November 1986 VIII/3
ON PLAYING GOD
Appear on a radio or TV talk show devoted to questions of medical ethics or discuss in a clinical setting a difficult patient care decision and, if the proposed ethical solution suggests that a person be allowed to die, someone will object to the solution and say, "You are playing God." This phrase is usually uttered with the implied meaning: "Life and death decisions in medical care must be left to God. Human beings have no right to interfere with God's work." Is this a reasonable attitude? Is there any sense in which human beings can and should "play God?" Or should human beings be more cautious, withdrawing from decision making when it becomes obvious that death might unavoidably ensue if another good is chosen. Understanding the concept "on playing God" will help us understand better the mission, nobility, and limits of medicine.
The term God implies an all powerful, wise, and good being whom human beings worship as creator and ruler of the universe (Webster's Dictionary). God is provident director of events and happenings in the universe. (Those who do not believe in a personal God might substitute for God the term "Nature:" meaning "a creative and controlling force in the universe" (Webster's Dictionary). Is there any sense in which human beings ought "to play God" or "assume the role of Nature?" The glory and challenge of being human is that we are called upon "to play God:" we are challenged to assist nature by being creative and controlling of our own lives and of the happenings of the universe. If we are to fulfill our humanity we must take an active role in shaping our own destiny, help others fulfill their destiny, and maintain the ecology of the universe. We are created in the image and likeness of God. We have powers from God (Nature), our intellect and will, which enable us to take an active and determining role in the decisions which affect our lives and our destinies. We can respect and develop our person and capacities, whether mental or physical, or allow them to deteriorate and atrophy. We can build great societies or allow ourselves to destroy one another through bitterness, envy, and violence. We can respect our environment and preserve it for generations to come, or we can ravage it rapaciously and leave a wasteland for our progeny. Medical research is an illustrious example of our ability and need "to play God." Medical research asks to improve human life by eliminating disease and improving our quality of life. Would it be fitting for the medical community to remain passive in face of the AIDS epidemic and say, "This is God's way of punishing people and we must not interfere." Of course not. Rather, the medical research community, at the behest of all caring people, plays God and tries to eliminate AIDS, thus controlling the future and eventually eliminating one more source of human suffering.
In medical matters, most people realize the need to be responsible for personal health. Realizing that they cannot expect God to send medical care unless they do something about seeking out the medical help they need, most people will seek medical help if they are ill. Few people realize, however, that we have the power and responsibility to be creative and controlling in regard to other facets of medical care. For example, by working together we can do something to provide more adequate health care for all members of our society. Moreover, through mutual cooperation, we can improve our environment and the quality of life in our cities
Though we have the power to play God, or influence Nature, in respect to our personal, social, and ecological responsibilities, we do not have unlimited power. God has unlimited power, but to be human is to be limited. Unfortunately, admitting limitations and shortcomings seems to be difficult for human beings. If we choose one goal it usually means we must relinquish another. By choosing to avoid physical or mental suffering, one with a fatal pathology may also reject life prolonging therapy and thus hasten death. We can't "have it all!" "Playing God" in the sense of not admitting limitations leads ultimately to personal unhappiness and social disaster. Thus we are called upon to play God insofar as being creative and planning for the future is concerned, but in order to realize this power responsibly we must recognize our limitations.
In medical care the tendency to ignore subconsciously the limitations of knowledge and technique is prevalent. (l) Some physicians, for example, act as though death of a patient is a personal defect. Thus physicians themselves testify that those who have incurable and terminal disease often are not given the same attention as those who may recover from their illnesses. Given the limitations of human beings, helping people die well is just as much a part of medical care as healing. Knowing when to cure and when to "simply care" is the epitome of the science/art of medicine.
Admitting limitations for research programs in also difficult. Do those who set policy for research programs stop to say "We can't do everything; What are the most beneficial things we can do with our limited resources?" Rather, it seems that political economic pressures determine the research agenda. In our country, medical care and research programs emphasize experimental procedures for the few, such as transplants and artificial organs, while more basic programs for the many, such as neonatal care, are often neglected. Medical progress requires that some attention be given to experimental procedures, but are policies in regard to research and practice formulated with a view to social as well as personal medical needs? A neutral observer evaluating our national research programs' medical practice might state, "These programs are based on the assumptions that medical care can enable people to live forever and that there are unlimited financial resources."
Not only health care professionals but also the general public often presume that there are no limitations to health care funding. Many consider it an egregious violation of human rights if a representative of a health care facility (especially a Catholic health care facility) is forced to say, "I am sorry, we don't have the funds to accept you as a patient." True, health care facilities, especially Catholic health care facilities, by reason of the profession to which they are dedicated, should do as much charity care as possible. But institutions as well as individual persons have limits, and it is not a violation of others' rights if hospitals acknowledge publicly these limits.
Playing God in a worthwhile sense means that we realize we are responsible for the destiny of ourselves, others, and the universe. But it also means that in fulfilling our responsibilities we must admit our limitations. Admitting limitations is simply another way of saying that we must pose the relevant ethical questions: If we can't do everything, what goods or values are more important than others? Which research and therapy programs should receive priority? What must we give up in order to provide more equitable access to health care?
Kevin O'Rourke, OP
1. Eugene D. Robin, MD, Matters of Life and Death. (New York: Freeman Co.; 1984) p.179ff.
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