About the author:
Dr Theo D Holtzhausen (BVSc PGDIpIntnlHlth) is a practicing vet and author Spheres of Perception
ETHICAL CHALLENGES HEALTHCARE WORKERS SHOULD PREPARE FOR.
‘The aim of science is not to open the door to infinite wisdom, but to set a limit to infinite error’. Bertoldt Brecht in Life of Galileo 1994.
Perspicuous as Bertoldt Brecht's statement may be, one could add to it, ‘…in our search for some meaning among ephemeral truths’.
Even truth and error have become hard to define in a discombobulated number of new discoveries and publications in recent years. Over the years an objective healthcare science (if healthcare can still be considered as such) has slowly created the image of a 'good' practitioner as an individual highly skilled in knowing how to use specific flowcharts and algorithms based on specific measurements and perceptions of specific symptoms and latest research. This is combined with objective laboratory results and values and/or imaging methods to arrive at a specific diagnosis with a certain prognosis and therapy.
Inarguably, those of us on the frontline in dealing with patients know there is a bit more to caring for our patients than the mere robotic application of such statistically based algorithms, flowcharts, and proven method.
If we, as perceptive and ethical vets, or doctors, want to continue to serve as more than mere directors in flowcharts of disease (soon to be outrun by AI) we must be open to learn from other disciplines. If we aim to practice healthcare in a professional capacity where a blend of ethical care and high clinical standards are still considered essential, we carry a great responsibility here. Bioethics inarguably joins other disciplines in synthesis of a scientific theory, including arriving at a diagnosis with a patient as a unique individual in distinctive environment.
In what should be a much more integrated transdisciplinary approach to healthcare and disease, it is inevitable that we will witness ethical conflict that arises between scientific methodological and humanitarian demands in evolving societies.
Apparently most social scientist and philosophers (and practitioners I talk to) do not share similar enthusiasm as that of the more 'objective' research workers and financiers employed by industry. Inevitably, and with escalating evidence our patients (and aren’t we all at one point) are now seen as vulnerable and interlinked to a heathy environment— with animal and micro-particles (microbiota) as an interlinked symbiosis. We are only beginning to understand a system where financial constraints will be an insufficient excuse to defend a healthy bio-genome facing emerging environmental changes and future pan-epidemics. More and more do science, and those ordained to act as the gatekeepers of our health, also warn us that our healthcare systems, morality and genome as a unit are under serious threat— overshadowed by a dependency on chemical remedies and unhealthy environments. Staring us into the face is the evidence of this malaise as being linked to the health of both our environment and the human-animal bond —as an unavoidable interconnected living web.
My aim is to not add more rhetoric on the undeniable and pressing impact of climate change and the inevitable ethical and legal dilemmas we must soon confront in medical genetics as it is about a personal interest in the future of our profession as healthcare workers. This is reflected in the current despondency and burnout rates witnessed among healthcare workers on all levels.
I will start here with my own conclusion in three words — stress, environment, and moral dilemmas.Being a clinical lead vet in a busy practice I daily confront these elements in both clients and staff while remaining aware of our inadequacy in dealing holistically with the interconnections between the health of our patients, the human-animal bond, and the environment.
Today almost everything new in medicine can be linked or traced back to an aberration of a certain part of the genome, where DNA and RNA are responding to changes in their surroundings. Many of these rearrangements potentially resulting in disease, cancers, and allergies— or the ability to outsmart villainous intruders. Researchers are only begging to understand the diversity of responses on a genetic level to similar chemicals or diverse environments. This significant shift from the image of a blueprinted DNA to a more mobile version, has not only opened new doors but has significant implications on the future of healthcare ethics. In an unexpected way it has also given us a new avenue to defend our concerns about a heathy environment and morality. Furthermore, how disparity is escalating can only result in isolationism and marginalization of individuals and communities, something that would not benefit our biogenome.
Our environment, the drugs we take the chemicals, media and stresses we expose ourselves to daily can increasingly be seen as having a more significant impact on altering our wellbeing, that of future generations and subsequently affect the way we practice as ethical healthcare professionals. We aslo have a duty here as protectors of a heathy human-animal bond.
Today most of us can relate to the following statement— more lives can be saved, and suffering prevented, if we refocus our healthcare systems on preventative measures that are born from an interconnected healthcare evolving in an adaptable morality to cope with changing environments and needs. Once we start balancing these measures against the current costs of tertiary healthcare with its expensive drugs and therapies against the long-term implications on the environment, indirectly perhaps our mental health and the human/animal genome will be better placed to heal and reduce our chemical dependancy.
In a discovery as significant as Darwin’s evolutionary theory, today we can see us and our world as living systems within living systems—adaptable biomass with transgenerational links, constantly adjusting and carrying messages from one generation to the next. With some of these affects harmful and others beneficial. Understanding ourselves as more than mere higher primates fighting for survival, we need to learn how to coexist within our changing environments rather than how to control or merely benefit from it. A more realistic goal is now how to adjust and successfully interlink a healthy genome to rapidly changing environments — morally.
In the field of genetics researchers now know and are only beginning to see how DNA is perceptive on all levels, with a memory bank to be carried for many generations. This should not be afflicted by outdated versions (or ignorance) on morality and ethics still pivoting around personal biases or historic belief systems and unbendable laws.
With disparity growing in uncertain times, the inarguable link between healthy environments and our own health and the emerging evidence of the impact even the smallest participants (a strand of RNA) can have, how can we still practice ethical medicine and feel satisfied in distributing pharmaceutical agents as directed by flowcharts only? Perhaps the time has now arrived to broaden our view and more bravely confront the so-called 'workplace stress' to cover some of these moral conflicts the practitioner has to daily face.
Mere talk among academics and intellectuals is not enough and if we are serious about protecting our status as ethical healers, the change will have to come from us, as the frontline workers and not policy makers operating from a distance.
Books by Theodore Holtzhausen:
Sensible Gene Selfish Being (2016) and Spheres of Perception, (2020).
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