What Bing AI thinks a menagerie of animals is. Some of these creatures have no head. Yikes.
This is edition of Miles to Go is going to be short because its the first week of classes and I’m getting my ducks in a row. I thought I would talk just a bit about the opening gambit of Chapter 1 “The Transposition of the Great Arteries” and why I love starting with it. It gives me insight into the kinds of “moral critters” I’m dealing with on the first day.
I mean no disrespect to my students. I just like getting a feel for the class as a whole. Whatever intuitions they have, its my job to test them. The “Transposition of the Great Arteries” case study that I adapted from Atul Gwande’s wonderful book Complications: A Surgeon’s Notes on an Imperfect Science. is a great way to get a feel for the class.
Infants born with transposition of the great arteries die lethargic, blue-tinged, and gasping for breath because the artery that sends blood to the lungs to receive oxygen bypasses the lungs altogether, sending oxygen-poor blood back into the body... The Senning procedure wasn’t all that risky (infants died in only about 5 to 10 per cent of the cases), but survivors of the procedure were at a much greater risk for heart defects later in life; because their hearts were compromised, most never made it to old age. The surgeons of the Great Ormond Street Hospital in London wanted to switch from the Senning procedure to something called the Jatene procedure. In the Jatene procedure, the arteries are surgically removed and reattached. The new procedure increases quality of life, and those who get the surgery can live full and active lives. There was a cost, however: Surgeons had to gain experience with the new procedure because surgeons learn on the job.
A study done twenty years after the fact showed that, in the beginning, infant deaths rose sharply for a few years but then declined rapidly so that almost no infant dies of transposition of the great arteries today. If the hospital had stuck with the traditional procedure, there would have been less risk to infants during surgery, but those infants would have had a poor quality of life.
This case study tests for the presence of strong consequentialist intuitions the way a urine dip tests for a UTI. If we do the new procedure we will help lots of future infants, but we will also sacrifice infant mortality in the short term. Don’t forget the results of the switch were not known until the retrospective study. Utilitarian intuitions are great for evaluating the efficiency of an action. On the other hand, if we stick to what’s best for the present infants, we honor beneficence over utility.
It’s fun to see how different sort of students wrestle with the intuitions. First they squirm under the claim that “surgeons learn on the job” and the trade-off between “expertise and progress.”
I find that first day very few people are willing to commit to the consequentialist option of long-term utility. No one in my first section was willing to commit to nudging a new procedure if it would likely increase infant mortality in the short term. Only four people in my second section.
Nursing students are the sort of critters to immediately identify with the individual patient. They will opt for the “We should disclose everything and let each patient decide.” No surprise, they opt for individual autonomy. Nurses are most often the first point of contact with patients and their primary virtue is caring, so this makes sense. I remind them that sometimes, especially in Public Health and Research, circumstances will test that individual patient priority.
It was for these folks that I added this question to the case study:
In addition, just how much should surgeons tell the parents about their inexperience with the new procedure? Should they mention just the increased risk of dying or their inexperience with the procedure as well?
My other largest set of student are pre-med majors. If anyone is going to test positive for consequentialism it’s these folks. Some are willing to bite the bullet. (Of the four that did opt for consequentialism, two were pre-med.)They seem to recognize the importance of medical progress and they anticipate learning on the job. I can see their faces sort of light up when they have a name to associate with their intuitions. Then I say, “We’ll see if you stay consistent with those consequentialist tendencies.”
This year, I have a whole different group of first day critters that I don’t quite know how their intuitions run yet. My university just added occupational and physical therapy and radiology tech majors to our catalog. The first time I taught bioethics, it was a class chock full of PT majors. Alas that was 2007. I barely remember those classes because when I wasn’t teaching, I was writing my dissertation. So we’ll have to see.
I’d love to hear from instructors on how your students sort with regard to their intuitions.