Current Discussions, Procedural Guidelines, and Developments

“Thousands of ethicists and bio-ethicists professionally guide the unthinkable on its passage through the debatable on its way to becoming the justifiable until it is finally established as the unexceptional.” [34]

This quote, in somewhat of a “tongue-in-cheek” fashion, distills the evolution of changes in our perceptions of what constitutes an action or idea as being “ethical.” It begs the question, “HOW DO SOCIAL SHIFTS IN ETHICS OCCUR?” Wesley J. Smith ^[35], an anti-euthanasia activist and journalist, outlines the progression of the relaxation of medical ethical principles. He sees this relaxation occurring first among the experts in healthcare theory. This change then moves into the world of philosophers and other academics. The progression of the loosening of stringent values is then carried into the realm of physicians, who take it into institutions where it affects protocols and policies. By this time, the change in ethical standards will have reached the attention of some members of the public, and it is bantered about in debate between the conservative and liberal elements of the populace. A few legal test cases where “experts” give testimony take place (these experts rarely being persons who are directly affected by the loosening of these guidelines), and the result of these courtroom challenges is a legitimizing to the public via the media of this shift in ethical thinking. The media have a unique role to play in that often they provide very “in the moment,” sympathetic stories that involve the specifics of individual cases rather than presenting a projection of any long-term, larger implications of this shift in ethical standards.

Smith, like many others who monitor social policy and its impact on persons with disabilities, sees ethical changes as occurring in quiet and oblique ways, without a lot of drama which would draw public attention to the change in underlying morals involved in the alteration. Protecting human life, he states, has been viewed as the central purpose of organized society. ^[36] The issues around the placement of DNR Orders are only one part of a much larger discussion about the role of the state in preventing harm to the weak and the vulnerable. But even such a phrase as “the weak and the vulnerable” carries with it a tone of paternalism which is loathsome to those who want to be active in determining their own destiny as full citizens in a democratic society.

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34	IBid.
35	Wesley J. Smith, Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder. New York: Random House. 1997. 19. For a fuller explanation, the chapter "Creating a Caste of Disposable People" is invaluable.
36	IBid.

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