The perennial American debate over aspects of healthcare has once again pervaded Georgetown campus, as the Philodemic Society considered the topic, Resolved: DNRs are necessary for quality healthcare. DNRs, or “Do Not Resuscitate” orders, were defined in this debate as instructions for medical practitioners to do everything they can to revive a patient until their heart stops. In some countries, they are known as ANDs, which stands for “Allow Natural Death.”
Mr. Michael Whelan (COL ’16) of Connecticut began the debate with a philosophical overview of the healthcare profession: What is the role of a doctor? He cited the time-tested Hippocratic Oath to answer the question with “to help, or at the very least, to do no harm.” The goal of healthcare should not be to prolong life for its own sake, but rather to ensure that people are in the position to live the most wholesome life that they can with the days that they do have. Some treatments do more harm than good — CPR can result in broken rib cages and other problems that compromise the health of a patient so severely that their subsequent chances of survival are slim.
Opening for the negation, Ms. Andrea Cohen (SFS ’15) of Texas began by stressing one key word in the resolution: necessary. She said that the negation does not advocate removing DNRs from the healthcare system or discouraging anyone from signing them, but rather the negation contends that stating DNRs are necessary for quality healthcare is counterproductive to the idea of healthcare. She framed the debate as a contest over the values that underpin our healthcare system. Saving lives should be the foremost obligation of a doctor.
Mr. David Edgar (SFS ’15) of Ohio built upon Mr. Whelan’s philosophical foundation by presenting practical reasons for affirming DNRs as a necessary aspect of quality healthcare. Because “quality healthcare” should be considered as a service, or a “man-made, man-provided commodity,” there follows two important implications: 1) it can be cancelled (i.e., the patient may opt-out of the service); and 2) the priority is to satisfy the needs and demands of the customer. DNRs are necessary because it is important to preserve that aspect of choice for every patient, so that they can express an intelligent decision about their own health needs. “No doctor has a right to pull me from a finality I have considered and rationally accepted,” Mr. Edgar affirmed.
Ms. Maggie Cleary (COL ’14) of Virginia introduced the theories of Immanuel Kant to bolster the negation’s argument. Citing Kant’s Second Formulation of the categorical imperative, she argued that we should only act if everyone would do the same as we would do. “Treating yourself as an exception is morally impermissible,” Ms. Clearly contended. She also said that the economic rationales for instituting DNRs were morally questionable and violated the spirit of healthcare. Quality healthcare requires “spreading resources to make sure everyone is okay,” not artificially reducing demand for services by letting some opt out. “The idea of quality respects all walks of life at all costs,” she concluded.
Mr. Desnick (COL ’13) disagreed with Ms. Cleary’s application of Kant, pointing out that the philosopher had other principles which would arguably make him affirm the resolution. Kant also advocated respecting the autonomy of others, which implies that doctors have the categorical imperative to respect their patients’ autonomous wishes about their healthcare. Mr. Diasti (NHS ’14) stated that despite the fact our nation’s healthcare system is utterly bankrupt, we cannot sacrifice the quality or quantity of services for any patient using utilitarian calculations. “DNRs are not the only way to make sure everyone gets quality health services,” he said. Ms. Wynter (COL ’14) refuted the premises of both previous floor speeches: “DNRs are about peace. When you become conscious of the fact that you will one day die, DNRs are a manifestation of an acceptance that you are human.” She concluded by stating that the acceptance of death is necessary for an affirmation of life. Mr. Monod (COL ’14) agreed about the need for choice within a healthcare system. We have negative rights as well to not accept services or to not practice our rights, which must also be preserved. Mr. Donovan (COL ’13) stated that people have a right to decide when they die within a quality healthcare system, but DNRs are not necessary for exercising one’s right to die because DNRs can be overridden or ignored.
Ms. Miller (COL ’14) told a moving story about a personal experience with someone who had signed a DNR, which was later overturned by a family member who was a signatory to the DNR due to unforeseen circumstances. Standing on the negation, Ms. Miller said that healthcare systems must have flexibility in order to cater to the very emotional needs of families and loved ones in trying times. Ms. Wood (SFS ’14) followed with her own personal story about her mother, who was severely injured in a near-death car accident and continues to require surgeries and other medical services today. Ms. Wood realized from this experience that if her mom chose to sign a DNR, it would not be her place to refute that choice, no matter how much she loves and needs her mom’s presence. “Life is more than having your organs work and more than being able to breathe,” she said, implying that resuscitation efforts cannot guarantee life. Mr. Spagnuolo (SFS ’14) switched the focus to a healthcare system, and he said that he could think of 10,000 things more “necessary” to quality healthcare services than DNRs. Mr. Wooten (MSB ’13) pointed out that because DNRs already exist, the relevant question is whether quality healthcare be affected if they were removed. He answered his own question with an emphatic yes because it would violate the agency of people who have already signed DNRs. Tia Baheri (SFS ’16) espoused the significance of quality over quantity of life: “Consider yourself in unbearable agony. It’s necessary to have DNR’s because otherwise, you have a healthcare system that doesn’t give patients the freedom to relieve themselves of agony.” Mr. Dulik (SFS ’13) agreed, bringing in the Jesuit principle of cura personalis as the central objective of healthcare. He believed that DNRs are necessary to maintain the well-being and welfare of an individual, to respect their agency and autonomy. Mr. Snow (COL ’13) repudiated Mr. Dulik’s focus on the individual, drawing upon personal experience to stress that in a moment of near-death, a patient is not thinking about themselves, but rather of the loved ones that they are leaving behind.
In her closing speech, Ms. Cleary reiterated the negation’s fundamental values for a healthcare system: “We believe in a system that stands for life, such that no one feels like a burden and everyone has an opportunity to choose the life that they want to.” She said that the negation stood for a healthcare system which protects life; we do not need people to choose DNRs, although they may. Mr. Edgar turned one of Ms. Cleary’s sentences on the negation: “‘We have no right to say what life is for other people’ — which is why you must affirm” to allow for DNRs as a choice. He emphasized that DNRs are necessary because otherwise, an emergency medical technician’s default option is to resuscitate. “Just because other things are necessary or even more necessary than DNRs does not mean that DNRs are unnecessary. DNRs are necessary to ensure that people’s lives are worth living,” he said.
Arguing for the negation, Ms. Cohen posed the nexus question of this debate as the symbolic nature of choice and what place choice has in our healthcare system. There are necessary things in our healthcare system that aren’t about the choice to be resuscitated, which shouldn’t be seen as a fundamental pillar of our healthcare values. “Hypothetically getting rid of DNRs wouldn’t erase choice from healthcare completely,” she concluded. Finally, to end the debate, Mr. Whelan argued that overemphasizing the preservation of life detracts from the quality of life. That’s why the affirmation’s support of choice and quality of life is superior to the negation’s. He finished by wittily pointing out a logical fallacy in his opponents’ argumentation: the affirmation claims that choice is necessary in a quality healthcare system but that DNRs are not necessary… yet DNRs are the only mechanism through which people can express their choice to not be resuscitated.
The Society voted 18-14-16 to negate.
The Society inducted Mr. Whelan and Ms. Cohen into the Society. Congratulations!
Mr. Snow: 5
Mr. Spagnuolo: 4
Ms. Wynter: 3
Mr. Askonas: 3
Mr. Dulik: 1
Mr. Dulik: 10
Mr. Spagnuolo: 10
Ms. Wood: 5
Mr. Snow: 5
Mr. Petallides: 3
Mr. Donovan: 3
Mr. Askonas: 3
Ms. Wynter: 3
Mr. Ringwald: 3
Mr. Berryman: 2
Chloe J. Krawczyk