Life as an Extreme Sport

editing wikipedia

I was back at Wikipedia’s bioethics “talk” page this evening, looking for a quote someone had made about secular bioethicists being baby eating commies (or somesuch, it wasn’t that extreme, but only barely), and got to wondering if I am close enough to the discipline that I would be considered, by Wikipedia guidelines, to have a conflict of interest. So I asked Michael what he thought. His answer? I think you have too much valid information. Sadly, according to the CoI guidelines, he’s probably right and I probably do.

This is probably best for my blood pressure, though.

It does lead to an interesting question, though. How can Wikipedia be a place where experts contribute to the discussion with lay people, when experts are not allowed to participate in the creation of articles, because they have conflicts of interest by being in the field? Of course, in the CoI guidelines, they say that, for example, an expert on climate change is welcome to contribute to articles on that subject, even if that editor is deeply committed to it. However, it also specifically says that if you work with the people or institutions being talked about, you should probably not work on the page.

It might not be an issue if it were something like gardening, but bioethics is controversial. Just take a look at the talk page! Although it hasn’t been edited for a few years, it’s clear that the people discussing it are pretty divided.

And on top of it, as Crooked Timber noted a few weeks ago, you get into a situation where the expert does know more than the lay person, yet by Wikiepedia rules you have to keep both opinions there – and the laity has as much say as the expert. Don’t we have experts for a reason, though? I agree that they should be more accessible, but aren’t we doing everyone a disservice when we give the 17 year old high school student the same credence and weight of word as we give the person who’s been an expert in their field for 30 years?

House (M.D.) Trivia

Occasionally it’s fun read the IMDB trivia page for TV shows. For example, while I’ve long dismissed the criticism that there’s no such thing as a diagnostician team/division of diagnostic medicine in hospitals (while I am willing to accept I sometimes have a creative mind, I’m not yet willing to believe I’ve completely made up people I know, working in hospitals, who are working in that field), I’ve been puzzled by Chase’s title, intensivist. According to IMDB, an intensivist is doctor who specializes in intensive care. This specialty is new and uncommon in the United States, but well-established in Australia, where the character is from. Neat, eh? A good attention to detail, which is something I can appreciate.

(For those who might have missed out, I’m actually working on a project about television, media, medicine and responsibility. And by working on, I mean doing a lot of reading, and debating justifying the purchase of the first two seasons of House, MD…as research, of course.)

Open Access Hospice

The New York Times is doing a series of articles on new approaches to address common shortcomings in our health care system, and the first is on hospice. Interestingly enough, it’s the insurance companies who are starting to say what some of us have said (and known, empirically) for years: hospice can often extend the quality of life of the patient to the point that they actually live longer. It’s not uncommon for someone to enter hospice with the 6 months or less until death sentence on their head, only to beat those expectations and live much longer.

The problem is, until recently, hospice has required people give up conventional treatment. So if people are living better, and longer than expected in hospice without any treatment, just how would they do while still being able to receive treatment?

Seems that the least usual suspect stepped up to find out: insurance companies, and the results are promising. Promising enough that major insurance corporations will be changing the way they allow and pay for hospice care. Well, with the exception of one of the largest insurance companies in the country, Medicare, which is still making you choose between treatment and palliative hospice care.

Can you imagine being in that position, of being told that you can have the benefits of hospice – people coming to your house to help out, home nursing care, massage, even something as basic as cooking and cleaning for you – or you can keep being treated for your disease, but not have both? No wonder so many people choose to fight the disease until the very end, ringing up huge medical bills in the process. The current paradigm asks people to either fight or give up, and most of us are indoctrinated to not give up.

Shifting towards integrating palliative hospice care with traditional treatments for disease seems like it would, in the end, benefit everyone involved. It would make the patient’s quality of life ever so much better, appears that it would extend that life, plus would decrease the end of life ER runs, ICU stays, and other things that cause medical bills to skyrocket and makes death one of the most expensive medical conditions.

But it is still weird seeing the big insurance companies, so often painted as part of an evil capitalist conglomerate, doing something proactive and good.

why bioethics?

The other day, a friend of mine asked me, rather out of the blue, “why bioethics?” It’s a fair question, and it’s not one I’ve ever really explained to people. But trying to think through the process of why and how is a bit of a challenge – I didn’t go back to school planning on a career in bioethics, and the decisions I made that landed me here are ones I largely made by myself. And if you think my external thought process is messy, you should see what it’s like inside my head.

Matt’s not the only one who’s asked, recently, “why bioethics?” Most of the applied ethics job candidates have some background in bioethics, and want to know why I want to go into the field. That makes sense; chances are good I’ll be working with whomever comes on board in some capacity or other, and knowing my motivations is important. Now if only I could articulate them – perhaps I should ask my sounding board (Michael); he might remember things I don’t.

But anyhow, while I’m still internally mulling and externally mumbling about my own decision for bioethics – for the rest of you reading this who share the field, why bioethics? Why did you decide to devote your life to this? What drew you in? Why are you here in this particular gloom and doom level of hell with me? (Not that I’m complaining, mind you – company is always better when you’re contemplating such things!)

Back at ASBH, one of the journal editors was really pushing the idea of approaching certain journals about editing one-off issues on a special topic. I kept thinking about a story Bob Veatch told in August, and the idea of origins. I mean, which of us was bitten by that radioactive bioethicist, and who found a ring laying on the ground, and who had the early childhood trauma? (And I did have this idea prior to the bioethicists as superheroes piece that came out in the ASBH Exchange today, thank you very much.)

So entertain me, fellow crazy people: tell me your origin story. Here, in the comments, or in email if you’re shy…but I do want to know. And when I figure out how to give words to my reasons, I’ll post it…right after I call Matt to let him know what the answer to his question is.

high on my list of annoyances right now

We’re hiring. I think I’ve mentioned this. We’ve done four of the six interviews, and after every interview, we tend to stand around and chitchat about the applicant. And I swear, if one more non-applied ethics/bioethics person, be they faculty or student, tries to tell me what bio or applied ethics studies, publishes about, or in general thinks, I might scream. Or actually get violent.

Tonight’s conversation went something like this:

Me: So, what’d you think?
Person: Well, I thought it was interesting how he brought in biology, since ethics doesn’t handle that.
Me: …wha?
Person: Yeah, no one doing ethics – you know, applied or bio or whatever, really considers biology, especially evolutionary biology in their writing.
Me: …er…
Person: But like I said the other day, ethics is just all dialogue anyhow.
Faculty: Too many people kvetching. There’s no science or logical thought or process in ethics, especially bioethics.
Me: Are you trying to taunt me?
Faculty: It’s a known fact!
Person: Kvetching is a great word to describe the entire field! No one does serious research.
Me: …I’m leaving now. I need a drink.

Moral of the story: I need to spend some time at AMBI, around people who aren’t going to try to tell me what my field studies, or dismiss the entire thing as pointless and not important.

I mean, I know it sounds silly (and yes, GM, I know – just ignore them), but to listen to a group of graduate students and faculty share this opinion about bioethics just being a bunch of people kvetching and not doing real research just made me want to curl up somewhere and cry. It’s hard not to take this personally, and assume that what they think about the field they also think about me. They’re painting bioethics in a very broad and extremely unflattering brush, and it’s kind of hard to see how they could not think similar about me.

I came here for this?