Life as an Extreme Sport

Author: Kelly

food ethics

...and everything else, Bioethics

How and why we eat has been an interesting aside for me since reading Michael Pollan’ The Omnivore’s Dilemma last summer. Always something of a binge reader on food history and related books, I really took advantage of living close to Powell’s to go overboard on the subject. But one prolific food writer I have yet to crack a book of is Tony Bourdain. I’m not sure why – I generally agree with his stand on celebrity chefs, I find his travel show No Reservations to be exceedingly funny and fascinating (and in fact have the New Jersey episode saved for a weekend of fun some time), but the actual reading of his works has simply never happened.

I’m making my way through a backlog of episodes of the show – the DVR caught over a dozen episodes in some marathon while I was in Oregon – and opted to do a little reading on Bourdain while watching him eat his way through Ghana. This quote from a Salon article is interesting, and rather nicely articulates a major concern people have when it comes to Peter Singer, animal rights, speciesism, and food ethics:

It would be nice to think that people know the difference between a crap chicken and a good chicken. If you can afford a good-quality free-range chicken, it’s nice that you have options. A lot of people in the world can’t afford that.

I like the idea that we could live in an agrarian wonderland, where there are heritage animals wandering freely and making delicious farm-fresh eggs, but that ain’t gonna happen; there are too many hungry people in the world.

I love Whole Foods talking about lobster and clam cruelty, when people are being fucked to death, kidnapped, starved, bombed. [The grocery chain recently stopped selling some live shellfish on the grounds that the practice is inhumane.] There is so much cruelty to humans — so much cruelty to animals — in this world. And people are worried about a fucking mollusk. Unbelievable.

to intubate or not to intubate, that is the big ethical question

Bioethics, House MD, Pop Culture

We’re in the middle of an impressive snowfall, so I’ve decided to curl up on my couch and watch TV. Currently, an older episode of House is playing, and as you well know, I love the ethical spin the show brings. To catch you up on what’s happening, House doesn’t believe a patient has ALS. Patient thinks he has ALS and has signed a DNR while he can’t. House’s team decided to try a medication on top of what the patient was already receiving, to rule out another possibility for paralysis. The patient reacted badly to the medication, and went into respiratory distress. House’s team refused to intubate, citing the DNR, so House intubated and bagged the patient, then placed him on a vent.

House: Everyone knows what’s wrong with me. What’s wrong with him is much more interesting.
Foreman: You tubed him and he didn’t want to be tubed! He has the legal papers saying just that!
House: To intubate or not to intubate, that is the big ethical question. Actually, I was hoping we could avoid it and maybe just practice some medicine.
Foreman: There’s no question. It’s the patient’s decision!
House: If the patient is competent to make it. If his thyroid numbers aren’t making him sad.
Foreman: Oh my god, you don’t believe that.
Cameron: His thyroid levels were a little-
Foreman: It’s nothing. Do NOT defend him.
House: Why do you think he signed that DNR?
Foreman: Wha – I didn’t talk him into it!
House: No, he signed a DNR because he didn’t want a slow, painful death from the ALS. What was happening to him had nothing to do with the ALS.
Foreman: Right! Exactly! It is the IViG! You screwed up! You’re not going to let him die because you screwed up!
House: Technically, your case. You screwed up. Is that what this is about? Looking bad in front of your old boss.
Foreman: You assaulted that man.
House: Fine. I’ll never do it again.
Foreman: Yes you will.
House: All the more reason this debate is pointless.

So, who’s right here? Is House right – do you intubate because the patient was not dying because of the ALS? Or is Foreman right, and House assaulted the patient?

Now, in many treatment facilities, this entire scenario is moot because the DNR (which, as House notes earlier in the episode, stands for do no resuscitate, not do not treat) is specific enough that you can actually decide things like whether or not you want treatment for medical issues not related to your primary diagnosis. You can specify out how far you want treatment, at what point it should stop, even if you want only comfort care. Of course, the key here is “many” – I’ve seen DNR forms that simply specify no treatment and that the patient should be allowed to die from whatever disease or illness they have; this is when the scenario that played out in the episode of House comes in to play. At what point is it assault, when is it treatment, when is it counteracting side effects of treatment, and when do you just stop?

So I’m curious – given the scenario outlined above, where a patient has a non-descript DNR and a side effect from a treatment not treating the primary condition, what do you do?

forced perspective

Academics, Bioethics, blog as therapy

Interesting evening yesterday. I realized, pouring myself in to bed at 3am, that one of the things I like most about my job is that my boss is what would happen if you took the energy of the dotcom era startup companies and poured it into bioethics. It’s a combination of everything I love about my field and everything I loved about the computer industry – there is a lot of mad energy and joy in the sort of creative energy that exists in that startup environment, and it was something I thrived on. I think it might be why I overloaded myself so much while an undergrad at UW – I seem to do much better if I’m juggling 12 balls at once, rather than 3. I’m not entirely sure why that works the way it does, but there you go. Maybe it’s just that too much down time makes for idle hands; I always feel so slow if I have too much time and not enough interesting things to do. (Of course, therein lies the rub – there’s always a lot to do, but most of it is boring stuff like housework, and why would I want to do that? Much more fun to be swinging madly from the chandelier, trying to grade papers in one hand while write a term paper in the other.)

That, however, was not necessarily the interesting part – that was just the fun part of the night, finding myself back in an environment so familiar, but enhanced with all the things I love of the academe. The interesting part was having an aspect of my personality called out, and being forced to acknowledge that in fact, I do like being in the middle of everything, knowing and watching what is going on. I do continually find myself in these places of watching groups and conflict, and said boss was right – I enjoy it, and need to stop acting like I don’t. There is a definite pleasure in realizing what’s going on, socially, politically or otherwise, and then watching it play out as predicted.

What the boss was wrong about, however, is that I enjoy it all the time. While there’s a definite enjoyment and (I’ll admit it) smugness about seeing things and piecing things together that no one realizes I’ve figured out (a sort of ha-ha, take that, attitude), I rapidly dislike it when I move from being observer to participant. As the song goes, I’m only watching the game – I don’t like being forced to play in it.

The vast majority of the time, I can maintain my observer status and simply watch. But I get cranky, stressed out, and otherwise unhappy when I’m booted off that observing perch and forced to play. Normally, this doesn’t happen, but there are times where by virtue of needing to make decisions, it does. What I am thinking of, in particular, is being placed in a position where someone reveals something to me that will negatively affect someone I am loyal to – because in my world, love, affection and loyalty are powerful, inter-related concepts that trump just about everything else. And if you place me in a spot where I have to come down from the observers tower and interact with the players, it’s because you’ve done something against someone I do have powerful emotional entanglements with.

Unfortunately, I think I generally play those commitments towards others very close to my chest – I have to, in order to watch the game. So the stress then comes from being forced (in my view) to reveal those commitments by virtue of wanting to make sure that the person I care about is okay. Revealing commitments then leaves me open to having that caring rejected – and I think I’d rather just care quietly about people than knowing it’s unwanted or unwelcomed.

All of which I never would have really thought about or articulated if I hadn’t been forced to, which in itself is interesting.

wtf?

Bioethics

Today’s “wtf” conversation. For background purposes, you need to know I’m dressed in work appropriate clothing (given, y’know, I was working), and have my AMC graduate student badge on (I don’t get my research coordinator one til Monday). Apparently the back side of the badge, which is my AMC/Albany Pharmacy library card, was showing.

Guy in class: Oh, are you a pharmacist? Do you handle drugs?
Me: Er, [walking out the door] no, I’m not and don’t.

I come back in the room, sit down.
Me: I work at the bioethics institute at the hospital.
Guy in class: Yeah, someone else told me. So, do you handle drugs?
Me: …