Thursday, October 30, 2014

Paws and Talk About Cost

By Chelsea A. Jack

“The capacity for suffering and enjoying things is a prerequisite for having interests at all, a condition that must be satisfied before we can speak of interests in any meaningful way,” –Peter Singer

Singer has argued for the equitable and fair treatment of animals based on their ability to suffer in ways similar to humans. I wonder if, in some circumstances, ill pets are treated more humanely in times of crisis than their human counterparts.

Daniel Callahan, co-founder of The Hastings Center, has thoughtfully written on how Americans view cost as a morally acceptable factor in decision-making when it comes to the death of a pet, but not always the death of a human loved one.  Veterinary doctors are not only willing to explain a patient’s prognosis, but also the financial costs for a family choosing among various treatment options for their pet. The reason for this seems to be that conversations about end-of-life decision-making come more easily in the context of veterinary care than when the patient in question is a human loved one. Because medical doctors are often reluctant to talk about end-of-life care with their patients, conversations about the financial costs of such care do not occur either. This is not necessarily the case with veterinary care, where, if anything, vets go out of the way to prepare families for the likelihood of death – and its costs. With both human and non-human patients facing illness, the financial costs of care can be startling and deeply upsetting. Callahan has asked how medical doctors might deliver care options to patients in the way his family’s vet did: “beautifully integrat[ing] money, medical candor, and compassion.”

I found myself considering Callahan’s reflection on the death of his own Cavalier King Charles as I sat in the waiting room of the VCA Animal Specialty & Emergency Center in Wappingers Falls, New York a few weeks ago. In no more than three minutes, my beloved 8-month-old Boxer-Pit mix named Trapper – after MASH 4077’s Trapper John, MD – ventured away from me with another canine companion during a cookout with my neighbors. He played leap frog in-between cars speeding down a nearby highway. When I realized he was gone, I ran down to the road with an ominous feeling in my gut. After calling his name for a minute, an adrenaline-charged Trapper came bolting up from the highway and collapsed at my feet completely out of breath. He had deep abrasions along his front-left paw, which was visibly knotted, and, as the adrenaline wore off, he could barely stand, even though he remained stoically silent with his ears back and eyes locked to my face.

I broke every speed limit on the way to the emergency care center where Trapper went into shock and began convulsing. Exchanging worried glances, the nurses quickly carried him away from me into another room where they attempted to stabilize him.

Immediately, but kindly, a nurse presented me with a series of consent forms and unsettling numbers: Was I okay with paying $400-600 to stabilize Trapper? Did I want them to try and resuscitate Trapper if his heart stopped, even if it meant spending $500 on a procedure with a success rate around 17 percent? Did I consent to the three recommended x-rays of his front-left leg, chest, and hips, which would approach $400 – without factoring in the possibility of further x-rays later over the next 24 hours? There was a possibility that Trapper would pass away due to contusions in his lungs – did I want to keep him overnight for monitoring even if that was another $200? Did I want to see the credit plan offered for 12 months without interest for patients who cannot afford expensive high-quality care?

Throughout the whole nightmare, the doctors and nurses presented each decision-making scenario with at least two options: cost projections for the “ideal” treatment plan versus the “less-ideal” treatment plan. As I weighed these projections, I thought how the word “ideal” places a nontrivial degree of guilt onto the decision-maker who opts for the less-ideal options. It problematically values the more costly decision as morally preferable, even when this might not accurately reflect the moral landscape – marked by competing financial obligations – in which real-time decisions are made.

Individuals and families (more often than not) cannot isolate an immediate, short-term moral decision from the other long-term ones lingering in the background. For example, as I weighed the two treatment plans presented to me, I thought, “I have signed a lease committing me to pay $X/month. I love my apartment and cannot legally break this lease agreement, and I cannot emotionally or financially afford to forfeit my living situation even if it means that Trapper has to receive the 'less-ideal' treatment plan". As a recent post-grad, I weighed the costs of fulfilling one long-term goal (i.e. living happily in my new home) against the costs of fulfilling my obligations to care for Trapper as my pet who was facing a health crisis. Committed and interdependent moral agents are forced to make these kinds of decisions every day. In my case, it was productive to not only have Trapper’s physician initiate a conversation about our end-of-life preferences, but also address possible treatment options and possible costs. 

Miraculously, Trapper is expected to make a full recovery and came  home from the emergency care center after 24 hours of observation. I’ll borrow Callahan’s language to describe my own personal take-away from this ordeal: Trapper’s care team embodied those qualities that “we might hope for from a doctor for our care, but by no means yet reliably available” in the human medical context.

Chelsea is a Research Assistant at The Hastings Center. She graduated with highest distinction from the University of Virginia, where she received a B.A. in political and social thought and anthropology with a minor in bioethics. Her research interests include medical and legal anthropology, political and social theory, bioethics, and contemporary feminist thought. 

Wednesday, October 22, 2014

A Minor Case for Existentialism in Biosemiotics

By Matthew Cuffaro

“Existentialism protests the rationalism and idealism who would see man creatures only as a subject—that is, as having reality as a thinking being.” p. 12 Angel, Ellenberger, May, Existence: A New Dimension in Psychiatry in Psychology.

The following argument advocates existentialism in biosemiotics to the reader of this blog—presumably up-and-coming bioethicists—to mull over how an existentialist understanding of biosemiotics is relevant to considering the ethics of medicine and health, environment, etc.

What biosemiotics is, how it can integrate existential thought, and how it relates to the bioethicist is a major concern: the predisposition to think of animal cognition and decision-making as purely genetic impedes our attempts, as organisms “creative past our genes”, to identify with animals, if not the biological world. In fact, you can derive the entire motivation and most of the points from the first page of the preface in J. Hoffmeyer’s Biosemiotics. Hoffmeyer’s writing is beautifully lucid and recommended to the readers, but it will be kept short so the existential argument may be covered.

To begin, the crux of contemporary biosemiotics can be understood as the disbelief that organic communication is merely “mechanical.”

What J. Hoffmeyer, Biosemiotician, offers:

With the current outlook, other organisms remain empathetically inaccessible—they are separated by a gulch of misunderstanding or anthropocentrism. We are still surprised when new research reveals “human” emotions (grieving) in animals. Perhaps the difficulty of stationing “complex” emotions in cultural terms—terms not patently equivalent to a notion of a general animal cultureperpetuates this idea.

Partially the mechanical explanation is to blame from theoretical biology’s honest expedition to resolve the problem.[1] The complete genome is an enticing structure; it is not hard to imagine that a reductive appetency towards a promise of rich structural coding creates a tendency to “delegate to [the animal’s] genetic apparatus” the complete spectrum of their ethology as well. This continually denies the creature the evolutionary merit of having an intellectual middle-man. Hoffmeyer uses this example to describe the creative semiotic faculty of the animal:

“When a brown hare spots a fox approaching in the open landscape, the hare stands bolt upright and signals its presence instead of fleeing…ethologist A. Holley [claims that the] hare can easily scape a fox simply by running – a fact that the fox seems to ‘know.’”.

The hare signals the fox that it has been spotted, and so subverting the actual use of its physiological advantages. The quick legs of the hare begin to have a more symbolic importance to the hare that tries to remove the need of their use.

Perhaps we can assume that a being capable of understanding not just their asset’s advantage, but what the asset means for it, is to imply that the genetic body of the hare is interpreted and communicated to other animals by a being that can experience itself.

The hare capable of interpreting and communicating itself must recognize the significance of itself in sustaining its life. We suppose that the hare has not just experienced life but is capable of commuting its interpretations into actions fundamentally significant to its survival, e.g. signaling the fox. The hare is striving to exist, and so it is exercising a creative faculty to mediate itself with the environment.

To account for the experiential and concomitant existential[2] questions that would crop up if Hoffmeyer and Co.[3] had their way, I sketch in the sand existential biosemiotics (EBS) to take up the burden.
What Existential Biosemiotics offers:

The overt task for existential biosemiotics is to extend semiotic theory, or the study of signs—“things that refer to something else”—into the domain of experience. We may formulate this project to coincide Merleau-Ponty’s phenomenology with scientific knowledge under a common metalanguage. Hoffmeyer lobs us a notion of biological referentiality to organize the analyses of the organism’s relation to itself. In the case of the hare above, the hare’s reference to itself is tickled by a suppression of its internal or bodily ability to run (which it is genetically equipped to do well) in light of an external threat.

If we take seriously a creative faculty in the animal, then there is, in the fabric of experience, certain semiotic weights that give it shape. The EBStian would deal with identifying the significant[4] structure underlying shaped experience. In other words, how a bundle of signs (e.g. a predator, a potential mate, a hare’s leg, the arrangement of a room) designs the world of the experiencing organism, or รก la Hoffmeyer, how the “ubiquitous intentionality of communicative behavior” is articulated, and how these decisions that govern the total and embodied experience of the creature (e.g. run very fast, a sense of peace in a clean room) have a conjugate physical response (e.g. mad adrenaline rushes through the prairie, muscular relaxation etc.) and vice versa (how does a particular space become associated with my impressions of it, my gut feeling, etc.?).

The biosemiotician in this scope hopes to demonstrate that communicative and behavioral similarities between organisms enriches approaches to interact, understand, and imagine the biological sciences.

Matthew Cuffaro is a philosophy student at the University of South Florida with a concentration in the philosophies of mathematics and religious studies. 

[1] Conway’s Game of Life, for instance, illustrates evolutionary “life” as a series of small-order recursive processes that, with special initial states and a sufficient run-time, can construct superstructures that remind us of genetic transcriptions. Check it out here.
[2] Mind you, “existential” here brackets the organism’s self-consciousness of mortality; “There, organisms never ‘try to survive’–for the simple reason that they cannot know they are going to die.” Instead, viz. generalize “existential” to the organism by its own presumed agency making decisions not to avoid death but to continue life.
[3] Biosemioticians such as Emmeche, Merrill, Rigby, Seboek, Uexkill, &c.
[4] Pertaining to signs. Semiotics may be argued as a science that identifies the significant aspects in a scene caveat emptor, tread lightly.