How bioethics helps us to navigate the big questions of health and medicine

Author: Menios Constantinou

Why is bioethics important? Impact caught up with Dr David Kirchhoffer, Director of ACU’s Queensland Bioethics Centre, to discuss the value of bioethics education.

When should life-sustaining treatment be withdrawn from a critically ill patient? It’s a highly emotive and controversial question with no clear or simple answer. And it’s just one example of the type of ethical quandary that bioethicists spend their time researching, studying and debating.

Take the tale of Terri Schiavo, the brain-damaged woman who lived on a feeding tube for more than a decade. Schiavo fell into what doctors said was a “persistent vegetative state” after a sudden cardiac arrest in 1990, resulting in a drawn-out legal battle between her husband, who insisted she wouldn’t have wanted to live in her condition, and her parents, who did not want artificial nutrition and hydration switched off.

The disagreement led to more than a dozen legal appeals and hearings in both state and federal courts, prolonging the suffering for all involved. While Schiavo was an American, her case had international ramifications, especially in Catholic biomedical ethics.

Meanwhile, in the UK, the Supreme Court recently ruled that the doctors and relatives of “minimally conscious” patients could stop treatment without the legal approval of a judge, provided they agreed it was in the patient’s best interests. The decision seemed to be recognition that in the medical realm, some problems can’t be solved by lawyers and judges alone.

“Making ethical decisions in spite of not knowing exactly what will happen requires a level of ethical thinking that is much more nuanced than simply appealing to the relevant law,” said Dr David Kirchhoffer, the new Director of the Queensland Bioethics Centre, a partnership between ACU, the Bishops of Queensland, and several Catholic health and aged care agencies.

“Every case is going to be slightly different, and while it’s important to have clear guidelines and strong legal frameworks, the danger is when the rules become the ethical or moral code.”

This, says Dr Kirchhoffer, is where bioethics becomes crucially important to the fields of health, medicine and the life sciences.

While it is often seen as a forum for people to discuss abortion and euthanasia, bioethics covers many other ethical issues. Like whether artificial intelligence could lead to a loss of human contact in healthcare. And whether climate change is a health issue. Or, at a day-to-day level, the challenges faced by a nurse navigating the rights of a patient refusing treatment.

And many health workers, while skilled in their own fields, often don’t have extensive formal training to understand how to make informed bioethical decisions.

“Can anybody do bioethics? Yes, in the sense that anybody is affected by it,” Dr Kirchhoffer said. “But it’s not realistic to expect everybody working in a hospital to navigate these issues to the level of competence that experts who spend their life studying and arguing the issues might.”

As Director of the Queensland Bioethics Centre, Dr Kirchhoffer will provide research, advice and training to help doctors, nurses, aged care workers, bishops and priests make ethical decisions.

His research and writing, which includes his recent book Human Dignity in Contemporary Ethics, has focused both on the concept of human dignity and the principle of autonomy, which concerns the right of patients to make decisions about their care. While patient autonomy and informed consent is important in medical practice and research, bioethicists argue it has many limitations.

“This model of the perfectly rational human being who is always capable of making free, informed decisions is very problematic, because actually very few such beings occur, even those who think they are. So this raises all sorts of questions as to whether informed consent actually does its job of protecting human beings from harm,” Dr Kirchhoffer told Impact.

Some individuals, like people with dementia and infants, are unable to give consent, and others have their autonomy compromised because of addiction, psychological issues or power imbalances.

“The white-coat phenomenon causes a real power imbalance,” Dr Kirchhoffer said. “There have been all the scandals recently about knee replacement surgery and whether it’s always really necessary or just a money-making exercise, and people just go with it because the doctor says, ‘yeah, you need to replace that knee’.”

“Do people really understand what doctors are saying to them when they consent to surgery or treatment?” he added. “In a research context, do people actually understand that they may not benefit from the drug that’s being trialled? As a researcher or a doctor, you might have that box ticked, you might have a signature on a piece of paper, but what's really happened here?”

Dr Kirchhoffer said the Queensland Bioethics Centre would provide health workers with training and advice, using contemporary research methods and the wide range of Catholic thinking.

First established in 1981 by Archbishop Francis Rush, the Centre is now based at ACU’s Banyo campus, joining the Plunkett Centre for Ethics, at Sydney’s St Vincent’s Hospital, in providing a place for the study and teaching of biomedical ethics to those working in Catholic health care.

Dr David Kirchhoffer is a member of ACU’s Faculty of Theology and Philosophy and of ACU's Institute for Religion and Critical Inquiry. He grew up in Johannesburg, South Africa, where he studied biology and psychology at the University of the Witwatersrand, and theology at St Augustine College of South Africa.