Living wills, bad research, obesity, GM food, fishy ethics…

More Bioethics cases: living wills will probably lower Medicare costs, assuming most of us don’t opt for extraordinary measures to prolong the mere empty shell of life, but that’s not what we want to hear from Health & Human Services. We want to hear that our government’s policy is to expand human dignity and “good death” (not to be confused with Sara Palin’s “death panels”). And Ezra Klein’s right: nobody should tell you what choice to make, but you should make a choice while you can.

“Bad research disguised as cases” is Glenn McGee’s description of much anecdotal reporting passed along by news media with “no idea how to deal with case reports.” The term “case” enjoys a patina of unearned credibility, and does not rise to the status of evidence in most instances. Again, the decline of professional journalistic standards bears troubling biomedical implications, and sows public confusion. (Do any of the “cases” in our text merit the same analysis?)

America spends 300 times more on weight loss than prenatal care, 6,000 times more than on physical education in public schools. And we wonder why there’s an obesity epidemic? Targeted weight loss clearly doesn’t work, Glenn says, we need to expend serious calories on constructive public works and then watch the pounds fall away. This is an unexpected application of William James’s 1906 proposal that we more routinely wage the “moral equivalent of war” on many fronts “to redeem life from flat degeneration.” I’m sure he’d approve.

Case 52 is a curious one, an older offering that clearly has not had its consciousness raised by Michael Pollan (et al) over issues like genetically modified (GM) foods. Do we really face a stark choice between feeding the world OR avoiding the unforeseeable consequences of large-scale genetic modification? Contrary to Glenn’s tone here, concern over GM was not still just a quirky little European obsession even in 1999. [MP.com… Bittman, Why GMOs Need Protection] And today, “there are the stirrings of a movement…”

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The next case seems more current. “Stop eating creatures that are being fished to extinction, and tell your friends…” That’s all we need, isn’t it? Clear direction, someone simply to tell us what we need to do? Stop eating bluefin tuna! In fact, “more than half of tuna species face extinction but overfishing is “too profitable to stop.” Same old story, flip-side of “too big to fail.”

I thought we might be done with sad Ms. Schiavo, but Case 54 looks at the bulimia that set her up for coma-inducing heart attack.  “People should not be allowed to linger for years in a fully-conscious, suffering-riddled persistent state of self-starvation.” Agreed. But won’t many suppose that “paternalism about weight and food” is precisely the bogey that prevents effective intervention to treat this scourge?

The next section says we should “beware of ideologues and demagogues,” who want either to theologize, de-theologize, or secularize bioethics.

I actually think the professional practice of ethics should always take place in the secular arena, where we must all meet to conduct our “state” business. But bioethicists are as free as anyone else to retreat to the sanctum of personal belief in conducting their own affairs.

Glenn’s a good pragmatic pluralist and thus favors every voice in the conversation of life, particularly “ecumenical and thoughtful religionists” and relatively less partisan representatives of the political spectrum. That’s not where the money is, of course. So, yes: beware.

Finally today: Case 56 is a little ticklish, insofar as it involves an implied self-defense on our author’s part against charges of conflict of interest. Glenn McGee resigned as chair of an ethics advisory board, and here finds it necessary to declare that “I am proud of the work I and others in bioethics have done in the context of funding by industry.”

Can ethics and industry “co-exist”? That’s long been the uneasy American model, hardly ideal. But somebody’s got to fund research in a country where public subsidies for private enterprise are almost always problematic. (Though I did see a disturbing figure about how much we’ve all been subsidizing fossil fuels, for instance.)

Can somebody also please be paid to proof-read? It’s Joe McCarthy, not George.

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