Who Gets the Final Word?
In philosopher Peter Singer’s book Ethics in the Real World: 82 Essays on Things That Matter, he writes about the sanctity of life and the ethical implications of medical decisions in life-or-death moments. A central question I pulled out from this chapter is, how do we make medical decisions for people who can’t communicate their needs/desires to us themselves? And, when making these decisions, should the doctor or the family get the final word?
In his essay, “No Diseases for Old Men,” Singer brings up Samuel Golubchuck, an 84-year-old man from Winnipeg, Canada who has “limited physical and mental capacities” due to severe brain injuries. His doctors suggested withdrawing life support to his children when he was hospitalized with pneumonia, but his children resisted this suggestion.
In this case, should Golubchuck’s family be the ones to decide whether to continue life support, or should his doctors make this decision?
On one hand, continuing life support in this situation may just be prolonging Golubchuck’s suffering, because his doctors do not foresee him making a recovery. This would, therefore, be using up money, resources, and personnel on Golubchuck that could be used towards patients who have a chance of recovering. Similarly, taking this route would mean continuing to give Golubchuck pneumonia antibiotics. The more antibiotics are given to people, the more we raise the chances of viruses developing resistance to it; so, these antibiotics should really be used sparingly and on patients who have a more promising prognosis. In this situation, Golubchuck’s family’s judgement may be clouded by their personal connection to him, preventing them from thinking about what is best for society. The doctor in this situation would give the most impartial and objective decision, based upon science and their expert opinion, that will best serve both the patient and society.
However, science itself is never truly objective, orvalue-free. In Helen E. Longino’s “How Values Can Be Good for Science,” she notes how social values come into science through our background assumptions and hypotheses. Science is built upon social values, and we cannot eliminate them from science. Doctors themselves have implicit biases as well, which is another way in which subjectivity can enter into science.
Knowing the indelible impact relationships and social values have on science, why then should the person least attached to the patient make the final decision? The way I see it, if the doctor’s decision can never be truly objective, both because he/she as a human is biased and because the field of science itself carries subjectivity and biases, then it should be the people who know the patient the most making the final decision about their life. As Longino explains, relationships can close the gaps left in our knowledge instead of being an obstacle left by it. We should therefore use these relationships to make the most informed decisions we can.
Singer, Peter. Ethics in the Real World: 87 Brief Essays on Things that Matter. Text Publishing, 2017.
Longino, Helen E. “How values can be good for science.” Science, values, and objectivity (2004).