AP Photo/Jim Cole
From the beginning of life as a fertilized embryo to the end of life as an elderly person, people have moral decisions to make. Usually the one making the moral decision is not the very smallest person, as in the case of the embryo, or the very oldest, as in the case of the elderly person. Usually the moral decision rests with someone else. In some cases a family member makes these decisions, in other cases a doctor, still in other cases a more removed third party. Central to the health care reform debate raging today is this question: who is empowered to make moral decisions on behalf of others and on what basis are these decisions made?
Regarding the beginning of life, here is a remark from Dr. Ezekiel Emanuel (brother of Chief of Staff Rahm Emmanuel and advisor to President Obama on health care), taken from a debate with Dr. Nigel Cameron. They were debating stem cell ethics and Dr. Emmanuel said:
"So part of what I’ve been trying to suggest is, I think we need to come to some moral evaluation of the embryo. What I’ve suggested is I think our intuitions are pretty clear already that we don’t treat it the same way in which we treat Nigel for all sorts of reasons. How far we’re willing to go, and whether in fact, manipulation and destruction with – but only in some circumstances is acceptable. I think -- I mean, my intuition is that most people would -- do find that acceptable for the reasons I’ve kind of suggested. We don’t have memorial services, so we don’t treat these like children, we don’t find it a moral outrage if they get destroyed when a freezer stopped, and they don’t have any of the qualities that we normally associate with higher human functions and valuable human functions."
In April, President Obama himself commented on moral issues at the end of life, using his grandmother as an example:
The president’s grandmother, Madelyn Dunham, had a hip replaced after she was diagnosed with cancer, Obama said in an interview with the New York Times magazine that was published today. Dunham, who lived in Honolulu, died at the age of 86 on Nov. 2, 2008, two days before her grandson’s election victory. “I don’t know how much that hip replacement cost,” Obama said in the interview. “I would have paid out of pocket for that hip replacement just because she’s my grandmother.”
Obama said “you just get into some very difficult moral issues” when considering whether “to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill. “That’s where I think you just get into some very difficult moral issues,” he said in the April 14 interview. “The chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health- care bill out here.” (April 29, 2009, Bloomberg.com)
Both men, like all of us, recognize that moral decisions have to be made regarding health care. Health care involves people and we are moral creatures who have intrinsic worth. As I asked in Part One of Health Care Ethics, what is the basis of our moral decisions? Dr. Emmanuel used the phrase “intuition.” This seems to be a subjective basis for making decisions. One person’s intuition could be different from another’s. Whose intuition is ultimately right? Obama acknowledged the moral issues and brought economics into the discussion. Making economics a factor can lead to a pragmatic or utilitarian basis for moral decisions. “The end justifies the means,” is a common way to put it. Do we cancel out the self-evident worth of a person because their care is too costly?
Evangelical Christians know that moral laws come from a moral Law Giver. God, as the author of moral laws, should be a part of the discussion. To relinquish the moral reins to subjective intuitions or economic considerations is an invitation for grave unintended consequences as a result of health care reform. Evangelicals want to know: what’s wrong with inviting back into the discussion the Creator of the lives we are debating?
By the way, here’s a tongue-in-cheek example of unintended consequences, from a classic scene in “Monty Python and the Holy Grail” (notice the person needing care is NOT the person who makes the moral decision):