HAS HEALTHCARE BECOME IMMORAL?

'A'MORAL HEALTHCARE.

• Theodorus Holtzhausen

• 9 minutes ago

• 6 min read

New challenges Healthcare Workers Must Confront.

“The aim of science is not to open the door to infinite wisdom, but to set a limit to infinite error.” - Bertolt Brecht, Life of Galileo (1994)

Clear as Bertolt Brecht’s statement is, it could be protracted to include “…in our quest for solidity amidst fleeting objective values”

Defining objectivity and error, has become increasingly complex due to the surge of new discoveries, research and publications in recent years. Over time, attempts to create an objective healthcare science has crafted the image of a ‘good’ practitioner as someone adept at using specific flowcharts and proven scientific method with precise measurements, perceptions of symptoms, and the latest research to apply patient care as a model set as 'gold standard’.

Undoubtedly, those of us on the frontline know there is more to patient care than the mechanical application of statistically-based algorithms, flowcharts, and the new research we respect and desperately try to adhere to however discombobulating it has become with addendums concluding more studies are needed. As perceptive and ethical healers, be it veterinarians or doctors, if we wish to remain more than mere blind directors applying set method to emerging diseases in evolving societies with diverse needs, we must accept that our hard gained knowledge and flowcharts will soon be surpassed by and demoted by AI. We must therefore embrace learning from other disciplines to retain our standing, as moral and caring healers.

If we aspire to practice healthcare professionally, where a harmonious blend of ethical care and stringent clinical standards are crucial, yes we bear a significant responsibility. Bioethics (which I pair with morality in this article) undeniably joins other disciplines in synthesizing a scientific theory, including arriving at a diagnosis with the patient as a unique individual in a distinctive environment. What we have to constantly keep reminding ourselves, is that as we are busy formulating new rules and applying our gold standards, both our discipline and society are evolving into new complexity.

In what should be a much more integrated transdisciplinary approach to healthcare and disease, ethical conflicts between scientific methodologies and humanitarian demands in evolving societies are inevitable. Most social scientists, philosophers, and practitioners do not share the same enthusiasm as the more ‘objective’ research workers and industry financiers. Increasingly, evidence suggests that our patients (and we are all vulnerable at some point) are perceived as interconnected with a healthy (in most cases not so healthy) environment—linked with animals and micro-particles (microbiota) in a symbiotic relationship. We are only beginning to comprehend a system where financial constraints will be insufficient or even detrimental to safeguard a healthy bio-genome amidst emerging environmental challenges and future pandemics in our blinkered aspirations to a ‘gold standard’ healthcare. Science and those acting as gatekeepers of our health, caution us that our healthcare systems, morality, and genome now seen as a unit is under severe threat—overshadowed by a dependency on chemical and new medical device remedies while ignoring unhealthy environments. The evidence of this malaise, linked to both environmental health and the human-animal bond, is a glaring evolutionary change with the genome should be accounted for in an interconnected living web and where neglect here comes down to a moral deficiency.

We should avoid adding more rhetoric to the undeniable potential impact of climate change, new disease outbreaks or emerging stresses on society, healthcare workers and social networks, but focus instead on how to create awareness of the new ethical and legal dilemmas we must soon all confront. These new moral dilemmas further complicated by the expeditious growth in medical genetics and biotechnology. This may to some extend also reflect on the current despondency and burnout rates observed among healthcare workers. I will mention here my personal concerns —stress, environment, and the daunting new moral dilemmas we face where there is a clash between a profit driven and moral driven healthcare. As a lead veterinarian in a busy practice for many years, I witness the impact of these neglected elements daily in both clients and staff while being acutely aware of our inadequacy to holistically address the interconnections between our patients’ health, the human-animal bond, and the environment—where it should be considered as an interdependent living network.

Today, nearly every new medical discovery can be traced back to a genomic aberration, where DNA and RNA are triggered to respond by altering protein production in response to environmental changes and triggers with stress standing out here. Many of these rearrangements can lead to diseases, cancers and allergies. Researchers are also only beginning to understand the genetic diversity of interactions and responses to similar chemicals and triggers in different individuals. This significant shift from a determinist view of a blueprint DNA and universal drug therapy for a specific condition, to a more dynamic and pliable version has opened many new doors and has profound implications for the future of healthcare ethics. Perhaps we can call it the quantum era of genetics spilling over into healthcare. Just as electrons are now known not to follow regular paths around a static nucleus, there is now also diminishing support for a deterministic view in evolutionary biology or even more so in healthcare. Unexpectedly, this new knowledge also provides us with more convincing support to see a healthy morality as the pillars of an interconnected society and healthcare system. Escalating disparity currently directed by a profit driven and aslo much more corporate controlled healthcare can only result in the isolation and marginalization of individuals and communities, which would not benefit our society or biogenome.

Our environment, the drugs we take, the chemicals, media, stresses and above all our moral

wellbeing have a significant impact on altering our health (mental and physical) and that of future generations. We also have a duty as protectors of a healthy human-animal bond to maintain a level of 'super-morality', to reflect perhaps here on Nietzsche’s morality of a ‘superhuman’ .

Today, most of us can relate to the statement that more lives can be saved, and suffering prevented, if we re-align our healthcare systems with preventative measures stemming from an interconnected healthcare evolving as part of a sustainable morality to cope with changing environments and needs.

Once we balance these measures against the current costs of tertiary healthcare, with its expensive drugs and set therapies, against the long-term environmental, health and longterm impact on the biogenome, we will be better positioned to deal with emerging challenges. It may even in the long run be proven as much more cost effective than our current short term profitability focussed healthcare systems, if not then only more ethical.

In a world that have woken up to the reality of Darwinism, evloution and now struggling to distance itself from the selfish gene concept, we now see ourselves and our world as living systems within living systems—a delicate biomass with transgenerational links, constantly adjusting and transmitting messages from one generation to the next. Some of these effects are harmful, others beneficial. Understanding ourselves as more than mere higher primates fighting for individualistic survival, we must learn to coexist morally within our changing environments rather than control or merely benefit from them short term. A more realistic goal is how to adjust and successfully rethink and interlink a healthy genome to a rapidly changing environment—morally. In genetics, researchers now recognize and are beginning to see how DNA is perceptive and pliable, within a previously much overlooked epigenome as a memory bank carried for many generations. This emerging knowledge should not be hindered by an outdated determinist morality and ethic still anchored in personal biases or historic socioeconomic belief systems with unbendable laws.

With disparity growing in uncertain times, the undeniable link between healthy environments and our own health and the emerging evidence of the impact even the smallest participants (a strand of RNA) can have, how can we continue practicing ethical medicine and feel content only distributing pharmaceutical agents as directed by flowcharts directing us to gold standards alone? Perhaps the time has come to broaden our view and create time to more courageously confront the so-called ‘workplace stress’ to address the moral conflicts practitioners face daily and see our patients and us more as part of the living network that we are. Mere talk or superficially funded research on these pressing issues is insufficient. If we are serious about safeguarding our status as ethical caretakers of health, a more holistic approach and change must originate from us, the frontline workers, not distant policymakers or stakeholders with their principle concerns profitability in a forever changing ‘gold standard’.

Blog article by Theodore Holtzhausen author, conclusions and concepts from Spheres of Perception, 2020

Books by Theodore Holtzhausen:

Sensible Gene Selfish Being (2016) and Spheres of Perception, (2020).