Jennifer Miller speaks during a panel at the bioethics conference.

Pontiac, Michigan, September 23, 2010 – Forty-eight years ago, the world’s first “Bioethics Committee” met to set the criteria to determine the allocation of scarce medical resources.  According to Jennifer Miller, those same criteria still influence such decisions today. 

Miller, the Executive Director the organization Bioethics International in New York, spoke at the first ever “Bioethics - A Humanistic Approach to Medicine” conference organized by Regnum Christi members and held September 23, 2010, in Pontiac, Michigan.  Speakers addressed the much debated topic of “human dignity” as a consideration in medical care.

Miller said the 1962 committee was convened to decide who would get to use the first of six existing kidney dialysis machines.  She said the committee made their determinations based on the perceived “social worth” of patients.  In other words, care depended on how much one could “contribute” to their community. 

Human Worth Is Intrinsic

Keynote speaker Rev. Joseph Tham, LC, M.D. and PhD, questioned this type of decision making.  “A person is what he is, not what he has,” said Rev. Tham.  The Assistant Professor at the School of Bioethics for Regina Apostolorum College in Rome said that thought on human worth, or “human dignity,” has developed throughout history, from the ideas of the ancient Greeks, who saw human dignity as based on perceived excellence in character and knowledge, to the ideas of modern philosopher Immanuel Kant, who said humans should never be understood in a utilitarian way, as a means to an end, but as “ends” in themselves.  Tham said Christian thought brought forth the idea that the human “person” had intrinsic dignity based on being created in God’s image.

Tham said Kant and Christians were not the only ones to recognize an inherent dignity in each human being.  Liberal secular scholar Jurgen Habermas stated that democratic society is

	Fr Joseph Tham, LC, M.D. and PhD, during his talk on human dignity.

grounded in the idea that all humans are equal.  The relatively recent human rights movement and institutions like the United Nations brought forth the notion that all humans should be understood as free, with equal dignity and rights.  Consequently, special protection must be given to the weak and vulnerable.

“But there has also been an ongoing debate that human rights do not exist,” said Tham.  Such critics claim the concept is “nebulous” and “cultural.”  Historical challenges to a notion of human rights and human dignity include:

• Scientific Positivism, in which science is seen as the only source of knowledge and anything that cannot be examined and verified by observation is not true. 
• Scientific Materialism, derived from philosophies of Descartes, Hobbes and Skinner, who saw humans as having “dignity” only because of their ability to reason, and as complex “animals” without a spiritual component.
• Darwinism, in which humans are just another part of nature with no special dignity.
• Transhumanism, which says humans evolved and are still evolving, and humanity should not leave this process to chance, but should employ self-directed evolution with genetic engineering.
• Neuroethics, which says all morality is biologically based, and that humans are “wired” like computers and can be “rewired.”
• Contractualism, based on the ideas of Richard Dawkins, which says morality is decided by who has the most power.
• Pragmatism, which says “human dignity” is a useless concept, just a “Trojan horse” for religion.

Reform Bill Challenges Human Dignity

Emergency room physician at St. Joseph Mercy Oakland Hospital Pontiac, Michigan, Dr. Jeffrey Thewes, MA, M.D., one of the organizers of the Bioethics conference, discussed the topic of human dignity in the current US health care reform program.  Interestingly, his talk and the conference itself took place on the same date as the start of a major provision in the new

	Participants at the bioethics conference discuss what they have learned.

law, the Patients’ Bill of Rights.

Dr. Thewes discussed how some aspects of health care reform undermine “human dignity.”  These aspects include economic concerns, social justice concerns and the treatment of human life. 

In the first place, he challenged the idea that US healthcare “costs too much.”

“What is more important to our society than investing in healthcare?” he asked.  “What object or program would you rather spend your money on? The human person is not a commodity that has a limited value. Its value is limitless and framing the argument in terms of dollars threatens the intrinsic dignity of humanity.” 

He countered that if the argument focused on how people can´t afford health care because it is expensive, then “we would have the beginnings of a debate that honors the dignity of the human person.” 

He also disagreed with the argument that the US does not provide quality care for the investment.  Thewes said such claims are based on the 1999 World Health Organization report that ranked the health care systems of 191 countries in terms of quality of care.  The US ranked 37th.

“This ranking seems to me to be false or at least misleading,” he said.  The study rankings were based on five indicators: overall level of population health; health inequalities (or disparities) within the population; overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts); distribution of responsiveness within the population (how well people of varying economic status have been served by the health system); and the distribution of the health system´s financial burden within the population (who pays the costs.)

“The study had almost nothing to do with quality,” he said.  Higher rankings went to the countries with the most socialist forms of government.  Colombia ranked highest because low income citizens pay the equivalent of one dollar per year for health care, while a high - income individual pays 7.6 dollars. “Clearly this study had almost nothing to do with quality and more to do with favoring redistribution of wealth.”

Thewes said the only real indicator of health care quality is how well the system acts and its responsiveness.  “Guess where the US falls in this ranking?” he asked without having to give an answer.  “We already have the best healthcare quality in the world in this regard! And when you add in the other factors, the US still ranks in the top 20 percent of the most generous nations in terms of distribution.”

Thewes questioned the current healthcare reform for not truly addressing social justice.  “As a wise friend of mine once said, it is truly disturbing to see a man vote to take money from the wealthy and give it to the poor and pat himself on the back for being generous.  True generosity requires self sacrifice. Confiscating someone else’s goods to give them to yourself threatens true generosity and human dignity.  It lessens the ability of someone to be truly generous, and threatens personal liberty by mandating how we are to use our resources.” 

Caring for the Most Vulnerable

Thewes also questioned how healthcare reform addresses the “sanctity of human life.” 

“As the bill is written, there is not enough pro-life language,” he said, pointing out that there are many loopholes to the executive order 13535 which supposedly limits funding for abortion.  He also said the US Bishops cite several areas where reform funds can still be used for abortion services. He also said funding has been allotted to pay for activities that demean human dignity, such as contraception and sterilization.  

Finally, Thewes questioned the usefulness of reform proponents touting data that the elderly and terminally ill use a disproportionate amount of healthcare dollars.  This suggests it is too expensive to take care of older people before they die.

“The reason we spend so much money in the last year of life is because that is when people are the sickest, and they need the most care! It is difficult to make the argument that the gravely ill are using up scarce resources at the end of life, since they are using up resources at the same rate they always have.”

Another conference speaker, Dr. Miguel Lis-Planells, MD and Vice Chief of the Neurosurgery Department at Sinai Grace Hospital in Detroit, Michigan, said his profession makes end-of-life decisions all the time. He discussed how he does this ethically.  “I start every day with prayer.”

“Terminal patients are those whose treatment will invariably lead to fatal outcome within 6 months,” he explained.  He said the decisions are easiest when a patient is able to make his or her own decisions, but things get more complicated when they cannot.  Then it is up to the next of kin or to a court appointed advocate.  Consequently, Lis-Planells strongly suggests everyone make an “advanced directive” legal document to make their end-of-life decisions known.

Lis-Planells stated strongly his opposition to end-of-life practices such as euthanasia and physician-assisted suicide, calling these a “direct detriment to basic human dignity and the right to life.”

Embryos and Human Dignity

Professor Alberto Garcia, JD UNESCO Chair in Bioethics and Human Rights, Rome, Italy, discussed one of the most hotly contested issues in medical bioethics today, the use of embryonic stem cells for research.

“Why should we worry about human embryos – they are so small you cannot see them,” he said.  “What are they?  Who are they?  If they are not human, there is no problem, but if they are human, we must consider this.  It all comes down to the words of Shakespeare, ‘To be or not to be? That is the question.’”

Garcia said there is a subtle distinction in international law regarding the status of the embryo.  “Philosophically, there is no difference between the following concepts:
• biological material
• a human organism
• a human being
• a person

“But in international law, ‘persons’ have dignity and an entire set of rights.”

He said embryos are understood to be human but not persons, to be human life, but not human beings.  “They have dignity, but not a full set of human rights.”

He pointed out that those of us making the decisions must consider that if we have a “right to life” we also have a responsibility not to kill another.  He also echoed the social comments of Rev. Tham. “The state has the responsibility to protect everyone, especially the weak and vulnerable.  Who is more weak and vulnerable than an embryo?”

He suggested those making ethical decisions take a cue from science.  “An atom is one of the tiniest of things – but if I split an atom, there is enormous power and energy released.  Also, in a small embryo, there is all the power and energy of a human person.”