PSU Magazine Fall 2004

cans. The clinicians felt justified in their approach-idemification of drug– addicted mothers would ultimately benefit the children involved. The students' responses showed how deeply troubled they were by this case: "The action was taken without the patients' consent or knowledge; there was a breach of confidentiality in giving results to law enforcement," students said. "This is a good beginning," Backlar replied. "But are there other factors that should be considered7 ls there anything that might justify such an intervention?" she asked. Students then asked: "Was treatment offered to the women7 Were they given access to drug treatment7 Was treatment offered for the newborns?" With each question, the answer was no. From the perspective of many of the students, MUSC clinicians failed in their fiduciary duties toward the patients. Other students saw that the implementation of public health poli– cies intended to benefit populations By Eva Hunter issues relevant to biomedical ethics. In 1996 President Bill Clinton appointed her to the National Bioethics Advisory Commission, where she worked on such ethical issues as genetic research, human cloning, human embryonic stem cell research, and public policy on international research in developing countries. D uring the fall term course, a team of students presented a sketch set in an emergency room. A dying, overdosed patient is admitted with a note pinned to his chest: "I have Huntington's dis– ease. Do not resuscitate." His wife tells the emergency department doctor to save him; she can't live without him. What is to be done7 The students who presented the sketch had weeks to ponder a decision and ask themselves questions. Was the patient informed7 Was he competent to make a decision to end his life7 When he came to the emergency department, he was unconscious and could not answer these questions, but his surro- ethics can come into direct conflict with individual human rights. hie knowledge Backlar gains from her own research is an essential component in her approach to the policy and prac– tice of bioethics. She piloted the study of a novel method of intervention in mental health treatment, known as psy– chiatric advance directives, which received funding from the National Institute of Mental Health. In 1994 Backlar received the Oregon Mental Health and Developmental Disability Division's Mental Health Award of Excellence. Active as both a writer and editor, Backlar publishes widely on gate-his wife-requested treatment. What should the clinician do? The students know that in reality decisions must be made quickly and decisively. Since the patient's prefer– ences are unclear, the acute condition is easily treatable, and the harm of not treating is very great, the students' con– sensus is to provide treatment for the immediate, life-threatening condition and create the opportunity to talk with the patient about his preferences regarding his chronic condition at a later time. A lthough the concept of biomedical ethics is not new, the comprehensive teaching of the processes involved in "doing bioethics" is a relatively new field of academic study. William Sack, Kip Kinkel's psychiatrist and professor emeritus of child and adolescent psy– chiatry at Oregon Health & Science University, says he never had an ethics class when he was in medical school or during residency and that "the ethical issues were kept in the background . it is something quite new, to present biomedical ethics issues in a didactic and formal way." This change, he says, is due both to medicine becoming more complicated, and to society becoming more diverse. "You don't just rely on a minister or a priest in these situations as you used to." The broad approach of Backlar's classes, says former student Ben Reich, who is awaiting news about his appli– cation to medical school, offers tools students will use not only in medical school and eventual practice, but also for life itself. "The course pushes us to become whole human beings, to look beyond our own belief systems," he says. And, yes, Reich says, maybe what is learned here could be characterized as the process of gaining wisdom. D (Eva Hunter is a freelance writer based in Portland.) FALL 2004 PSU MAGAZINE 13