human behavior

The blame game

Posted in Health & Medicine, Religion & Ethics by humanb on October 11, 2010

My husband and I were discussing the ethical scenario I mentioned in an earlier post at dinner, when he put forth a slightly different hypothetical. It’s not so much about ethics as logic. Or law. Or, well, something.

Consider:

John and Sam hate Matt. Matt decides to go out into the desert for a walk. John secretly poisons Matt’s water bottle. Later, Sam secretly drills a hole into its bottom. After walking some time in the desert, Matt becomes thirsty but finds his water bottle empty. After some time, he dies of dehydration. Who is responsible for Matt’s death?

My first answer was that Sam, who drilled the hole in the bottle, was responsible. After all, Matt died of thirst not poisoning.  But my husband, a lawyer, remarked:

Really? But Sam extended Matt’s life. If he hadn’t drilled the hole, Matt would have drunk the water the moment he was thirsty and died of poisoning. Poisoning would have killed him sooner than dehydration. He had a longer life because of Sam.

This is an interesting conclusion. It doesn’t directly answer the question of culpability, but I like it, because it acknowledges that the answer isn’t simple. And as simple as the story is, the question is profound.

For me the story immediately recalled the eternal question in medicine regarding the terminally ill:

Are we extending life or delaying death?

There’s a subtle difference between the two. In the former you seek to give. In the latter you resist the inevitable. But the more ethically perilous scenario is where a person is on the verge of death:

Are we extending life or prolonging death?

This requires being able to recognize when someone has actively entered the stage of dying. Any attempt to extend life here is drawing out the dying process – an exercise of variable benefit and often questionable morality.

And then there’s the scenario in medicine that most approximates the story:

A woman is diagnosed with cancer. Her doctor prescribes a robust regimen of chemotherapy, which is essentially a poison to rapidly dividing cells. The woman’s immune system is so weakened by the chemotherapy that she dies of an infection that could have been easily fought by a healthy immune system. What is responsible for her death? Cancer or chemo?

This is a dangerous scenario to put forth, because I absolutely do not want to suggest that chemotherapy should be avoided. It is without doubt not only life-extending but life-saving for many cancers. I have a loved one who is very young that is alive and well today because of it and because of the doctors who prescribed it. So I favor its use strongly where indicated.

But the question remains.

It’s an important question to ask in some scenarios – most notably law and medicine. Someone’s gotta go to jail for Matt’s death in the desert, so who’s it gonna be? And in medicine, much time, effort and money is devoted to researching the efficacy of drugs to determine their benefit relative to their harm; and the two most important questions medical research poses about treatments are: How many years of life can we save, and how many years of health can we ensure? So assigning responsibility for a patient’s health, sickness or death is critical.

But there are plenty of other scenarios in life where assigning blame is best left undone. Consider some aspect of your current life that largely defines your existence. I wager you could find a way to trace your current circumstances all the way back to say, your first boyfriend, or to something your parents said one day that stayed with you. I can, anyway.  Along the way, there are any number of people and events that serve as landmarks on the path to where you are now – all potential targets of culpability for your present lot in life.

It can be worthwhile to consider how other players in the game have influenced your hand. Reflection and self-awareness and all that.  But assigning blame is tricky business, since there’s a myriad of ways to interpret a person’s influence on your life. In a way, everyone I know is either prolonging my life or hastening my death.

But I’d rather not see them that way.

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2 Responses

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  1. JW said, on October 11, 2010 at 6:21 pm

    They are both guilty of attempted murder.

  2. humanb said, on October 11, 2010 at 6:27 pm

    You say “attempted” murder. Legally, okay, they both clearly tried to kill the guy and could be thrown in jail for trying to, but who is actually responsible for his death? The guy is dead. Who gets charged with actual murder? No one?


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