In the past year I’ve been injected a couple of times with solutions containing the chemical element technetium for stress tests. Technetium is radioactive and makes it possible for blood flow in the heart to be observed and measured. The use of such radioactive tracers is quite common. but the name of this particular element, “technetium,” suggests that something out of the ordinary — at least of what used to be ordinary — is involved. This element doesn’t occur naturally on earth because it decays quite rapidly. In 1937 it was the first “technically” produced element, a feat that the old alchemists would have envied.
But modern medicine involves more exotic items than that. “Antimatter” has a mysterious sound to it, and most people probably picture it as something confined to high energy physics labs or the engines of fictional starships. But some readers may have had, or know someone who has had, a diagnostic procedure called a PET scan. PET stands for Positron Emission Tomography, and a positron is a positively charged electron, the antiparticle of the far more common negative electron.
For this procedure the patient is injected with an artificial radioactive element that decays by emitting these bits of antimatter. Within a very short distance of their emission, these positive electrons encounter their negative counterparts and the two annihilate one another, their energy usually being converted into two gamma rays going in opposite directions. When the gammas from a number of decays are detected, their origin can be pinpointed. Since the detection can be done very quickly, it’s possible to get dynamic imaging of processes in biological systems rather than just static pictures.
There’s a lot of fascinating physics here. (I first encountered PET scans when I was teaching a general physics course directed toward pre-med and nursing students.) The question of why antimatter is so scarce in our universe in comparison with normal matter is a still unresolved problem in cosmology. In this column, I don’t want to go off into space, though, but to stay down to earth.
A great deal has been written about the rising costs of health care in America and the pressures that this puts on individuals and on businesses. But there are aspects of the problem connected with science and technology.
When we discuss ethical issues raised by developments in science-based medicine such as organ transplants and genetic engineering, we often concentrate on the new challenges that they raise. Scientific advances have dispelled many of the mysteries surrounding life and have made it possible to bring healing for conditions that were untreatable a couple of generations ago. But another issue of biomedical ethics is exacerbated by these developments. And there’s a mystery connected with it. Why haven’t we in the United States been able to deal with it adequately?
And the mystery is why we haven’t been willing to face up to the problem and really do something about it. The issue I refer to is the availability of health care.
Of course a great deal has been written about the rising costs of health care in America and the pressures that this puts on individuals and on businesses. There are major economic and political problems to be solved, and as I write this in January 2009, at a time of deepening economic crisis, it would be naïve to think that solutions will come quickly or easily. In any case, I’m not going to push my inexpert economic or political views here. But there are aspects of the problem connected with science and technology.Science, Health Care, Ethics
The first point to be made is perhaps obvious but needs to be explicit. Issues raised by biomedical technology are those of social as well as individual ethics. Certainly there are questions individuals must answer, such as whether or not to undergo a particular genetic therapy or to terminate life support for a family member. Those are the types of questions about which a pastor might be called to counsel. Even here, there are larger societal questions about whether or not various courses of therapy are legal. And fixing the health care system, in distinction from just muddling through with it, obviously requires communal decision making and resolve.
Then we need to take into account the fact that the use of new medical technologies is a major factor in making health care more expensive. I’ve already mentioned a couple of “medical marvels” and could make a much longer list — new drugs, genetic therapies, fertility technologies, and other more sophisticated diagnostic techniques could be mentioned.
One reason why those diagnostic techniques can raise costs is that doctors may, quite understandably, have them done when there’s the slightest possibility that they may reveal a problem, in order to protect themselves from charges of negligence and malpractice. But even if unnecessary tests and procedures are avoided, new medicines and machinery cost a lot of money, and somebody has to pay for them.
And the general public bears some responsibility here too. The need for some expensive new treatments could be decreased if more people paid attention to their health and used such low-tech treatments as sensible diet, exercise, and not smoking.
Some scientific advances may introduce other issues beyond their cost. Our ability to determine a person’s genetic makeup and to discover predispositions for conditions like some cancers or Alzheimer’s disease may make preemptive treatments possible, but also raise questions about genetic privacy. In particular, the availability of that information to insurance companies would mean that people with serious genetic problems could be able to get coverage only at tremendously high rates or be denied it altogether. While we may feel that this is unfair, it’s not surprising that insurers want to charge more for people who are at higher risk. Those who get lower rates for car insurance because of their safe driving records will appreciate this.
It’s going to be very hard to keep medical information completely private in an Internet age. (A significant number of people are unwilling to participate in genetic research because of fears that the information will be used against them.) Mark Rothstein’s “Keeping Your Genes Private” (Scientific American
, September 2008) suggests that universal health care, because it would enable costs to be spread more evenly, would be the best way to deal fairly with the problem faced by people with dangerous genetic conditions.Transplant Allocation
Other technologies create problems of allocation. Organ transplants can save lives, but shortages of donated organs mean that decisions have to be made about which of the people in need of new hearts or kidneys will get them. How old do you have to be before a younger person has a better claim on longer life with a heart transplant?
Finally, this discussion brings out a general point to be remembered when we talk about “science and religion” or “science-theology dialogue.” While those phrases are convenient shorthand, we need to realize that we aren’t just concerned about relating the understanding of our faith (theology) to our understanding of the world (science). Discussions of those relationships inevitably draw in the applications of science (technology) and guidelines for their uses (ethics). There is really a four-way science-theology-technology-ethics conversation. And some understanding of all of these conversation partners is increasingly necessary in ministry.
More detail on PET scans is on Wikipedia's Positron emission tomography
. (Wikipedia isn’t always the best source for information, but this article gives more detail on the science that’s involved than some other online resources.) See also the ELCA Social Statement on Health and Healthcare, Caring for Health: Our Shared Endeavor
is available online.George Murphy, a physicist and retired ELCA pastor, is adjunct faculty at Trinity Lutheran Seminary in Columbus. He lives in Tallmadge, Ohio, and can be contacted at email@example.com. Check out his Web page, the Science-Theology Interface with information on workshops, lectures, and consultations.
This article appeared in the May / June 2009 issue of Lutheran Partners Online.