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Teaching Bioethics Today: Waking from Dogmatic Curricular Slumbers

Published online by Cambridge University Press:  09 November 2023

Leonard M. Fleck*
Affiliation:
Center for Bioethics and Social Justice, College of Human Medicine, Michigan State University, East Lansing, MI USA
*

Abstract

The Dobbs decision has precipitated renewed medical, political, and professional interest in the issue of abortion. Because this decision handed responsibility for regulation of abortion back to the states, and because the states are enacting or have enacted policies that tend to be very permissive or very restrictive, the result has been legal and professional confusion for physicians and their patients. Medical education cannot resolve either the legal or ethical issues regarding abortion. However, medical education must prepare future physicians for caring for patients seeking abortion-related services. Physicians must be prepared to interact appropriately (sensitively and with integrity) with patients or colleagues whose views on abortion differ significantly from their own. This essay describes our educational effort to achieve that objective. The motto that governed this exercise was “No Easy Answers.”

Type
Research Article
Copyright
© The Author(s), 2023. Published by Cambridge University Press

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References

Notes

1. Kant, Anderson A., Hume, and the Interruption of Dogmatic Slumber. New York: Oxford University Press; 2020 Google Scholar. Readers trained in the history of philosophy will quickly recognize Kant’s awakening from his dogmatic slumbers because of his reading of Hume. “Hitherto it has been assumed that all our knowledge must conform to objects. But all attempts to extend our knowledge of objects by establishing something in regard to them a priori, by means of concepts, have, on this assumption, ended in failure. We must therefore make trial whether we may not have more success in the tasks of metaphysics, if we suppose that objects must conform to our knowledge.” Kant I. Critique of Pure Reason. 2nd ed., preface; 1787.

2. Paltrow LM, Harris LH, Marshall MF. Beyond abortion: The consequences of overturning Roe. American Journal of Bioethics 2022;22(8):3–15. Rubin, R, Abassi, J, Suran, M. How caring for patients could change in a Post-Roe v. Wade US . JAMA 2022;327(21):2060–2CrossRefGoogle Scholar. Cohen, IG, Daar, J, Adashi, EY. What overturning Roe v. Wade might mean for assisted reproductive technologies in the US. JAMA 2022;328(1):1516 CrossRefGoogle Scholar. Harris, L. Navigating loss of abortion services—A large academic medical center prepares for the overturn of Roe v. Wade. New England Journal of Medicine 2022;386(22):2061–4CrossRefGoogle ScholarPubMed. Adashi EY, Cohen IG. EMTALA after Dobbs: Emergency reproductive health care in the balance. Annals of Internal Medicine 2023; 176(2):268–69. doi:10.7326/M22-3222. Bermas, BL, Blanco, I, Blazer, AD, Clowse, ME, Edens, C, Ramsey-Goldman, R, et al. Overturning Roe v. Wade: Toppling the practice of rheumatology. Arthritis and Rheumatology 2022;74(12):1865–7CrossRefGoogle ScholarPubMed. Palaniappan, A, Blitzer, D, Bacha, EA, , Anderson BR. Overturning Roe v. Wade: Increased prevalence and economic impacts of congenital cardiac defects. Journal of the American College of Cardiology 2023;81(7):703–4CrossRefGoogle Scholar. This list represents just a small sampling of the likely effects of the Dobbs decision on many areas of medicine. Abortion is not limited to obstetrics and gynecology in its potential effects.

3. Boodman E. In a doctor’s suspicion after a miscarriage, a glimpse of expanding medical mistrust. Stat News 2022 June 29. In a doctor’s suspicion, a glimpse of budding medical mistrust over abortion (statnews.com). See also Cha EA. Physicians face confusion and fear in post-Roe world. Washington Post 2022 June 28. New abortion bans leave physicians in gray area in post-Roe world – The Washington Post.

4. Bazelon E. Risking everything to offer abortions across state lines. New York Times Magazine 2022 Oct. 4. The doctors risking everything to offer abortions across state lines – The New York Times (nytimes.com).

5. Howard Brody, MD, PhD, a former director of our Center and well-known grandfather in bioethics, deserves credit for introducing this motto. It clearly has the virtue of inducing intellectual humility, which is much needed in the debates regarding abortion.

7. Hartig H. Wide partisan gaps in abortion attitudes, but opinions in both parties are complicated. PEW Research Center 2022 May 6, available at https://www.pewresearch.org/fact-tank/2022/05/06/wide-partisan-gaps-in-abortion-attitudes-but-opinions-in-both-parties-are-complicated/?utm_campaign=wp_week_in_ideas&utm_medium=email&utm_source=newsletter&wpisrc=nl_ideas.

8. Greasley, K, Kaczor, C. Abortion Rights: For and Against. New York: Cambridge University Press; 2018.Google Scholar

9. See note 8, Greasley 2018. Kristin Luker made a similar point several decades ago in her book Abortion and the Politics of Motherhood (University of California Press, 1984). She observed how various views regarding abortion are tied up with complex social and political views and practices that are integral to the identity of individuals. To change their views would require, not just a change in intellectual beliefs, but a change in one’s social identity, i.e., giving up one’s evangelical identity to become an atheist or vice versa.

10. Dworkin, R. Life’s Dominion: An Argument about Abortion, Euthanasia, and Individual Freedom. New York: Vintage books; 1994:10 Google Scholar.

11. Dias E. When does life begin? New York Times 2022 Dec. 31. When does life begin? The question comes into focus Post-Roe – The New York Times (nytimes.com).

12. National Library of Medicine. Trisomy-13. 2022. Trisomy 13: MedlinePlus genetics.

13. Benjamin, M. Splitting the Difference: Compromise and Integrity in Ethics and Politics. Lawrence, KA: University of Kansas Press; 1990.Google Scholar

14. This session was exclusively designed to address the professional challenges physicians faced in caring for patients with whom they disagreed regarding the matter of abortion. The larger challenges will be generated by state policy regarding abortion and its potential effects on the professional integrity of physicians and other health professionals. That challenge cannot be met by individuals as individuals. That requires a coordinated response from representatives of the medical profession as a whole. In this regard, see Serchen J, Erickson S, Hilden D, for the Health and Policy Committee of the American College of Physicians. Reproductive health policy in the United States: An American College of Physicians brief. Annals of Internal Medicine 2023. doi:10.7326/M22-3316.