Greetings from St. Louis and WashU. For my ‘Surgical Ethics Education Resources -- #18’ communication, I am sharing with you (inserted below) the four metaphors -- i.e., ‘conscientious objector’, ‘life guard’, ‘backed against the wall’, ‘peripheral vision’ -- by which to differentiate responses to abortion cases I offered WashU’s incoming Ob/Gyn interns during the values clarification session I co-facilitated for them earlier this week. Each slide includes an explanatory commentary.
These four metaphors first came into focus for me some twenty years ago as a grounded theory qualitative research interpretation/construct when I was several years into a fourteen year (1992-2006) longitudinal study of how a cohort of Dutch physicians were approaching cases in which they considered assisting patients in the dying process. The research upon which this longitudinal study was based began in 1991 as an extension of an ethics project we conducted in The University of Michigan Department of Obstetrics and Gynecology. We studied end-of-life decision-making from the perspectives and experiences of 108 gynecologic cancer patients who were receiving care from the department’s gynecologic oncology division. The subject of assisted dying became a central issue in Michigan with Dr. Kevorkian shortly after the data gathering for this study had been completed. Needing to expand the project to incorporate the subject of assisted dying, in Spring 1992 I made the first of fourteen annual research trips to Holland. The University of Leiden Department for General Practice served as host for the initial visit, made accessible its faculty as well as its residents, and remained helpful in the coordination of the subsequent visits. During each two-week research trip to Holland, I spent time with a steadily expanding network of Dutch professionals -- including 24 physicians. This research network included:
- five general practitioners of varying persuasions regarding euthanasia;
- a former chair and emeritus professor with The University of Leiden Department for General Practice who contributed significantly to the formation of a consensus by the early 1980s regarding euthanasia for competent patients experiencing unbearable suffering;
- a senior neonatologist with the Amsterdam Medical Center who chaired the Dutch Pediatrics Association ethics committee for addressing neonatal decision-making in light of euthanasia guidelines;
- a senior professor of medical ethics at The University of Leiden who was a past-president of the Voluntary Euthanasia Society;
- three junior members of the research team at Erasmus University doing follow-up studies to the Remmelink Commission’s 1991 national study of end-of-life decision-making in Holland;
- a psychiatrist whose assisted-dying case was the first case considered by Holland’s Supreme Court in which the patient’s suffering was not related to a somatic condition.
Doug
