Page 25 - Community Living Magazine 34-3

ethics

Our current medical abuses and
exclusions – detention and mistreatment
in assessment and treatment units, DNR
notices, preventable hospital deaths – are
all rooted in this dubious medical heritage.
Why does this happen? First, medical
practitioners are singularly ill suited to be
the arbiters and controllers of the lives of
people with learning disabilities.
Learning disability is not an illness or a
disease, and it cannot be cured or treated.
People with learning disabilities are who This way: all people with learning disabilities
they are, and no amount of medical became a priority for Covid vaccination only
intervention will make them into after campaigning by public figures such as BBC
someone different. radio DJ Jo Whiley
This is why, before the 19th century,
medical practitioners steered well clear of problem” to think though ethical
idiocy. They were paid for curing people problems. Here, you are standing by a
and they were not interested in spending railway line and see a train hurtling
time on an incurable, unchanging condition. towards five people who are tied to the
When medical men were looking for This medical outlook tied in with wider track. You are in a position to change the
new areas of control and authority in the currents of thought. Utilitarian thought points, and can divert the train off on to a
19th century, they had to invent a story dominated 19th century public policy- spur. However, there is one person tied to
that “idiots” were a danger to either making and ethics. the track on the spur, who will die if you
themselves or others, and that somehow It was very much a practical philosophy, switch the points. What do you do?
only the medical profession could applied to everyday life and, by its nature, In its basic form for a utilitarian, this
recognise, control and “treat” these always loaded heavily against people with dilemma is a no-brainer. You switch the
dangers within high-walled asylums. learning disabilities, as we shall see. points, even though you are effectively
Their choice of language to describe making a decision to kill somebody,
their new patients was revealing – they A seductive, bad idea because in doing so you are saving five
called them “mental defectives”. We know utilitarianism best by the maxim lives while sacrificing one. The numbers
If something is defective it is broken. It “the greatest happiness of the greatest tell you this is the right action to take, and
lacks something. “Defectives” could not number”. Actions are judged by the you must put aside any squeamishness or
be mended; instead, they had to be eased amount of satisfaction, happiness, moral hesitancy that might cloud your
first out of society and then out of improvement or benefits they bring to the rational judgment.
existence. Confinement, sterilisation and greatest number of people possible. The trolley problem can be put through
eventual institutional death would start to Faced with two difficult choices, we all sorts of permutations to tease out the
rid society of this group. choose the one that brings the most solutions to complex ethical dilemmas.
The medical profession’s role never was benefit or causes the least harm. What if the five people were all elderly,
Christy Lawrance; Student Radio Association/ Wikimedia Commons; Roger W Haworth/ Wikimedia Commons
to make people with learning disabilities Like many bad ideas, it is at first sight with terminal health conditions, while the
“better”. It was to remove them from very seductive and seems to make a lot one person tied to the other track was
society somehow and to prevent their of sense. young and healthy with their whole life
future existence. The aim was, in short, Modern utilitarian thinkers have used ahead of them? Would you switch the
their extinction. what has become known as the “trolley trolley then? Or would you not intervene
because the one other life was of more
utility than or at least equal to the other
five put together?
You do not have to jump very far from
here to see how utilitarianism is used in
current medical ethical thinking. Who gets
the ventilator in a Covid ward – the young
person more likely to respond or the old
person less likely to benefit? Then, what
if it is a young person with no health
problems against someone of the same
age with an underlying health problem?
To go back to the trolley problem, what
if it is a person without a learning disability
tied to the track ahead of you, and a
person with a learning disability tied to
the spur – do you switch the points? What
might the average doctor respond to that?
Utilitarian thinking continues to exert a
Building distance: medical interest in learning disability led to exclusion from mainstream society great influence on medical ethics. The ▼
www.cl-initiatives.co.uk Community Living Vol 34 No 3 | Spring 2021 25