Human dignity in the public square

from the CDC's Zombie Preparedness website

This article is an address given to incoming medical students at the University of Notre Dame Australia earlier this year.

I’m surprised that I was invited here, actually. I’m not a doctor, or even a bioethicist. I’m just a journalist.

My favourite quote about journalism comes from Nicholas Tomalin, of the London Times, a famous reporter who was killed on assignment: “The only qualities essential for real success in journalism are rat-like cunning, a plausible manner, and a little literary ability.”

Nothing there about expertise.

So I’m not an expert on anything. In fact, in my view expertise can sometimes be a handicap for journalists. It’s their job to ask experts the dumb questions which the rest of us are too embarrassed to ask.

But here I am at your bioethics intensive, having been asked to speak on “human dignity in the public square”.

Even though I lack expertise I can offer a few reasons why it’s worthwhile for you to focus on this aspect of medicine for a couple of days.

I wouldn’t be surprised if a few of you, or more than a few, secretly think that this bioethics stuff is a waste of time.

It’s not. I specialise in reporting on bioethics issues from around the world and it can be very distressing to read about the suffering that doctors and healthcare personnel sometimes inflict on others – often without really meaning to.


Let me share with you a recent personal experience. Not too long ago I was checked out for suspected mild early-stage heart failure. While this was not exactly welcome news, it sure beats being in early stage Ebola, so I have lots to be thankful for.

I had to spend a couple of nights in a hospital ward for tests. One of my fellow patients was a Tongan man whom I’ll call Amos.

Amos was a tall, strapping man, a school teacher with chiselled features, a Pacific Islands answer to George Clooney. He and his wife had two lovely kids; he was a revered figure in the local Tongan community. He came from a large family and all of his older brothers died of heart disease in their 40s. Now was his turn. He was 44 and his heart was a mess.

Although he was quite good-humoured, Amos was staring death in the face. He had been in hospital for about ten days for tests while the doctors figured out what they could do.

Being in teaching hospital for tests means that at any time from 7am a procession of specialists, registrars, interns, residents and medical students can appear at your bedside. A couple of them will have wheeled lecterns with laptops for taking notes. It reminded me of Darth Vader and his storm troopers with R2-D2 taking up the rear. Many of the storm troopers looked a bit bored.

For Amos there was a cardiology procession, and then a respiratory procession, and maybe a haematology procession. And then perhaps a couple of processions led by registrars who took a wrong turn at a galaxy far, far away. They all asked the same rapidfire questions about his symptoms and his history. No one ever asked about his family, his fears, his future.

Amos was getting pretty sick of this. I told him that I was going to be speaking to some medical students next week. Did he have a message for them?

“Yeah, I’ve got a message,” he said. “I’m a man. I have dignity. I should be treated with dignity. They just think I’m just a body. I’m not a patient. I’m a human being, a husband, a father. I’m fed up with these guys.”

Human dignity is plausible

So this “human dignity” business is not some airy-fairy, empty, pointless bagatelle for senior common rooms. You need to be personally sensitive. And you also need to know the principles which underpin the human dignity with which patients should be treated.

We live in a time of rapid social and technological change. This throws up new questions which we – you, me, doctors and journalists – are at a loss to give quick answers.  

What about female genital mutilation, now that it is not the barbaric practice of desert tribesmen, but a ritual carried out secretly in Sydney homes? Or overseas surrogacy, using the bodies of Laotian women who survive on a dollar a day to bear children for couples back in Sydney? Or tanning salons, whose product might cause skin cancer? Or might not.

These are such tricky issues that I hesitate to select one of them as a case study. One of the eminent professors here in the lecture theatre will almost certainly pull me up, and say, Michael, have you thought about this, or considered that, or read this paper?

Well, um, I haven’t.

A zombie outbreak

So let’s pick a topic on which we are all on an equal footing – and is potentially a catastrophic extinction event which even the eminent professors, I suspect, have neglected to prepare: the terrifying prospect of a Zombie outbreak.

To give it its proper name we are talking about Communicable Ataxic Neurodegenerative Satiation Deficiency Syndrome. There are quite a few documentaries which show the frightful potential of zombie outbreaks -- I Am Legend, Shaun of the Dead, 28 Days After, World War Z, etc. The Centers for Disease Control and Prevention, in the United States, has a website about zombie preparedness.

A lot of research has been done on zombies. An assistant professor at Harvard Medical School analysed their physiology in his 2011 book The Zombie Autopsies.  He describes their brain erosion, shambling walk, and insatiable hunger. The proximate cause is a prion which destroys most of the brain but leaves just enough working tissue behind to let them walk. It also interferes with the hypothalamus—the part of the brain that regulates feelings of hunger, which explains their insatiable craving for human flesh. 

A recent article in the Journal of Physics Special Topics from the University of Leicester (in the UK) has shown that a zombie epidemic could wipe out humanity in less than a year. A team of physicists analysed the threat using SIR analysis, an epidemiological model that describes the spread of a disease throughout a population.

  • A zombie outbreak would have a 90 percent probability of turning others into the undead
  • 100 days after zombie infection fewer than 300 people would remain alive globally
  • After 100 days human survivors would be outnumbered a million to one by zombies

Imagining a zombie outbreak in Sydney

Let’s assume that a zombie outbreak has been contained within the North Shore, from Manly to North Sydney to Hornsby to Palm Beach. The Harbour Bridge has been blown up. The Army has drawn up a quarantine wall from Meadowbank to Hornsby. As far as anyone knows, everyone from Waverton to Waitara is dead or zombified. There may be pockets of survivors but we don’t know. The photos sent back by drones only show hordes of ravenous zombies staggering about.

This has all happened in about a fortnight.

Here comes the bioethics bit. The Prime Minister proposes to bomb the North Shore to smithereens to eliminate the zombie threat. He appears on prime time TV and says:

My fellow Australians, for several days we have watched in dismay as the North Shore of Sydney succumbed to a zombie epidemic. It has been contained by the heroic efforts of our armed forces.

But we face an existential threat to the survival of Sydney, and, indeed, of Australia itself. With the backing of the American President, Mr Donald Trump, who has enthusiastically tweeted his support for our Z-Wall, we are about to deploy small scale nuclear weapons which will terminally neutralise all zombies within the affected region.

This is a heart-breaking decision, the hardest decision that an Australian Prime Minister has ever made. But my leadership is all about making hard decisions.

I must acknowledge that there may be people on the North Shore who have survived. They may be huddled in cellars or attics in terror of their lives and listening to this broadcast. They, too, will die. I pay tribute to their sacrifice. But the job of a great leader is to think of the greatest good of the greatest number.

Operation AntiZeptic will begin at 9am exactly tomorrow morning. Soon Australia will be disinfected and free.

Shock jocks Ray Hadley and Alan Jones think it’s a jolly good idea. Nuke the bastards. All political parties support the idea, even the Greens. A Sydney Morning Herald columnist notes that a scorched earth policy, while undoubtedly tragic, does have a bright side, as five safe Liberal seats will be also terminally neutralised.

The ethics of exterminating zombies

But, hang on, is zombie extermination ethical? In fact, if this is World War Z, is it ethical to treat them as fundamentally different from enemy combatants in a war? The last time we dropped a bomb on enemy aliens was Nagasaki and Hiroshima – and we have regretted it ever since. Yes, zombies are almost an alien species, but if know your history, the Allies also described the Japanese as sub-human aliens.

Let’s unpack the PM’s speech.

Are his facts right? You cannot do good ethics without good science, evidence-based science. Is really true that no one survives a zombie outbreak? Shaun of the Dead proves that some zombies survive in an impaired, but peaceful, state. Six months after the outbreak, civilization has returned to normal, with the zombies now used as cheap labour and entertainment. Shaun keeps the zombified Ed tethered in the backyard shed so they can play video games together.

What is the philosophy behind this decision? It seems basically utilitarian. It is based on a calculation of the benefits versus the costs. But is that the right way to do ethics? In particular, is it ethical to sacrifice possible survivors? What gives the PM the right to disregard their lives?

Are zombies human? Do zombies have dignity? Utilitarians like Peter Singer (you’ve heard of him, right?) would argue that “human dignity” is a vague and irrelevant concept. He believes that rather than squishy notions like “dignity”, respect is due to beings in proportion to the degree of their consciousness. That’s why he has famously said that a pig or a dolphin deserve more respect than an intellectually handicapped newborn child. But zombies are more aware than pigs – would it be ethical, even from a utilitarian point of view, to kill such a creature?

Can we cure Communicable Ataxic Neurodegenerative Satiation Deficiency Syndrome? If we find a cure, should we cure them? Can we afford it? If we can’t afford it, what should we do?

Downstream from zombie extermination, what will the ethical consequences be? Ideas tend to take on a life of their own. A possible take-away from the PM’s speech is that people with a neurodegenerative syndrome may be eliminated if they constitute a life-threatening danger. But people with severe Alzheimer’s also have a neurodegenerative syndrome and they threaten the government’s bottom line. What about them? After the threat of the zombie outbreak has faded, some people will surely ask: why not euthanise the worst cases in nursing homes?

There are so many unanswered questions. Or better, so many unquestioned answers.

This is why we need bioethics

That’s one very good reason why you need some bioethics training. Otherwise you will become a megaphone for someone else's theory.

What if you were to ignore the study of ethics? As a patient with some recent experience, I’d suggest that this is dangerous. Not only will you harm patients, but you could harm yourselves.

Let me return to Amos. His final message to me was quite cynical: “Doctors are rich. If they don’t respect me, they must be doing it for the money. No money, no medicine.”

What makes doctors trusted is their patients’ belief that doctors will act in an upright and ethical fashion. If enough people were to share Amos’s cynicism, hospitals will be very, very difficult places for you to work in.

So, please, think ethically, act ethically. Remember that each of your patients has a unique and inalienable dignity.

Michael Cook is editor of MercatorNet


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