be following the legal, political and cultural tides, none of which are inherently moral.

            There is much more to do in identifying the problem, the dilemma, and I’m gratified that you and Rose allow that there is [or could be, anyway] a dilemma. My biggest discomfort is always in the denying there is a dilemma atall.

            The next problem is the idea of “moral neutrality,” that abstention is the only solution to a moral dilemma, just kick it down the road to the next fellow who doesn’t have your scruples/reservations. But there will always be somebody like that to kick it down the road to.

            After that, that the medical profession–and those who control its normative ethics—will push out all those who refuse to go along with their morality [or lack of it], or with “moral neutrality.” This has always been the technique to dispose of inconvenient moralities, to get rid of those who hold them. In less than a century, Hippocrates has gone from being opposed to euthanasia to allowing for the possibility. What is next? Gender selection, eye color? Height, weight?



            Frankly, I’m getting afraid of the medical profession the more I think about it, how they come up with their ethics, and that the profession may, can and will squeeze out those who don’t play ball with the modern project. For at this point, from my POV, they are already attempting to manage the ethics of the immoral, yes, building on sand. And as the science of reproducing man gets more powerful, the philosophical dilemma will only get worse.

            Hence, the attempt to ignore or abolish the very existence of the dilemma. Such a brave new world.

          • It’s certainly a reasonable position that preventing greater evils can justify certain acts that would normally be immoral (and I trust, Tom, that you do think a physician lying to a patient would NORMALLY be immoral). But if that’s the case, why focus on the medical ethics?

            If you knew a woman planned to drive to get an abortion, w0uld you slash her tires, Mr. Van Dyke?

          • And that’s the problem at the end of the day.

            To what extent do you have the right to prevent a particular abortion?

            If you agree that you do not have the right to imprison the woman until the baby is brought to term (and, I suspect, we agree that we do not have this right) then… well, we’re haggling over where to draw the line, aren’t we? Some people put it here, some there. Some on this side of the “lie to her about it” line, some on that one.

          • This is a thorny problem. The good news is that this problem is recognized by the AMA, and they’ve committed to having a group of top medical ethicists study it, with a first draft due by the end of the year, and a final recommendation for how to address these issues scheduled for mid-2013.

            (OK, none of that is true, but we all felt better for a few minutes, so I feel good about having written it.)

          • Doctors’ “right” [duty?] to perform abortions would be the question here. Criminalizing the woman is the facile way to moot the discussion, but that’s not the point. How did the law and “medical ethics” swing to facilitating that which was formerly unthinkable?

            I’m starting at the beginning rather than working back from the end. As a doctor himself, Mr. Saunders is rather stuck with starting at the end, but we civilians are not. Further, eugenics ain’t dead yet, and in the very least, there’s abortion for gender selection as a reality or a near-reality.

            We have not addressed the questions as a people, and I do think it was Roe that offered us a happy escape from confronting these dilemmas. But constitutional law is not morality, at least not always. Unfortunately, it seems medical ethics let itself be subsumed by legalism, moral agency replaced by the chimera of “moral neutrality.”

          • After that, that the medical profession–and those who control its normative ethics—will push out all those who refuse to go along with their morality [or lack of it], or with “moral neutrality.”

            I am intrigued by this vast conspiracy you see behind the medical profession, Tom. You do imagine the most entertaining fictions.

            As a doctor himself, Mr. Saunders is rather stuck with starting at the end, but we civilians are not.

            Oh, Tom. You have always styled yourself in such a polite way. What a pity you have chosen to abandon that habit.

          • Oh, I was sincere about you being obliged to start at the end, Doctor. Even if I am completely correct, you’re in the thick of it as a med professional. [And could hardly approve of lying.]

            As for the “evolution” of medical ethics of late, the Pilate Syndrome is one of moral passivity, not aggressiveness. [Although I’m sure you have a few of those.] And yes, I do see more passivity than courage in confronting these questions, the American medical community’s positions being more reflective of party politics than moral reasoning.

            For example, in the UK, although the majority of UK doctors favored cutting the limit for abortions from 24 to 20 weeks, the “political” doctors of the BMA overwhelmingly voted against.


            Pls don’t tell me there isn’t a politics to medical ethics. Medical ethics is whatever you can muster up the votes for. In the United States, the medical establishment can’t even muster up condemning abortions AFTER 24 weeks. They should be drumming the late-term abortionists out, not defending them or hiding behind the veil of “moral neutrality.”

            I’m sorry you have a stake in this fight on the personal level, Russell, but this is where your co-blogger’s posts have taken my thoughts, and it seems several others are at least open to the questions being raised.

          • Tom, I think medical ethics allows gender-specific abortions, or abortions for other traits, largely because it hasn’t figured out a way to prohibit them (ethically, not necessarily legally) without prohibiting other stuff that most don’t want to prohibit. The problem is a very difficult one, and one that a lot of people are wrestling with, both within medicine and outside of it.

          • Tom, I think you misconstrued my comment on the other thread and I think you’re missing the nuance with the Pilate Syndrome reference.

            It’s just a given that people in general are going to be subject to moral quandary, right? I mean, we can accept that statement on face value, yes?

            A man who cannot qualify for a C.O. who has been drafted has the choice of going to war, or going to jail. A man who is in the field, who is a commander and leader of men, has obligations to his men in addition to the obligations he has to his conscience. A just folks who knows their neighbor deals pot to what looks like just harmless cancer patients but who feels very strongly about bein’ law abidin’ has a conflict.

            There are conflicts everywhere and everywhen.

            The conflict that you’re laying out here is a red herring. The conflict has been kicked down the line, by hemming and hawing and choosing not to take a stand and then all of a sudden the doctor is faced with a patient who may want to abort and they feel conflicted.

            Tough shit.

            The proper time to let someone know about your moral reasoning is when you accept them as a patient. “I’m a strong believer that abortion is immoral, and I’ll have a hard time dealing honestly with you as a patient if you become pregnant if you’re not willing to carry that baby to term.” Or, “I need to inform you that this practice will not perform elective abortions.” Or any one of a number of other methods of ground-clearing.

            This isn’t comparable to the Nazis showing up and asking if you have someone in the attic. It’s not a surprise. It’s your choice, as a doctor, to accept patients who may require you, as a patient, to take actions that infringe upon your own moral reasoning.

            You cannot suddenly abdicate your role as a doctor to play moral arbiter any more than a soldier who went to the military academy at age 18, did his mandatory service, decided to up for the 20, served 10 of that 20 and then got deployed to Iraq and had to actually decide to shoot somebody or let them massacre his platoon can’t suddenly decide to abdicate his role as a field commander to play “I’ve actually been a pacifist all these years.”

            Even if he *is* a pacifist. Tough shit. You put yourself into a role that is going to cause you a conflict, and your way out of it when that conflict hits you is to lie to your patient? That’s not moral reasoning.

            It’s cowardice.

          • There’s a “grandfather” problem, PatC, that what was considered immoral &/or unethical when one entered the profession is now moral/ethical. Well, hold on a minute, son.

            Further, there’s the problem of abandoning the medical profession to those who have no more moral scruples than an auto mechanic. [An honest mechanic, mind you.]

            Therefore, the prevailing “ethics” become no more than a bland utilitarianism. So I appreciate the “tough shit” comparisons, but they don’t hold. The only way the Conscientious Objector is going to stop violence is with violence, so he’s screwed either way. This is not the case here.

            Disobeying The Fugitive Slave Act, other examples as limned above. How can the AMA avert its eyes at post-24 week abortions when even the liberal BMA is against them? I’m not sure we can get any further. That we have broached the subject and existence of the dilemma, well, that will do.

            As for Chris’ cite of gender-selection abortion, that’s precisely the legalistic approach that can’t address the question of what is moral, what is right or wrong. For Pilate to wash his hands if that dilemma were to arise, well, he can’t. Perhaps in the eyes of the law, or in the eyes of his professional association, but not morally.

            If that doctor could do something to save that little girl from being aborted, I have no moral condemnation. And I suspect that doctor would never regret it. That much of a position and moral certainty I do have.

          • Sure, they hold, Tom.

            There isn’t a grandfather problem here. Or if there is one, it’s pretty minor. You’re a doctor, you don’t want anything to do with abortion, you just tell your patients that. Now. And all new ones you get.

            You’re not under an obligation to perform them. Your patients can walk out the door if they have a problem with this. I don’t think anybody who is a patient of a doctor who tells them this is going to stick around if abortion at will is something they think is a good idea.

            You want to stand up at AMA meetings at talk about post 24-week abortions? Go ahead! Nobody can take away your license to practice on that account. You want to assemble in a pro-life march, do that too!

          • I’m not ceding the “moral neutrality” argument, PatC, nor will I condemn the doctor who saved that little girl from being aborted, nor will I cede that the profession of medicine should be yielded to the “morally neutral.” Indeed, the AMA’s lack of leadership [as contrasted to the BMA’s, which at least took a stab at it] shows exactly why medicine in the United States is being given over to the internal politics and powerplays of institutions like the AMA.

            Which—I realize now, PatC—why my rant about the legitimacy of the AMA, etc. promulgating medical ethics is key to my discomfiture, because I do question their legitimacy. The process, the persons, their authority to decree what is ethical and what isn’t. IMO, it changes with the political tides, not via moral reasoning.

            I’m the rebel here, dude. Question authority. Up the establishment. Turn the profession over to them, the mechanics? Why?

            I think Mike Schilling was being sincere here.

            “He’s a very moral obstetrician. All his patients are expecting perfectly healthy boys.”

            Regardless, it’s chilling, man, at least to me. Like some Stepford horror movie or something, and it’s closer to reality than abstract what if? argument.

          • Me, sincere? How long have we known each other?

            Anyway, now that you’ve pointed it out, I can see how ambiguous my comment was. What I meant was that he tells all of his patients that they’re having healthy boys, even if they’re Tay Sachs-afflicted girls. The result being that very shortly no one believes a word he says.

          • Speaking for myself, if slavery and the Fugitive Slave Act existed today, I’d slash the tires of a modern-day slave hunter, at least if I thought I could get away with it. I’d slash the tires of an SS officer. If I balked, I’d count that a failure of courage, not a triumph of morality.

            So if you want to keep comparing lying to patients to prevent abortions to defying the Fugitive Slave Act, I’d really like to know your position on tire slashing.

          • From the mouths of the most cynical of babes, Mr. Schilling.

            Mr. Fnord, you’re doing a good job of extrapolating from what I’ve written so far re the tires. I’m in discussion mode; Rose’s post and this discussion have put me at least into virgin conundrum, not just a re-spout of previous ruminations. I don’t have a thesis yet, just questions and things that trouble me.

            I’d count that a failure of courage, not a triumph of morality.

            The problem of moral courage is more what this is about. From the first, I’ve let Dr. Saunders off the moral hook because he’s made up his mind about the relative status of the fetus. The examples I’ve used [Fugitive Slave Act] are an attempt to trigger further discussion based on an a moral premise/conundrum we might agree on.

            The Fugitive Slave Act was thoroughly legal and constitutional. I put professional ethics as promulgated by an American Medical Association on no higher plane. If you can disobey one, you can disobey the other. Do the right thing.

            Mr. Schilling’s practical objection, that a lying doctor would soon be found out, is stipulated. Mr. Fnord rightly asks about slashing the SS tires, but what if you could get away with it?

            And I would add, what if it achieved its purpose, to save a life?

            If that doctor could do something to save that little girl from being aborted, I have no moral condemnation. And I suspect that doctor would never regret it. That much of a position and moral certainty I do have.

          • > nor will I cede that the profession of medicine should
            > be yielded to the “morally neutral.”

            Tom, I’m getting exasperated.

            Where in my last comment do I say that the profession of medicine should be yielded to the morally neutral (whatever that term is supposed to mean)?

            Are you saying that I’m implying there is no position available in medicine for those who have a moral objection to abortion? Whereforeso? Am I not pretty explicitly *granting* that the opposite is the case?

            Are you saying that it’s somehow a *burden* on a doctor to inform their patients at the beginning of their professional relationship that they have this moral reasoning? If so, why?

            And even if it ’twere a burden (“Mwah, all my patients will leave me!!”) how is it even germane? If all of your patients want abortion on demand, and you don’t want to provide it, well… that seems to be something of a pickle but it’s on you to take that out. Not punt down the road and then lie to your patient because you didn’t have the courage to stand up for your convictions in the first place.

            This is our world, Tommy. People are allowed to believe most anything they want. They don’t get to square that with potential conflicts by *deceit*.

          • This is our world, Tommy. People are allowed to believe most anything they want. They don’t get to square that with potential conflicts by *deceit*.

            Sure they do, Paddy. As Michael Corleone says to Kay, now who’s being naive?

            Mr. Schilling’s objection is sustained here, of course. Or per Mr. Fnord’s observation, you just can’t slash every SS tire in your neighborhood before even the stupid Nazis figure you out.

            And as the Global Warming liars are finding out, in the end they have hurt their cause by exaggerating it. [Sometimes fabricating!]

            I’m not making a rule out of the exception that offers itself. Oskar Schindler couldn’t save everybody, right? [Sorry for the Godwin again, but this is the gravest of issues.]

            We’re being subversive here. Don’t let your left hand know what your right hand is doing. Now that’s a sweet bit of wisdom.

          • I think the solution would be to inform the patients of the doctor’s moral reservations by some means; in the same manner that Justices on the Supreme Court recuse themselves from participating in certain cases.

            I see Tom’s point: that the Constitution is to limit the powers of government, and not to determine what is moral; that professional organizations evolve policy on bases other than sheer morality; etc.
            And no, doctors are not the ones to police themselves any more than cattle ranchers should be in charge of how and when beef is tested for mad cow, or coal mines should test the purity of drinking water. That is, they should have input, being affected parties, but should not be allowed the sole determination.
            I don’t see why that’s even an issue.

          • Right, WillH. I’m not seeking a solution. There is none, or if there is, it’s only legal not moral. I would lie, cheat or steal to save your life. Anything else would be unethical. So sue me.

            That’s where we all started with this, I believe. The circle closes.

          • FWIW, since I did say it was a moral dilemma, and this got started on a post I wrote, I will just throw in that I do indeed think patient autonomy trumps in this dilemma, even if you consider the fetus a person.

            I think Patrick’s solution of informing the patient is a good one.

            Interestingly, my OB is pro-life. He refers his patients to other doctors for procedures with which he disagrees. If one is not willing to do that, then, as Patrick said, the doctor has to be up front with what information she will provide (the “informed” part being a pretty big deal for informed consent, which again, is a pretty big friggin’ ethical deal, not some backroom handshake situation).

          • I would lie, cheat or steal to save your life. Anything else would be unethical. So sue me.

            I won’t sue you, Tom, but I’ll admonish you never to become an obstetrician.

          • On a strict Kantian reading, the value of life is incommensurable. So two lives are not more valuable than one. And you can’t kill one person to save two. (Just as we can’t go killing a healthy person, havest her organs, and save five lives.)

            Let me stress again how strongly I disagree with not saving the mother in an ectopic pregnancy. Just saying if you think the fetus is a person at conception, and the value of life incommensurable, then it could follow.

    • We already went over this a couple months ago. Abortion for gender is not any more immoral than any other abortion at the same stage of pregnancy.

      • Michael, as someone who is staunchly pro-choice, I disagree. I think there are serious ethical issues related to abortion for gender that have to be contended with, and which don’t apply to other abortions. It gets even stickier when we start aborting for other traits (sexual orientation? athleticism? intelligence? hell, at some point, political orientation?). It may turn out that there is no practical way to avoid these sorts of abortions without banning all abortions, and I think that would be an unacceptable consequence, but it doesn’t mean there aren’t very real issues to work through here.

        • You seriously feel that abortion for gender is less moral than abortion for “I don’t feel like being a parent right now even though I got pregnant due to careless sex”? What’s the argument?

          There may well be aggregate outcome issues to be concerned about if doing this becomes a norm, but in my view that is not an argument about the morality of the discreet acts.

          • I actually agree. I have a dour view of abortion, but don’t see one rationale as being worse than another. The only way I see it as being worse is, as you say, aggregate outcome.

            (It’s noteworthy that there’s a strong case to be made that gender-selected abortion in the US would actually favor women rather than men as is the case elsewhere.)

          • Probably you and I recall that discussion better than others, Will, so perhaps I should have been a little less forward with my tongue-in-cheek “We already covered this” quip. So apologies for that, everyone.

          • I disagree.
            Morality is not a thing to be determined by outcome.
            That’s the very same issue as the OP.
            Is lying right or wrong, or is that to be determined by the outcome?
            I have to say that I agree with our resident physician here.

          • Will H.

            How is

            “There may well be aggregate outcome issues to be concerned about if doing this becomes a norm, but in my view that is not an argument about the morality of the discreet acts.”

            at odds with, “Morality is not a thing to be determined by outcome”?

            I think we are in agreement.

          • I’m not so sure what your position is here.
            Mine is that the forest is made of trees, and even if you remove half of them, it’s still a forest.
            The sewer is full of turds, and even if half of them floated away, you still wouldn’t want to swim there.

          • Whatever else it is, my position here is not inconsistent with a view that its “Morality is not a thing to be determined by outcome.”

            I’m just curious where you found something that you thought conflicted with that.

          • I was replying to Trunwill’s, “don’t see one rationale as being worse than another” statement.
            I was actually agreeing with your, “that is not an argument about the morality of the discreet acts” statement.
            The two are separate concerns.

          • Michael, your mistake, from my perspective, is viewing the relevant moral issue behind gender-specific abortions as one related to abortion, and not one related to choosing gender (or whatever we’re selecting for). In your defense, this is what abortion opponents like Tom want to make it about, but it isn’t about abortion per se.

          • Chris,

            I do not regard sex selection by means other than abortion as morally problematic. And I don’t regard abortion as immoral (with a certain amount of uncertainty as to that position, but not enough to make it not my position, as to late-term abortion). So for me, my statement above stands. You are welcome to try to explain to me why I should regard, say, genetic manipulation of a fertilized ovum so as to select its sex as immoral, but at the moment I can clearly say I don’t, so I don’t view my not having a problem with choosing to abort a pregnancy on the basis of sex preference as mistaken by virtue of failing to reject sex selection. Because I don’t reject sex selection.

          • If you’re talking about moral and immoral actions, I wonder if you two might not be talking about two different actions. One is having a gender preference, which Michael thinks is permissible and Chris wonders about (it does have a mere means-y feel, but the person doesn’t exist yet). The second is the abortion – which if the fetus is a non-person is totally all right, and if the fetus is a person is not all right.

            Although there might be shades of grey between person and non-person, where our treatment of it is not all or nothing – we have some obligations to treat it with respect, but not personhood. Flag, artwork, corpse, (possibly) animals, someone’s treasured necklace from her grandmother, etc.

          • I think I agree with RW almost entirely here. Certainly a fetus is an entity worthy of treating with respect. However, I think virtually or maybe even literally any reason a woman has to think that it would be better for her not to become the mother of the child that fetus will become at this time is sufficient cause to morally justify her decision to terminate her pregnancy, that is the moral weight I give to granting her the full autonomy to make that determination, in full knowledge that the result will be the termination of the life of that fetus. The practical requirements for respect for a fetus do not come within a country mile of encroaching on a woman’s full moral autonomy to make that determination about her life and bodily integrity. So abortion is a step that can be taken that does not violate the imperative of proper respect for the entity that is a fetus.

            As i have said, I am something less than 100% sure that there is no point in a pregnancy at which we should come to regard a fetus as a moral (and therefore legal) person. But I am sufficiently unsure that there is such a point (perhaps 91% sure there is not, in fact), that my functional position is that all abortions are not immoral, because, as I said, I give great weight to the certain need for personal autonomy for women, and that certainty easily resolves the uncertainty about the moral state of a late-term fetus for me in favor of the woman’s autonomy.

            I believe we should keep the person/non-person distinction that clear in our minds, because we keep it that clear for all other moral and legal considerations we make about persons. I take a very dim view of the enterprise of trying to describe, much less for practical moral purposes, define, intermediate moral states of partial-personhood during stages of gestation. Morally and biologically, in my view, that path becomes extremely ad-hoc and thus morally meaningless extremely quickly.

          • Rose, right, that’s what I was saying: the abortion itself isn’t the moral issue (for me), it’s the gender selection that is. If it’s wrong by other means, why isn’t it wrong by this particular means? The issues related to gender selection are many: gender discrimination, harm to society, etc., and the fact that abortion is the method doesn’t make them go away. They have to be addressed, at the very least.

            I don’t think fetuses are persons. I think they have a moral status greater than that of most things, but less than that of full persons, so I choose the woman over the fetus in most cases. But gender selection isn’t just about the particular fetus. It’s a moral choice with much larger implications.

          • Michael, Here is a question? Is it possible that gender-selecting abortions cause harm that other abortions do not? If so, then it is probably the gender-selection component that is potentially immoral. What you seem to be saying, in essence, is that whatever moral issues might arise as a result of abortions that choose for particular traits (whether it’s gender, sexual orientation, or whatever), they are for you outweighed by the morality of abortion itself. And I’m fine with that. I myself think that reproductive freedom is important enough, morally, that it will outweigh most other considerations, including this one. I don’t think it will be possible to prevent gender-selective abortions, or trait-selective abortions generally, without unduly limiting reproductive freedom (how do you outlaw a personal justification for an otherwise legal action, without outlawing that action entirely?), but that doesn’t mean that gender-selective abortions aren’t immoral (just because something is immoral doesn’t mean we should outlaw it).

      • I don’t know that I agree with this, Michael.

        Now, I don’t know that this means that we have the right to *PREVENT* an immoral abortion (such as one abortion a particular gender/sexuality/cosmetic trait) but that doesn’t mean that an abortion for this reason is morally identical to an abortion for that reason.

        (Assuming moral realism, of course.)

        • You don’t have to agree, but I hold that it is. ()

          • So an abortion because of a tubal ligation has the same moral content as “I found out the infant was going to be female and I’d prefer to have a real baby”?

          • Yes.

            The sentiments don’t have same moral content (you could put any words in the mind of someone making the choice, as you do with the “real baby” manipulation, which is not precisely what was being discussed), but the actions do.

            What is your opinion of the moral content of, ““I don’t feel like being a parent right now even though I got pregnant due to careless sex, so I’m having an abortion (at, say, 16 weeks).”?

          • Abortion because of a tubal ligation? {scratching head}

            For my part, I wasn’t clear in my previous comment. I meant decisions to abort of a certain type are created equal. Which is to say, “I wanted a girl” and “I don’t want a baby right now” and “I don’t want a baby with this particular man” and such are all about equal. They’d fall in roughly the same category to me.

            “I don’t want to die and having this baby could kill me” would be in a different category.

            “I don’t want children and the doctor must have botched my tubal ligation so here I am pregnant and I need to get out of this” (is this what you meant?) would be in a different category.

            “I was raped and I don’t want a child from that rape” would also be in a different category.

            (So I am pretty sure MDrew and I do not agree on this after all, though we at least agree on the lack of distinction within my first category.)

          • Ectopic pregnancy. That’s what I meant.

            Like the internet, ladyparts are a series of tubes.

          • To me, either the fetus is a child (which I don’t believe is the case for the greater part of a pregnancy) and it cannot be killed for any reason, even the life of the woman (though that is certainly a contended question), or else it is not a child, but is rather essentially part of the woman’s body and the decision is a matter of her best health and personal autonomy.

            If the fetus is a child at some point during the pregnancy, it at that time can no longer be aborted for reason of gender selection, simple preference not to be a parent, or ineffective permanent contraception procedure. But if it is not, in my mind, all those reasons are equivalent, even to safeguarding the health of the mother. This is because if a fetus is not a child, in my mind there is not moral burden to satisfy – the action in question is the exercise of legitimate pursuit of health and personal life choices by the woman.

            As I mentioned, the question of risk to the life of the pregnant woman under the assumption that the fetus is a person is actually quite a separate matter (really, all of this is a different question from abortion per se under that assumption, but anything but a threat to the life of the pregnant woman is a non-candidate for justification for the abortion (killing) of a person in utero) – namely, the question of the killing of a legal and moral person. This amounts to the question of whether it is moral to actively kill a person who is innocently situated in such a way that only killing him will eliminate him as a potential (not certain, except maybe in quite rare instances) threat to the life of another (only one other) person.

            I don’t really see shades of gray here, or perhaps more accurately, I don’t believe they can be defined and cashed out as a matter of practice, and since people doing that is essentially what I believe morality is, as opposed to there being an underlying metaphysical truth about the morality of these propositions, this is equivalent to their not existing. To my mind, there is only, is it immoral for her to make this particular decision, or is it not?

          • Michael, I see the difference between a stand your ground law being used to shoot someone trying to steal your car and it being used to chase someone down, start a fight with them, and then shoot them.

            As much as I find “stated intention” a silly measurement of intention, it remains true that intention carries with it moral content.

          • Just to be clear, by asking his opinion of “I don’t feel like being a parent right now even though I got pregnant due to careless sex, so I’m having an abortion (at, say, 16 weeks),” what I want to know is whether Jaybird views this as a less moral thought-action than “I found out the infant was going to be female and I’d prefer to have a boy, so I’m having an abortion (at, say, 16 weeks).”

          • I see a moral difference between the two, sure. (Don’t know if I want to rank them, different moral systems would rank them differently.)

            This is not to say that I believe I have the right to prevent either.

          • Jaybird,

            On your general point on intent and morality, clearly as a blanket matter I don’t deny the role of intent in morality (and I did not extend the point that way). I would cash it out in the case of abortion in a way where in my view one’s reasons (which itself is a different question, though not unrelated one, from intent, and which was the question we were discussing) for seeking an abortion end up being basically without import as to the morality of the abortion. This is quite complicated, though; consider this a placeholder, as I don’t have the wherewithal to work that out here now. But point acknowledged, let me get back to you, here or elsewhere.

            I would point out that the particular example you provide is not a good one to illustrate the point, as standing one’s ground and killing and giving chase and then killing are indisputably different courses of action. But that is a particular, and the general question is much more involved rather than more straightforward. I’m not sure when I will get back around to it, but I hope to. Perhaps I will send you an email.

          • Just to clarify a medical issue before I fade back into the background and let the conversation continue, abortions because of ectopic pregnancy should be considered morally neutral. They cannot ever be brought to term, because by definition they occur outside the uterus and cannot be sustained. The only alternatives are either surgical removal, in which case the mother lives, or both mother and fetus dying. There is literally zero chance of the pregnancy surviving under any circumstance.

          • I will just say that I disagree with my esteemed co-blogger here that ectopic pregnancies are necessarily morally neutral. I think they actually are morally. But if you think the fetus is a person at conception, then killing it before it dies has some moral weight. And if you think the value of life is incommensurable, and it is never okay to deliberately kill one person to save another, then you’ve got yourself a moral problem.

            NB: I do not agree with this line of reasoning. But it’s a non-crazy line of reasoning, and one that some people would hold as not only valid but sound.

          • Hmmmm. I see your point, Rose. I will concede that the death of the ectopic fetus would doubtless have moral weight, and that its death would be considered tragic by many. But since the only available choices are “the fetus dies” or “you both die,” but never “the fetus lives, even if you were somehow able to sacrifice yourself,” then it negates the moral element of the decision. If there were the possibility that, by dying, the mother might allow the baby to live, I’d understand the decision to carry to term as a moral choice (though one I’d disagree with), but if that option is foreclosed then I don’t see how a moral argument can be made for her to die needlessly.

          • @Michael Drew,

            To me, either the fetus is a child .. or else it is not a child, but is rather essentially part of the woman’s body

            I’m tempted to exclaim, “fallacy of the excluded middle!” But rather than exclaim it, I’ll just point to it and ask, are you sure you’re not committing that fallacy; what is the basis for thinking it can only be X or Z, and not Y?

          • To say something is either X or it is not X is not to say that if it is not X it is Z and not Y. A fetus is either a person or it is not a person, but it may indeed be something else in addition to being a fetus while not being a child. But of the things it could be (fetus, person, something in addition to fetus but not person), I am not certain enough of the moral status of anything other than a person to be able to say that, if a fetus is anything other than a person, its survival morally trumps the autonomy of an individual woman to decide whether to become a mother (or a mother to that child) at time t.

            To anticipate a question you might ask in response, no, if somehow, a living, adult horse had to be killed in order for a woman to be bale avoid having to become a mother at a time when she did not want to, then the killing of that horse would not be immoral.

          • A bit more clarification/acknowledgement for James:

            The, “but is rather essentially part of…” bit of , “…or else it is not a child, but is rather essentially part of the woman’s body and the decision is a matter of her best health and personal autonomy” is indeed subject to that fallacy. I didn’t mean to advance that part of the claim as being incontrovertible in the same way as the X-or-not-X part, but I didn’t separate it off properly. The way I meant for that to go was, “Either it’s a person or it is not a person. If it is not a person, how is it best understood? To me it seems best understood as part of the woman’s body until time t when we can say that it is a person. But that conclusion can vary depending on your perspective. Regardless, a non-person to me has a moral status too uncertain to trump the moral prerogative of a woman wrt her reproductive autonomy.”

          • …I would also say that essentially everything about a woman’s pregnancy is essentially a matter of her best health and personal autonomy, and that any fetus, even one that is a person, is essentially part of the woman’s body. So I don’t view those contentions as dependent on the person/non-person tautology. So I guess the word I would withdraw there is “rather.”

          • It’s the fact that any fetus that is a person, when removed in a manner to promote viability, is then undeniably not a part of the woman’s body.

            If I were to shove a brick up inside of a woman, do you think she would want it removed? Why?
            After all, it would then be a part of her body.
            What if I referred to it as an “enhancement” of some sort?
            Bill it as a form of birth control.
            Does that alter the status of the brick in any way?

          • Well yeah, I guess that’s right, Will. Once you’ve been born, you’re a person. We don’t generally put them back in after that. So I regard the moment of birth as the critical moment. How barbaric of me.

          • Perhaps there was confusion as to where I stand. I was answering james’ question as to the basis of my contention that a fetus is part of a woman’s body. I myself believe that any fetus who has not been born is not a person, or at least I have great doubt that it is. But I was making the point that, even if I could be shown to be demonstrably wrong about that, I would still believe that that fetus is part of the woman’s body. I realize that that would be strained view, but those are bound to exist at the very boundary of where we say that personhood is and is not. Moreover, I don’t believe that any fetus is a person, so it’s not actually a problem.

            So to be clear: a fetus that has not been born yet is not a person, and it is a part of the woman’s body. If I am shown to wrong about it not being a person, then I maintain that that person is still literally part of a another person’s body if it has not yet been born. Two persons in one body (again: this is not what is the case – it is a conditional). However, once a fetus is born and alive outside the womb, then it is a person. (We should all reflect on just how straightforwardly commonsensical this view of the beginning of personhood is, such that it is the standard that must over turned with a burden of demonstration of some sort or other being placed on the alternative view. “Personhood begins at birth.” Radically not-radical.)

            If a baby is born alive, thereby becoming a person, is then placed back inside the distended vagina or uterus of the mother, then it is a baby person who has been placed inside the distended uterus or vagina of its mother. It is not a fetus, and it has not lost its personhood. Also, that action is likely a crime, as would be the placing of a brick inside a woman’s vagina, just by the by.

            Everything clear enough?

          • Do you have any precedence for regarding the beingness of any other entity based solely on its physical location?

            I hear a lot about “the moment of birth,” but which moment is that, really?
            Because my understanding is that the thing can go back and forth for a bit before it actually comes out.
            So there’s the doctor standing there, ready to deliver the baby, saying, “It’s a person! Not any more! It’s a person again! Not any more!” for about ten minutes or so, until he finally lands on, “It’s a person!” because we all know the direction of travel in this instance.
            Or is it that only part of the baby is a person at that time, while the rest of the baby is not a person?

            And really, I’m glad you responded to that comment because I really didn’t care for the tone of it.
            I felt that leaving a sequential comment would draw unnecessary attention to that.
            And your response gave me opportunity to express my previous comment with greater clarity and diminished vitriol.
            I’m sorry, but I find it frustrating when you come so close to understanding, then fall back on a crutch.

            Intent matters.
            A rock cannot strike a person with malice.
            A fire cannot kill a person with malice.
            Therefore, we hold the person directing or responsible for those things to be accountable.
            Various states of mind include: recklessness, negligence, willfulness, and with direct intent.
            Ok, so you have– quite literally– a life and death matter.
            To proceed as if the thing were not alive when you know darned well it is amounts to “intentionally.”
            And remember, this is intentionally taking the life of another we’re talking about here.
            It matters not one whit if the “another” is fully realized at present due to the fact that the state of full realization is pending.
            This is where healthy babies are different than unhealthy babies.
            Because within that pending state the thing-in-itself will be fully realized, with reasonable presumption, barring effects of external forces.

            Suddenly, I became tired of explaining something so patently obvious.
            You’re free to go in ignorance.
            I have accomplished my objective of restating the previous comment sufficient for my purpose.

          • I’m actually not looking to argue this out with you. I clarified what I think because it obviously wasn’t clear enough; is it so important that I be interrogated about it? You are entitled to a different view yourself, by all means. I do not say you cannot believe otherwise.

            I would submit, however, that however much inning and outing there is at birth, it is still a less vague determinant than any other moment we would identify. And ultimately, I am okay with a degree of vagueness at the bottom of morality, because morality I believe is a functional invention of mankind, not an absolute truth. So if at bottom it remains vague like in quantum mechanics, that’s okay, but like in physics, less vagueness is still better than more. So I go with birth. If you have a better system; great.

            And I’d like to hear it! I’m not inclined to answer more questions about my views, but I’m happy to consider whatever you have to offer, exposition-style. Put it to me. I’m just saying what I think. I’d much rather just say, by all means, maybe I am flat wrong, than offer myself up for limitless questioning, merely because I have hazarded my view. If you can show I’m wrong by presenting a positive view that is better, have at it. But not by playing the part of Socrates to my inferior Greek. I’m not up for that. Maybe I’m wrong.

          • Intent absolutely matters. But not all possible reasons for an intentional act have significantly different moral valence, and that’s what this discussion was initially about. You have done a good job illustrating the difference between intent and reasons. If a woman has an abortion to select the sex of her child or if she has an abortion because it has been determined the child will have Down, either way the intent with respect to that fetus is the same in the way you describe intent. but those are different reasons. Similarly, if I murder someone because I don’t like the color of their hair, I murder them just after they have stolen something off my desk at work, either way my intent as you describe intent is the same: to kill them. But my reasons were different. This discussion began as a discussion about how reasons affect the morality of an abortion where the intent and facts of the action remain basically the same.

            In the case of a pregnancy that threatens a high likelihood of fatality or in the case of defending oneself from a real threat to one’s life, in my view the intent is different from an abortion of a fetus with the Downs or someone who has just stolen from you but is otherwise not threatening, and this indeed makes the action morally different. But the intent is different because the facts of the situation faced by the person who forms the intent are fundamentally different. It’s not merely reasons that differ here; it is the fundamental shape of the situation. A pregnancy that threatens the life of a mother does not merely offer different potential reasons to consider an abortion, it is fundamentally a different situation for the mother than are either having a fetus with Downs or one whose sex is not what you would prefer. The threat to the mother is a fact that makes the situation so different as to make comparing reasons for abortion to any situation in which that is not the case nonsensical.

            So, yes intent does matter. But when the facts of a situation are really fundamentally different, it is incidental that intents differ between them; the moral differences are determined in that instance by the differing facts. That, again, is just my view; we can just assume you differ if you do, we don;t have to have it out.

            Cc: Jaybird.

      • A real question here..

        Who here agrees with “hate crime” legislation, specifically the type that treats a crime motivated by certain types of “hate” as differnt than those that lack those types of “hate”?

        Abortion opponents like to equate abortion with murder. I don’t agree with that but lets run with an analogy…

        If a white guy kills a black guy but had no history of racism and gave no indication his choice of victim was based on race, does he deserve a different punishment than a white guy killing another white guy? Why or why not?
        If a white guys kills a black guy and calls him a “spook” and recently wrote a manifesto on the need to kill blacks, does he deserve a different sentence than either or both of the guys in the previous scenario? Why or why not?

        I will be honest and say I don’t know for myself exactly what I think the answer to these questions are, but answering them is informative IF you accept that abortion is wrong in the fiest place and ought to be illegal but isn’t.

        What of those who consider abortion permissable? We need a different analogy.

        Suppose one is a shopkeeper. A woman walks in looking for a job and he does not hire her because he has no need for a new employee at that point. Okay or not okay? Why or why not?
        That same shopkeeper has a help wanted sign in the window but refuses to hire a women because if her gender. Okay or not okay? Why or why not?

        Wait a minute… Is mothering a child akin to running a store open to the public? I’m not so sure.

        Okay, how about this… A woman is approached by a man in a bar looking to date her. She is not interested in dating and declines him. He is black. This did not factor into her decision. Okay or not okay?
        A woman who single and ready to mingle is approached by a black man and shoots him down as she prefers white guys. Should this be legal or not? Why or why not?
        Same woman (who is unabashedly heterosexual) is approached by a woman and shoots her down as she prefers men. Should this be legal or not? Why or why not?

        These are all imperfect analogies and I do not hold that any specific one is the “right” one. In part it depends on your initial view of abortion in the abstract. In part, it depends on your view of the role of the state in legislating against immoral behavior. In part, it depends onyour view of the rights of the fetus in relation to the rights of the mother.

        Personally, I lean toward the white woman rejecting the black man because of his race… Disgusting, abhorrent, something I would denounce but ultimately something that can’t be legislated against because her right to choose who she dates trumps his right to date her andferreting out why she rejected him is damn near impossible absent an explicit statement on her behalf.

        Your mileage may vary, and probably should. But answering these questions might help us figure out where the kine ought to be.

        • I’m not crazy about hate crime legislation but I do have to admit that there is a difference of kind between spray painting “HITLER WAS RIGHT” on the side of a synagogue and spray painting “EAT AT JOES”.

        • It’s really hard to find the perfect parallel.

          I don’t think opening a store to the public is akin to fathering a child, much less mothering one.

          I have no problem with a white woman that rejects the romantic advances of a black man because he is black. “Any reason or no reason at all” is the rule of the day when it comes to partner selection, in my view.

          That being said, the hate crime thing does pose some interesting questions. Because I am not opposed to hate crime laws in theory. However, my main reason for not opposing hate crimes are the external effects. Which is to say, a burning cross in someone’s lawn is not just vandalism, but an implicit threat to all black people around. That doesn’t really apply to the world of abortion, since it is generally a private act. If it becomes a thing, and the existence of men in doubt, then we have the aggregate effect problem, which itself is a big deal.

        • I’d like to take a stab at this one.

          Hate crimes: Should be an aggravating factor only, and not a separate offense.
          Shopkeeper: Not really enough information to make a solid determination. All things being equal, if the only reason the shopkeeper denied the woman employment was because of her gender, then she was wronged.
          Mating: This is entirely a matter of preference, and observance of those preferences.

          • All good points. The real question is which of those is most akin to abortion. If none are particularly close, is there a better analogy? Analogies aren’t perfect but they can be useful jumping off points…

          • BSK: None of those analogies work but the closest is the dating scenario — it’s the only one that involves physical autonomy. And I hope that “shoots him down” is a metaphor.

          • Karl-
            Indeed. I was trying to give a range that might reflect the range of views on abortion n the abstract, especially w/r/t the rights, if any, of the fetus.

          • Oh, I get that. It just gets so frustrating that so many arguing points about abortion conveniently ignore or diminish the value of the woman involved — it’s nothing on you, you’re always cool.

  2. Just like “doctors mustn’t operate on their patients while intoxicated”

    Except that they are required, for a time, to work when exhausted and sleep-deprived to the point of intoxication.

    (Sorry, couldn’t resist.)

    • Surgical residents as well? (A real question; somehow, I thought they’d be treated differently, if only for insurance reasons.)

      And next time you’re complaining about bugs in your computer games, picture what it’s like near a deadline and be grateful the damn things even load.

      • Complaints about video games aren’t usually directed at the guys writing the games, they’re directed at the organizations that are selling the stuff.

        Similarly, “surgical residents ought not to operate while exhausted” isn’t directed at the residents as much as it is at the system that makes this an operating condition.

      • My understanding (which could be flawed) is that prior to the 80-hour limit, surgical residents had it worst of all. My wife had to perform c-sections under circumstances where I would question how safe it would have been for her to operate a motor vehicle (maybe adrenaline was enough to mitigate this – I wasn’t in the delivery room). (This was after the 80-hour limit was instituted, but before the residency figured out how to accommodate the 80-hour limit into a workable schedule.)

        Having been on the QA side of things as deadline approaches, I agree with your second paragraph. Things switch from “This isn’t perfectly right” to “Will this ruin the experience?”

          • There’s a reason I never, not once, considered being a doctor.

            I’m way tooo damn lazy for that. Also ornery.

          • To be fair, Patrick, my wife brought in an hourly wage (well, salary divided by hours worked) *above* minimum wage. Not much above ($8/hr), mind you, but above.

          • I’ve worked seven 12’s on a number of occasions, usually shutdowns, and scheduling is imperative.
            Laundry on laundry day, groceries on grocery day, etc. One slip and it’s about two weeks of catch-up time.
            I typically slip in my schedule about three weeks into it.
            But I’ve never worked those hours any longer than a six week stretch.
            I was making way more than eight bucks an hour though.
            I don’t remember being on a job where the benefits pyramid with hours like that though.

        • PC – same. It’s like the craziest damn thing I’ve ever heard of.

          • There are some drill sergeants who are worse; two of my friends made it though basic only to get medical discharges because of injuries sustained by their idiot drill instructor. But it’s not epidemic across all drill sergeants.

            The fact that the medical community, en masse, seems to think this is anything other than completely crazy is a source of constant amazement. Present company excluded!

            I can see working an 80 hour work week for a month, under really strict supervision, because you may be subjected to some sort of insane stress load in the real world (a pandemic or Katrina or something) and being aware of your limitations under such conditions is useful… just like in the military.

            But it’s otherwise hardly a good baseline for anything other than “we’re teaching you what it’s like under disaster conditions.”

          • Well, yeah,”Yes, I will go die if necessary for my country” is up there too. But that’s over in four or eight years if you want it to be.

            Going the hospitalist/ER/surgery route is saying, “This is my life, starting now til I’m 60.” Different kind of crazy. (Present company excluded, if applicable.)

            Obviously, we need people to make both of these choices (though whenever the med establishment wants to dial this particular thing back a tad, I’m okay with, I won’t feel in any less capable or trustworthy hands so I say this with utmost respect and gratitude). Hooray for the crazy!

  3. Follow the advocacy for doctors lying to their patients to prevent immoral actions being taken to its logical conclusion and things get a little scary…
    1.) Could a defense lawyer who knows his client is guilty but also that the prosecution has a very weak case exaggerate the strength of that case to convince the client to plead out?
    2.) Could a government lie about the immediate need to go to war to justify a moral crusade that would otherwise not have the support needed to initiate?
    3.) Can people in health advocacy lie about the harmful effects of recreational, illegal drugs to discourage individuals from taking them?

    If we permit doctors to lie to their patients in order to discourage their patients from committing what the doctor believes to be an immoral act, that we also permit the rest of these. While I realize not all of the prior examples include the potentially complicating factor of the doctor’s professional relationship (if there is one) with the fetus as patient, I do believe the first two do. And that still begs the question of whether or not the fetus IS a patient of the doctor.

    • Along these lines, I don’t think there’s any justification for saying that the ethical obligations of one’s professional role are just sort of a glass bead game as opposed to real morality. The roles we take (friend, parent, job) require us to act differently from person to person. As a teacher, I have an obligation to my students that is different from my obligations to any other person. And some of those obligations are moral obligations.

      I think a doctor can have special obligations and one of them is to respect autonomy in patients in all cases where autonomy is possible, whereas they might not be required to behave that way to non-patients.

    • Really, my sticking points from the OP are:
      1) the use of placebos by researchers, and
      2) what might constitute complete or comprehensive information.
      There are a few judgment calls in there.

      • To answer your sticking points:

        1) People who enroll in research studies must be fully informed that they may get a placebo, and that measuring their response to the placebo would be part of the study. It’s a kind of “informed deception,” if you will, with the participant aware of what’s involved. If patients do not want to face the possibility of taking a dummy medication, they should be totally free to opt out without pressure or coercion.

        2) Giving patients “complete” information is a judgment call on the part of the provider. For example, if I order a complete blood count either to check for signs of infection or to screen for anemia, I generally don’t bother to discuss the clinically irrelevant results. What’s important is that I give an honest and comprehensive interpretation of the results. And, of course, if the patient wants to have all the numbers, then I provide them.

        • Isn’t it an important point that, should you discover something of clinical significance that is not related to the purpose for which you ordered the test, then obviously informing the patient of that is part of providing complete information – i.e. “complete” is not defined only by “whatever might relate to the particular issue that was the proximate reason for the consultation”? I.e., once a patient is in your care, your duty is to their entire health, not simply the problem they presented to you?

          • Of course! If on that routine CBC to check for anemia I notice that the white blood count is 23,000 (normal would be ~10,000) but the hemoglobin was normal, I wouldn’t say “Whew. Good thing she’s not anemic!” and file it away. I’d relay the information about the abnormal result and do the appropriate follow-up.

            On the other hand, if there’s some mildly abnormal result that I judge to be clinically insignificant, I don’t bother to mention it. My job does require a certain amount of discretion on such matters.

          • Not sure why i felt I needed to spell that out. I guess it’s just that the theme here has been people not acknowledging what we’d have thought to be obvious if implicit implications of your oath.

        • The first is very much what I would expect you to say.
          But it doesn’t quite cover an hierarchy of consent.
          That’s ok though.

          With the second, I was thinking something more along the lines of some manner of lab test that would be 72% accurate, but is really the most accurate test available.
          Do you give the results of the test to the patient or order more tests?
          If you tell the patient, do you also state the reliability issues of the test?
          More those kind of concerns.

          • If reliability is a consideration, I’ll generally include a discussion of it. An easy example is the rapid strep test, which is more specific than it is sensitive — a positive test is more reliable than a negative one. A culture is the gold standard, and all of our negative rapid streps go to the lab for a culture to make sure we didn’t get a false negative. I inform patients of this.

            Whether or not to order more tests varies from clinical situation to clinical situation. But I generally try to keep patients as informed of their results as I can.

    • Thank you for supplying those links, and my apologies for having overlooked the original posts, both of which are helpful additions to the conversation.

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