Medical Ethics: A Primer for Students
by Robert D. Orr and Fred Chay

by Louise Kaegi

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	Louise Kaegi, MA, Chicago, writes on health care, ethics, education, and cultural politics and was formerly Executive Editor of the Joint Commission on Accreditation of Healthcare Organizations' Joint Commission Benchmark newsletter.
	Post Date: March 26, 2004

Moral reasoning in health care has become marginalized. "Having lost its place at the head of the table in our culture, biblical thinking is often not even invited to sit down in ethical debates," attest Robert Orr, M.D., practicing physician and clinical ethicist, and Fred Chay, Th.M., D.Min., theologian and medical ethics professor.

To prepare future Christian doctors and dentists, Orr and Chay have designed a down-to-earth, good-humored, and accessible primer, laced with vivid quotations and extended hypothetical clinical cases. The primer is designed to allow students in small groups to practice identifying the major worldviews and ethical systems that they will likely encounter. Questions and scriptural citations help students clarify differences between the ways Christians and non-Christians generally make decisions. Reference tools include the Christian Medical & Dental Associations' oaths, the Hippocratic Oath, and the AMA's "Principles of Medical Ethics."

Seasoned professionals can also use this primer as a tool for self-assessment, as they too are challenged by burgeoning beginning- and end-of-life issues and threats to human dignity and personhood. They may be surprised at how entrenched the "atheist-naturalist" worldview has become, compared with the worldviews of "pantheistic monism" ("new age") and "transcendent monotheism." Doctors should ask themselves: How would they answer the questions posed in this book? Are they spiritually disciplined and professionally equipped to mentor their students? Are they doing all they can to safeguard and improve the health care profession?

Administrators can also assess whether policies and daily practices are consistent with institutional ethics supported by religious and secular prohibitions of lying, often at issue in financial conflicts of interest; "upcoding" to justify reimbursement; and shaky "informed consent." Educators might adapt the cases for role-playing exercises or journal clubs.

"The need of the hour," assert Orr and Chay, "is for men and women with a
biblical mind and a public philosophy." A thorough knowledge of the Bible is not enough; we must also understand our society's thoughts and interface with its technology so that we may "present to the watching world a winsome witness in the medical workplace." To foster this mission, they offer a "Principled Matrix for Decision-Making," based on the commonly used "four-box" pictoral model (Jonsen, Siegler, and Winslade) of medical indications, patient preferences, quality of life, and contextual features and the related secular principles of non-maleficence, autonomy, beneficence, and justice. Surrounding those quadrants in an outer frame are Christian/scriptural principles--(1) truth-telling and non-exploitation; (2) free will, God's purpose, obedience, dominion, stewardship, faith, and sovereignty; (3) Imago Dei, sanctity of life, contentment, compassion, service, and meritorious suffering; and (4) mercy, grace, hope, eternity, and scripture. A fifth principle of fidelity (to the patient), taken from nursing ethics, pervades all four quadrants.\

To help professionals use rather than misuse the Bible in ethical decision-making, Orr and Chay draw on Terrance Tiessen's principles for identifying "trans-cultural absolutes" that can be applied in any age. As a final take-home task, students are asked to write a Christian credo of their medical/dental ministry, using this pattern:

"Because I believe ___________, I will (will not) ___________." CBHD