A conference on “Bioethics, Moral Argument and Social Responsibility” will be held on campus April 27 and 28. The conference is designed to encourage discussion about biomedical topics such as stem cell research, genetic engineering and end-of-life decisions. Conference co-organizers Nancy M. P. King, professor of social sciences and health policy at the Wake Forest School of Medicine and co-director of Wake Forest’s newly established graduate program in bioethics, and Michael Hyde, University Distinguished Chair in Communication Ethics, explain why it’s important to discuss the ethical and public policy controversies surrounding some of the most important issues of our time.
What is bioethics?
Nancy King: Bioethics is applied ethics. It is the study of ethical issues in health care and medically oriented research, in social context.
Why is a discussion of bioethical issues so critical?
Michael Hyde: The tempo of our high-tech times means there is a greater need to talk about these issues and to talk about them using real language. Doctors and researchers must be taught how to better communicate with the media, their patients and the public. Jack Kevorkian’s controversial euthanasias and Terri Schiavo’s medical crisis are just two examples of how bioethical issues, such as those related to end-of-life decisions, need to be discussed. To have conversations about bioethical issues and to develop appropriate policies as a result of these talks, people must learn about the issues. In a democracy you need an informed public, and if you don’t have an informed public, democracy becomes shallow.
Do people realize how important these discussions are?
Nancy King: They should, because bioethical issues affect each of us, and therefore, we should be committed to discussing them. The purpose of the conference is to articulate the issues and to help people explore how to make good decisions for themselves by thinking about and talking about what’s at stake. The conference will provide an appropriate public platform for this kind of conversation. The people we’ve picked to participate are people who know how to talk to real people in the real world. They understand they are in a relationship of equals with the audience, and that’s what’s going to make this a strong forum.
Michael Hyde: This conference is not just about presenting scholarly papers. There will be question and answer sessions and opportunities for public discussion. It’s going to be an entertaining conference: entertaining in the sense of being both amusing and thought provoking.
Why bioethics and communication?
Nancy King: When I came to Wake Forest, I realized that it was actually possible for someone on the medical school campus to collaborate with someone on the arts and sciences campus. Michael and many other people in communication are doing great work with health communication and with communication ethics. There is a lot of research available and nobody in bioethics has yet taken advantage of it. Michael and I felt it was critical to bring these two fields of study together and say something about what they can contribute to each other.
Michael Hyde: The thing that unites bioethics and communication is language. In our evolutionary development, we can change what it means to be a human being more than ever before, and we need a language to talk about this because whoever defines the discourse has the power.
How is Wake Forest looking toward the future of bioethics?
Nancy King: We’ve launched a master’s programs in bioethics, which is a whole new way of educating current and future health care professionals and people working in the biosciences to incorporate bioethics into their daily work. A proposal for a new bioethics center is also in preparation. The University’s focus on creativity, innovation and interdisciplinary work is very fruitful for bioethics.
Michael Hyde: Wake Forest encourages interdisciplinary research and study, and bioethics is the mother lode.
Why are community-level conversations so critical?
Nancy King: In politics, the people are supposed to inform their elected leaders about issues so that these representatives can then take on the necessary policy-making functions. In our recent history, however, public discourse on significant issues is often replaced by lobbying and competing interests. It is preferable to enrich political discussion at the local level by enabling people to talk about issues and why they’re important in order to make sure our legislators respond the same way.
Talking about and thinking about the reasons on which bioethical decisions are based can inform policy. Every segment of society can benefit from having this kind of discussion in a more productive and meaningful way than is currently going on. The goal is to get all the issues and different perspectives on the table so that we can move forward. It’s a process of reasoning, not a process of trumping.
How does better communication help with end of life decision-making processes?
Nancy King: People are advised to plan for their health care needs while they have the time and capacity to do so. It’s critical to bring these discussions out of hospitals and law offices and into physicians’ offices and people’s homes. People need to know how to think about the choices available and talk about them with family. It is all about saying what you want and talking about it with people who need to know, before a medical and emotional crisis.
Today, it is common for advance directives to lay out technical medical choices about interventions a person may or may not want. This is exactly the wrong way to go about the process. The right way to think about advance directives is to ask what the goals of treatment are and whether they can be achieved. For example, a patient might say to her doctor, “It is really important to me to stay alive to see my grandchild graduate from high school,” or “It doesn’t matter if I have physical limitations so long as my mind is good.” Specific treatment decisions can then follow from these statements about treatment goals.
What are other examples of bioethical issues we face?
Michael Hyde: It costs $30,000 for a total knee replacement. Life greatly improves for many who receive this treatment. Knee-replacement surgery allows people to do what they otherwise wouldn’t be able to do. But a person who doesn’t have health insurance or the money for a co-payment will probably be crippled for life. How are we going to reduce the health care crisis between the haves and the have-nots? It’s going to cost a lot of money. The relationship between health care and money is a hornet’s nest.
What factors do you see as being critical in improving communication about bioethical issues?
Michael Hyde: Bioethical discussions require time — not just the 10 minutes per visit you often get in medicine today. These discussions also require virtues, such as patience and trust. Will we have the time? Will the doctors have the time? Are your questions being answered? Will the economy allow for this? These are the things we’ll talk about during the conference.
Nancy King: There is an enormous problem with what is paid for in health care. For example, in the rapidly growing field of geriatric medicine, there is a great need for more “think time” and “talk time.” Medication assessment and care coordination are essential, but aren’t high on anyone’s radar screen for reimbursement. We’re stuck on a model of technical medicine, because it’s easy to measure. We’ve been slowly trying to change this. We’re getting better at measuring preventive efforts, and this helps. The medical profession must move away from its emphasis on technical medicine; this change is just as critical as health insurance reform.
What can be done to help people confront these complex issues?
Nancy King: The conference is going to address this in part, but what’s on the agenda doesn’t even begin to scratch the surface. One of the things to be discussed is the role of the media in facilitating or being a barrier to public understanding. Information is not the same as knowledge and understanding. Bioethics and communication professionals must work together to outline a framework to help people deal with increasing amounts of information.