ARE THEIR LIMITS TO MEDICAL INTERVENTION?

Bob Corbett
March 13, 2000

Puzzles about heath care, gene therapy and related issues.

Some 30 to 35 years ago Jacqueline Grennan (now Wexler), president of (then) Webster College invited Gerry Letvin, medical researcher at Harvard University to do a summer seminar for the faculty. Gerry came to St. Louis for several weeks and among other exciting presentations one was on the question of arresting metabolism. Gerry argued that if this bodily process could be halted then people would theoretically live until they either died of accident or purposefully killed themselves. He made a strong case that this was no science fiction, but a relatively near-future possibility. I have no idea if this was so or now, just that Gerry made a strong case for it.

A close colleague of mine at that time was Bob Strobridge, art faculty member. Bob called me a few days after this incident and asked if I'd like to go canoeing with him, he had things to talk about. I agreed and we took off for a few days together on the Current River. Bob drove the nearly 5 hours to the put-in spot in virtual silence. We got the canoe in, settled back and I asked, "Bob, what's this all about?" It turns out Bob was just as taken with what Letvin was saying as I was and wanted to talk about: Suppose we could live forever, how would we go about making a conscious decision to die? It was a memorable few days.

I think I've never gotten over the question; never answered it for myself; always managed after thinking about it a while to put it aside and forget about it.

In recent times the discussions I read about gene therapy raise some of the similar questions. Suppose the to-be parents know their fetus has a gene condition which is likely to cause some serious life hardship (medical or other) and that the technology is available to alter, remove, fix or whatever, that offending gene. What is to be done?

There seems to be a general human tendency to believe that ANYTHING is acceptable in the improvement of our personal health situation and that no act which improves our chances of survival, or better life, should be avoided. Not only do we readily use virtually any medical intervention which we believe will work, but increasing numbers of us are willing to have preventative or corrective medical intervention to aid us in this quest, from heart operations to enlarged breasts or reduced nose size.

The situation is not quite the same in educating. Again, back in the mid-1960s the Behaviorists, under the leadership of B.F. Skinner, were making extravagant claims about what behaviorist methods could achieve. If the "teacher" were to have at his or her disposal the proper "stimulants" then virtually any "outcome" behavior could be achieve, at least it was so alleged.

The objections were of two sorts:

1. That the behaviorists were wrong and that their methods were not quite so powerful.
2. That even if the claims were true, some forms of intervention went beyond acceptable notions of intervention, even in the name of a general good like advancement of learning.

What struck me then, and continues to plague me now is that there was a general received view that there were some limits on legitimate interference in someone's life in order to improve one's learning, but there were NO limits on legitimate interference in someone's body in order to improve its functioning or utility to the owner.

Why the limit in one case and not the other?

There is a strong intuitive appeal for limitlessness in the medical case. I certainly feel it. Humans from as early as we know, did all they knew to do to improve their health situation. In early times the knowledge of what to do (at least as we perceive it today) was quite limited, even primitive. There was a common view that transcendental beings controlled a significant degree of personal bodily health and that part of any regime of "good medicine" was the appeasing or begging of help from the spiritual beings. Other practices were more magical, and in the hands of "specialists" in that sort of thing.

The knowledge seems to have gotten better and, to some degree, is more widely spread among us. Supernatural or transcendental explanations of bad heath are less common. However, modern methods of healing are not much less "magical" in the practical sense for most of us. One is ailing and goes to a physician. The physician tells us we need this pill x and it will stop the fever, reduce the cough -- whatever. And most of us will dutifully take the pill in about the same way the ancients might have left an offering for a deity or drank a prescribed tea.

Our personal knowledge is certainly greater today and many more people have it. This access to knowledge and skills to use it have dramatically increased with the advent of the world wide web and has the likelihood of continuing to grow. Nonetheless, medical knowledge remains quite mysterious to most people and the nagging questions I have about reasonable limits to the use of medical knowledge seems to me a question rarely asked.

As specific issues emerge the questions arise in regard to those specific issues. Today gene research and therapy, cloning and euthanasia are topics which are widely discussed. But the most fundamental principles that would deal with any criteria of limits, if any, are not much discussed, at least it is a literature I don't know.

What is especially puzzling is the seemly unquestioned distinction between body and person which is taken for granted. Somehow this distinction, which I find to be extremely fuzzy and unclear, seems to be taken a quite clear. Thus there is this tendency to regard the body as a machine and any tinkering is reasonable. Whereas the "person" is taken to be something very different and entitled to certain limits of legitimate interference. This seems to be, for example, the root of the widely accepted limits of behaviorist teachers to interfere in the lives of children in the process of teaching them.

It seems to me this dualistic view needs much clarification and investigation to discover if it is as powerful and clear as it seems touted to be.

I have no answers nor even clear avenues of questioning, just a growing discomfort with the hiddenness of these questions and the pervasiveness of medical technology to dance merrily along without many questions being asked.

Anyone else share any of these discomforts?

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