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HEALTH ETHICS TODAY
Editor's
Forum Paul Byrne, MB, FRCPC This issue of Health Ethics Today includes a re-printing of the provocative article by Alice Dreger published in the New York Times (July 28, 1998). The article is very effective in forcing us to consider the basis of our perceptions of difference between individuals in society. Dreger cleverly and somewhat humorously (the Double-X Syndrome) uses the example of discrimination against women as a means to focus our attention on attitudes which foster any type of discrimination. The subject of sexual identity, as dealt with in medical education, has been blurred over many generations with that of sexual appearance. The traditional and current medical approach to babies with ambiguous genitalia emphasizes the importance of ensuring that possible life threatening associated hormonal deficiency is not present and then applies a similar sense of urgency to allocating a gender as soon as possible after birth to avoid 'confusion'.1 Confusion for whom we might rightly ask, and for whose benefit must we 'pigeonhole' the genital appearance of a little newborn baby? This approach arose from a belief that the gender of a baby must be assigned before the baby became a member of the community because to remain ambiguous was not acceptable. "What will be put on the birth certificate and in the notice in the newspaper, Dr. Byrne," I heard my professor ask many years ago in response to a suggestion to delay gender assignment. Dreger's recent Hastings Center article examining this issue from the perspective of adults who had undergone 'corrective' surgery left little doubt that the confusion lay in others' perceptions of these patients' best interests.2 We recognize that the 'best interest standard' is at best a compromise in the ethical decision-making process and we must strive to replace it with patient wishes whenever possible. The commentary on Dreger's New York Times article, by Eleanor Stewart Muirhead and Susan James, broadens the discussion to address the very basic concepts underlying our distinctions between normal and abnormal. They trace the history of these distinctions and of their recent application to human health. They reiterate the concerns of many marginalized groups in our society that the basis for all discrimination is to be different. They conclude by questioning the validity of categorizing any person as abnormal on the basis of a particular trait. The ethics case report and analysis by Michael Stingl deal with the very real issue of patient preference in the hospital setting within the context of the single payer Canadian health system. In this era of increasingly powerful medical technology and expertise coupled with decreasing financial resources, the focus of many ethical discussions has shifted away from paternalistic medical interventions to concerns about patient demands for everything to be done. Stingl examines the ethical basis for decisions about health care resource allocation to communities in general. He then examines the problem posed by the case of a specific patient whose values may differ from the majority in our society. He gives us guidance as to how to resolve the apparent conflict between our ethical obligations to patients in general and to a particular patient. In this way the case discussion complements the other articles in this issue of Health Ethics Today in that it deals with an ethical issue which arises from an individual's difference resulting in moral conflict. References
Contents
Health Ethics Today Credits Editorial Committee: Health Ethics Today is produced by the John Dossetor Health Ethics Centre, University of Alberta and the Provincial Health Ethics Network. The opinions expressed in this newsletter are those of the authors only and not necessarily those of the John Dossetor Health Ethics Centre or the Provincial Health Ethics Network.
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Updated September 7, 2010
Health Ethics Today
