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. 

My Apologies to Past Inamorata

By: Matthew Cuffaro 

This post introduces semiotics, the study of signs, in a philosophical formulation of sex. This claim is not principally bioethical, if we understand that bioethics is the extension of ethics to fields with a technicality that often demands both a masterful technical understanding and philosophical prowess. However, this method of conceptualizing sex utilizes understandings from a previously distant intellectual tract to forge a novel method of contemporary ethical thought. Current bioethics has failed on this point, much to its detriment.

Firstly, two disclaimers:

While the themes of sexual semiotics papers may stress the boundaries of bioethics, it is helpful to know that the roots of philosophy are in that body— the distinction between ethics and bioethics blurs at the flesh.

Further, because “sex” is such a vague term in academic discussion, I leave it undefined. Sex could be from foreplay, penetration, or even a particularly witty discussion-courtship. A couple will be used as the example, but the specifics, such as sex and gender, style, orientation, setting, etc. are variable.

Not all sexual encounters appear out of the void; they are usually prefaced by something to arouse the mood. Whatever arouses the mood is usually based off a list of characteristics that the interpreter can vividly imagine but probably murkily articulate. These characteristics, such as swaying hips, musculature, skin tone, are articulations themselves, because they speak for the otherwise silent figure flying across the ballroom, which only leaves impressions (like footprints in the sand).

These characteristics are then positively buzzing with the possibility of influencing the impression of the person of interest; this potential influence is a recharacterization of them, so that the next impression will be accompanied by recognizably sexual features. We can, with an almost offensive ease, recharacterize the space enclosing this encounter. If the person of interest perhaps stole your mortal soul when they picked up that punch, the very room and its objects will be irradiated with meaning, each like a phylactery. I understand this happens frequently to couples with particular songs, movies, classes, workplaces, pen pads, etc.

Room, song, or person, each item then becomes its own place, because they are spaces infused with interpreter’s wild and private meanings.[1] A lover can use this to the couple’s advantage by uncovering old songs, re-enacting older charms of the relationship, or transforming a space into a loving place with the insertion of these meaningful signs. Yet, there can always be novelty, and either way the lover guides the mood through articulations—the most arousing actions from a lover can move a couple to a sexual encounter the same way a rogue percussive sound can invoke horrors in a PTSD-afflicted veteran; both open a world unto themselves.

Whether or not the arousal was arranged or accidental, it appears that it automates the couple into the sexual mode as if they were guided there. In a sexual encounter, each phase seems to proceed fluidly as if the lovers were guided as well. The idea that each sign is not just an indicator but a motivator is the theme here, because it seems to relieve the lovers’ self-consciousness. Neuroticisms, ninny-picking, wandering trains of thought are eroded as the sexual encounter assumes small tiers of consciousness in its participants. This is more prominent in sex; actions seem to be reflexive and talking seems absurd. In the more passionate throes of sex, lovers may be consumed with each other. The lovers become responsible for a spectrum of emotions in the other: they become their pain, struggle, angst, suspension, hope, and pleasure. It is almost if the lovers, only for a moment, wish to –in a very physiological way—forget that there is a psychic difference between them, and while they may object to physical fusion, the emotional will have to do.

If such potent experience is accurately described here, then it summarizes how many fields of contemporary philosophical thought can discuss sexuality in a cogent way. Though sexuality is still intellectually murky, it is suspended between what we might say are medical and philosophical realms desperate for each other’s enrichment. Cooperation may be difficult because the canonical, arcane concepts from philosophy can quickly annex and impede comprehension from other professions.

To ameliorate this problem, bioethics is the representative of ethical study in the very least; it mediates between two academically distant fields providing insight into political issues such as fetal and patient rights while formulating theory and architecture. The semiotic argument above, is another form of this philosophical application—preparing a consistent framework into our understanding of sexual practice to illuminate its influence in our social and individual practice.

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

---

[1] People are not necessarily spaces insofar as they take some up, and songs are on an entirely different physical order, but they are both invitations to a completely different world themselves.