When Medicine Plays God: Why Bioethics Still Matters
Annette Byun
“Above all, I must not play at God.”
The Hippocratic Oath, the first morally binding code of bioethics, dictates one esteemed rule above all others: to be humble, to be responsible, and to resist succumbing to pride and vanity.
But with the power of life and death in your hands, how can you resist the temptation of God? With every advancement in medicine and research come many sacrifices: some monetary, some greater. Consider, for a minute, the incredible medical inquiries powering the Guatemala Syphilis experiments, human experimentation in Nazi Germany, and American radiation experiments. It is easy as a student to declare these experiments unethical, violent, and reproachful. Yet consider less extreme cases: covert coercions such as paid human subject research, unconsented surgeries disguised by medical jargon, and biased medical professionals failing to provide full transparency, compassion, and empathy.
The power of God, to control life and death, rests faithfully in the hands of researchers, doctors, and others in the medical field far more heavily than in the majority of other professions. What, then, dictates the line in which the patient’s best interest becomes the doctor’s in disguise?
Historically, there have been efforts to define what is bioethically sound and what may be permitted under the law. Although conversation surrounding these principles has picked up speed, generally humanity has gravitated toward figuring out what is morally and ethically “right.” One of the difficulties as a historian, Dr. Elizabeth O’Brien, an associate professor at UCLA, says, is not to superimpose today’s values onto yesterday’s history while still maintaining a critical lens. The Hippocratic Oath is the most prevailing example, but others include the Nuremberg Trials and the Belmont Report. The Belmont Report, in particular, labels the four principles of bioethics as autonomy, nonmaleficence, beneficence, and justice. Dr. O’Brien defines bioethics under the “do no harm” principle. In this way, nonmaleficence is the context in which medicine, and everyday life, should be approached.
Here is what we know, though: the field of bioethics has grown exponentially since the morally questionable 20th century. Although the 1900s brought great scientific advancement, it was “an era of great devastation.” O’Brien calls it “a century of genocides.” Since then, moral and ethical ideals have indeed taken great steps to bridge the cruelty that disproportionately affected marginalized communities, yet day by day, principles of justice and autonomy are ignored.
Conversation surrounding this topic is highly controversial. There is a general belief that utilitarianism should prevail, that is, the greatest benefit for the largest number of people. And yet, Dr. O’Brien pointed out, who decides the moral justification? The classic trolley problem began as a bioethical conundrum: who should survive, the individual or the masses? Of course, in a world devoid of context, we logically feel compelled to sacrifice the individual for the greater good. But, “as soon as you put any [moral system] in a contextual situation, it all falls apart.”
Going back to the theory of utilitarianism, the approach focusing on the “greater good” sounds fantastic until it invites conversations supporting eugenics, violated autonomy, and the oppression of minority groups. Dr. O’Brien points out that utilitarianism is intrinsically intertwined with eugenics, as eugenicist governments promoted a “dominant race” to prevail. And where eugenics come into play, so does the violation of autonomy, which crudely undercuts a key principle of bioethics.
So, as future medical professionals and scientific researchers, why does this matter? Why can we not assume our code of ethics will hold fast against outside pressures and internal biases? The idea that any one individual can cause a bioethical tragedy such as the aforementioned experiments is daunting and laughable. However, bioethical tragedies begin at an individual level before they spiral out of control.
Dr. James Burt, an OB-GYN who became infamous for his unconsented “Love Surgeries,” showcases how a single man can wreak havoc on decades’ worth of patients, forever altering the lives of hundreds. A deeper analysis uncovers violations of many bioethical principles, especially autonomy, justice, and nonmaleficence.
To showcase the broader implications of losing touch with bioethics, I introduce Dr. Jonathan Metzl, a psychiatrist and author of The Protest Psychosis. He analyzes how personal biases in the psychiatric field can bleed into official diagnoses and social constructs, causing racial injustice and criminalization. The particular example in his book is the criminalization of African American patients diagnosed with schizophrenia versus white patients diagnosed with schizophrenia. In short, his book analyzes personal bias and its real-world implications.
Dr. O’Brien expressed that the principle most often violated in medicine is justice. Justice can have many definitions, but in bioethics, it is the principle of fairness, in other words, equality and indiscriminate treatment. Therefore, the most dangerous pitfall in medicine and research is neglect: neglect to treat, neglect to understand, and neglect to empathize with patients and subjects alike. She urges students in STEM to acknowledge the history of medicine, make an effort to understand and empathize with people of diverse backgrounds, and collaborate with historians who can offer their rich knowledge of past ethical violations so that they may not happen again.
And so, the Hippocratic promise not to play God prevails, not as a warning against power, but as a warning against pride. If it is human nature to control, then as future engineers, doctors, researchers, and the like, we must control and educate ourselves in empathy, understanding, and above all, bioethics, so that we can serve our communities with a clear conscience and leave a positive mark on the world.
Special thanks to Dr. Elizabeth O’Brien for taking the time to interview for the making of this article.
