some reflections on ethics, technology, medicine, and a real life story from extreme poor Africa

My father pastors a congregation in rural Swaziland. Their biggest task is looking after the victims of HIV & AIDS in a home-based care program. Earlier this week he wrote a story on the use of technology in this extremely poor area of Africa, where even running water and electricity is a luxury most people don’t have access to.

Ons of the things I do somewhat on the sideline is working in ethics at the University of Pretoria. Over the past few weeks I was part of a team teaching Engineering Ethics (I’ve been part of this for a number of years now), and I marked a number of papers in Christian Ethics and Health care. From this ethical perspective, I’d like to make a few remarks, to point out some of the complexities raised by the story. I’d suggest you first read this.

One of the complex questions we try to bring to the attention of Engineering students on their way to make a life in the field of technology, is the problem of the weakening between the causal link of an action, and the possible negative outcomes. This raises the question of who are to be held responsible in the case that something went wrong.

On the other hand, in ethics and medicine we tend to focus on doctor-patient relations, and all kinds of potential models for how medicine should be applied or understood, while the reality of Africa is that there simply isn’t doctors available for people, many times not adequate medicine available, and difficulty in accessing medical facilities from rural areas. The questions concerning medicine and ethics in areas of poverty might by much less about what to do with the doctor that messed up an operation, than about what to do about a system which doesn’t allocate enough doctors to the poor (or doctors who prefer not working with the poor).

Now, some questions and reflections surfacing out of the above and the story.

If I ever visited a doctor, who looked at my medical record, and took out his phone to check the name of something written there, and in reference to some random google hit (which didn’t get to number one on google because the South African board of medicine thought it should be there) would tell be what I should do in future, I’d be really unhappy. But in this case we’d probably be OK with the act (or maybe you wouldn’t, but then I’d get to that in a moment). But lets say that the answer found from google was wrong? Now, I’d agree that chances are almost nothing, but what if it were? Who’d be responsible? If it was my hypothetical doctor, we’d surely say he’s responsible, since he was supposed to have access to the right journals and textbooks. But what if it was my father the missionary, pastor and theologian? Is he responsible? Can we hold wikipedia responsible if incorrect information was found on there site (assuming he got the info from a wikipedia site), which lead to wrong advice given in this situation, and possible worsening of the patients condition? How does the fact that there is a total lack of doctors in this specific area affect our thinking? The fact that we live in a system where it’s simply not possible that a doctor or nurse would see this lady of her family to make sure that they have all the correct information.

More complex, is the questions concerning the photos. What if the pharmacist would make a wrong judgment on the photo, and prescribe something which would worsen the wound? Would he be responsible? What if he refused to look at the photos? Would he then be responsible for not giving advice? What about all the millions of trained doctors that isn’t giving advice even electronically? Can the fact that distant advice is possible become a hindering factor in making sure that adequate doctors are sent to these poor areas? Can new possibilities in applying medicine distance interfaces become a further reason for not getting doctors into the areas which need them most? And what about the story told by comment no. 4 about doctors being trained to use advanced technology, and now refusing to work in areas where this technology isn’t available. Could the wonders of modern medical science become yet another worsening effect for the health of the poor of society?

Reflecting on the layers of complexity in the decisions that need to be made in this situation should obviously bring out the importance of context, and be a reminder that certain answers we give in our comfortable developed existence, simply cannot hold in other contexts. Furthermore, it’s a reminder that in times of crisis, we change our perceptions of right and wrong. Few of us would rely on the methods described above in our daily medical care, but in the extreme crisis the people of rural Swaziland are finding themselves with HIV & AIDS, these same processes become life-giving beyond our imagination. But furthermore this story brings out the absolute injustice of medical care, where the rich have access to the most amazing possibilities thanks to technology, while the poor don’t have access to the most basic of medical attention.

And as you read this thanks to the same technology that delivered the pictures to the pharmacist, and gave the answer to my father, technology becomes the tool focusing our attention on the injustice mentioned above, and the question is forced down: Who should now take responsibility for this injustice? And what is our responsibility when technology make us aware of injustice in the world?

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discipleship and church and many questions!

It’s quite a hectic time at the moment. Will be preaching twice on Sunday (all my respect to those of you who have to do this every week), and since we are busy with a series where similar sermons are preached in both our services, I have to finish my one sermon by tomorrow to send it to the other guy that will be preaching. What’s worse is that he has been a pastor for 40 years or something, and I just started out, so it’s kind of a stressful idea!!!

What’s more I’ll be having a meeting tomorrow about this years Engineering Ethics, a course at the university where I’m part of the team teaching and facilitating discussions. So the lecturer asked if I’d bring along my ideas for possible work we could add/change to/in the curriculum, especially with regards to Ecological Ethics, which we would like to give higher priority this year. I’m thinking about the first chapter of Fritjof Capra’s The Web of Life, but it contains a lot of philosophy which I’m not sure what the Engineering students will make of. So, if you have any ideas which might help, and you can let me know within the next 12 hours, I’ll appreciate it. I’m looking for something scholarly, something radical, something ecological, and something the lay reader can understand (The average engineer isn’t that interested in philosophy or ethics).

OK, a question. What’s the relationship between discipleship and the church? I’ll be preaching on discipleship and biblical formation on Sunday (again, I have about 18 hours to finish my draft on this sermon), and as I was working this afternoon, some questions arised.

Discipleship is not coming to church, but it’s going into the world. What do we do when we go into the world? Where is the world? Is the church part of the world? Sometimes I wonder why even keep the church? Well, it seems like the task of the church would be to prepare people for discipleship; I get this mainly from Matt 28 (read the thoughts of David Bosch in Transforming Mission on this), go and teach what you have learned from Jesus; Jesus made disciples, now go and make some more, to make more, to make more? No, to do what Matthew wrote in his account of Jesus from chap 1-28, to take part in the Kingdom of God, the Kingdom of Heaven, to heal, bring hope, feed to poor, look after the vulnerable etc etc. Why have another sermon on this? What do I say when I have another sermon on this? Can the church actually “train” people in discipleship? Is biblical formation and discipleship the same thing? Is discipleship and making disciples the same thing? Maybe biblical formation and disciples, or making disciples is supposed to be the same thing, but do we use this terminology for the same thing in our churches?

I’m reading Emerging Churches by Gibbs/Bolger, especially chapters 3 and 4, as part of my preparation. Is this the answer? Should we close down church and start alternative communities? What about the millions in traditional congregations who will never fit into new models, are they “lost for discipleship”? Is discipleship possible in a traditional Reformed congregation? What about in a hip mega-church? Bring back the question, in what way is discipleship (or making disciples ) and church linked at all?

Well OK, have to go now, I’m having dinner with some nice people from the congregation. A technical error (I’m sure the database we are using has some programming error) caused me to phone the wrong person to sympathise with a husbands death. As Murphy would have it, this person had a brother with the same name as the dead husband, and I left a message just to say that I heard, and would call later. She got it, thought her brother died, then found out he was alive bla bla bla. You can imagine the bad experience it must have been! I felt very bad. So actually I just wanted to go and say sorry, but, in spite of my horrible mistake, the nice people are giving me some food (which is great if you are in bachelorhood!)